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HomeMy WebLinkAbout12449-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hale Southold, N.Y. Certificate Of Occupancy No. 7.122,1.6 ......... Date .... J.~, .~.~.R.¥..25 ................. 19.8.{ THIS CERTIFIES that the building . .hl~W. DV/~II&Ih!G ................................ Location of Property ... 2,100..G.L$~'~..R.Q.~D. .............. .S.O..-t4T...H.O.L.D' ................. House No. Street Hamlet County Tax Map No. 1000 Section .'. 0.7.2 ...... Block ..... 2 ......... Lot ..... ~8 .......... Subdivision .hrl~IST..CREF.,.K .ES~PATES ......... Filed Map No.. 3.8.48..Lot No ..... 2.1, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... 4Ulq~..21 .......... 19~t3. pursuant to which Building Permit No ..... .1.2 .4.4. 9. ~ .......... dated ...... JLID.¥ · 28 .............. 19 .@3, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .... ~or..a. n~.~t .on~ .family. d.w~i.qg ......................................... The certificate is issued to ... ROBERT .&, CAlgl. Lhl~ .['/;[~QN ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....1,3.,-so,.,57 ............................. UNDERWRITERS CERTIFICATE NO... N..6.23 l~9.fi ..................................... Rev. 1/81 Building Inspector I~OF,~ NO. 2 TOWN OF $O~JTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12449 Z Permission is hereby granted to:~_~ . ........ ~.~.~/~...././.~.~.../..~..c:... ...~~....~..~ ............ z~z ,o ......... ~.~.~.z.g.~.~ ...... ~....~.~.~.~....~.~gf~.....~.~ .............. ................................................ ~ ........ ~.~:.~.....~a~....L~L~.~ .................. ~,~,~,~,ed ~,....~z.aa ........ ~/~...~...., ........ ~-La~..~.~w County Tax Map No. 1000 Section ..~...~..Z ....... Block ....~..~... ........ Lot No. ~.~.....~.. .......... pursuant to application dated ......... .~.~/x~.......~./. ................ , 19.¢~,., and approved by the Building Inspector. Fee $..../....~........~... .... Budding Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Depar'(men"~ Town Hall Sauthotd, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and subr~itted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topograohic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4o Commercial buildings, Industrial buildings, Multiple Residences and similar buildings end instatla- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing building:; (p~ior to April 1957), Non-conforming uses, or buildings end "pre-existing" land uses: 1o Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition 6f buildings. 3. Date of any housing code or safety inspection of buildings or premises¢ or other pertinent informa- tion required to prepare a certificate.. /, 1. Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 N ildi x. Old P isti g 8 ildi g(X) /Va ant L d ew Bu ng ............ or re-ex n u n ......... ~ o an ............ Location of Property. 2~1~' Gl. on Road, Sout? old Hous~ No. Street Ham/er Owner or Owners of Property .... .Fp.b,e?.t and... .Ca~, iJj, e ,,,,..-Wllsqn.. ............................... County Tax Map No 1000 Section . .. 72. . Block 2 Lot Subdivision, W. est. Creek Estates 3848 21 ................... Fil p No. . ........... ed Ma .......... et No .............. Permit No. ........ ].2~.~9.Z Date of Permit 7./.2.8./.8.~..Applicant Riverside ........ Homes, Zr.~? .' Health Dept, Approval ...~, .SO. ,5,7 .............. Labor Dept. Approval ...................... ~.. N6.23,1.96 Planning Board Approval Underwriters Approval ....................................... Bequest for Temporary Certificate Final Certificat~ .x. structton on above described b~e~ all es and regul, ations. 1035018 : THE N£W YORK BOARD OF FIR£ UND£RWRIT£RS ~ BUREAU OF ELECTRIC!TY ~- 85 JOHN STREET, NEW YORK, NEW YORK 10038 .a,e November 11, 1983 ~p.,leati.. No. o. fle 227321--83 N 6 2 3 1 9 6 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the aboRe application nu tuber in the preo*ises of R~ Wilson, S/S Glem Rd. 2070.57 E/O Bayvi~w Rd., Southold, N.Y. in the followlng location; [] Basement [] 1st FI. .~.sex,,,nl.edon November 3, 1983 F,XTORR ~XTURES OUTLETS SWITCHES FLUORESCENT 20 42 30 20 [] 2nd FI. Section Block and found to be in compliance with the requirements of this Board. rot 971 RANGES EXHAUST DRYERS FURNACE MOTORS APPLIANCE FEEDERS TiME CLOCKS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: Motor~: i~F 1-G.F.C.