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Home My WebLink About25060-zFORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 25060 Z Date JULY 27, 1998 Permission is hereby granted to: ALEXANDER F MASSIMI (ROMANO) 4414 DROMEDARY ROAD PHOENIX AZ~ 85018 for : CONSTRUCTION OF A SINGLE FAMILY DWELLING WITH 2 CAR GARAGE AND A COVERED FRONT PORCH AS APPLIED FOR. DECK FEE NOT INCLUDED - OPTIONAL. at premises located at 580 UHL LA County Tax Map No. 473889 Section 015 pursuant to application dated MAY Building Inspector. ORIENT Block 0005 Lot No. 024.014 18 1998 and approved by the Fee $ 597.00 ORIGINAL Rev. 2/19/98 :OUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & .FLUMBING' INSULATION PER N. Y. STATE ENERGY CODE COMMgNTS FINAL [ON~L COMMENTS: DEPARTMENT OF HEALTH SERVICES COUNTY OF SUFFOLK ROBERT J, GAFFNEY SUffOLK COUNTY EXECUTIVE PERMIT MARY E. HIBB£RD.'M,D,, M.P.H. COMMISSIONER . THE ATTACHED PLAN, WHEN DULYSIGNEi5 BY A REPRESENTA~TIVE 0F THE DEPARTMENT, CONSTITUTES A' PERMIT TO CONSTRUCT A WATER SUPPLY AND/OR A SEWAGE DISPOSAL SYSTEM FOR THE pROPERTY AS DEPICTED. CONSTRUCTION MUST CONFORM WITH APPLICABLE sTANDARDS INCLUDING THE STANDARDS FOR CONSTRUCTION OF SUBSURFACE SEWAGE 'DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES AND 'STANDARDS AND PROCEDURES FOR PRIVATE WATER SYSTEMS. THE PERMIT (PLAN) EXPIRES THREE (3)'YEARS AFTER THE'APPROVAL DATE. ANY MODIFICATIONS WHICH MAY AFFECT THE PROPOSED SEWAGE DISPOSAL SYSTEM OR WATER SUPPLY REQUIRE SUBMISSION OF A REVISED PLAN AND ANY ADDITIONAL FEES, PRIOR TO cONSTRUCTION. NO INSPECTIONS WILL-BE PERFORMED BY THE DEPARTMENT ON EXPIRED PERMITS. PERMITs MAY BE REISSUED UPON THE SUBMISSION OF NECESSARY APPLICATIONS,' pLANS AND FEES, AND WILL BE REQUIRED TO MEET THE STANDARDS IN EFFECT AT THE TIME OF REISSUANCE. A PERMIT MAY BE TRANSFERRED INTO ANOTHER PARTY'S NAME UPON RECEIPT OF WRITTEN pERMISSION FROM THE ORIGINAL APPLICANT AND THE RECEIPT OF ANY. REQUIRED TRANSFER FEES. IN THIS CASE, THE pARTY PAYING THE ORIGINAL APPLICATION FEE 'WILL BE CONSIDERED TO' BE THE ORIGINAL APPLICANT. WWM-058 DIVISION OF ENVIRONMENTAL QUALITY COUNTY CENTER PAGE 1 oF 2 INSTRUCTIONS It is the applicant's respoosibility to supply facilities prior to backfilling~ and h~spections of the water supply grading. Other inspections may be FOR FINAL APPROVAL OF CONSTRUCTED SYSTEMS call the Department to arrange inspections of the sewage disposal system and water These include inspections of the soil e~cavation for the sewage disposal system well,~well lateral, public water supply line, disposal system, piping aud final ~quired. Following satisfactory construction ~nd inspections: . 1. The applicant must submit 4 prints of an as-built plan (up to and includh~g 1 l"xl 7"), by a licensed design professional, of the subject property showing the following: 1 the lot location and dimensioBs; b. the lot number(s) and the mu~e/of the subdivision, if applicable; c. permanent structures (i.e., buildings, driveways, walkways, swimming pools, decks, etc.); d. the exact location of the private well, if applicable (give at least 2 dimensions measured from the comers of the building); ~ ] e. the exact location of the public water line, if applicable; f. the exact locatiou of the septi,: tank and leaching pool(s), if applicable. Give 2 dimeasions fi'om the buikling comers to the co. vers of the sel~ tic tank and each leaching pool; g. the exact location of the sew~ r line from the dwelling to the street; if applicable; and h. have a clear area at least 3~ xS" for the Department's approval stamp. The applicant must submit a ce~ tificate from the sewage disposal installer attesting that the system bas been installed according to the criterJ a of the Suffolk County Department of Health Services, when applicable. 