HomeMy WebLinkAbout13289-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-25662
Date: 04/21/98
THIS CERTIFIES that the building DWELLING
Location of Property: 2095 ELIJAH'S LANE
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 108 Block 4 Lot 7.12
Subdivision Filed Map No. __ Lot No. __
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 10, 1984 pursuant to which
Building Permit No. 13289-Z dated JULY 16, 1984
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 ONE FAMILY DWELLING WITH ATTACHED GARAGE AS APPLIED FOR.
The certificate is issued to VITO & EVELYN DELUNA
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 14-SO-130
ELECTRICAL CERTIFICATE NO. N677694
PLUMBERS CERTIFICATION DATED 08/01/97 VITO DELUNA
04/17/98
02/07/84
Building 'Inspec~r
Rev. 1/81
TOWN OF SOUTHOLD
BUILDING DEFARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 13289 Z
Permission is hereby grante~d~o; _ ~ c-~n
..Y~... .................... ~ .......... ~ ................
........
.~t~.~.....~.:.~.:....cl.~.c...~ .....
~ ................................................ .~...;...; ....... ~ ....... ~ .......... ~ ................ ~7 ....... ~ ..................
at premises I~ated at ~...~.~ · ..~... ~.~ ..... ~
County Tax Map No. 1000 Section ..... J.....(~....'~.. ....... ~lock .......... .~.. ........ Lot No...].,.1..~...
tO oppllcation dated ...... ...~..~..0. ........................ , 19..~..~., end approved by the
pursuant
Building Inspector.
Rev. 6/30/80
TOWN OF SOUTHOLD
BUILDING DEPART~'IEI~f
TOWN HALL
765-t802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter OR ink and submitted to [he building
inspector with the following: for new building or new use:
i. Final survey of property with accurate location of all buildings, property lines,
streets, and unusual natural or topographic features.
2. Final Approval from ~ealth Dept. of water supply and sewerage-disposal(S-9 form).
Approval of electrical installation from Board of Fire Unde~zriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
Upre-existing" land uses:
t. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy is denieR, the Building Inspector shall state the
reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existinM Buildinm - $100 00
3. Copy of Certificate of Occupancy - ~ .25¢.
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
~ate .0.~..~ .O.~. :..~q.. ...........................
New Construction....~ ....... Old Or Pre-existing Building .................
Location of Property ........ i,~?.1 o..-~ ............................
House No. Street Hamlet
Onwer or O=ers of
County Tax Map No 1000, Section. ~O~ ~l ~ ....... ~
............. Block ................ Lot....: ..........
S ubdivision..~. ~ ~ .'.~... ~ ...... ~ ..... Filed Map..~ .~.~...~-r... Lo t.
..... Date of ermit ....... .Applicant.f .... .... ............
Planning Board Approval ........................
Request for: Temporary Certificate ........... Final Certicata....x. ......
Fee Submitted: ~..~.5..~....~..~ .................
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-'~ 802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
CERTIFICATION
Building Permit No.
Owner:
(please print)
(please print)
I certify that the solder used in the water supply system
contains less than ~-/10 of 1% lead.
Sworn to before me this
MARIANNE PATTO
Notmy Publie, State of New York
No. 01PA5018056
Qualified ir~ Suffolk Courtly
THE NEW YORK BOARD OF FIRE UNDERWRITERS
EUREAU OF ELECTRICITY ~
85 JOHN STREET, NEW YORK, NEW YORK 1OO3~,
~/';¢C; February 7~ 19~ ~78~/~
~,~ ~,,~.,,o. ~o..,,~,,~ . N 677694
THIS ~iRTIFlf$ THAT
only the e~ctrical equipment ~ described belo~ and i~tro~ by the ~pp~ic~t n~n~ed o~ the above application number i~ the premises of
was examined on J~'t~r ~ ~ ~)~ and found to be in compliance with the requirements of this Board.
