HomeMy WebLinkAbout26230-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-27500 Date: 01/08/01
THIS CERTIFIES that the building ALTERATION
Location of Property: 1325 SOUNDVIEW RD ORIENT
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 15 Block 3 Lot 15
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 19, 1999 pursuant to which
Building Permit No. 26230-Z dated DECEMBER 28, 1999
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 INTERIOR ALTERATIONS & RENOVATIONS TO AN EXISTING ONE FAMILY DWELLING
AS APPLIED FOR.
The certificate is issued to PETER G PIRO
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. H-069788 11/02/00
PLUMBERS CERTIFICATION DATED 11/27/00 PETER G. PIRO
_ a
Authorized Si ture
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. 26230 Z Date DECEMBER 28 99
Permission is hereby granted to:
PETER G PIRO
1325 SOUNDVIEW RD
ORIENT,NY 11957
for
CONSTRUCTION OF INTERIOR ALTERATIONS & RENOVATIONS FOR AN EXISTING
SINGLE FAMILY DWELLING AS APPLIED FOR.
at premises located at 1325 SOUNDVIEW RD ORIENT
County Tax Map No. 473889 Section 015 Block 0003 Lot No. 015
pursuant to application dated NOVEMBER 19 99 and approved by the
Building Inspector.
Fee $ 75 . 00
Auth ri ed Signature
ORIGINAL
Rev. 2/19/98
Form No. 6 GG f Q
WN OF SOUTHOLD 4-,o
BUILDING DEPARTMENT ')
' TOWN HALL
f' 765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and subm_itcd tg, t1ae--bui� I
inspector with the following: for new buildin or new use: T ra g
g �r'
1. Final survey of property with accurate location of all bgflidi 'gs, property lines,
streets, and unusual natural or topographic features.
2. Final Approval from Health Dept. of water supply and sew
�ag'e-disposa4(S'-9 forms'.
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder �sedlin system contains
less than 2/10 of 1% lead.
res""
responsible for the building. and similar buildings
5. Commercial building, industrial building, multiple reside
and installations, a certificate of Code Compliance from architect or engineer
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 Buildin¢ - $100.00
3. Copy of Certificate of Occupancy - 250
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date . . . �y/z 7/U 0 . . . . . . . . . . . . . . . . . . . . . .
New Construction. . . . . . . . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . .
Location of Property. . .
House No. Street Hamlet
Onwer or Owners of Property. . .pfI(.�!` . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
County Tax Map No 1000, Section. . . t-9 . . . .Block. .0.ec?.3. , , , , ,Lot. . L9l ate. . . . . . . . . . . .
Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
262. 30 7�
Permit No . . . . . . . . .Date Of Permit.(* Z8/V. . .Applicant.L . � . : . ����
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . .
Fee Submitted: $. , Z .S ° U
/�.. . . . . . . . . . . . . . . . . . . . . . . . . . .
APPLICANT
CO Z'0 5 a a
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH BG.
[ ] FOUNDATION 2ND SULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMAR
DATE INSPECTOR
r
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
8078652 BUREAU OF ELECTRICITY
40 FULTON STREET, NEW YORK, NY 10038
Date NOVEMBER 02,2000 application o. on file ' 9791600/00 If 069'788
THIS CERTIFIES THAT PERMIT N0. 26230
only the electrical equipment as described below and introduced by applicant ed on the above application number is in the premises of
PETER GEORGE PIRO, 1325 SOUNDVI'EW ROAD, ORIENT, NY
in the following location; ❑ Basement ® lot Ft. ❑ 2nd Fl. OUT Section Block Lot
was examined on OCTOBER 27,2000 and found to be in compliance with the National Electrical Code.,
FIXTURE RECEPTACLES SWIT;INCANDESCE!� FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMI. K.W. AMT. X.P.
DRYERS FURNACEFUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS M LTI.OUTETDIMMERS
SYSTEMS
AMT. K.W. OIL H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. M.P.;- NO.OF FEET AMT WATTS
a 60p
SERVICE DISCONNECT No.of S E R V I C E
METER NO.OF CC GOND A.W.G. A.W.G. A.W.G
AMT. AMP. TYPE EQUIP. 1 D 2W 1 0 3W 3 D 3W 3 0 4W pER 0 OFA GOND NO.OF HIAEG Of HI-LEG NO.OF NEUTRALS OF NEUTRAL
OTHER APPARATUS:
WHIRLPOOL BATH-•1
PADDLE FAN.-F-1
G.F.C.II-1
SMOKE DETECTORi -1
PETER PIRO L L
1325 SOUNVIEW ROAD
ORIENT, NY, 11957EGENERAL MANAGER
Per 11
This certificate must not be altered In any manner; return to the Office Of the Board If Incorrect. Inspectors may be Identified by their Credentials.
COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ J FOUNDATION 2ND [ ] INSUL N
[ ] FRAMING [ AL
[ J FIREPLACE A CHIMNEY
REMARKS:
.(a ,e
,DATE INSPECTO
FFOL
Town Hall,53095 Main Road co
COD :X Fax (516) 765-1823
P. 0. Box 1179 Telephone (516)765-1802
Southold, NewYork 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
C E R T I F I C A T 1 0 N
DATE
Building Permit No. .2- 6Z 307
Owner: pz�-e'� C-? ro
(please print)
Plumber:
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
--(-P��igna�ure
0 6v-1
Sworn to before me this
=,27 day of
Notary Public, 'CO31-pty
EL17ABETHASTATHIS
NOTARY PUBUC,State of New York
No.01 ST60081173,Suffolk County
Tenn Expires June 8,20a.�
F...DF D `NSPECTION REPORT - DATE COMMENTS
FOUNDATION ( IST)
cz
ISI II
FOUNDATION (2ND) _ _ _ _ _
ROUGH FRAME fi —A ,,rictic
PLUMBING owz*, A; cl x�
ISI-_ _71
------------
CAL
i
II I
INSULATION PER N. Y. it y
STATE ENERGY ii
Jl--- 1I
CODE
ii =#
II
I� �I
FINAL
42 AC--
II
---------- --
---- ____- ADDITIONAL COMMENTS: Em
0
ro
H
d-z ;o g� I
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] RO H PLBG.
[ ] FOUNDATION 2ND [ ] SOLATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARK e-0
DATE / INSPECTO
c� 3�
M-1802
BUILDING DEPT.
I NSPECTIO
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] F NDATION 2ND [ ] INSULATION
[ FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
RE ARKS:
G
DATE INSPECTO '
Peter W. Charapko Architect
31 March 2000
Town of Southold
Building Department
Town Hall
Southold NY 11971
Dear Ladies and Gentlemen:
This letter is addressed to the Building Department
regarding a construction revision for the Application
for Building Permit dated 18 November 1999, 1325 Soundview Road,
Orient, Tax Map 1000, Section 015, Block 3, Lot 015.
Regarding Details 1 and 2 of Drawing A1, latest issue 18 November,
1999, adjacent double slider doors (insulated) have been installed along
the north end wall of the main bedroom, requiring a continuous 11-foot header and
end supports. The new header is 3 ea. 2 x 6s, with a 6" x 3/8" steel flitch
plate set between the joists, through-bolted 6" on center. The composite
beam is attached to the roof joists. The beam rests on 3 ea. 2 x 6s
at each end, acting as load-bearing posts within the exterior partition.
These notes are submitted for inclusion in the Application record.
Respectfully submitted, hr
littted, ��eA������
Peter W. Charapko AIA
cc: Peter Piro and Deborah Iannelli, 1325 Soundview Road
218 Madison Avenue New York NY 10016-3466 212 685-0847
Peter W. Charapko Architect
31 March 2000
Town of Southold
Building Department
Town Hall
Southold NY 11971
Dear Ladies and Gentlemen:
This letter is addressed to the Building Department
regarding a construction revision for the Application
for Building Permit dated 18 November 1999, 1325 Soundview Road,
Orient, Tax Map 1000, Section 015, Block 3, Lot 015.
Regarding Details 1 and 2 of Drawing Al, latest issue 18 November,
1999, adjacent double slider doors (insulated) have been installed along
the north end wall of the main bedroom, requiring a continuous 11-foot header and
end supports. The new header is 3 ea. 2 x 6s, with a 6" x 3/8" steel flitch
plate set between the joists, through-bolted 6" on center. The composite
beam is attached to the roof joists. The beam rests on 3 ea. 2 x 6s
at each end, acting as load-bearing posts within the exterior partition.
