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Home My WebLink About12934-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12934 Z Permission is hereby granted to: County Tax Map No. 1000 Section ........ !.J..! .......... Block ......... ...~.. ........ Lot No ......... .~...~ ......... pursuant to application doted ........ ~ ................................ . 19.~...~., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Departm0nt Town Hall $outhold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANc' Instructions This application must bo filled in typewriter OR ink, and submitted ~a ~ to the Buildin9 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 unu~al natural or topographic features· 2. Final approval of Health Dept. of water supply and sewerage dhposal-[S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and inst011a- tlons, 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 buildings (prior to April 1957), Non-conforming"uses, or buildings and "pre-existing" land uses: 1, Accurate survey of p~perty 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. Certificate of occupancy New Dwelling.$25.00, Acce.,sory :$10.00 Bu~:ne.~.'3 $50.00 2. Certificate of occupancy on pre-existing dwelling $ $ 0.00 3. Copy of cartificate of occupancy $ 5.'00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C..O. $ 50.00 Oate .......................... 6. ~%lterat~on $25.00 NewCons t ruct, ion Old or Pre-ex(sting 8ui(dJng Vacant Land Location of Property ......................... /'Hard/et House No. Street County Tax Map No. 1000 Section .... //./. ....... Block ...... .~. ....... Lot .... /..~. ........ ' ' ' .--7'. Flied Map No ;~.r Lot No ' Subdwm~on ................................................... -Permit No./, ,~,,~. ,//.~Date of Perml~. J/,/~/,/,~¢: ,~.Appllcant.. ,~,~.,~.~.. J'V~,6.,/-,- ............ Health Dept. Approval ........................ Labor Dept. Approval ................... Underwriters Approval ........ ,~. ,/[/. ,~, ¢./, ,~,~....Planning Board Approval .... ~ .............. Request for Temporary Certificata ..................... Final Certificate .... ~ ............. Fee Submitted $.. ~. ..... . ....... Construction on above described building and permit meets all applicable codes and regulations. Appl'cant ~ 10.10-78 TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. /~3~- 0wner-~5 ~. ~- ~'¢~ (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this of / (plumber's ~ignature) THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITYL 85 JOHN STREET, NEW YORK, NEW YORK 1OO38 THIS CERTIFIES THAT only the electrical equipment ~ described be~ and int~d~ced by t~ applicant named on the able applicat~n nuotber ~n the premises of '~n~as Wall~ Wum~ata ~d, Cutc~ N.Y in the follo~in~ ~oeatlon; ~ Basement wasexaminedon ~.~ 2~ FIXTURE SWITCHES OUTLETS 25 ~7 ~ 2nd FI. Section Bloch Lot and found to be in compliance with the requirements of this Board. FIXTURES RANGES ' OVENS DISH WASHERS EXHAUST FANS DRYERS 25 SYSTEMS NO. OF FEET 1-G.FoC.I. 1-~ Detector's. R V I C 1 1 1 1 Cutchog~e, N., Y, L1935 This certificate must not be altered in any manner; tetu[n to the office of the Board if incorrect, / ~ ~O~FOR ~LD~N~ DEP~RTM~NT' TH~r GENERAL MANAGER Pe~ -- by their credentials. ANY MANNER: lAIrS, ISC. 575 Broad Hollow Road, Melville, N.Y. 11747 (516) 694-3040 FAX: (516) 694-4122 ENVIRONMENTAL and INDUSTRIAL ANALYTICAL LABORATORY Hmrry Goldman Wmter Analysis Mmin Romd M~ttituck, N.Y. 11952 Oate Collected: 8-10-89 Date Received: 8-1Z-89 Point: Wunneweta Rd., Cutchogue Thomas Wall Collected By: D 99 ANAL. Y_ .T~A_L,, RESULTS vinyl chloride . methylene chloride ....... { i,l-dichloroethyiene ........ ( ( 1 1 1 { 1 ( 1 < 1 ( 1 ( 1 ( 1 ( 1 ( 1 ( 1 ( 1 < 1 < i 1,1-dtohloroethmne ........ chloroform ............ 1,2-diohloroethane ........ 1,1,1-trichloroethane ........ carbon tetraohloride ....... 1,2-diohloropropane 1,1.~-trlchloroethylene tetrmchloroethylene chlorobenzene benzene ........... toluene ...... m-xylene ............ o-xylene .............. p-xylene . o-dichorobenzene .......... P-dichiorobenzene ........ Results reported meet Suffolk County Drinking Water Limits. Date Reported: 8-16-89 John J. ttolioy, P.E. Laboratory Director LABS, INC. Environmental Testing Laboratories ~ 57~Broad Hollow Road, Melville, New York 11747-6076 * (5i~ 6) 694-3040 Water/Waste Water Laboratory · ~azardous Waste Laboratory · Air Testing Laboratory Pilot Plant Studies and Other Analytical Services ?0105~ IAB NO~ F~ELD NO. TIME COL. BY ~ ~ HARRY (~OLDMAN'WATER ANALYSIS iIATT I TUCI(~ NY 11952 WUNNEWETA RD~CUTCHOOUE CWF OTHER (3) LAB. I.D 03 Bacte~'ia APC/ml (<t) N~trates (mg/~ N) (10,0) (mg/I CaCO~) Color (umts) (15) Chlorides (mg/I) (250 )Hho P) Odor: Cold Total (3) AIkahnlty (mg/I as CaCO3) ;oppe~ 0 .o) Total Ire? (mg/I) (0i3) Sohds (mg/~) (mg/I CaCO3) Free CO~ (mgll) Nomograph -- ,Tara~on Detergen s (mg/ as MBAS) ~ , Ammonia (mg/I N} Hexavalem Chromium (mg/I Cr +~) N~trites (mg/I N) Temp. (Field) °F COPIES TO'. REMARKS; O1,;'iS/~r~ALL~ CUTCH000[ -,-' '' 1 TEST~ MARKE)3 * EXCEED No¥'oS~ L. IH;[TS FOR POTABLE WATER SUM OF IRON AN).i HANOANESE EXCEEDS 0,3 iIG/L, SIGNATURE ~ ~- TITLE ( ) ~amment Level (MOL) N.Y. State Sanitary Code LASORATOR~ DIRECTOR "'~ DATE REPORTED 1/20/ BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. ~i FOUNDATION 2ND [ ] INSULATION [ ] FRAM~ [~NAL 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ;ZND [ ] INSULATION [ ] FRAMING [ ]FINAL · REMARKS· 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST ~,/~ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL REMARKS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING ROUGH PLBG. INSULATION [ ~'*~INAL 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND[ ] INSULATION [ ] FRAMING REMARKS: ~NAL DATE FIEL~ IN~?ECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: .11 H.So OWNER SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES REF. NO. COMPLETION REPORT - LONG ISLAND WELL ADDRESS LOCATION OF WELL DE~H OF WELL ~ELOW SURFACE DEPTH TO GROUND WATER FROM SURFACE,..~ ~:J' CASINGS ft. DIAMETER LENGTH SEALING Jn. ft. CASINGS REMOVED SCREENS ft. J ft. MAKE DIAMETER LENGTH DEPTH TO TOP FROM TOP OF CASING DATE DURATION OF TEST STATIC LEVEL PRIOR TO T ST MAXIMUM DRAWDOWN PUMPING TEST TEST OR PERMANENT PUMPJ bou,sJ in below / LEVEL DUR NG MAXIMUM PUMPING to;, of ca,i.gJ ,. I ft. Approximate time of gallons per min, in. below top of casin~ return to norma}l level after cessation of pumping hrs.I min. PUMP INSTALLED TYPE MAKE MOTIVE POWER MAKE NUMBER BOWLS OR STAGES ft. of discharge head DIAMETER /~;~/ in. LENGTH /~"~ ft. of total head DROP LINE SUCTION LINE DIAMETER LENGTH METHOD OF DRILLI USE OF WATER COMPLETED WORK ET A RTE D ~//~e~,///~ '~ ~/~::~ '~ '"N~E: Show Io~ of well - ma~ri/~countered, with depth below ground surface, waler bearing beds a~ water levels in each, casings, screens, pump, additional pumping tests and other matters of interns/. Descri~ remit See Instructions as to Well Drillers' Licenses and Reports. Pages 5 - 7. iN. ft. lo f2 ] 8-135 9:7186 Well No. ~ LOG Ground Surface El. , ft. above sea A ft. V TOP OF WELL Casing: Type of Material ~-~ ~-~ Drop Line: Type ofiMatertal /~$,J ~f~ If plastic, was torque arrestor used? 3/16" S~S. cable installed? Sanitary Seal: Type Used $p/~//'~ Storage Tanks: Size ~ gals.; Type Inside Material U/~v/x Typ~ of Tank Drain Pressure Gauge Installed ~~.' Sbu.t-Off Valve Prior to Tank c~ Sampling Tap Provided . ~/~ Shu't-Off Valve With Bleeder Line Insi'talled on Outflow of Tank Method of Disinfection: Well Lateral: Depth Below Grade ~y~ ~ ~x Mat~ri al ,/~)~;, i'~' ~ Water Treatment Eqm~iprnent I~s~Jl~led ~"~ For Treatment ~f Make : Type Model Number Mailing Address Telephlne Number / 2 of 2 TO~,FN OF SOUTIIOLD OFFICE OF BU1LDING INSPECTOR iLO. BOX 728 TOWN IIALL SOUTIIOLI), N.Y. 11971 To Whom Th~svMay Concern, TEL. 765.1802 We are urlablc to complete your Certificate olfcupancy because .of the following reasons. /_-~// An application for Certificate of Occupancy _ /~ s not on file. /_~;,o Underwriters Certificate on file. ~f_// 'lhe check is (outdated/not ~n ~ el~q_~.)~ ~C3 /Z Lo Health Dept. Approval on file.' /~/ No final in.~pe, ction has been made. Please contacC our office on this Thank you for your ' ' cooperatzon. Building Permit ,, _~ ~ ..~ ~ Z matter. **~/~ ~;o Plumber Solder ertmfzcate on file. ( all permitu involving plumbing being is:;ued after April 1,1984 ) TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR ILO. BOX 728 TOWN ItALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 This in to adv~e you that the job under building permit no. 12934Z xsnued to Thomas on ~3~A.~BA_____for ~e~ Dwallin~ is completed and a fi. nat ~nspeccion baa ( ) ha~ not ( x ) been done. [n order to complete thi* file, it is necessary that a Certificate of Occupaocy be issued. Please fill out the enclosed form, return name to the above office with a cheek for $25.00 payable to the Town of Sou~hold. Please indicate to Whom the Certificate of Occupancy zs to be mailed, and arrange with this office for an inspection date Occupancy or ri, ne is nnl. awful without a Certificate of Occupancy, Pleane hclp ua tO clear up thi, a matter no that legal action doen riel have to be taken. Thank you for yo.r prompt attention. Very truly your~, Victor Lessard Executive Administrator VL:gar encl . L ~ C~ ? z m mz~m T m 0 ID z 3: 0