FIXTURE
OUTLETS SWITCHES
DRYERS
FIXTURES RANGES OVENS DISH WASHERS FANS
FURNACE MOTORS FUTURE , TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
OTHER APPARATUS:
2,-G.F.C.~I. l~Smolm De'tec'~or.
S E R V I C
A W,G
0'~C£ CqND
NO OF Hi-LEG
AW, G
OF HMEO
E
4
Richard C, t~Jlyer
P. O. Box 372
Laurel, N.Y. 11948
This certificate must not be altered in any manner; return to the office of the Board if incorrect.
COPY;FOR B~JILDING DEPARTMENT. THIS COPY OF~ CEI
GENERAl, MAN/A~E~
may be ,identified by their credentials.
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hell
Southold, N.Y. 11971
765 - 1802
APPLICATION FOR CERT]FICATE OF OCCUPANCY
Instructions
A. Tiffs application must be filled in typewriter OR ink, and submitted ~a ~ to the Building In~pec-
tor with the following; for new buildings or new usa:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unu~al
natural or topographic features.
2. Final approval of Health Dept. of water supply and sewerage disposal-{S-9 form or equal).
· I
3. Approval of electrma installation from Board of Pire Underwriters.
4. Commercial budding. Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a certificate of Coda compliance from the Architect or Engineer responsible for the building.
5, Submit Planning Board approval of completed site plan reqmrements where appl'cable.
B. For existing boildings (prior to April 1957). Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate ~Jrvey of property showing all property lines, streets, buildings and unusua~ natural or
topographic features.
2. Sworn statement of owner or previous owner as to use. occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees: . '
'1. Cartificate of occupancy New Dwellzng.$25.00, Acce?~sory ..$10.00 Bu~3[ne.~: $$0.00
2. Certificate of occupancy on pre.existing dwelling $ 50. O0
3. Copy of certificate of occupancy $ 5.'00, over 5 yeara $10.00
4.Vacant Land C.O. $ 20.00
$ 50.00 Dar0 ..........................
5. Uodated
6. ~lterat[on $25.00
NewC OhS tvuc ~ ion ...... Old or Pre.existing Building ............ Vacant Land .............
Location of Property ·
House JVo. Street Hamlet
Owner or Owners of Property ................................ '.'. ..........................
Couoty Tax Map No. 1000 Section ............... Block ............... Lot ................
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No Date of Perm!~ Applicant . ..
Health Dept. Approval ........................ Labor Dept· Approval ........................
Planning Board Approval
Underwriters Approva~ ..............................................
Final Certificate
Request for Temporary Certificate ............................................
Fee Submitted $ .............................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant ...................................................
II,v. 10.IO7~l
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
January 29, 1998
Vito & Evelyn DeLuna
2095 Elijah's Lane
Mattituck, New York
11952
SECOND NOTICE
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
An application for Certificate of Occupancy is
not on file. (Enclosed)
XX
No Underwriters Certificate on file.
The check is (not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(Ail permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT ~ 13289-Z
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION2ND [ ] INFLATION
[ ] FRAMING [ L,/]" FINAL
[ ] FIREPLACE & CHIMNEY
INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND
[ ] FRAMING
] I~ULATION
FINAL
FIREPLACE & CHIMNEY
DATE
INSPECTOR, ~~
76S-~80~
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [~/ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[~FRAMING
RE:MARKS,
DATE/( ~/~/~
FINAL
iNSPECTOR
7GS-'~802
BUILDING DEPT.,
INSPECTION
]FOUNDATION '~ST [ ] ROUGH PLBG,
FOUNDATION 2ND [ ] INSULATION'
] FRAMING [ ] FINAL ~
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
[ ] ROUGH PLBG.
[ ] INS1JLATIONc
[ ~FINAL ~/~~
REMARKS:
DATE ~///~//~ INSPECTOR~
FOUNDATION
(1st)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
QODE
Ye
FINAL
paul a. mingler p.e.
