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Home My WebLink About15582-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-16288 Date October 15, I987 THlS CERTIFIES that the building One Family Dwelling with attached 2 car garage Location of Property . 350 Saltaire Way Mattituck, New York House No. Street Hamlet County Tax Map No. 1000 Section 100 .Block 0 I . .Lot 38 Subdivision ............................... Filed Map No ......... Lot No conforms substantially to the Application for Building Permit heretofore filed in this office dated December 10, 1986 15582 Z ........................ pursuant to which Building Permit No ...................... dated..Decemb...er .... 22....., 1986 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 2 CAR GARAGE The certificate is issued to JAMES & ELLEN LEMONDA ..................... .................... of the aforesaid building. Suffolk County Department of Health Approval 8 6 - $ O- 2 4 5 UNDERWRITERS CERTIFICATE NO... N 8 3 6 2 2 5 PLUMBERS CERTIFICATION DATED: September 24, 1987 Rev. 1/81 FO~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPART/v~EHT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 15582~ Z Permission is hereby granted to: ~q ..... ....~....?..~...~A.~. ............................................... ..... ~.~.~.,~.....,~..:.~.:....~..~..~.~...~ ........ ,----~ ,o ........... et premises located at ....................... :. ..'. County Tax Map No. 1000 Section .... ~',..~ ........ Block ...... ,.~,..I ......... Lot No ...... ..~,.~ ............. pursuant to application dated ~,,.,.,~..,..,J.,,,O, ......... . I0..~,,,,~,., and approved by the Building Inspector. Fee $ ..................... Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m~ 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 topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposel-(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 installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. §. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty 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 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. Fees: 1. Certificate of occupancy ~.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O./ $15.00 Date ..... '.. New C on s t r u c g i on .v'. .... Old or Pre-existing 8u ilding ............ Vacant Land ............. Lo .t o o roo.rtv House No, Street Hamlet Owner or Owners of Property ~.~.~.~...~.~.~ ~ ~ ~ , County Tax Map No. 1000 Section .../.~.~ ....... Block .../ ........... Lot..~.~ r. ~ ~ .... Subdivision. ~.~~. ~.~.~....Filed Map No. ~...Lot No..~ ....... Permit No.Z~. Date of Permit ~/~/~.Applicant .~'~ .~ ~.~,. ....... .................... L~bo~ Dept ApprovsI ........................ Unde~ri~ers~pprov81 .................... · ..,Pl~nningBo~rdApprov~l ............~ .. ........ ~equest for Temporsry Certificate ..................... Final Certificate .~ ................. Fee Submitted $. ~.~..( .................. Construction on above described building and per. mit meets all applicable codes and reguJ~tions. ,,, a.t ..... . OUNDATION OUNDATION OUGH FRAM/ FLUMBi~~'''~ [NSULATION FER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 76S-1802 BUILDING DEPT. FOUNDATION 1ST INSPECTION [~ROUGN PLBG. FOUNDATION 2ND [ ] INSULATION I:V~/F~tAMING £ J FINAL INSPECTOR~-~ ~/~ 76.5-1802 <///~B N BUILDING DEPT. SPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [] ROUGH PLBG. [ ] FOUNDATION 2ND[ SULATION [ ] FRAMING [ ] FINAL DATE '~*-~ r~- THE NEW YORK BOARD OF FIRE UNDERWRITERS 1l~302 BUREAU OF ELECTRICITY o~y the eleetric~ equipment ~ ~scri6~ ~e~ a~ i~tr~ce~ ~y t~ ~ic~nt ~ed o. t~e m~ ~pp{icatlon n~ber i~ the pre~e~ of J~e~ Le~onda, 350 saltaire Way, ~attttuck~ N.Y 100,00 01.00 038,000 ~s ex~mi~ed on a~d found to be in compliance with the requlretne~ts of this Board. DRYERS FURNACE MOTORS FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS TIME CLOCKS UNIT HEATERS MU~.Ti-OUILET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V NO, OF CC COND, A W O. 2/0 OTHER APPARATUS: Panelboard$: l-Stir. 125amps, Selected load Panel 1,-60amp Transfer Switch, 4-G.F.C.I. 1--Smoke De~ectors Electric Room Heaters; 1--1.Sk~ I C NO. OF HI-LEG A. W, G NO OF NEUTRALS A W (~, Of HI-LEG OF NEUTRAL 1 2/0 Three "C" £1ec~ric Inc. RT~I Box 45M Sound Avenue Rlverhead~ N,Y. 11901 Lic. 3327E This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may credentials. COPY-FOUR BU LD NG DEPARTMENT T~IS COPY OF CERTtF ~TE ~US~I~OT BE ALTERED IN ANY MANNER. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. Owner j~* ~ (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 '~ day of ~/~ ~ , ? Notary Public, ~~ County Notary /Publ ~c ANTIMONY B. TOH~L, R C. April 13, 1987 Mr. Vic%or Lessard Administrator of the Building Department Southold Town Hall Main Road Southold, New York 11971 Re: James and Ellen Lemonda - Construction of Single Family Residence at SCTM No. 1000-100-01-38 (Mattituck) - Lawrence Liso, Jr. Dear Mr. Lessard: Enclosed is a copy of an agreement now executed by the captioned parties, as a result of which it is requested that any stop work order issued with respect to construction at the site be discontinued and that construction be renewed in accordance with the codes and regulations of the Town of Southold and the enclosed agreement. Thank you for your cooperation. Very truly yours, ANTHONY B. TOHILL ABT:ts Enclosure cc: Mr. and Mrs. James Lemonda Liso Construction Corp. THIS AGREEMENT made this ~/~ day of April, 1987, by and between LAWRENCE LISO, JR., doing business as LISO CONSTRUCTION CORP., having its office and principal place of business at Herricks Road, Jamesport, New York, hereinafter called the "Contractor," and JAMES LEMONDA and ELLEN LEMONDA, residing at 71 Dovecote Lane, Commack, New York 11725, hereinafter called the "Owner." W I T N E S S E T H : WHEREAS, the parties have heretofore and on the 15th day of December , 1986, entered into a certain contract for the construction by the Contractor of a single family residence at premises owned by the Owners known and situate at Suffolk County Tax Map District 1000, Section 100, Block 01, Lot 38; and WHEREAS, the Contractor did thereafter commence construction of a single family residence at the subject premises; and WHEREAS, during the course of construction of the foundation for the subject premises, certain distress cracks were noted, arising by reason of the pouring of concrete which was subjected to freezing prior to curing; and WHEREAS, the Owner did thereafter consult with and retain Frederick M. Showers, P.E., who prepared a written report.annexed as Exhibit A; and WHEREAS, the parties, in order to avoid litigation and delay in the construction of the subject single family residence., have respects. NOW, THEREFORE, as follows: 1. days of this agreed to modify their aforesaid written agreement in certain it is acknowledged, understood and agreed The Contractor shall promptly and within fourteen (14) date, cause certain repairs consistent with the annexed Exhibit A to be made at the aforesaid premises at Saltaire Way, Mattituck, New York, which said repairs shall be as depicted in SK-2 of annexed Exhibit A. 2. All said repairs shall be made at the sole cost and expense of the Contractor. 3. Fees incurred to date by the Owner for the services of Frederick M. Showers, P.E. in the sum of $350.00 shall be refunded by the Contractor to the Owner within fourteen (14) days of the date of this Agreement. 4. All repairs made by the Contractor pursuant to this Agreement shall be inspected and approved by Frederick M. Showers, P.E. and his statement for services in connection with said inspection shall be paid directly by the Contractor within fourteen (14) days of even date. 5. The Contractor shall, in his corporate and individual capacity, hold harmless and indemnify the Owner against any claim, cost or expense, including attorney's fees, arising by reason of any mechanic's lien that has been or may be filed on the subject premises in connection with any work relating to the pouring of a foundation or other masonry work incident to the construction of -2- the single family residence aforesaid. 