HomeMy WebLinkAbout27220-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-27746 Date: 06/13/01
THIS CERTIFIES that the building NEW DWELLING
Location of Property: 200 OLD FARM RD ORIENT
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 25 Block 5 Lot 5
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 1, 2001 pursuant to which
Building Permit No. 27220-Z dated APRIL 10, 2001
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 GREENHOUSE AND ATTACHED TWO CAR GARAGE AS
APPLIED FOR.
The certificate is issued to MARIE CATALANOTTO
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-99-0252 03/26/01
ELECTRICAL CERTIFICATE NO. N 807503 05/05/87
PLUMBERS CERTIFICATION DATED 04/20/87 MIKE JACOBI
Authorized ignature
Rev. 1/81
FORM NO. 3
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)
PERMIT NO. 27220 Z Date APRIL 10, 2001
Permission is hereby granted to:
MARIE CATALANOTTO
BOX 625
ORIENT,NY 11957
for
RENEW AND REPLACE BP# 13674Z FOR A SINGLE FAMILY DWELLING AS
APPLIED
at premises located at 200 OLD FARM RD ORIENT
County Tax Map No. 473889 Section 025 Block 0005 Lot No. 005
pursuant to application dated APRIL 1, 2001 and approved by the
Building Inspector.
Fee $ 1, 274 . 00
Authori Signature
ORIGINAL
Rev. 2/19/98
Form No. 6 "s, jo`�3Q
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
iAPPLICATION FOR.CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form) .
3. Approval of electrical installation from Board ofFire Underwriters.
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.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
'-'pre-existing" land uses:
1. 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 denied, 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-existing Buildine - $100.00
3. Copy of Certificate of Occupancy - .25vp
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date
New Construction. . . . . . . . . Old Or Pre-existing Building. . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Location of Property. y/ PJ4'G. . 1/Z
House No. Street Haml
Onwer or Owners of Property. . . . �Cl�:':`O ??. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
County Tax Map No 1000, Section. . . :? . . . . . .Block. . . . . . . . .f . . . . .Lot. . . . . . . . . . . . . . . . . .
Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No,-'. 7� . . . . . . .Date Of Permit. . ,/� �. . . . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . .
Fee Sub itted: ^$. . . .'l�.��% . . . . . . . . . . . . . . . . . . . . - -/
c5q; 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
APPLICANT
TEL. 765-1802
�pS��F� CpG TOWN OF SOUTHOLD
y�c OFFICE OF BUILDING INSPECTOR
z P.O. BOX 728
y STOWN HALL
SOUTHOLD,N.Y. 11971
C E R T I F I C A T I O N
Date Q
Building Permit No. / :3 /
Owner` 4 01��C-A t'
(please
ppri t)
Plumber ��C� VCp t
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(plumbe s signature)
Sworn to before me this
a�U day of
19�� • Notary Public
Notary Public, County
"WKOEOOE
NOIAIl11�M18l.IC. pow Vorkft �
Tone Expires Kwh 30.19..-x./
TEL. 765-1802
TOWN OF SOUTHOLD
y< OFFICE OF BUILDING INSPECTOR
c An P.O. BOX 728
TOWN HALL
SOUTHOLD,N.Y. 11971
C E R T I F I C A T I O N
Date
Building Permit No. 1D y+G—
Owner 0. C4.
(please print)
Plumber �� / k �G�GO� /
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(plumb r s signature)
Sworn to before me this
_day of
19 �QQ .
%
Notary Public
Notary Public, t '
FORD[ NO
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)
N2 13674 Z Date .....LI/.............. 19L1..�
Permission is hereby granted to:
........ ........
... ................... � ... . .S'.
.....� ..... . ..... . ............................
... . . . ...::-.. .: ..........
to ...... ........ .... . . .. .. . . .... ... r...`
.........................................z.3�.0 ... ........................ ....... ....
atpremises located at ..... ...... . ... . .. ..................... . ........
.. . .... '.7 ...... ....... . ... �....... ... .0..........
Coun Tax Map No. 1000 Section .. ..... Block ... .. Lot No. do.` 7.......
