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HomeMy WebLinkAbout23520-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24853 Date JANUARY 13, 1997 THIS CERTIFIES that the building NEW DWELLING Location of Property 3608 OLD NORTH ROAD SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 55 Block 2 Lot 25.5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 30, 1996 pursuant to which Building Permit No. 23520-Z dated JUNE 18, 1996 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 GARAGE AS APPLIED FOR. The certificate is issued to JOHN D. & TONI ANN SINNING (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-95-0031-DEC. 26, 1996 UNDERWRITERS CERTIFICATE NO. H-052553-OCT.31,1996-&N-400537-OCT.21,1996 PLUMBERS CERTIFICATION DATED DEC. 2, 1996-PEAK PLUMBING & HEATING nr^j� Building Inspect Rev. 1/81 sows NO. s 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) N° 23520 Z Dote ........... ........................... 19..l Permission is hereby granted to: .a:.....iac.../..5�%j................................. ........... . r?'!rr?e��...... ... ..,.../.�1./..9.7�.1s. to . .fT�4� .... P ......7W-12... 171 ... ...... ......... !-....... ,�/�✓ CA147f...../?!✓.... 7? ......... .tea....... . ..................................................... �7 i at premises located at ......—F4m .....ea...... ..,/`� ...................................... ......................................................... ?.4�1........................................................................ ................................................................................................................................................................. County Tax Map No. 1000 Section .....�r........ Block ......©Z.......1Lot No. ...�4�.:.�*�.... pursuant to application dated ..........."Oz' .. . . .... ........, 19- .ft4 and approved by the Building Inspector. Fee $.. �:.�......C✓�. B ding Inspector Rev. 6/30/80 f IA OG'O A/e>/env en.AD 'yP rr /C e090 9f�E 2J� ra s�xurw x n sama t� 1"a, ; 'r a� F �ifi�fl!°d of f `�b as Edi'(3e�$ Ot ERVI � \ L ���:3ti�tire`SA° eyo LANo 0 km tm, Wor All �e�, ° oDEC 2 9 1996x , +ti �d'iMrl .a e s:nit3°u gd�'.h5 W'rd��a �n25y"ty�F 3�E�ia^2°s@.`� N '"°�G�tt`'u�6a W.i'l g�¢J+jgvY '3 'fw2or R'Ea'h` AF`e n $ Ys' 1p Gd�'(iLf l r O3 ss Sputa's A� Ojsl.,P.E.,�Wzl ! 4 Ai o €B'�w^8�itfR�U> ¢�6 Iry c Q Z 0°� Dq No 6.KC• y�9.b' l C Nfl_ M4' J l lip ip z (�3'� lis'RiydB i flocyE '' w, x. , r ;. ,' ` �uRY�-'YFO,d �Oh�NI��NNiiYG✓•f' TON/ vla ole"�NOOJ•S/D.f'/ ' ' } /rn%vi.��,ryey�carr/ra�r2�yyari � : Ohre JuGy9/yy6 � 70 OZ-Z' IIIs; ( X'I p, r,, 7 rOLm no. b TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL JAN W 8 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OF, 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 of Fire 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) nou-conforming uses, or buildings and "ore-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 Building - $100.00 3. Copy of Certificate of Occupancy - .25C, 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date New Construction. . . Z . .. .. . Old Or Pre-existing Building. . . . . . .. . / . . f� J(/ Location of Property. .,.-3.(0 Al�llp/ ,XN!!u. .. . . d !!t /.:J�(./. . . I ��. . . House No. Street / Haml'et Onwer or Owners of Property.. .VJgZS�2. cS7/Aw//V J.e AA)b -T,-,Vl hi„/U County Tax lap No 1000, Section.473eSq• • -.Block. . 5`.�.'2... . . .Lot. . . . . . . . . . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .Filed Map.. .. . . . . . . . .Lot. . . . . �. . . . . . . . . . . . . . . . .. . . . . . . Permit No. . ��/ 1! ate Of Permi.t.V" g( ?. . . .Applicant. �/ r �. C. 1nf' ii)�/ • • - Health Dept. Approval V .. . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval . . . . . . . . . . . . . .J. . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . , . Final Certicate. . .�! . . . . . . FeeSubmitted: $„ 60 . . . . . . . . . . . . . . . . . . . . . . . � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �^ e 2Vb 9 APPLICANT THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGF, 1 1135021 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NY 10038 Date OCTOBER 21,1996 Application No.on file 12323396/96 N 400537 THIS CERTIFIES THAT ' only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of JOHN SINNING, 3605 OLD NORTH ROAD, SOUTHOIUD, N.X. in the following location; ® Hosement ® I st Fl. ® 2nd Fl. GAR/ATTIC/OUT Section mock Lot was examined on OCTOBER 16,1996 and found to be in compliance with the National Electrical Code. FIXTUR! FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS ECEPTAClES SWITCHES I$HCANDESCENTI FLUORESCENT I OTHER I AMT. I K.W. I AMT.j K.W AMT t.W AMT KW AMC H.P. 39 41 43 1 39 1 1 1 1 2 1 F DRYERS FURNACE MOTORS FUTURE APPLIANCE TlEDERS ISPICIALRLICIPTI 71ME CLOCKS JELLUNIYHEATERS MUL_...ET DIMMERS AMT K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS, TRANS. AMT H P NSYO.OFSTEMSRET AMC WATTS 2 F 3 20 SERVICE DISCONNECT 140.OF S E R V 1 C E AMT. AMP. I ME METER 1.0 A tVl 1,e'SW 3 R 3W S,e'AW NO.OF CC GOND. A.W.G. N0,pF MLIEG A�' G' NO OF NEUTRALS A.W.G. EQUIP. PER.O' Oi CC.CONp. OF HIAEG OF NEUTRAL 1 200 CB 1 X 1 410 1 2J0 OTHER APPARATUS: WELL PUMP-1 ASR CONDITIONER 4 TON-1 HOTORSt1—F H.P. ,1—F H.P. ,1-4 H.P. PANEL,BOARDSt1-1 CM 60 G.F.C..It_g SMOKE DETECTORI-6 L L t THREE "C" ELECTRIC LIC.#3327 k GENERAL MANAGER RT. #1, 13OX 45H SOUND AVENUE as Per This certificate motV4114W reci fi pn)jNftr; return to the office of the Board if incorrect. Inspectors may be Wintified by their credential:. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE` MUST NOT 8E, A4.YERED IN ANY MANNER. THE NEW YORK BOARD OF FIRE UNDERWRITERS PAcE 1 I 8062094 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NY 10038 Date OCTOBER 31,3 996 Application No.on file 123'72996196 H 052553 THIS CERTIFIES THAT only the electrical equipment"described below and introduced by the applicant named on the above application number in the promises of JOHN & TONI ANN SINNING, 3608 OU) NORTH ROAD, SOUTHOLD, N.Y. in the following location; ❑ Basement ❑ I st FL ❑ 2nd Fl. OUT , Section Bloch Lot was examined on OCTOBER 28,1996 and found to be in compliance with the National Electrical Code. i FIXTURE FCEPTACLES SWITCHES FIXTURES RANGES COOKIroO DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FlUORESCENi O7HEn AMT. K.W. AMI K W. AMT K.W. AMT. K.W. AMT. rip DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIMECLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT, K.W. Olt NP. GAS H.P. AMT. NO. A.W,G. AMT. AMp. Ami. AMPS. TRANS. AMT H.P. SYSTEMS .T AMT. WATTS NO.OF FEE SERVICE DISCONNECT NO.Of S E R V I C E MIT. AMp. ME METER 1.0 TW 1,/'3W 3 9 3W SX AW NO.OF CC COND A.W 0 NO Of HbLEG A W.G. NO.Of NEUTRALS A.W.G. EQUIP. PER+B' OF CC.GOND OF H61EG Of NEUTRAL OTHER APPARATUS: TRANSFORMER & TRENCH ONLY-1 TRANSFOPWR;1-25 KVA JOHN D. SINNIG L jcredentials.P. 0. BOX 1943 SOUTHOLD, NY, 11971 GENERAL 11 _. EI PerThis certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST,'NOT BE ALTERED IN ANY MANNER. SU 0( Town Hall, 53095 Main RoadsQn Fax (516)765.1823 P. O. Box 1179 4$� Telephone(516)765-1802 Southold, New York 11971 ifi p� 0 '43z2x2Zn-j� OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T 1 O N p DATE. Building Permit No. Owner: Joke SI o h 11\J(-; (please print) Plumber: re PEAK PLUMBING o HEATING 919th Stet (please print) Wading River,NY 11792 (516)929.6097 I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (PItfutbers Signature) r f i Sworn to before me this day of � 19�� Notary Public, County ROSEANN GRIFFITH Notary Public, State of New York- No. 4814557 Qualified in Suffolk County Commission Expires Mon k ��� ��' I'K7 o�0���11fF0(xcoG�� � ae Town Hall, 53095 Main Road p , Fax(516) 765-1823 9y �� Telephone(516) 765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD December 16, 1996 Mr. & Mrs . John Sinning P .O. Box 1493 Southold, N.Y. 11971 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: XX An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. XX The check is (not on file. ) $25.00 XX No Health Department Approval on file. No final inspection has been made. XX No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984) . BUILDING PERMIT # 23520-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. �+ a Town Hall, 53095 Main Road Fax(516)765-1823 9y � Telephone (516)765-1602 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD December 16, 1996 Mr. & Mrs . John Sinning P.O. Box 1493 Southold, N.Y. 11971 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons : XX An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. XX The check is (not on file. ) $25.00 XX No Health Department Approval on file. No final inspection has been made. XX No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984) . BUILDING PERMIT # 23520-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] R PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLA S CHIMNEY REMARKS: t { DATE �� INSPECTO 765-1802 BUILDING DEPT. INSPECTI0 [ ] FOUNDATION IST [ ROUGH PLBG. [ ] FOJJNDATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY nn REMARKS: A�4-GJ��Z5& ©! 1� r 6 DATE l INSPECT M-1802 BUILDING DEPT. INSPECTION [, ] FOUNDATION 1ST, [ j _ ROUGH PLBG. [. ] FOUNDATION 2ND [ ) INSULATION [ 7 FRAMING [64INAL REMARKS: Cekc 4L0 4 t i DATE 411aislIf6 INSPECTOR IC4 f I ILIJ'"�I Ilb 1'1;1, 1 11)11 Ilt,1'UV11 UPII' Cr. .:�. ............ .,..,,,,,...... ., ... ,. ....,. ... ,,.�. ..,......,,,........; 106 Qj P ! lunar❑ rnnue r, — �_..- - __ o� 0 ..................I . ...m,. — 40_ z ' -,,..d....N...,...,.. ............... nIID 1 1 I QUn 1.,.1;t)1111L11 l,........... .,...._...............�,,..._...,.,..,.., i I� w ._ _ ,:u..,: ""`. _;a",�."A.p^•,A""':iz.«.v;:scya ""�,'�,:;�-:�;''.."T. Y:a ,- -__ +^ Y. _.._.. ... {S. 765-1802 BUILDING DEPT. INSPECTIQ [ ] FOUNDATION IST [ ROUGH PLBG. [ ] FO DATION 2ND [ ] INSULATION [ RAMING [ ] FINAL FIREPLACE & CHIMNEY REMARKS: / f s � OJT f TE INSPIRE """� M-1802 BUILDING DEPT. NSPECTION ( ) UNDATION IST [ ] ROUGH PLBG. [ FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLA S CHIMNEY REMARKS: I DATE INSPECTO Quo /t/o,�ry .COAD o�y 4$. LEW I &a96 0 z L /30,77' KN NO YaY.�R /OyNlJ�ryi��YG✓P rd To1YiViV-V 1-2zeng" y, p ,y E'p��•vvors�arr' , ear-,3 ` LOGY1.bN,•'1blr01.NOL0,.'fOFrrA[.ClO�NTi/`•��! 7/ � �` �'S9i�•/"=/CSO 1 7. Rnure of wont (0ieck wlri(It al4A icable); Pew lend dint; ... .. Akli Lion ... ....... Alteration .......... Relxrir ............ Re"mal ............. lkmrl it ion ............ OMier Work .................................. [" (Ikscription) f 4. Est unrated Cast 4 ���+ OOC fee ......�.............. ...................................... ((o be paid on filing this applicatim) 5. If :iJeli ing, nn,rer of dcaelling units ..... Uorber of. (A elIing units on each floor ........... ..... Ifgarage, oudrer of cars .............;....................... // G. If Insirress, cemrercial or mixed occulmney, specify natures acrd extent of each type of use......N*......... 7. Diuensims of existing structures, if any: Front.....41.!F..... )?ear ............... Depth ................. Ieight Mnirer of Stories ...................... [dimensions of sate structure with alterations or additions: Front ........ ....... Rear ............... Depth .................... Ileii;irt ................./..... Rlaler of Stories ............... w R. Dinensions of entire neconstrtrfioo: FronL . 17.( rd ... i?ear ....G7•�Q .. DepLh ....:�� i n leiloll: ......zatb................ timber of Stories ......+K............ 9. Size of lot:'l Frlx - ..A.........0......... Rear ........... ....... .. D/epth ....................*See ts�ty i(1. Date of Rrrchase .....q' R�qy..... Name of Forcer Wier ..�i:r?P�f!!'�.'•.x3o/'h ................ 11. Zane or use district in which prenises are situated .....R'R5...................................................... 12. hoes proposed construction violate any zming lacy, orlinance or regulation: .....N.O............... 13. Will lot: be regraded ........11............ Will excess frill Ire removed from lneinises: YES Q �1 14. Nares of Owner of premisesNo. TM-7.�r .L�. �!v. Ino a .S�/. Nine of Arc:lritecL .................. .................. Address .............................. I'(xxr No. ...... ........ tlare of Contractor .....Awn Ar.!ty................... Adklress ...............................1'Ixne lb. .............. 15. Is this prolrerLy within 3(X) feet of a tidal wetland? * YES .......... NO .......... *IF YES, S(MITAD IUM 'II?1MO; FEINIT MAY III? MAIM]). PLOT DIAGRAM locale clearly and distinctly all buildings, whether existing or proposed, and inlicate all set-Track dimensions frau property lines. Give street ant block nad)er or description according to deed, and show street names and indicate whether interior or comer lot. SUM--, (R' N;.W Y(RtK, t1n SS (MMY` IV ..S(l:1.i1/�k.......... ....�?�!!n.^..)i :..`SirlKl1tI J.f.......... ............bei( dol ....... V,' y sw)rn, delxrses and says UtaC he is U)e appl iclnrl (None of irxlivitk><-rl signing corm ract) above nosed, lit! is tlle ............................ ............. ................................ .......................... ((anLractor, agent, corixrrate officer, etc.) of said owner or orm)ers, mKI is duly cnrlhorized to Ierform or have Irerforned (he said cork and to mite arxl file this application; that all statements contained in this alrplicatim are troe to the best- of his krxrwledge and belief; nod that- Ure weak will 1)e Ierforned in file ncnner set forth in the application 'tiled therewith. RAnn to herorp ne Lhis . 64 —e ..clay of ...'.!'l ......19.� ... -' Notary Pndrlic ?pa(VeZSppj`lcaoL ) HELENE D.HORNE Notary Public,State of Now York No.4951364 Qualified in Suffolk County !