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HomeMy WebLinkAbout14206-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. ~IFI~ OF OCcupANCY No Z-22894 Date MARCH 10, 1994 THIS CERTIFIES that the buildin~ NEW Location of Property 8340 M~IN BAYVIEW RD. SO~TuOLD~ NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 87 Block 5 Lot 23.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 29~ 1985 pursuant to which Building Permit No. 14206-Z dated AUGUST 16~ 1985 was issued, and conforms to all of the reguiraments of the applicable provisions of the law. The occupancy for which this certificate is issued is ON~ FAMIY DW~.~N~WITHGARAGED-~DER & ATT~r~m DECK The certificate is issued to of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 85--SO--101-MAR. 1~ 1994 UNDERWRITERS CERTIFICATE NO. H--039058 -- JRd~u~/t~ 14~ 1994 PLUMBERS CERTIFICATION DATED JAN. 18~ 1994 - F~K PLU~IN~ & HEATIN~ /~uil/ding Inspector Rev. 1/81 I~Olll~ NO, Il TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) 14206 Z Date ~-/////~' -~ ~ ...,:.....,,..~.~.~./.. ......... ./. .............. , Permission is hereby granted to: ...... .z~,.,.,.,.,.,.,.,.,.~:.~..(,..c......,.~ c~.~.. .......... ........ .~....o..~..,~.~...-....~.:..~.....z.:..~..7/ ,o ............. ~.z.-~.~..qT.....~ ...o.~.~'-t ....... ~,,~!~.,~....~..~.~...~.J..~..~ ...................... pursuant 'o application dated ....... 9,7.~./,,,.~.. ......... ...'~....~.. ............... , 19...~....~.Tand approved by the Building Inspector, Fee Building Inspector Rev. 6/30/80 J~t2 ll99~ TOWN OF SOUTHOLD BUILDING DgPART~ENT TOWN HALL MOUTNOLD, NEW YORK 765 - 1802 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY CONSTRUCTION .~.. .... OLD OR PRE-EXISTING BUILDING ...... VACANT LANai ........ HOUSE NO. STREET HAMLET ~er or Owners of Property ........... ,o,~,-, T,,~ ,.,,,p No. ,000 ~ion .~3.... B~oe~ ;bdivision ....................... Filed Map ........ Lot .......... ......... . .. u. A~.~.L.. ~c rmlt alth arming Board Approval ................ uest for Temporary Certificate Final Certificate s.b~:~od: ~ .... ~,~. .......... AP~Li .c~..~ ....... 10/14/88 FORM NO. 6 TOWN OF SO'JTHOLD BUILDTNG DEPARTMENT TOWN I1ALL 765- 1802 APPLICATION FOR C~RTIFICATE OF OCCUPANCY INSTRUCT A. This application must be{filed in typewriter OR ink and Inspector with the follo~ing; for new buildings or new u I. Final survey of property with accurate location of al streets, and unusual hatnral or topographic features. 2. Fimal approval of HeaSth Dept. of water supply and se 3. Approval of electricaI installation from Board of Fir 4. SwOrn statement from plumber certifying that solder than 2/10 of IZ lead.i 5. Commercial buildings,{industrial buildings, multiple buildings and ~nstallatmons, a certificate of code co O~ Engineer responsibie for the building. 6. Submit Planning BoardiApproval of completed site plan B. For existing buildings (Pr~or to April 9, 1957] non-toni and '~pre-existing" land ~ses: i. Accurate survey of property showing all property lin~ unusual natural or topographmc features. 2. A properly completed ~pp!icatlon, a consent to inspe~ and a certified abstrlact of title issued by a title ~ show single amd separ!ate ownership of the entire lot . If a Certificate of Oiccupancy is denied, the Buildin reasons therefor in writing to the applicant. 