...
pursuant to application dated ...... ....�........................ 1 X ., and approved by the
Building Inspector.
Fee $•z��...`...'1�...
B Ilding inspector
Rev. 6/30/80
Phone (516) 734-7484 MAIL ADDRESS
Night (516) 765-1128 P.O. BOX 932
CUTCHOGUE, N.Y. 11935
GLENN F. HEIDTMANN & SON, INC.
BUILDER
COX LANE, CUTCHOGUE, NEW YORK 11935
January 9, 1985
Town of Southold
Main .Road
Southold, New York 11971
Re: Sal Catale
New Residence
Orchard Street
Orient, N.Y.
Energy Code Resistence -
All roof area to receive 61, insulation R 19 factor
All exterior walls to receive 4" insulation R 11 factor
All basement area to receive 4" insulation R 11 factor
All exterior window openings to be Perma-shield windows
Manufactured by Anderson Corp.
All exterior door openings to be hollow mwtal insulated
manufactured by Benchmark Corp.
All exterior aliding door openeings to be Perma-shield
manufactured by Anderson Corp.
Glenn F. Heidtmann & son, Inc.
A�p��SUfFO�,�coG
yam►
Town Hall, 53095 Main Road
yZ Fax(516)765-1823
P. 0. Box 1179 �,• n� Telephone(516)765-1802
Southold, New York 11971 •
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
March 25, 1998
Marie Catalanotto
P.O. Box 2021
Orient, New York 11957-2021
Re: Building Permit # 13674-Z NEW DWELLING
Premises : 200 Old Farm Rd. , Orient
Suff . Co. Tax Map #1000-25-5-5
During a review of our files it was noted that the above
building permit has expired, and a Certificate of Occupancy has
never been issued.
According to the Code of the Town of Southold, Article
XXVIII 100-284, it is unlawful to occupy or use a structure
until a Certificate of Occupancy has been issued.
Please contact this office as soon as possible so that we
may clear up this matter.
Thank you for your cooperation in this matter.
Very truly yours,
SOUTHOLD TOWN BUILDING DEPT.
,. 0
1001071 THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
85 JOHN STREET. NEW YORK, NEW YORK 10038
Date May 5, 1987 Appliration No.on file 344318/85 N 807503
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
Sal Catale, 200 old
Old Farm Rd. , Orient, N.Y.
in the following location; 29 Basement �}� 1s1 Fl. 1?S Ynd Fl. Section Block Lot
was examined on April 27, 1987 and found to be in complionce with the requirements of this Board.
pXTtE
FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS NTACLES SWITCHES NCAND[SCENT FLUORESCENT v AMT. K W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. N.P.
1
DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS SPECIAL REC►T TIME CLOCKS BELL UNIT HEATERS MULTI.OUTLET DIMMERS
SYSTEMS
AW K.W. a► M.P. GAS N.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPs. TRANS. AMT. N.►. NO.OF FEET AMT. WATTS
SERVICE DISCONNECT NO.OF S E R V 1 C E
AMT, AMP, TYPE METER t,I 7w I,e'3W 3/3w 3,9 sw NO.OF CC.CON0. A.W.G. NO.OF redEG A.w.G. nq,OF NEUTRALS A.w.G.
EQ(IIP, R OF CC.COND. Of N1-lI'd
1 200 Cb 1 X 1 4/0 1 4/0
OTHER APPARATUS:
Blank-9
1-6.OK.W. Steam Unit
G.F.C.T.-1, Smoke Detectors-3
G & S Elec. lic.#578-E
Box 215 vENUM MANAGER
Southold, N.Y. , 11971 11 01,
Psr
This c.rtificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by thei+ credentiak.
7i6-3802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION is'T [ ] ROUGH PLBIi,
[ ] FOUNDATION 2ND [ (IN8UWTION
[ ]
FRAMING [ ] FINAL
REMARKS: AfALL12. 6,
Of
Ail
i, DATE 1� � INSPECTOR .