These notes are submitted Cinclus -
Respectfully
At_ plication record.
submitted,harapko AIA -
cc: Peter Piro and Deborah Iannelli, 1325 Soundview Road
218 Madison Avenue New York NY 10016-3466 212685-0847
� --- LONG
�. S.X301c . Pee rcE�
MAP
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2OA0 rP�QWKVANrO➢f A5 SUZ,/EYEU MAY2 t $7 !
l&WW!jjY!Tf4r-sGA-wOmg 5— 0 CO
iNTH ' t7Ef �R7.C.tEt21G .aFF€C�j IAF=��7T --SFO�AN� J�-- --- - LIGLAWD 51;QVEYq 2S ' q!?l CUL .N�!i
BOARD OF HEALTH . . . . . . . . . . . . . . .
FORM NO. 1 3 SETS OF PLANS . . . . . .. . . . . .. .. „
TOWN OF SOUTHOLD SURVEY .. . . . . .. . . . . . . .. . . .. . . . .
BUILDING DEPARTMENT CHECK . .. . . . . . . .. . . . . ... . . . . . . .
TOWN HALL SEPTIC FORM . . . . . . . . . . . .. . . . . . .
SOUTHOLD, N.Y. 11971
TEL: 765-1802 NOTIFY: � ��
CALL
Examined.................. 19.... 77 ll 2 7y: MAIL TO: . . . . . . . . . . . . . . . . . . ..
Approved......tZ.:Z�.... 191� Permit No. d' ;C� ....................................
Disapproveda/c ..................................
....
.... .. ... .i(. .. .... .
(Building Inspector)
�I F1A LICATION FOR BUILDING PERMIT
Novenber 18
f. - INSTRUCTIONS
a. 'Ibis application mist be completely filled in by typewriter or in ink and submitted to the Building Inspector Gait
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 mist be drawn on the diagram which is part of
this application.
c. Tice work covered by this application may not be commenced before issuance of Building Penmit.
d. Upon approval of this application, the Building Inspector will issue 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.
APPLICATI(N IS HERM 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 appl.i.cable laws, ordinances, Wilding code, housing code, and
regulations, and to admit authorized inspectors on premises and in building for necessary inspections.
.... ��..11.� ...........................
(Signature of applicant, or name, if a corporation)
1325 Sounilvi@1v„P,q ,.$uuthcild.NY.1.1971....
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plcnber or builder
Owner ...............................................
.........................................................................
Nam of owner of premises ..Peter Piro and Debra. Iainnelli ......................................................
..
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
..............n/.a.................. ...................
(Nam and title of corporate officer)
Builders License No. ..?omeowner............
Plumbers License No. . 19riet au.,,,,,,,._„
Electricians License No110lAeQVA X............
Other Trade's License No. ....................
1. location of land on which proposed work will be done..............................................................
1325...........................Squndviaw.Read.................................... }int..............................
House timber Street hamlet
Cam Tax Ma No. 1000 Section ..015.......... Block ....03Lot.......... ..
tY P 015...........
Subdivision ...Orient, . the,,S,gq.............. Filed Map No. ....277.7.7..... lot p/n.19 . -a11 of 20
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
single family dwelling - resiuential
a. Existing use and occupancy .............................................................................
b. Intended use and occupancy ........AiDgIe.£a i1.y..d1¢ening.:..residerntial........................
I, Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..XX......
Repair .`........... Removal .... i........ Demolition ............ Other Work ..................................
(Description)
Estimated Cost ...�. 11,000.00 I''....... fee .................................:............
(to be paid on filing this application)
If dwelling, nuhber of dwelling units ...1........, dubber of dwelling units on each floor ...1............
If garage, number of cars ......il.......
If business, commercial or mixed 11 occupancy, specify nature and extent of each type of use....iV..a..............
Dimensions of existing structure, if any: Pront Ra!:A'!........ Rear ..88.1:011..... Depth ..4.2!:A'!.:......
height ...12.ft............... 1 Umber of Stories ..•...1...............
Dimensions of sere structure with alterations or additions: Front ...same ,.... Rear ..same ••.....
Depth ....sane•••'••'••• ueig)h� .....'same.......... Umber of Stories ....i..........
Dimensions of entire new constrtu�tion: Front ..no—change... Rear ...:!.. it...... Depth !!..ll.........
Ileigiht ...].2.ft............... i,Nmmber of Stories ......1..............
n. Size of lot: Front ...125.$t..1....... Rear ....1.35••ft........ Depth ....360. ft.........
fc�Mb>rQ
O.IY Date of Purchase ...............1...bq9.. Nare of Former Owner ...Robert•Se•Mumford................
40
1. Zone or use district in which premises are situated ...R.........................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ...no...................