3. D~te of any housing c.:ode or safety inspection of bu~ p~rtinent informatio~ required to prepare a certific~ C. For Vacant Land CertifiCate of Occupancy: I. An application for vgcant land Certificate of Occupa~ and a certified abstract of title issued by a title , separate ownership of the entire 10t prior to April' the application. Ifla Certificate of Occupancy is d. shall state the reasons therefor in wrltin§ to the a CERTIFICATE OF O~CUPANCY - New Dwelling $25.00, Alteration to Dwelling $25.00, Swimming Pool, $2 Addition to Accessory buildings, $25.00 - Busin Certificate of O~cupancy on pre-existing dwellin! Copy of Certificate of Occupancy - $5.00 - over Vacant Land Cert~flcate of Occupancy - $20.00 Updated Certificate of Occupancy - $50.00 Temporary Certificate of Occupancy -$]5.00 Ee~ Co~ e,. ]0/14/85 0NS ~ubmitted tn the Building buildings, property lines, ~rage-disposal(S-9 form). Underwriters. sed in system contains less' cesidences and similar.' npllaoce from the Architect requirements. 0rming uses, or buildings streets, buildings and signed by the applicant :ompany which shall ~rior to April 9, 1957. Inspector shall state the lings or premises, or other ~cy shall be submitted, :ompany showing single and I, 1957 shall also accompany mied, the Building Inspector )plicant. %dditions to Dwelling $25.00, L00. Accessory building $25.00 ~sses $50.00. v $100.00. years - $10.00 dential merclal TOWN OF 5OUTHOLD OFFICE OF DUILDIHG INSPECTOR P.o. BOX 72~ ' TOWN IIALL SOUTIiOLD, N.Y. 11971 TEL. 765.1802 CERTIFICATION Dat~ BUilding Permit No. \k~(~~°--~- (please print}' ' -- Ins less than 2/10 of 1% lead. (plumber's nignature! UNDA J. COOPER Notary Public, State of New Yo~ No. 4822563, Suffolk, CounW~ Term Expires December 'i THE NEW YORK BOARD OF FIRE UNDERWRITERS _~, ~ ~&.~,6~.A~ BUREAU OF ELECTRICITY [~ 85 JOHN STREET, NEW YORK. NEW YORK I0038 Date JANUARY 14,[B9~ ~pplicationNo. onfile 82748593/~3 ~ ~39a, 5~ THIS CERTIFIES THAT RUSSELL HiLLMAN, 8340 BAYVIEW ROAD, SOUTHOLD, N.Y. u~s exatnined on JANUARY 1~,t994 ~d found w be in compliance with the Na~onal Elec~al Code. Lot FIXTURE ~'ECEPTACLE$I SWITCHES I FIXTURES I RANGES ICOORING OECX$ / OVENS IOISH WASHERS EXHAUST FANS DRYERS I FURNACE MOTORS I FUTURE APPLIANCE FEEDERS "ECIALRFC'PT TIMECLOCKS I BELL lU"'THE*FEEE *,~;~[~T DIMMERS SERVICE DI~ONNEC/ ~ ~. OF I S E E I C E OTHER APPARATUS: JACUZZI-1 SHONE DETEC?OR:-3 RUSSELL HILL~[AN 834~. BAYVIEW ROAD SOUTHOLD, NY, 11971 GENF.~AL MANAGER 12 Thi~ certificate must not be altered in any manner; return to the office of the Board if incorrect. ~nspectors may be identified by their credentials. TOWN OF SOUTIIOLD OFFICE OF BUILDING INSPECTOR I'.O. BOX 1179 TOWN IIALL SOUTIIOLD. N.Y. 11971 February 21, 1990 TEL. 765-1 gO~2 RUSSELL HILLHAN 8340 MAIN BAYVIEW RD. SOUTNOLD, NEW YORK 11971 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 ~/.,!/////lhe check i:; (D]~X~'T~X]~not on file. ) $25.00 /-~ No Ilealth Dept. Approval on file. /-_'/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. l!uilding Permit {! I 4 2 O 6 Z Dui l~g Dept. ***/~/ ~k) Plumber Solder~Certificate on file. ( all permits involvin~ plumbing being issued after April 1,1984 ) F~ELD ]iNSPECTION DATE COMMENTS 1, /~r I . ,, ~ ~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION tST [] ROUGH PLBG. '=OU"~"~"ON ~"~' ~ ~ '"~UL~"O" FI~AMING[ ]FINAL 7GS-X80~ BUILDING DEPT. INSPECTION [ ] FOUNDATION ZST []ROUGH PLBG. [ ] FOUNDATION 2ND []INSULATION [~RAMING []FINAL / ~-, . . .~- -/ ~ -~ 765-1~02 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ~//~/OUNDATION 2ND [ ]INSULATION FRAMING [ ] FINAL DATE / ~///~//~ INSPECT'O~ / / ~ 765-~.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST I- ] ROUGH PLBG. [ .] FOUNDATION 2ND [ ] INSULATION NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERYATION Building 40, SUNY--Room 219 Stony Brook, NY 11794 (516) 751-7900 RE: Permit No. AMENDMENT TO PERMIT EXTENSION OF EXPIRATION DATE Your recent request to extend the above permit has been reviewed pursuant to 6NYCRR, Part 621. It has been determined that there has not been a material change in environmental conditions, relevant technology or applicable law or regul- ations since the issuance of the existing permit, therefore, the expiration date is extended to ~.