I �
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ J ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSU TION
I 1 FRAMING [ NAL
[ ] FIREPLACE 8 CHIMNEY
REMARKS: 44ew�
DATE Z y l�7 INSPECTOR_1��� G�
BUIMING DEPT.
INSPECTION
I FOUNDATION 1ST ROUGH PLBG.
I FOUNDATION 2ND INSULATION
bC�
L1 _ '. • ' / «.i/ til � % /'
� '. k&U ' 0 cL.a�.a�.4
DATE -INSPECTOR �Ii. e
i
/ 7(( ,2
�I
4c- �
13UILDING DEPT.
INSPECTION
FOUNDATION IST ROUGH
FOUNDATION 2D N�A •
FRAMING FINAL
FIREPLACE & CHIMNEY
REMARKS
,DATE
r �
i ./ INSPECTOR
l
70-19*2
suiLDiNa DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INtULATION
[ ] FRAMING [!]FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
r
oe
A A�/,� o
,DATE 14:1 INSPECTOR
FIELD INSPECTION REPORT DATE _ COMMENTS
Vv
1 �t
FOUNDATION ( IST)
1 11 b
I
FOUNDATION
II
2ND)—===-- -------- ----=�—__=______---------------------- ------------- �
I
ROUGH FRAME &
II O
PLUMBING I'
II
11 r
II =1 CS
INSULATION PER N. Y.
STATE ENERGY
CODE
1A A
11
FINAL
. �aaxaaf¢sax==xa�=as:assa
wsrsaa- aas=sa__--
ADDITIONAL COMMENTS:
0
N
N
O
x
N
• � � •
IlAl
NEI
,_-
I . A WAM WNWOROWN
ISI
� l
/IWKAPF47TPrA -
� �U • COMMENTS :
r ,-
WNW
- -��.•
_FF�/ T
l
FORM NO. 1
TOWN OF SOUTHOLD '
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
12e—
Examined
Examined . Received . . . . . . . . . . . , 1 9 . . .
Approve?da/
. . . . .. . . . . .. 1��Permit No. . . ,
Disappro I .
_
V:
(Building Inspector)
- 'APPLICATION FOR BUILDING PERMIT
Date . . . . . January. 9. ., 19 85
INSTRUCTIONS
i
a. This application must be completely fitted 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 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 inspections.
. . . . . . . . . . . . . . Heidtmann 6; �o � . Inc . . . . . . .
(Signature of applicant, or name, if a corporation)
.P.0... ,Box ,932.,, .Cutchog,4e,. N.X.. .1193.5 . .
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
. . . . . . . . . . . . . . . . . . . . . . . . .Aent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of owner of premises . . .Sa 1. .Ca tale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(as on the tax roll or latest deed)
If applicant is a corporation,signature of duly authorized officer.
Heidtmann & Son, Inc.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Name and title of corporate officer)
Builder's License No. . . . . 10
Plumber's License No. . Mattituck Plumbing
}
Electrician's License No. . .E.E. C.O.
Other'trade's License No. . . . . . . . . . . . . . . . . . . . . .
1. Location of land on which proposed work d be done Orchard Street, . pr�eAt;, ,N...Y. . . . . .
�4Q /50. . . . . .�:rchardy. Street. . . . . . . . . . . . . . . . . . . . . . . .Q '�.eut. . . . . . . . . . . . .. 1
House Number Street Hamlet i
County Tax Map No. 1000 Section . . . . .025. . . . . . . . . . Block . . . . 5. . . . . . . . . . . . . Lot . . .S. . . . . . ... . . . . . . . '
Subdivision . . . . .Bayview Farm . . . . . . . . . . . , Filed Map No. 7.Q45. . . . . Lot . . . . . .5. . . . . . . .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy . . . . . . . . . 1/�
�
b. Intended use and occupancy . . . . . . . . . . . . . . . . . . . . .�!w '_` `•1!C . . !G � << .