1 If a well has been installed as t~e potable water supply, the applicant must submit a current well water analysis (within one year) and a well driller's certificate. If the well or water quality does not conform to standards, proof of corrective measures will be t In those cases where public se~ sewer line inspection approval copies of Form S-9, duly execu In those cases in which the inst; the Department of Health Servk ~quked. Refer to "Standards and Procedures for Private Water Systems." ers are utilized for the dwelling, the applicant is also to submit one (1) copy of the rom the public sewer district. In distric[s operated by Suffolk County, two (2) ed by the Suffolk County Department of Public Works, are required. [lation and connection of the public water service line has not been inspected by es, a tap letter from the appropriate water company is required. HEALTH DEPARTMENT REFERENCE NUMBER MUST BE ON ALL CORRESPONDENCE OR DOCUMENTS SUBMITTED. SUBMIT ALL SECESSARY FINAL PAPERS AT THE SAME TIME. PHOTOCOPIES OF DOCUMENTS WILL NOT BE ACCEPTED. WWM-058 PAGE 2 OF 2 IIOAEI) OF IIIt~flLTII ............... 3 SETS OF PLANS ............... SUEVIz, Y ........................ (;IIECK ......................... SEPTTC FOI{H ................... NOTIFY: (;ALI ................... HAll. TO: .................... I)ale ................ , 19 1 NS'l'lt IIC'I'IOItS a. 'lhis al~plicnticn~ ,mst I)e co~l)letely filled in by typ~.~ril'er or in ink a~l mJhnkt~l to the ~dhling T,almclor uhl' 3 ~ts of plans, acmrate plot plan to ~ale. F~ acco~ling t'o sch~hfle. I). [>lot plan ~h~ l~att~ of lot a~ off h~ihlh~s ~ prmfl~s, relation~dp to mljoining proni~en or i~*hlic thi~ ~'. 'll~e ~rk c~r~ I~ this aa~licatil~ my mc t~ co.~al I~fore iss~u,~e o~ l~dldi~ Pemk. I~..lt gudl I~ kepi: al tl~ I~e.i~8 ~olld*le for i.~l~ctt(~ lh~all~a,t Lhe ~.'k. e. a~ I~dldhqI *d~./1 I~ ~cupi~l or ual In ~*le or i. 1~,~1. lot rely l~.'lX~ ~alever u.~il ~ (}~1 irlcnle (kC.l~il~y ti~all have ln~o i~rpot~l I)y tl~ I~lil(ling In~l~tOr. AI'L*I.I(~'I'J(~ IS I~[~[BY ~E to the IkiildJnlt l~[~(tll~lll: for Ihe ismJonce o~ a I~dl(iln~ Pet.dC IXl~i~tflrtL LO the I~Hhlin8 ?a~ ()rdtIv.~e o~ I1~ ~1 of t~itlsfld, td~olk (~int?, ~ York, a~d olher Ol~tlcable las, Ordinate. l~ilula~t~e, ~or tl~ a~trl~tl~ o~ Isdldi~*gs, ~kias or alterat o~s, or ~or te~el or d~l kion, as herein ~_ ~--~y~-- ......... :~.. ................................. State ~e~-/tll~ 1o ~r, le~e, t~gent, archhec~, entailer, general con~racLor, electrician, ph.i~r or (~ tille o~ COrl~.-nte officer) I~fihlert~ l.lcen~m ~ .............. .... .... ..................... 3, 10. I~lle of I~lrehm~e ............. Il. ?xx~e or u~ di,lrict in 13. ~lll lo~ I~ ~es~d ......... 16. oE ~J~k (check. ~4~i(dls al~ltlical)le): Nc-~ Ikdhlinl~ ........ ~klitic.~ .......... AIl'eration .......... ~ (l~:rl pt i~)~ I~sl.i~,wt~l C~sl: / fee ! (to Im [mid otl fil , / ................ Iki~,t .................. ~=d~r oF Stories .............. hie at,y xxa~ing I~, o~d[~mT~:e t)r reBulat}la~: ...~O ................ Ard~ltee~ .................................... Nklre~ .............................. / clearly mvl dlath~tly ~all I~Hldh~a, d~ether exiath~g or pro[~sed, m~l l,xlie~te all aet-I~k dlnenaiona f~(~n proi~art y ,.dmll.:r inler~or or ¢:or~ar lol:, !~IWII~, (Hz ~ (Nmx~ ol i~livlth,ll. ,ll[,Inll C()ll(ttl(:l ) IkJ ill IJll~ of mild (~r or ~rB, m~l J~ dul~ at,thori~l lo l~rro;m or Imv(~ [~rl'or,~d lira mild ~)r.k el~l lo ii~]ke m~l File thi, ~)t.~try l~d)J lc HOPE H'ILLYER NOTABY PUBUC. State 0f New York N0. 01H~5022~7~ Suft01k Term ~xp~res 3ahuary I8. FR LANE . % LO 0 NO.1. o34' 00"~ t79.81' Z ~"0 -0 m \ / 0 0