6. The parties agree that the time of completion as set forth in Article 2 of the aforesaid contract dated the 15th day of December , 1986, shall not be deemed modified or extended by reason of this amendatory agreement. 7. Except as amended herein, the aforesaid agreement between the parties is affirmed in all respects. 8. By his execution of this Agreement, LAWRENCE LISO, JR. hereby personally guarantees that the foundation at the subject premises, as corrected in accordance with the terms of this Agreement and Exhibit A annexed, shall not crack or develop leaks or breaks for a period of five (5) years from the date of issuance of the Certificate of Occupancy for the subject single family residence and in the event of any said crack, leak or break, LAWRENCE LISO, JR. shall be personally liable to pay for any repairs necessary to correct said condition arising prior to or within said five (5) year period. IN WITNESS WHEREOF, the parties have executed this Agreement on the day and year first above written. LISO CONSTRUCTION CORP. L~WRENC~ LISO, ~., M ELLEN LEMONDA L~WRENCE LISO,~Jr., ~s to Personal Guarantee Contained Herein -3- (~ULDI AND ~1~O~VEItS PROFESI;II ONAL ENGtNEER8 Inspection of~ Foundation Distress New Construction saltaire Way Mattituck, New York 11952 for: Jim and Ellen LeMonda (~ULD1 AND SHOWEHS March 23,1987 Jim and Ellen LeMonda 71 Dovecote Lane Commack, New York 11725 RE: Foundation Distress New Construction Saltaire Way Mattituck, New York 11952 Inspection of the above referenced single family residential foundation was made on March 17, 1987 in accordance with your instructions. The following observations and comments are based on the site inspection as conducted and supplied wall reinforcement proposal, 'SK'. (Parenthetical numerals refer to respective photographs.) 1. The following cracks were noted in the existing foundation walls: No. 1 No. 2 No. 3 No. 4 East Wall Garage (1,2,3,4) North Wall House (5,6) West Wall House (7,8,9) Southeast Corner House South Wall and East Wall (10-17) These cracks are identified on sketch SK-1. The cracks are apparently the result of the concrete being subjected to freezing prior to curing. 2. It is recommended that the proposed reinforcing pilasters, as supplied (see sketch 'SK'), be installed Page I WESTHAMPTCN L£AEH, N.Y. 11978 17: ~"~ GULD] & 1111 ~I\"EP. Hc-;,~D RGAD WESTHAMPTON BEACH, N.Y. 1197~ ~'?ATT/TI. ICl(, $/241 8'7 SECT/OM (TY£) (T'r'P) (~ ULDI ~D Inspection of: Foundation Distress New Construction Saltaire Way Mattituck, New York 11952 for: Jim and Ellen LeMonda (~ULD! ~ND SHOWEHS 288-6201 March 23,1987 Jim and Ellen LeMonda 71 Dovecote Lane Commack, New York 11725 Foundation Distress New Construction Saltaire Way Mattituck, New York 11952 Inspection of the above referenced single family residential foundation was made on March 17, 1987 in accordance with your instructions. The following observations and comments are based on the site inspection as conducted and supplied wall reinforcement proposal, 'SK'. (Parenthetical numerals refer to respective photographs.) 1. The following cracks were noted in the existing foundation walls: No. 1 No. 2 No. 3 No. 4 East Wall Garage (1,2,3,4) North Wall House (5,6) West Wall House (7,8,9) Southeast Corner House South Wall and East Wall (10-17) 2e These cracks are identified on sketch SK-1. The cracks are apparently the result of the concrete being subjected to freezing prior to curing. It is recommended that the proposed reinforcing pilasters, as supplied (see sketch 'SK'), be installed Page I Jim and Ellen LeMonda March 23, 1987 with greater width and with additional reinforcing steel as shown on sketches "SK-i" and "SK-2". It is my considered opinion that the subject residential foundation wall will prove adequate for loads imposed, if reinforcing pilasters are installed about found cracks and any further cracks which may occur during construction. However, the compressive load bearing capacity of the installed concrete can only be verified by testing, as suggested by the building inspector. An indication of the concrete quality may be obtained by data recorded on the batch ticket as may be availabe from the eupplier. 