October 8, 1984
Town of Southold
Building Department
Southold, New York
11971
Re: Building Permit # 13289Z
W.DeLUna Project
Gentlemen:
I have reviewed the plans for the above dwelling and have evaluated
the repair to the "miss-cut" roof rafters.
The affected repair of the roof rafters is a sound and valid repair
of the condition. The section modules is in excess of that required.
The existing structural system meets the intent of the New York Build-
ing Code.
I hereby certify to the structural acceptability of the subject work
and further certify to the structural integrity of the repair.
Very truly
Paul A. Wi]
Consulting
PAW/ar
cc: W.DeLuna
consulting engineer
471 townline road
hauppauge, new york 11788-2825
(516) 360-3300
TOWN OF SOUTHOLD
OFFICI.; OF BUILDING INSPECTOR
P.O, BOX 728
TOWN IIALL
SOUTHOLD, N,Y. 11971
TEL. 765-1802
This is Co advise you that the job under buildlng
permit no. 13289Z issued to Vito ,Deluna
oa __~/1_~6_/_8!.- for New Dwell,lng is completed
a final ~n~;pectlon hen ( ) has nee ( x ) been done.
and
[. order to complete thie file, it is necessary that
t, Certificate of Occupancy be issued. Please fill out the
ancl0ned form, return name to the above office with a check
for $25.00 paynb;e to Clio Towtl of Southold. Please {~d{cate
to Whom the Certificate of Occupancy ia to be mailed, and
arrange with this office for an inspeetlon (late
Occnpancy or use in unlawful without n Certificate of
Occupancy. l'losne, help un to clear up thin matter .o that
legal action doe~ not have to be taken.
Thank yeo for yo.r prompt attention.
Very truly y~,
Victor Lesoard
Executive Adr~intsttator
VL:L, nr
cae ! ,
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
ILO. BOX 728
TOWN ItALL
SOUTHOLD, N.Y, 11971
TEL. 765-1802
This is re advise you that the job under building
permit no. 13289Z issued to Vito Deluna
or, _ 2d~!~_~_ for ~New Dwel-~n_~g is completed
a final inspection has ( ) has not ( x )--been done.
and
In order to complete this file, it is necessary that
a Certificate of Occupancy be issued. Please fill out the
enclosed form, return same to the above office with a cheek
for $25.00 payable to the Town of $onthold. Please indicate
to Whom the Cercificate of Occupancy is to be mailed, and
arrange with this office for an inspection date
Occupancy or uae i.~ unlawful without a Certificate of
Occupnncy. Please help us to clear up thi~ matter so that
legal action docs not have to be taken.
Thank you for your prompt attention.
Very truly f~,
Victor Lessard
Executive Administrator
VL:gar
7GS-1802
BUILDING DEl)T,
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMING
[ ] FINAL
DATE
INSPECTOR
paul a. mingle;'
OctoDer 8, 1984
Town of Southold
Building Department
Southold, New York
11971
Re: Building Permit # 13289Z
W.DeLuna Project
Gentlemen:
I have reviewed the plans for th~ above dwelling and have evaluated
the repair to the "miss-cut" roof rafters.
The affected repair of the roof rafters is a sound and valid repair
of the condition° The section modules is in excess of that required.
The existing structural system meets ~he intent of the New York Build-
ing Code.
I hereby certify to the structural acceptability of the subject work
and further certify to the structural integrity of the repair.
Very truly
Paul A~ Wil
Cons~ ~lting
cc: W.DeLBna
consulting engineer
471 townline road
hauppauge, new york 11788-2825
(516) 360-3300
Page 7 Southold Town Board-'- May 24, 1983
IV. PUBLIC HEARINGS.
3:30 P,M. - wetlands application
3:32
3:35
behalf of
3:37
behalf of
3:40
behalf of
- wetland application of
- wetland application of
of John J. Farrell.