£~ 1-fmoke Detector S E R 'V I C E A.W.G NO, OF HI-LEG A,W.G. NO OF NEUTRALS A.W G OF CC, COND OF HI-£EG OF NEUTRAL 1 1 1 Peter Charbonneau 35 Sheppard La. Srmithtown, N.Y., 11788 LIC~ #2697 mvst not be altered in any manner; return to the office of the Board if Inspectm may be MANNER· Riverside Homes, Inc. P. O. BOX 274 1159WestAAain Street Riverheed, N. Y. 11901 Phone: 516 - 727-3395 December 15, 1983 Building Department Main Road Southampton, New York 11971 RE: Building Permit No. 12449Z Gentlemen: I understand that this house is approved for issuance of C/O. I am enclosing herewith application for C/O and the $5.00 fee required. Board of Health approval will fol- low shortly. I also enclose a copy of the Fire Underwriters Certif- icate. EC:jg Enclosure Sincerely, E1i abe~~nnazaro Riverside Homes, Inc. P. O. BOX 274 1159 West Main Street Riverhead, N. Y. 11901 Phone: 516 - 727.3395 January 16, 1984 Building Department Main Road Southold, New York 11971 Re: Permit No. 12449Z Gentlemen: Enclosed please find final Board of Health approval in the captioned matter. You have all other final papers.~ Please issue Certificate of Occupancy. Sincer~y,//~ Enclosure Eli~Cannazaro TOWN O~..$OU~fl~OLD FIELD ,{NSPECT~ON.~ '~ FOUNDATION (1st) FOUNDATION (2nd) 2. COMMENTS ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: Riverside Homes, Inc. P. O. BOX 274 1159WestMain Street Riverheed, N. Y. 11901 Phone: 516 - 727-3395 July 21, 1983 Building Department Main Street Southold, New York 11971 Attn: Mr. Hinterman Re: application for building permit for Robert and Camille Wilson Glenn Road, Southold Gentlemen: Enclosed are the surveys showing mean sea level elevations as prepared by Van Tuyl surveyors. As you can see, near the house area, we have 15 feet above mean sea level. The lowest opening to mean sea level would be the Bilco door, which would be on the southeast corner and would be approximately 10 feet above sea level. Please note that this elevation will be plus or minus 1 or 2 feet; but please keep in mind that we will still be well above the 8 foot minimum. We would aprpeciate the Building Department issuing us a building permit at this time so that we may go ahead with construction. Thanking you in advance, I am S~i~n~erely, Riverside Homes, Inc. P. O. BOX 274 1159 West Main Street Riverhead, N. Y. 11901 Phone: 516 - 727-3395 July 8, 1983 Building Department Main Road Southold, New York 11971 Re: Wilson - Glenn Rd off Bayview Rd, $outhold Gentlemen: Enclosed please find application for development permit required by your office. I am including another copy of the survey, and cross section, 1 copy of which was sent to you the other day. DEC I hope that this is what you are looking for, and we would appreciate receiving the building permit ASAP. Call if you need anything else. Enclosures Sincerely~ Eli~'abll~ A. Cannazaro Riverside Homes, Inc. July 6, 1983 Building Department Main Road Southold, New York 11971 Re: Robert and Camille Wilson Property on Glenn Road off Bayview Road, Southold Application for Building Permit Gentlemen: Enclosed please find copy of DEC approval, copy of cross section of house with mean water indicated and copy of survey showing elevations to mean sea level. Enclosures NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION 0-83-0400 PERMIT UNDER THE ENVIRONMENTAL CONSERVATION LAW [ ARTICLE 15, (Protection of Waler) [] ARTICLE 25, (Tidal Wetlands) ARTICLE 24, (Freshwater WetlalMs) La ARTICLE 36, (Construction in Flood Hazard Areas) PERMIT ISSUED TO Robert & Camille Wilson ~DDRESS OF PER~ITTEE 145 Adam Road, Massapequa, NY 11758 LOCATION OF PROJECT (Section of stream, tidal wetland, dan building) West Creek off of Goose Creek, Lot 21 on west side of Glenn Road, 2,070 1.f. east from Bayview DESCRIPTION OF PROJECT Construct one family house 50' from Glenn Road and associated septic system; all parts of house and septic system are to be within IZ/ 1,I. ct Glenn Road in accordance with plan submitted May 13, 1983. There is to be no disturbance to terrain or vegetation greater than 147' from Glenn Road by filling, grading, clearcutting or excavating without additional approval ~rom NYSDEC. COMMUNITYN~ME(City, Towo, VillaBe) Southold TC~oNuthold COUNTY J FIA COMMUNITY NO. J DAMNO. PERMIT EXPIRATION DATE Suffolk June 30, 1984 GENERAL CONDITIONS /' 1. The permittee shall file in the office of the appropriate Regional Permit Administrator, a notice of intention to commence work at least 48 hours in advance of the time of commencement and shall also notify him promptly in writing of the completion of the work. 2. The permitted work shall be subject to inspection by an authorized representative of the Department of Environmental Conservation who may order the work suspended it the public interesl so requires. 