SURVEY OF LOT # 5
"MAP OF BAY\v/IEW EAtRM" ��►�I"�`�
DEPT r
F I LED A<5 MAP # -1045 � w � � " .E
51 TUATE: ORIENT
TOWN: 5OUTHOLD .99 DEC _7
5UFFOLK COUNTY, NY
SURVEYED 11-03—aq
SUFFOLK COUNTY TAX #
1000 - 25 - 5 - 5
GERTIFIED TO:
SAL GATALANATTO
MARIE GATALANATTO ISO
0
In
<' 20
D �10 J
r , 600;
1l
ay 9-8�
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i
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2001 Y. : . ala 99-oZsZ
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JT '"^t+y� ,a
T .•..±..:3 4 �, t_ .. ., LY.lr.l_-. . ..
S..i
✓ b'.t ...�1� . Vl A '�lf'i Y .+. 1
NEk�
� �Q� Ey�9`p�
♦�•Y'?a•. 4w�l,i 9"n ♦y" � `�� APPROVAL pu"",oriT alteration o atld't' t ur-y
Vap".army a licensetl ]antlrs v r ]si
iolat,on of section 7209 suh tl' 1 2 of the
York State Etlu[at ion Lav
A ( /{� Jy �.A G% /... 7l Only copies from the pr ig the of this survey
NOTES: ��+'� Cz , �/v (,/ /'Jj _ vr7 marker wits an bi9cons of the land s rveyor s
j T�. L /`"" stampetl eat shallbe considered to he valid trae
O� copies"
■ MONUMENT /} O Certifications innicated hero."signify that thia
• �� survey vas prepared i or Lanance vrth ahe ez
w- fisting Lone of Practice for Land
Surveys tloptetl
by
the Nev York State Asso[ia[ion of Profess Tonal '
o PIPE K�O �e D �J ono Surveyors. Saio certlf icatipns anal]run only
.1 to the person ror ,vhom the s vey is preparetl.
and on his behalf to the title company, govern-r-
tal agency no lending institution listed hereon, and
to the a signees of the ]entl ing insti tuf ion. Certifica-
AREA = 60,000 5F OR 1.38 AGRES y"""°'" n""„' `��i pneaare net transferable to additional inetitotinne
U . .
WELL SEPTIC LOCATIONS ' - € JOHN C. EHLERS LAND SURVEYOR
A5 PER HOMEOWNER
6 EAST MAIN STREET N.Y.S.LIC.NO.50202
6RAPHIG SCALE I"= 40' �? 2- 3 RIVERHEAD,N.Y. 11901
369-8288 Fax 369-8287 REF.-TIGER\PROS\99-28§'
SURVEY OF LOT # �
,
MAP OF BAYV i EW FARM k-p'
FILED A5 MAP # -1045
SITUATE: ORIENT _ _. , :�
TOWN: 5OUTHOLD •g9 DEC '
S
SUFFOLK GOUNTY, NY
SURVEYED II-03—aq
SUFFOLK GOUNTY TAX #
1000 - 25 - 5 - 5
GERTIFIED TO:
5AL GATALANATTO
MARIE GATALANATTO s6
s04220
F 7i
i
D, �c. /^0
z®¢ y /!U/
(C � �i� !, �j,
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ro 38 i
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P- .., Rto_ 99-o2.52-
WA
y
1
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C.6
un authoriz eo alteration o ueait' t ur
r s"aY
moo beari g 1 a landrs ter 1 i
i ration If t' nog sub❑i 2 f the
Neu yprk State EE t aw
NOTES: L �/J !/��'/�/" �. '/t m On1Y m the original f t r urves
�w,//(( y (J a kes wits a ri9cons of the ]anE s veyar'
/V./J stampetl ea] hal lebe itleretl to be—lid true
f Q npiea..