P.M. - wetlands application of Philip J. Van Bourgondien
P.M. - wetland application of Enconsultants, Inc. on
Benjamin Kowalchuk.
P.M. - wetland application of
Robert Wendell.
P.M. - wetland application of
Winds Way Building Corp.
The Land Use Company on
The Land Use Company on
3:42 P.M.
3:45 P.M.
Grassklaus.
3:47 P.M.
3:50 P.M.
- wetland application of
- wetland application of
James Bitses.
Charles Zahra and Alfred
'Edward R. Yanke.
Roger Stoutenburgh.
V. RESOLUTIONS.
1. Moved by Councilman Nickles, seconded by Councilman Townsend,
WHEREAS, Abigail A. Wickham, Attorney, on behalf of Constantine P.
Georgiopoulos applied to the Southold Town Board for a ~permit undcr
~the p~ovisions of the Wetland Ordinance of the Town of Southold,
application dated January 14, 1983, and
WHEREAS, the said applicatibn was referred to the Southold Town
Trustees and Southold Town Conservation Advisory Council for their
findings and recommendations, and
WHEREAS, a public hearing was held by the Town Board with respect
to said application on the 19th day of April, 1983, at which time
all interested persons were given an opportunity to be heard, now,
RESOLVED that Abigail A. Wickham, Attorney, on behalf of Constantine
p. Georgiopoulos be DENIED permission under the provisions of the
Wetland Ordinance of.the Town of Southold to fill ot with approx-
imately 1000 cubic feet of off-site fill~ in order to raise elevation
five feet and construct single family residence at 180 Lake Court, on
Great Pond, Southold, New York. This denial is without prejudice
because the Town Board has not received the Draft Environmental
Impact Statement.
Vote of the Town Board: Ayes: Justice Edwards, Councilman
Townsend, Councilman Murphy~ Councilman Murdock, Councilman
Nickles, Supervisor Fell.
This resolution was declared duly ADOPTED],
2. Moved by Councilman Murphy, seconded by Councilman Townsend, it was
RESOLVED that Supervisor William R. Pell, III be and he hereby is
authorized and directed to execute a lease agreement between the
Town of Southold and the East Marion Fire Distriqt,, for the-parking
and driveway a~eas at the' site of the East Marion Fire House, subject
to the approval of the lease by Town Attorney Tasker.
Vote of the Town Board: Ayes: Justice Edwards~ Councilman
Townsend, Councilman Murphy, Councilman Murdock, Councilman
Nickles, Supervisor Pell.
This resolution was declared duly ADOPTED.
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL,: 765-1803
Approved . .~-4~.~.~ .... 19~.\[. Permit No. ! .~..D,:.~..~..~..
Disapproved a/c .....................................
................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Received ........... ,19...
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted 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 of property must be drawn on the diagram which is part of this appli-
cation,
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval qf this application, the Building Inspector will issued 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 Zone 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 building for necessary~
./..Vg....lO,~ode~ff.../)r.,. ~. ,: .~.....c~..
(Mailing address of applicant) tO6/
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
0 .... ~..e/(.. ......... .G .................................................................
Name of owner of premises . .I ........ ' .............................
(~ on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No .............
Plumber's License No..~.~'~.~..
,
Electrician s License No. a~O~....-~..-~.. .......
Other Trade's License No ......................
1. Location of land on which proposed work will be done ..................................................
............. 0.kJc. .......... ....................
House Number Street Hamlet
Co n, a MapNo. lOOOSection ........ Block .... .¢. ........... Lot....7..'../.& .......
Subdivision .~..//.~.'t~h../~. · .]'~.~ Y.~..~?C~.,./. Filed Map No..~. 0 .~.,~.'~.... Lot .~. ..........
....... (34'a,~) '''7 ......