4. Warranty of the subject wall should be verified with the contractor. If there are any questions, please advise. Respectfully submitted. Very truly yours, . ~;~:~7 / Fre4~e~k M. Showers, P.E. Page 2 ! ....... L I $K-2 ,SECTION (TYP.) EL EVAT/~AI (TT'P) ~V. T.$. 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] iNSULATION GULDI AND ~HOWERS lT~ofessional ~n~ineers May 21, 1987 ~ TOWN'OF SOU'(HOLD ~ Town of Southold Building Department Main Road Southold, New York 11971 Att: Tom Fisher, Building Inspector Re: Inspection of Crack Reinforcements Foundation Distress New Construction Jim and Ellen Lemonda Saltaire Way Mattituck, New York 11952 Inspection of the above referenced reinforcements installed about the subject foundation wall cracks was made on May 7, 1987. The following observations and related comments are based the site visual inspection as conducted. References are made to the drawings 'SK-i' and 'SK-2', dated 3/24/87, as prepared by Guldi and Showers. The reinforcing steel and/or forms installed about cracks #1, #3, and ~4 are in general conformance to the intent of the design submitted. No reinforcing was installed about crack #2, at the north house foundation wall, as indicated on the design drawing. No increase is size or extent was observed in this crack. This crack is a 'hairline' crack, which in my experience and in my considered professional opinion, is a result of shrinkage and should not prove structurally consequential. Patching should prevent the possibility of water intrusion. Page 1 ~ULDI AND SHOWERS ~ PROFESSIONAL, ENGINEERS A 'hairline' was found at the exterior north juncture of house foundation wall and the wall serving the intended exterior stairway. This crack did not appear to be structurally consequential. Patching should prevent the possibility of water intrusion. It is my considered professional opinion that the observed reinforcing construction was done in a proper and workmanlike manner conforming to acceptable standards of good practice. And, that on completion of the reinforcing concrete work, this foundation should prove an adequate base for the intended residential construction. If there are any questions on the above, please advise. Respectfully submitted. Very truly yours~.~ Frederick M. Showers, P. E. Page 2 f I h'I~T'FITM¢I(~ M. ~' ,.SECT/ON (TYP. ) N.T.$. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved .-~.. ~...X~.., 19 .~.~. Permit No. [.~.-.~'. ?..~..~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 of 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 MX~DE 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ..... .L..t y..o.,,, .~..o..~., .~.-xT..,, .c_.o ac. ... (Signature of applicant, or name, if a corporation) I.ISO CONSTRUCTION CORP, ............... ta~i~ ~d.; l,'.'O'.'f~&~ ',i~V ......... .. J. qm. q*.R.o, ft.,. Iq.._ ¥,~.~1.1.9.,47..... ........ ~{iing address o'Lr applicant)hUider:-:l'f'' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or ............ .~. ~ .,:.4..~.u:..c_.~ ?-~...~..~.~.x-..o. :,5.. .................................................... Name of owner of premises .~.~..~. ~,-.-q .~ :~ .k,k~..~. ~.. ~., ~. ~:x.o. N C>. I~. ................................... (as on the tax roil or latest deed) If applicant is a corporation, signature of duly authorized officer. Builder's License No..772.. ...................... Plumber's License No. ~..~.,~..~. ~. ............... Electrician's License No..~. i .~'.~..-..~. ........... Other Trade's License No..' .................... 1. Location of land on which proposed work will be done..~..~..5.7. ~).~>.i~ r. ~.~.~..~..7~.~..~ .~.t~...xfi:,..~..~. i f ............ .. :,3 5 .'P. ................ S. ~.m. ~:.~...~..+~l .......... tn ~..xx :~ ?. ~ ~ .... N ::(: .......... House Number Street Hamlet County Tax Map No. I000 Section . . ./.~.~.~.O. ........ Block .Ola.~O.. ......... Lot ~$5.O..o..O ........ Subdivision. ,~.~?..-~..~.LO-,~-.. ~-.~.'~.t.~..-~'. ~..~ ....... Filed Map No. /-ff~q>~. ........ Lot ,~. .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy . .O..~.~. jE~,a~L,.~(...