13. Will lot be regraded ....no••••t.........Will excess fill be removed from premises: YES WD n/a
14. Names of Owner of premises Peter Piro and 1325 Soundview Rd:•••••••• Phone
X631)323•-0033
Preor ..Iann ............. Address .......
De�n,a Iannelli
Name of Architect (ddress21S.P4�dJSQD.AYe.NYC. 7Q016Ithone Nc{212J.485-A8A.7
Nam of Contractor ...)14mPR1'nPx....cLbQY.e.......... Address ...............................Phone No. .............
I
15. Is phis property within 300 feet of a tidal wetland? * YES ...... NO ..........
*IF YES, SOLMM IUA TRDS�S PMTr MAY EE REQOIR=.
PLOT DIAGRAM
Locate clearly and distinctly al� buildings, whether existing or proposed, and indicate all set-back dimensions
fres property lines. Give street and block namber or description according to deed, and show street names and indicate
wlhether interior or corner lot.
See attached IlSurvey, May 20, 1987, by Roderick Van Tuyl, P.C. , Licensed
Land Surveyors.
I
.;rNlrs Or MW YORK
sS
O(Jl1NlY OF /
Peter Piro
• ••••••. ....•••••••••••••••being duly sworn, deposes and says that he is the applicant
(Nano of individual signing contract)
above named,
Ileis the ........Gwnor..............1.......................................................................
(Contractor, agent, cprporate officer, etc.)
or. said owner or owners, and is duly alIRhorized 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 anxd
Uhat the work q will a performed in the!lmaoher set' forth in the application filed therewith.
Swm o befgk this ^ I S
�....�.D.........day of .��. ..19. ......
.....I �—
. .. ............................
Not Public ..... ........
THOMAS FAftlCf,a (Signature of Applicant)
Notary Public,State of New York
No.41.4 787501
Qualifier in Queens County
Commission Expires � ��„ 00 �,
ENERGY NOTES BUILDING DEPARTMENT AND ZOMNG NOTES —
Per'New York State Energy Conservation Construction Code Paragraph 1. This Application is submitted for review by the Town of Southold --
7810.6 ("Spope,") the proposed Work of this Application does not replace Building Department for renovations to the single family dwelling located on
more than 50 percent of any building system within a twelve monthCounty Tax Map. No. 1000 Section 015, Block 03, Lot No. 015, known as I I- IV_9`I f 0I LV IN& 17 At<TM6N f
period. 1325 Southview Road, Subdivision of Orient by the Sea, Hamlet of Orient, FIL IN(o
Town of Southold, New York.
Pursuant to "Special Conditions" (3)(i) replacement portions of exterior wall S
shall have an R-rating of minimum R-10. 2. The zoning is a Low-Density Residential R-40 District. Df (cc,
Voluntary energy-conserving aspects of proposed work: 3. Work applied for is limited to that described on the drawing submitted
Replacement of new windows with doublke glazing, with U-value (Dwg. Al). APPROVED AS NOTED
NATG Ii Fd AK Enh V ICP (F Max. = 0.58. 4. There is no change proposed in the Floor area of the house or the DATE: 2.21.59 S.P g�C� O
PA K (i6V 46 1NALL r'FMOVAi- -- -__ volume of the building. There is no change proposed in the use of the FEE:�$ 95 By. a•Rrc wr
,RAE NEW P(4 PIAL PLAN 2/A I '� Installation of 8" fiberglass batt insulation in attic over bedroom building or in the means of egress. NOTIFY BUILDING DEPARTMENT AT
_ and newly-located bathroom. 765-1802 9 AM TO 4 PM FOR THE
(-- -- - =� - - - - - -- - - _ - --- - NOTES TO THE CONTRACTOR 1 FOUNDATION - 7REQUIRED
FOLLOWING INSPECTIONON S:
(CRMO JE W.G. LAVA'fG2Y a 1. DimenSi0na, materials and assemblies shown on the drawing are t0 be FOR POURED CONCRETE
�I[OWEK FIK7Uf=Eh, gF ANGN , verified by th,e Contractor prior to the commencement of the Work. 2. ROUGH - FRAMING & PLUMBING
\YYrN'F UrvES ' WA"(61= LINE) --- Discrepancies shall be brought to the attention of the Architect prior to INSULATION NUALATIO CONSTRUCTION MUST
D , P portions 4. BE COMPLETE FOR C.O.
ALL MEET
- execution of such onion or mons of the Work.