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .......... ~..~..~.~.~ ..... /~r .... ~..~.,.~..,./.~. ~_~,
b. Intended use and occupancy, ic~, 7''' '/" '~'~' '/' '(~' '~/)~'/' ~' '/' '~', i~ ~ ~..~ ./i~.. ,~..:~27(,/: ~.'/~
· p ·
3'. Natur~ of work (check which a phcable): New Building .......... Addition .......... Alteration ..........
Repair .............. Removal ............ Demolition .............. Other Work ...............
~ '" : (Description)
4. Estimated Cost ....... '~...fl ........................ Fee ......................................
I (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 ....................................................................
6. If business, commercial or mixe~d occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structures, if any Front ............... Rear .............. Depth .......
ight mb ' '
He ............... Nu er of Stones ........................................................
Dimensions of same structure with alterations or additions: Front ................. Rear ..................
Depth'. ' Height Number of Stories
8. Dimensions of entire new c,onstruction: Front ............... Rear ............... Depth ...............
Height ............... Number of Stories ................... i .................. -"' '-' '-~ · ' ~ "~ 'i ......
9. Sizeoflot:Front...,¢j~..~).it. .......... Rear /.~7'.~. . . Depth
10. Date of Purchase ..... /.../.~.7. ~...~. .... i ..... ii i'~a~e of Fo~ir 6~vn;r /~r~.~4~ ' ~71~.'~
1 1. Zone or use district in which pr~mises are situated .....................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ...............................
13. Will lot be regraded ..(¢¢~5...[,.,....~.~..~ .... ..... Will excess fill be removed frqmp, remi~s~t,d~_~ Yes
14. Name;ofOwnerofprem{ses .~i'.~....~l)~~ddress~.~`~..~.~..~..~.`.~..~.~.r~h~n~ne°~{~.~.~.~`~l.g..-~C~
Name of Architect ' Address Phone No
Name of Contractor ~ . Address . Phone No.
· - , PLOT DIAGRAM ~,~r~- ~ ' ~{.
Locate .clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back 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. ~ ~.~
STATE O~ NEW YORK, i S,S
COUNTY OF .................
.................... , ........ . ..................... being duly sworn, deposes and says that he is the applicant
(Name of individual sigoing contract)
above named.
He is the ................. ~ .....i ........................................................ t ...........
· ! (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 statements~ con!ained in this application are true to the best of his knowledge and belief; and that the
work will b'e performed in the manner set forth in the application filed therewith.
Sworn, to before me this
........ .... .... day oi .... ............