■ MONUMENT <� 1ert:f_ytiane ind ipa too hereon st9nifY that this
s rvey w s prepared in It
. th the e•
isttng Code of Practice for Land 5 y dopted
�w�� • ��� by the New York State A i t n f P f siprrl
O PIPE .r. rr and torveynrs Said c t f t ,all
only
O .\ ageot^the person for h they p V ren
_ L V taland his behalf to- t't] p y g
AND 5 to the ass i gneesd p f eth en in,
ntl t ,t'tut t tl hC tifitad
AREA = 60,000 5F OR 1.38 AGRES t` - ono are opt traneferable tp add itienal i t.Lipo=
WELL � SEPTIC LOCATIONS J
JOHN C. EHLERS LAND SURVEY( R
1
A5 PER HOMEOWNER ;F :' '
6 EAST MAIN STREET N.Y.S.LIC.NO.5 )200.
6RAPHIG 5GALE 1"= 40' - �, .m RIVERHEAD,N.Y. 11901 •
--- r 369.8288 Fax 369-8287 REF.—TIGER\PROSIt9 —
SUPPOLK CO. HEALTH DEPT. APPROVAL
a ,
H. S. NO.
-0,0100 o STATEMENT OF INT NT _
�s+ THE WATER SUPPLY AND SEWAGE DISPOSAL
w SYSTEM FOR THIS RESIDENCE WILL
MAP , OF P OPE TY CONFORM TO THE STANDA0011 OF THS
:7-5 ___ .. __ SUFPOL�EPT. �I RVICES.
• 1f APPLICANT
o S
IU�sce '�� L
, -T SUFFOLK COUNTY DEPT. OF HEALTH
d AL __ ./ r �~�� �,, _,.. SERVICES V I — F A P P R V A F.
S CES FOR L O
BUILDING 5ETBA C V— L~f NE 0 AT
, CONSTRUCTION ONLY
to
DATE: .
.0f2if---INT H. S. REF. NO.: So - �
"HGL1
III � SiNG
c SUFFOLK CO. TAX MAP DESIGNATION:
- - -
40, __ 11 DIST. SECT. SLOr-K PCI,.
O
R OWNERS ADDRESS:
} 530 X54PPET25 C ANF-
' DEED: L-N/,& P.
5 < 0 f �
SCALE 50
r-1 sup
LO YM4 =UkYCY iS A YrL'a,lflCM OF
a=1 N,U_mtki-T. P OA IN9 OF THE?,V,W iOM STAT3
11tt IDLJ:iTIOM LAW
''maws OF 1"15ani y f 9R
4w NCA AUBatd4
''m
i q LAS w as - SEAL OR
6E A NA+ ?Y
I
Y x
fo ME
_..__-'�'�'! � �' � t a, i ➢ro a.ls�f-:ls.xy /dW'p
e r3¢ Lt io!'1Ci liMS24
AAE .d TR b�S�ift,ax
SEAL
tU
T f`1AP OF- '/�t� DEC
'�14E SUFF CG, CLFI2i-"5 OF E"SCF- Ae MAP htG,7 �" A
_.... ..__.. _ RO ERICK VAN TUYL, P.
LICENWD LAND SUR YOBS
GREENPORT NEW YORK
nuoym vim twt4w
Pik . qZ
STATEMEIS
THE WATER SUPPLY
SYSTEMS FOR TI-
CONFORM TO THE
75 SUFFOLK PT.
01
(S
APPLIC
SUFFOLK COUNTY
SERV ICES F 6 F
CONSTRUCTION ONL
DATE:
H. S. REF. NO..
3 APPROVED:
-1
SINQLE FALdll y
SUFFOLK CO, TAX
DIST. SECT.
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OWNERS ADDRESS:
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<-qo ti TEST HOLE
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if-ZON PIPE
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01
OCCUPANCY OR
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Of types K� rr SUPPLY SYSTEM CANNOT
EXCEED 2110 of 1% LEAD.
PLUMBER CERTIFICATION
ON.LEAD CONTENT BEFORE
Z CERTIFICATE 07 OCCUPANCY
— - - --- - AP R VED AS NMED
DATE: /D aB.Pq � .�
FEC BY .�
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NOTIFY BUILDING DEPARTMENT AT -
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•_ i FOLLOWING INSPECTIONS: _
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1 FOUNDATION
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COMPLETE FOR'C.O.' "'"' NOTIFY BUILDI DEE MEN7AT
765-1802 9 AM M
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