ALL CONSTRUCTION
\y 5 U N IMOD M 2. Substitution of materials, assemblies or products-shall be proposed THE REOUIREMEN-fS OF THE N.Y.
by the Contractort the Architect for response and/or approval prior to the STATE CONSTRUCTION ENERGY
AILEA 6(% W DI=K FU
construction or installation Of he related parts. CODES. NOT RESPONSIBLE FOR
�µlh API'LiGATIONDESIGN OR CONSTRUCTION ERRORS
� 3. Shoring, bracing and staging of Work is the responsibility of the
\ Contractor. The Contractor is responsible for damage to portions of the
building not scheduled for demolition or repovals. In such event the OCCUPANCY OR
Contractor shall inform the Architect as soon as possible and await the
GL Architect's direction. The Architect shall review appropriate course of action USE IS UNLAWFUL
r- - - - - - - --�
with a caner. WITHOUT CERTIFICATE
� I G A K A G E 4. Lumber indicated on the drawings shall be structural grade seasoned
GAN Douglas Fir (Larch) or other wood with a minimum bending stress of 1100 OF OCCUPANCY
psi.
� I
5. Steel bolts, rods, anchors, nuts, washers, etc. shall he fabricated of UNDERWRITERS CERTIFICATE
milled steel elements, not cast, with bending stress of 36,000 psi.' These shall PROVIDE OPENINGS FOR REQUIRED
be galvanized or zinc-coaled. EMERGENCY ESCAPE AS
L V l,il(o K� N( 6. Architect's responsibilities do not include the Administration of the
gEp P OD M REQUIRED BY PART. 7110E
/ _ Contract during the course of the Work. The Owner is responsible for N.Y. STATE BUILDING CODE. If copper tubing is used '
-- municipal inspections, sisnroffs, and any other required filings with the for water distributing
vTown or other regulatory agencies. This does not preclude the system;piping shall be
Architect's filing of amendments to the Contract Documents as required PROVIDE SMOKE-DEFECTING of types K or L only
during the course of the Work. Contractor is specifically referred to ALARM DEVICES
�I Items 1, 2 and 3 herein as part of "Notes to the Contractor." AS TO PART.721.1
ILYA BUILDING CODE.
LG L C C I--�
L
-- - - - - -- KITGN EN
O O -- - NGw VEN-1 PLUMBING
ALL PLUMBING WASTE
i~ T „ - - - - -, &WATER LINES NEED
i N - 2'- 1 TESTING BEFORE COVERING
(LGNIOVAL i d
FiA-fN - L '- LIG N'(,WA�y(Fi P+CA+w1.4; .,�f17�1U Edi
e tl cW �FATN r I hT WOK PLUMBER CERTIFICATION
ON LEAD CONTENT BEFORE
GI. � vdK%N k. Z. 4' y., 2' ` - -- -- - - � - - -F,___ - -_` SOlFICATEOFOCCUPANCY
4” �NCW WA�*tGuNfi? CERTIFICATE
EL5�ti�A .DER USED IN WATER
- - - - - -- - - G I w wA E SUPPLY SYSTEM CANNOT
¢ 6ANI'(A' VIAG�AM F,09TING 040161 f EXCEED 2110 OF1%LEAD.
AI N.T-�. -- GE LL AK_
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BUILDING PERMIT REVIEW CHECK LIST
Applicant/ Date
Owners Name: T 2�x�\ � Reviewed:
Architect/ Date
Engineer: PP,+�Z. ���RA�KO_
Architect/ Alf)
Z�2 � D4`1� Submitted:
SCTM #:
District: 1,000 Section: I Block: Lot: 1 5
Projectp \' Subdivision
1 '
Location: 1 30�� S41Ard V 1 a.-,) �� 02�I' Name: OQ-t -I-d o�
Single&separate Req=' x1571 �wtw
cemfication: (Yes No) o,
Req.
Zoning District: [Lot size: }Actual: ] [Lot coverage Proposed: J
Req. ��t s'r 1 Req. C J TTCV—.5 RW 1 d r—e444 A'/AJ
[Front Yard Pro sed: [Side Yard Proposed: 1 [Rear Yard Proposed: )
Project Description: J u-fO/dZ- g,4
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AGENCY PERMITS Permit
REQUIRED FOR REVIEW N.A. NO YES Number
Suffolk County Health Dept.
New York State D. E. C.
Town Trustees
Town Zoning Board approval:
Town Planning Board approval:
Flood Plane Elevation ???
Flood Zone:
Notes:
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