~ ~¢4 ~ ~ ] ~ g ~ ~is letter is an amendment to the original permit and as such, shall be attached thereto, and a copy posted at~e Jobsite. All other terms and conditions remain as written in the original permit. Very truly yours, Alterna~ P~gmmt Administrator RAG:c~ N~ YORE STATE DEPARTMENT OFENVIRONMENTAL CONSERVATION ~uilding 40, 5U~/--Room 219 Stony Brook, ~/ 11794 (516) 751-7900 RE: Permit No. AHENDMENT TO PERMIT Your recent request to modify the above permit has been reviewed pursuant to 6K~CRR, Part 621. It ~s been de~e~ined tha~ the p~oposed modifications ~ill no~ substantially change the scope of the pe~itted actions or the existing pe~tt conditions · ~erefore, the pe~it is amended to authorize: ~ ~~ This letter is an amendment to the original permit and as such, shall be posted at the Job site. All other terms and conditions remain as written in the original pet~ait. Very truly yours, / Daniel J. ~tn Regional Permit Administrator DJL:cz PERMIT SIGN No. 10-82-0257 has been issued to: William& Regina Victoria/James W. Dawson by: R. Cron address: ~ ~o~, ~.o. ~o~ ~ ~u~o~, ~ ~ Create a 4-lot subdivision, each lot exceeds 40,000 square feet. Construct one family dwelling on each io~ ~ ~ ~ f0r: imum of 75' from Tidal Wetland Boundary and install a sanitary system on each lot a minimum of 100' from Tidai Wetland Boundary. Create 25' wide X 406~' long gravel surface right-of-way along easterly boundary of Lot ~3 fc access to Lot #4. under the Environmental Conservation Law, [--[ Article 15, (Protection of WaterJ i IArticle 24, (Freshwater Wetlands) ~ Article 25, [Tidal WetlandsJ ~ Article 36, [Construction in Flood Hazard Areas] New York State D,'?~rtment of Environmental Conservation Permit Administrator 9S-20-T(9/7S) June 8, 1982 Date Issued May 31, 1983 Expiration Date NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION PERMIT 10-82-0257 UNDER THE ENVIRONMENTAL CONSERVATION LAW [] ARIICLE 15, (Proteclion Of Waler) [] ARTICLE 25, (Tidal Wetlands) ARTICL~ 24~ (F~eshwaler Wetlands) [] ARTICLE 36~ (Construction in Flood Hazard Areas) PERMIT ISSUED TO William & Regina Victoria/James W. Dawson by: R. Cron ADDRESS OF PERMITTEE Main Road, P.O. Box 953, Cutehogue, NY 11935 LOCATION OF PRO)ECT (Section of slream, Iidal ~tland, dam, building) West side of Victoria Dr., south side of Main Bayview Road, boas basin off Corey Creek DESCRIPTION OF PROJECT Create a 4-lot subdivision, each lot exceeds 40,000 square feet. Construct one family dwelli~ on each lot a minimum of 75' from Tidal Wetland Boundary and install a sanitary system on each lot a minimum of 100' from Tidal Wetland Boundary. Create 25' wide X 406*' long gravel surfa- ce right-of-way along easterly boundary of Lot #3 for access to Lot #4. COMMUNITY NAMEBayview(City, Town, Village) TOWN COUNTY JFIA COMMUNITY NO. I SufEolk GENERAL 1. The permitter shall file in the office of the appropriate Regional ~rmit Administrator, a notice of intention to commence work at toast 48 ours In advance of the time of commencement and shall also notify him romptly in writin$ of the completion of the work. 2. The permitted work shall be subject to inspection by an authorized ~presentattve of the Department of Environmental Conservation who may rder the work suslmnded if the pobllc inlerest so requires. 