Nota,, Public,....~..,~.'.. ~.~/~.~.~. Court,
NOfARY ?UBt3C, State of New
I ,, lq0 470787'8, Sulfol~ Couat~
apphcant)
Term £xp~res March 30. 19I~
SURVEY FOR
~:,Fo~,~ COUNTY ~?,.,~:,,~ .,..~ ,.~ ..... .,"C~'S I,'/TO DELUN~ ~ EVELYN DELUNA
LOT NO, 9, "EL/J~H'S LANE ESTATES, SEC~ I "
~U~ 13, 19~
FO~ APPROVAL OF CONStrUCTiON ONL~ AT ~TT/TUCK O~TE= DEC. ~/, /~3
~N ~ SOUTHOLD SCALE, / "= ~O '
DA~E HS REF. ~O. SUFFOLK COUNTY~ NEW ~RK NO. ~3-//23
*~UTH~ZEO A~T~RATION OR ADOITION ~ ~IS ~M~N~D
HEALTH DEPARTMENT*DATA Y~ APPRO~L TO C~STRUCT mE ~R~ FOR WHOM THE SU~EY IS PflEPAREO
~ ALDEN W,YOUNG~ PROFESSIONAL ENGINEER
EU~OIW~IO~ MRP ~IL~O I~ ~N~ O~FIC~ OF ~HE C~ff AND LAND SURVEYOR N,%S, UCEHSE NO. 12845
OF S~FOL~, COUntY ON ~E. I~, 1~7~ ~ ~lLff ~O,~E~, HOWARD W, YOUNG~ LAND SURVEYOR
~ L~T~ ~ ~L(W),~IC TANK{ST)a CES~OL$(~) ~N H[RE~ N.Y.S, LICENSE N0.45895
NGLJ
· FAMILY DWELLINQ ONLY
SURVEY~ FOR
SUFFOt, K COUNTY DEPArTMeNT OF HEALTH SERVICES LOTTO. 9,"~LIJAH'~ LANE ~STATES, S~CT I"
4T ~A~TI~C~ DATE: ~ ~1, 19~
FOR/APPROVAL OF CONSTRUCTION ONLY ~WN ~ ~OU~HOL~ SCALE: / "=~0'
DATE
/ JI~ ~V ~ ~UTH~IZEO ALTERATION OR AOOITION ~ ~lS
AP~OV~ ~ ~copigs ~ ~IS*S~VEY'NOT ~AR~G THE LAND
F/ ' T~~ -- SURVE~R'* INKED ,EAL OREM,OSSED SE,L SH,LL
N GUARANTEE! INDI~TEO~HEREON ~ALL RUN ~LY
HE~ DEP~RTMENT-D~T4 F~ 4PPR~ STRUCT ~ ~ ~ ~Ho~ THE SU~EY ~S P~EP4~EO
~E~ A~ ~ELL/~I WITHIH I00 F~ET OF T~S PROPERTY INSTITUTI~ GUARANTJE~ ARt ~T T~SFERABLE
TO A~ITIONAL INSTITUTI~ OR SUBSEQUENT
OTHER THAM tHOSE SHOWN HE~EON. OWNERS ' ~
NTfiEWATERSU~Y~SE~E OI~AL SYST~I~R~IOE~ ~OlSTANCE~ S~WN HEREON FROM PR~ERTY LINES
WILL C~FORM ~ T~ STAN~ OF THE SU~K CO~TY DEPARTMENT TO EXISTING STRUC~RE~ ARE FOR A SPECIFIC
OFH~LTH ~~ ~ ~~ PURPOS~ ANO ARE NOT to BE USED TO ESTABLISH
NOTE: M=MONUM~Nr &=SrAKff ALD/N W. YOUNG, PROFESSIONAL ENGINE ER
SU~D/V/~/ON'M~P F/LED IN THE OFF/CE OF THE CAERK ~ AND ~ND suRVEYOR N.Y.S. UCENSE NO. 12845
~ SO~OLK COONV? ON FE~./4,/~?4 ~ F/LE N0.6065. ~ ~~ HOWARD W. YOUNG, LAND SURVEYOR
~E ~ rl~ ~Tl~S ~ OR DATA OBTm~O F~ OTHERS ~ ~ ~ N.Y.S: LICENSE N0.45893
INC. 1046
DATE; '~'~.~-~'~-.
TITLE NO.
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CERTIFIED TO: ~,4o~.T' ~
Received
Suff0!k CoNnty
,., R 0 9 1998
Dept. Of tieaith Selwces
;.O_~_[qe Of Wastewster Mg~m~c
UNAU~'HORIZEO ALTERA3]ON OR ADDITION TO
THIS SURVEY IS A VIOLATION OF SECTION 7209
OF THE NEW YORK STATE EDUCATION LAW,
ONLY COPIES FROM THE ORIGINAL OF THIS
SURVEY MARKED WITH AN ORIGINAL OF THE
SURVEYOR'S INKED SEAL OR HIS EMSOSSED
SEAL SHALL BE CONSIDERED TO BE VALID
WILLIAM M. THOMAS
PROFESSIONAL LAND SURVEYOR
10 HANEY COURT MANORVlLLE, NEW YORK 11949
PHONE 516-878-6359
SECTION or.~2~ \ O ~ TAX BLOCK: 2~
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