~le~. ~&L~'a & ~' "~ ....................... ~Ni~<'" '~,'~:t; ': ;,' ........... 3. Natute ofwork (check which applicable): NewBuflding Addition Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... ! * :, ; ~, , (Description) 4. EstimatedCost../.~.~'~".~' ~.~. ...................... Fee .q.~.'.~ .......................... (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 . .~. ~ m~ ............................................................" 6. If business, commercial or mix,ed occupancy, spec~y nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height Nu'mber of Stories D~ensions of same structure Mth alterations or additions: Front ................. Rear .................. Depth .................. ;... HeiSt ....................... Number of Stories ..................... 8. D~ensions of ~ntire new con~tmction: Front .. ~.'~ .... Rear ............ Depth . ~ ...... Height . .~ .......... Number of Stories .. ff ~ ...... ) ( ..................... .... , ............... 9. Size of lot: Front .... J~.~ ............. Re~ ...~ ............... Depth ~ ................ I0. Date of Purchase .~,..i.fl.~ Name ofFo~er Omer ~ .......... 11. Zone' or use district in which gremmes are situated ..................................................... 12. Does proposed construction violate any zoning law ordinance or.regulation: . .~.~ .......................... ; 13. Will lot be regraded ~ ............... Will excess fill belemoved from premises: Yes ~ 15. Is this property located within 1:00 feet of a tidal wetland? ~ Yes ..... No ~ · If yes, Southold To~ Ttustees Permit may be required. P~T DIAGRA~ Locat~ clearly ~d distinctly ~1 bulldogs, whether existing or proposed, ~d~ indicate M1 set-back d~ensions from property lines. Give street and bloc interior or corner lot. k number or description according to deed, and show street names and indicate whether STATE OF NE~ YORK, i S,S COUNTY OF .~.c~.d~. ....... ........... .~.~.~...~./v-d,4. C,..~.~. ....~../.'?.~.... ~ .... being duly sworn, deposes and says that he is the applicant (Name of individual si~ning contract) above named. (Contractor, agent, corporate officer, etc.) .: of said owner or owners, and is d¢ly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manher set forth in the application filed therewith. Sworn to before me this : Notary PublLc, . ^. ............ ~,.. ~.ce_.-~..<.. Count UNDA J. C~ .~' (S~"-'-'efgnatur Notary 13ubllo, 8tare of New No. ~822663, 8offolk Count~ Term Expires Dm:ember The water ~uppty end se~tsge LISO CONSTRUCTION CO[P. r ..... ~-~_ FO SURVEYED FOR:- J.,4.,x-~,~---~-'~.~ ~ ,~"~ ~- ..,~_ ,,4,./ ,~ ~ ~ LOCATED AT ~ ~/~~ , TOWN OF ~~~ LOT ~ ~ ~'~ T~ ~ ~/~ /~ ~/~T~ ~ ~~Yo~ / MAP OF ~ / ~/~ ~/~ / '~ ~ SCALE 1" = ~' /, ~ SUFFOLK CO. TAX MAP DATA:- DIST. ,/~ , SEC. /~. ~ ~ ~ ~' "~ ~ BLK, ~/~ LOT ~ ~ ~ 0 DRAWN BY , SUFFOLK COUNTY N.Y. , CO. CLK. NO. 1 9~ BY ~ ' ,,.WILLAM R. SIMMONS JR. -" P/O BOX 377 " .: .,. J.',~M[sPORT, L.I., N.Y. 11947 ~., 7~---~:z~ ~,.' .:'.~' '~'~F;~,GE ~ GRID "'-'ill I TOWN OF $OUTHOLD LICENSED LAND SURVEYORS SUFFOLK CO. HE LTH DE T. Pt~OI~/AL THE WATER SU~LY AND'sEWAGE ~YSTEMS FOR THIS CONFORM TO THE STANDARDS SUFFOLK CO. D~T. OF HEALTH A~LICA~T SUFFOLK COUNTY DEPT. OF P~EALTH SERVICES -- FOR APPROVAL OF CONSTRUCT ION ONLY DATE: H. S. REF. NO.: APPR O V E D: ,, SUF FOLK CO. TAX MAP D£SIGI~IATION: DIST. SECT. BLOCK PCL. ~WhERs ~DR~: hEED: L. -"*'/'~ J T ST.OLE STAMP SEA£ i \e CouNT~ DATES'EP 2 ~ ~'~H.~. REF. NO. -~J' The sewaxe d)sposal and ~veteF su~p)y f~ci))b~s )oF th)s location have been inspected by th)s Del~adment and/or otheF agel,~ies a.~d (ound_to be~satis)~$;)J'v. ' ChieTo~ k~ureau of Wastewater/C~anagement DERICK VAN TUYL. P.C. LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. <_~6; - _,O -..,-T--it_. 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 HEALTP SERVICES -- FOR APPROVAL Of CONSTRUCTION ONLY DATE: H.S. REF. NO.: ,~-SO ~:-~' APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST, SECT. BLOCK PCL. OWNERS ADDRESS: DEED: L. ~/~ P. TEST HOLE STAMP SEAL ~OCCI3PANCYOR U~E]$ UNLAWFUL WITHOUT,CERTIFICATE O~'OCCUPAHCY Phone 477.0400 ~ ~ Main Road