3. As a condition of the issuance of this permit, the applicant has ac- 4. Any materia~ dredged in the prosecution of the work herein permitted 95 , 0-4 i7J~7~) (SEE REVERSE SLOE) Southold DAM NO. PERMITMay EXPIRATION3i~ 1982DATE CONDITIONS g. That the State of New York shall in no case be liable for any damage o7 i~iury to the slructure or work herein authorized which may be caused by or ,esult from future operations undertaken by the State for the conservation er improvemenl of navigation, or for other purposes, and no claim or right to compensation shah 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 and signals as 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 shaU be performed in accor- dance with established engineering practice and in a workmanlike manner, 11. ~f granted under Articles 24 or 25~ the Department reserves the right to reconsider this approval at any lime and after due notice and hearlng to conttn, ue, rescind or modify this permit In such a manner as may be found to be just and equHable. 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 the Department of Environmental Conservation may require, remove aU 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 rands or interfere with the riparian rights of others to perform the permitted work or as authorizing the impairment of any rights, litle or interest in real or personal property held or v~sted in a person not a party Io the permit. 13. The permlttee is responsible for obtaining any other permits, ap- provals, lands, easements and rights-Of-way which may be required for this project. 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 SO0 of 6 NYCRR (Construction in Flood Plain Areas having Special Flood Hazards - Building Permits) and in no way signifies that the pro~ect will be free from flooding. 15. By acceptance of this permit the permirte~ agrees that the permil is contingent upo~ strict compliance with the special conditions on the reverse side. St~£CI^L CONDITIONS 16. There shall be no disturbance to topography or vegetation a minimum of 50' land- ward of mean high water. Issu£ o^z£ June 8, 1982 Bldg. 40, SUNY--Room 219 Stony Brook, NY 11794 The followiug condi£ he,apply to all permits: A. If any Of the permit conditions are unclear, the permitter shall contact th~ Division of Regulatory Affairs at the address and telephone noted below. B. A copy of this permit or auproval and suppl~tary conditions shall he avail- eble at the project site whenever authorized work is in p~o~reas. The permit sign enclosed with this permit or a copy of approva~ letter shall be protected from the weather and posted in a conspicious location at the york site until completion of authorized work. At least 48 hours prior to commencement of the pro]ect, thepe~ttee shall complete and return the top portion of the enclosed receipt f~: cert~fying that he is fully aware of and understands all provisions and conditions of this pet~it. Within one week of completion of the pet~ttt~d york the bottom portion of that lorn shall also be completed and returned. ~or prolects involving activities to be accomplished over a period of more, than one year, the permitter shall notify the Regional Permit Administratorin ~riting at least ii hours to the conmevcement of". resumption of ~ork each year. If project design modifications take place after pet~it issuance, the ps.nit- tee shall submit the appropriate plan changes for approval by the Regional Permit Administrator prior to undertaking any such modifications. The permit- tee is advised that substantial modification may require submission of a new application for pet~0it. Atl necessary precautions shall be taken to preclude con~uation of any wet- lands or water~ay by suspended solids, sediment, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachers or any other enviromnentally deleterious materials associated ~rlth the project work. Any failure to comply precisely with all of the terms and conditions of this pe~t, unless authorized in~r~iting, shall