3. As a condition of the issuance of this permit, the applicant has ac- cepted expressly, by the execution of the application, the full legal respon- sibility for all damages, direct or indirect, of whatever nature, and by whom- ever suffered, arising out of the protect described herein and has agreed to indemmty and save harmless the State from suits, actions, damages and cosls of every name and description resulting from the said project. 4. Any material dredged in the prosecution of the work herein permitted shall be removed evenly, without leaving large refuse piles~ ridges across the bed of the waterway o, flood p~ain or deep holes that may have a tendency to cause injury to naviRable channels or to the banks of the waterway. S. Any material to be deposited or dumped under this permit, either in the waterway or on shore above high-water mark, shall be deposited or dumped 8. That the State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operatioes undertaken by the State for the conservation or improvement of navigation, or for other purposes~ and no claim or right to compensation shall accrue from any such damage. 9. That if the display of lights and signals on any work hereby authorized is not otherwise provided for by law, such lights nod signals ~s may be pre- scribed by the United States Coast Guard shall be installed and maintained by and at the expense of the owner. 10. All work carried out under this permit shall be performed in accor- dance with established engineering practice and in a workmanlike manner. 11. tf granted under Articles 24 or 25, the Department reserves the right to reconsider this approval at any time and after due notice and hearing to continue~ rescind or modify this permit in such a manner as may be found to be just and equitable. If upon the expiration or revocation of this permit, the modification of the wetland hereby authorized has not been completed, the applicant shall, without expense to the State, and to such extent and in such time and manner as lbe Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. NO claim shall be made against the State of New York on account of any such removal or alteration. 12. This permit shall not be construed as conveying to the applicant any right to trespass upon the lands or interfere with the riparian rights of others to perform the permitted work or as authorizinR the impairment of any rights, title or interest in real or personal property held or vested in a person not a party to the permit. 13. The permittee is responsible for obtaining any other permits, ap- provals, lands, easements and rights-of-way which may be required for this pro)ect. 14. If granted under Article 36, this permit is granted solely on the basis of the requirements of Article 36 of the Environmental Conservation Law and Part 500 of 6 NYCRR (Construction ia Flood Plain Areas havio8 Special Flood Hazard, s - Buitding Permits) and in no way signifies that the project will be free from flood, in8. 15. Ry acceptance of this permit the permittee agrees that 'the permit is contingent upon strict compliance with the special conditions on the reverse side. 95-~0-4 (9/75) (SEE REVERSE SIDE) ,;?ECIAL CONDITIONS 16. A copy of plan submitted May 13, 1983 showing all parts of septic system "107' min- imum from mean high water," is to be available on site while work is in progress. (NOTE: The tidal wetland edge has been determined to be 7' landward of "ordinary high water work" shown on plan, therefore septic system location shown is at the 100' minimum setback distance) SEE ATTACHED CONDITIONS A - J PEP~IT ISSUE DATE June 16, 1983 PERMIT ADMINISTRATOR ~ ~,~ /~ /~ I ADDRESS Bldg. 40, SUNY--Room 219 Stony Brook, NY 11794 PERMIT SIGN No m 10-83-0400 has been issued to: address: ~,~ Adam Road, Massapequa, ~ 11758 Construct one family house 50' from Glenn Road and associated septic system; all parts of house and septic System are for: to be within 127 1.f. of Glenn Road in accordance with plan submitted May 13, 1983. There is to be no disturbance tc terrain or vegetation greater than 147' from Glenn Road by filling, grading, cIearcutting or excavating without ad- ditional approval from NYSDEC. Project is located West Creek off.of Goose Creek, Lot 21 on west side of Glenn Road, 2,070 linear feet east from Bayvie~ under the Environmental Conservation Law, Article 15, [Protection of Water) Article 24, [Freshwater Wetlands) Article 25, [Tidal Wetlands) Article 36, [Construction in Flood Hazard Areas) New York State Department of Environmental Conservation ' // Permit Administrator June 16, 1983 Date Issued 95-~04 (9,v5) June 30, 1984 Formerly EAo93 Expiration Date 3068 BRONZE SLDG: PNL,' 5/8 INSULATED GLASS 1104812 ? SLIDING PANEL INSTALLATION Standard Stack This sliding panel is assembled for X--O operation as viewed from the outside. Reverse Stack To reverse the panel, simply remove the one round-head screw at each end of the interlock and carefully pull the stile completely off the glass. Replace after turning top to bottom. C H M C ACCEPTANCE #7361 P-N31070620 LB-AP132 REV 1-83 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST ~,~ ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION ~] FRAMING FINAL 76S-1802 BUILDING 'DEPT INSPECTI'ON [ ] FOUNDATION 1ST [ ~K)UGH .PLBG. [, 1 FOUNDATION ZND [)/J INSULATION ' [ ] FRAMING [ ]FINAL 'REMARKS: DATE /5~ Examined ............................... , proved ........ , BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19~. ,~,,, Permit No ..................... Disapproved a/c ........... ct:L"" ............................ ~ ............i~: ................... (B'uil'ding Inspector) Application No.../...~....~...~...~.. ........... APPLICATION FOR BUILDING PERMIT Date ....... ,..~. :.~...( ........................ ,19 ...... 2..~.. INSTRUCTIONS a. This application must be completely filled in by typewriter or~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drown on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zane Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if~ corporation) P.O.Box 274, 1159 W. Main St.,So~, NY ll901 (Address ,gl-applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................... .~.e...n. ~ / .B..u. ~ ~ .d..e. ~ ............................................................................................................................... Nome of owner of premises ..~P~.¢£.tZ..~...~.~]-.~-..Z.~....~..]-..~..o..n .................................................................................................... If applicant is a corporate, signature of duly authorized officer. ........... S..:....g..o.£,.d..o...q..,..~.e,..q ~.,e. ~. a..~ ~../..?.C .e .a.,.s.,u,.,~ e q (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ..... .2..0.~.0..P. .................................. Electrician's License No. ...2..~..?.2.~;. ............................... Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ....D.~B.C..R..Z..B.~.D...?.~.0.~.B.~]. Lot No ......................... Street and Number BlS Glenn Road. 2070.57' .E./O B.a~v.i. ew Road, Southold. NY 11~.01 ~1~ ~'o~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy Yacant ~and b. Intended use and occupancy ....0,1g..e....~..~.~.~..Z.~....D.~.e..]_.Z.~..~.~ ....................................................................................... 65 $+ / oqo Io.Ur-, l.u/ 3. Nature of work (check which applicable): New Building.....~ ........ Addition ...: ........... ;.. Alteration ................ Repair .................. Removal ................... DemolJtio~ .................... Other Work .................................................... ~(.,.~..~.~.. ' . ~ ,~ ~-- (Description) 4. Estimated Cost (~...~...~.. ............. i ........ Fee ...~.~.......~'.~...~ ............................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... ~ ................. Number of dwelling units on each floor ............................ If garage, number of cars two car ~ara~e ..................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire' new construction: Front ..... .q..0..'..2..". ..................... Rear .....~?..'..0..'~ .............. Depth ....5.~.'..0..'~ ........... · 26' . Height .................... Number of Stories ...R,q ............................................................................................ l. ................. lO0 O' 102 48" 251 O' 9. S~ze of lot Front ......... : .............................................. Rear ......... : ................................ Depth .......... :.V. ................. 10. Date of Purchase ....k.~..~.8.:...~.9..8..3: ....................... Nome of Former Owner ...~.o.~u.~.d.~..~.:..~.a..c..c..a. ..................... 11. Zone or use district in which premises are situated ..................................................................................................... t2. Does proposed construction violate any zoning law~ ordinance or regulation: ...~.q ................................................. 13. Will lot be regraded ..~.e..s. .................... Will excess fill be removed from premises: ( ) Yes (×) No 14. Name of Owner of premises ....R..°..b..e.~..,&...C..a..m.~.e...~)-..U.°..n.... Address .~..a..s..s..a..p.e. ct..u..a.:....N.~... Phone No ?.9...8.T.~..5.,5.7. ...... Name of Architect ...R..'.z..qh...a.~.d...~.a.~.o.~.o.~'.z. ....................... Address ?..~..y..e..~.}?.~.s..d.:....N.~ ..... Phone No. ?..2.7.T..3..3..9..5. ...... Name of Contractor .R.~ver.s..i..d..e...~.o..m..e.~.....Z.~.c..: ................. Address ?.~z.e..~...h..e ~a..d.:....N.~ ..... Phone No. ?.2..?.T..~..3..9..5. ...... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. SEE ATTACHED SURVEY STATE OF NEW YORK, t S S COUNTY OF ..~.b'.~.o..L..~ ................ f · ................................................................................................. being duly sworn, deposes and soys that he is the applicant (Name of individual signing contrecf) above named. I He is the i....AX~g..n..t...~.o.~...B.~,d..e.Y...~ ................................................................................... ...................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all stqtements contained in this application are true to that of his knowledge and belief and that the work will be perforr~ed in the manner set forth in the application file~erew~h. Sworn to be ~-me this / / ......... · ~.../... ~' day ~f .~: ............... , 19....~.... ta n . No ry J~ ~'"'"V~/ ...... ~".~ ........ COU ,t~ ~, .......... ~,......J...,~ ...................................................... /~ ~,/~'~J) / ~ ~(,,~,,6/C/ / (Signature of applicant) SUFFOLKCO.HEALT~'DEPT. H~$.,NO., ~T ~U~'.c'OL.Y_ COUNTY, "It should be noted that cnce t~is property is Io~td in ~. ~r~, the ~ossi~llt~ ~,i~s that the wCer supply moy conldn tr6ce ~mounts of pestic~es and/or nltrotes. Special ~t~[s r~¢, Contect this Dement ~ior to sampling% , ~ GRE:Eflt~'ORT NE~ CONSTRUCT t DATE: ~ oO-0 tn~ected b~ this LICENSED LAND SURVEYORS GREENPORT NEW SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. (si ...... APPLICANT SUFFOLK COUNTY DEPT· Of HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCT ION ONLY DATE: H.S, REF. NO.. l~ ~<~3-~7 APPROVED: I SUFFOLK CO. TAX MaP DESIGNATION: DIST. 1000 OWNERS ADDRESS: SECT. DEED: L. N~ TEST HOLE STAMP SEAL L ,.o/~.. £,C.) '= 1~ STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSA SYSTEMS FOR THIS RESIDENCE WIL CONFORM TO THE STANDARDS OF TH SUFFOLK CO. DEPT. OF HEALTH SERVICE APPLICANT SUFFOLK COUNTY DEPT. OF HEALT SERVICES -- FOR APPROVAL O CONSTRUCTION ONLY DATE' H. S. REF, NO. APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL OWNERS ADDRESS. STAMP - SEAL OCCIJ id (I¥ OR Of OCCIIi HC¥ If copper tubing is used for water distributing syslem; piping shall be ol~ types K or L only ,Il NOTIFY BuI~bJNG DE~Aff~N~ AT 765~18D2 9 AM TO 4 P~ FOR THE F~Lk~WlNG INS~ECTIOMS~ l.. FOUNpATION ~ TWO REQUIRED FO~. POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3 INSULAT~ 4. FINAL - CONSTRUCTION MUST BE C~MPL~E FOR C. 0 ALL CONSTRUCTION S~ALL MEET THE REOU~RfiMENTS OF T~E N Y, ~ATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIVE FOR DESIGN OR CONSTRUCTION ERRORS. ~0 J