be treated as a viohtion of the Environ~ental Conservation La~. The pe~aittee is advised to obtain any permits or approvals thafi may be re- quired from the U.S. Department of Army Corps of Engineers, ~ew York'Diatrict, 26 Federal Plaza, New York, NY 10007, (Attention Regulatory Functions,Branch), prior to co~encingwork authorized herein. The granting of this permit does not relieve the permitter of the responsib- ility of obtaining a grant, easement, or other necessary approval from the Division of Land Utilization, Office of Cemeral Services, Tover Building, Empire State Plaza, Albany, New York 122~2, which may be required for any encroachment upon State-owned lands under water. Regional Permit Aamiuistrator NYS Department of Environmental Conservation Bldg. 10, SLR/Y~P. oom 219 Stony Brook, NY 11794 .(516) 751-7900 DEC t 10-82-0257 / / / ! SUF--'~OLK CO. Htl STATEMIIJ THE WATER SUPPL'. SYSTEMS FOR CONFO.~o THq SERVICES -- FID[; CONSTRUCTION DATE: APPROVED . SUFFOLK CO. DIST. SECT. DE~D: L. ~O-FO FF TEST HOLE ~ L~AM 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.¥, 11971 TEL,: 765-1803 Approved.. ~..//fl. ......... 1~,~ Permit No...~f ........ Disapproved a/c ................ '----~. · · '.~? ...... 'f~ .... ~ · ........ "(Bfii[~ing 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 g 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 r~l or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bull '.~.gc_od~e, ho~ing~code, and regulations, and to admit authorized inspectors on premises and in building for necessary (Signature of applicant, or name, if a corporation) .~ __ , (Mailing a~tdress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............... ..................................................................... ............................................. Nmne of owner of premis · (as 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 ........... .-7 ............. Electrician's License No. 2~ ~' Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. · ........ ............. .......... [louse Number Street Hamlet County Tax Map No. 100~S~ction ...... ~ ......... Block .... 5 ............ 9~ Lot...$}.'~ .......... Subdivision~O~ .~ ...................... Filed Map No...~ ..... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of pr°p°sed c°nstructi°n: a. Existing use and occupancy ..................................................... b. Intended use and occupancy · .~,~-~ ~;~ .~', ¢,,~.,',~ ........................... Nature of work (check which applicable): New Building ..... ' ..... At Re r ...... , .......... ~., Rem vat ......... Demolition Estimated Cost, ,~ ...... r ~ .... If dwelling, number of dwellinglunits. [ dition .......... Alteration .......... .......... Other Work ............... ~ (Description) -T. ............ . Fee .......................... '~ ~ (to be paid on filing this application) ......... Number of dwelling units on each floor ................ tent 4f eacl~ ! i. il!il'Rear .... If gara. ge number of cars .... ; .......................................................... f each type of uso If business, commercial or mixed, occupancy, specify nature and extent ( .................... 7. Dimensions of existing structures, if any: Front ............................. Depth .............. Height ............... Number of Stories ................................................. · ' ~' ' or additions: Front Rear Dnnens~ons of same structure with alterations ........................... Depth ................... I... Height ...................... umber of Stories ..................... 8. Dimensions of entire new cons[ruction: Front ........................... Depth .............. Height ........ Nu er of Stories O ' .Z.O.~ ' ¢ .' ............ 9. Size of lot: Front ...... ~ ............ Rear... 0 ........... Depth .' .... 10. Date of Purchase.....~'.~.T. 19.,..t.qS?-., . ....... ..NameofForme:Owner .,~..t~.t'fl.~..k'd.l)b~W~O&l.. ...... I I. Zone or use district in which p~emises are situated .............................................. 12. Does proposed construction violate any zoning law, ordinance or regula dx, LQ ........................ be removed from premises: Yes No 13. Will lot be regraded . · .....~.. .................... Will excess fi 1 14. Name of Owner of premises '[~.iQ ~;..a~..C.. ~j .¢.c~..,,fi~9, Address ~-0. o..~6. Name of Architect .~'~...~f.~3.O~lq[..~. ........... Address .~ ~ Address Name of Contractor ....... i ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or propo~ property lines. Give street and block number or description according to de, interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ............... ~ · ......................... ; ....................... being dul (Name of individuallsigning contract) above nhmed. He is th~ .................. i ............................... ~ (Contractor, agent, corporat of said owner or owners, and is duly authorized to per[om or have pe application; that all statements ~ontained in this application are true to work will be performed in the manner set forth in the application filed th Sworn to before me this ............. ~'~'~ ~.- ~.d--~..dhY°f ............... l'19~' Notary Public ............. Coun[~ } . .'b.? . :~C- !) ¢_ ¢o Tr..g Phone ........... No. .. '[F~. ~ ...... Phone No. i¢.~ .').:c~f.~.... ............. Phone No ................ ed, and. indicate all set-back d~menslons from d, and show street names and tndicate whether sworn, deposes and says that he is the applicant_ officer, etc.) formed the said work and to make and file ttm the best of his knowledge and belief; and that tl~ ~.rewith. TE~T LICENSED LAND SUF~VEYORS GREENPORT NEW YORK 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. APPLICANT SUFFOLK SERVICES -- FOR CONSTRUCTION ONLY DATE: H. S. REf. NO. APPROVED: COUNTY DEPT OF HEALTH APPROVAL OF SUFFOLK CO. TAX MAP DESIGNATION: DIST, SECT. BLOCK PCL. . ~00~ .~7 5 -' ~,~ OWNERS ADDRESS: TEST HOLE ~rAMP SEAL q N. 65 O~ 50 VAN GREENPORT NEW SUFFOLK CO. HEALTH DEPT. APPROVAL h. S, NO. STATEMENT Of INTENT THE WATER SUPPLY AND SEWAGE DISPOSal SYSTEMS FOR THIS RESIDENCE WILL CONFO~qg~O THE STANDARDS OF THE APPLICANT DEPT, SERVICES -- FOR A~ CONSTRUCTION ONLY ~ H. S. REf . NO.. APPROVED, OF ' HEALTH OF SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT· BLOCK PCL OWNERS ADDRESS: DEED: L. 5©7© P. TEST HOLE STAMP ~ ~f ~h~ sm'vey m~p ~ ~ead~g SEAL ,/ q SUFFOLK CO. HEALTH DEPT. APPROyA~L : STATEMENT OF INTENT THE WATER SUPPLY ANDSEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. (s) APPLICANT .K COUNTY DEPT. OF PIE A[TH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY DATE: ~ , APPROVED: SUFFOLK CO. TAX MAP SECT. -BLOCK ~WNERS ~T F-;L~I4 OCCUPANCY OR ' USE IS UNLAWFUl. WilI T CERTIFICATE OF OCCUPANCY If copper tubing is used for water distributing -system; piping shall be of types K or L only pLUMBER cERTIt ON LEAD coNTEN C, ERTI. FICATE OF 0 J d c~× A"4 A-'I A"& (~OHT) ~ L.~VATIoM ~ LDVATIo~ j 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: ,I. FOUNDATION _ ~0 REQUIRED FOR POURED CONCRET~ 2. ROUGH - FRAMING & PLUMBING 2. INSu~TION 4. FINAL . CONSTRUCTION MUST BE COMPLETE FOR C, O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGy DESIGN O~ CONSTRUCTION 6 ~ ~. ~loU ~ ~ ~o~s. d~ ~o' ~Lvt, c pU~4~ ~VA ~w~lS~ ~A 88 v,/I kIP WA~..r2 IIq$'l OUT (*I) dL 7'& ~u'rbbuO, KI,M ~I bL~MA~-[ ~PFC DA~' owq; Pf 1L... L. ~A M llq~l 5 P P/--c. PI,C, LI~3 ¢· Jo~ dO: F~4 .... ~& v,/iN DW'A ~.P II