� Commission Expires May 22, 19 22 B05— OARD OF HEALTH . . . . . . . FORM NO. 1 3 SETS0 PLAN5 . . . . . . . . . . . . . . . TOWN OF SOUTUOLD IIRVEY . . . . . . . . . . . . . . . . . . . . . BUILDING DEPAR174ENTLiSE ECK �,. . ; . . . . . . . . . . . . . . . . TOWN HALL P7'1C FORM . . . . . . . . . . . . . . . . . . .. SOU'111OLD, N.Y. 11971 TEL.: 765-1802 NOTIFY: —7 ' I ///yyy/y�/''''����'''� CALL . , ,! ..q. .��..(. . Examined..... �.., 19l � MAIi. TO: . . . . . . . . . . . . . . . . . . . �//. .. .. Approved,..... // ,..., 19 ..tiD Permit No. .v..�" .. �—' Disapprovedarc/ .................................... ...................................................... (Buil in Inspector) APPLICATION FOR BUILDING PERMIT Date.. . . . . . .. . . . . . . 19. N.? i INSTRUCTIONS a; This application must 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, Pee according to schedule. b. ,Plot plan showing location !of lot, and of buildings on premises,,relations}nip,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 application. I c. The work covered by this application may not be camrenced before issuance of Building Permit. 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 OcLupany 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 Zane Ordinance of the Town 'of Southold, Suffolk Canty, 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, aal regulations, and Co admit authorized, inspectors on premises and in Wilding for saary inspections. .... .... .............. gnature o applicant, or ue, if. a corporation) (Mailing address of applicant) pp lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. State wl..OWJ!V.... .. owner, i...............................................................................I.... Name of owner of premises .• m (as,:l.;. d!1r1.�'a. .1r.,,,4!^ oho,A;r►,n., �/'es'�C ' . .h q{ �........................ on the tax ro or latest deed) If applicant is a corporation, signature of duly authorized officer. (Nare and title of corporate office,) D la , Builders License I!lo, ......................... MAY 10 �..� Pludiers License No. ..........}.............. BLDG. DEPT. Electricians License No. ......:.............. TOWN OF SOUTHOLD Other Trade's License No. ..... .............. 1. Location of land on which proposed work will be done.............................................................. 3 P$...... Old,..Nor .:9A:,... ®� hPa1s1 ...................................................... Louse lknber Street Hamlet Canty Tac Map No. 10010Sectio] ....��....... Block ......A....... Lot ..� :5...... Sulxlivision ...GCAV\' i!7.Jr.;'a5�re1........... Piled Map No. ............... lot ....'-3.......... (Name) 2. State existing use and occulauxy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .J........VQ..C.Q n.: Q.t........... .................................................. b. Intended use and occuuparcy .I'....... a,S� !!CA...' .�?!�g�4..Sr t. 1 i SUFFQLK CO. HEALTH DEPT. APPROVAL H 5 NO SUFFOLK TEA TCOUNTY, ~,a, � j • � � l DEPT. 0FF HHEALT i ERVICES 'I . RI) i AD lel'11901 SINGLE ri AMILV Di+vCLLi� ONLY 7 FEB _� n�� •�� /// ^.a.P•, �+�. w1•nrn- .rw• m^ R-nryna nrrw_. far nc.lne9,v+r.ae i• EB fH ; Q .:eF l�1s A:.Zj IEIa 16.E .b.r11aV G s.•.r :.. a:+. {�•' STATEMENT OF NT NT Ar / THE WATER SUPPLY AND SEWAGE DISPOSAL � p II SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE l SUFFOLK 1EB T. OF HEALT SERVICES. t 0 , {S1 — _ ! / LICANT qp PC�ALE 1001 I" SUFFOLK COUNTY DEFT. OF HEALTH J / lEA`Z 1(. SERVICES - FOR APPROVAL FOR ! =M,04UMEMT CONSTRUCTION ONLY I ;. _ _ ' DATE. MAR 08 in Fift i i' H. S. EF NO.. ..6^ 1a AP D SUFFOLK C.O. TAX MAP DE GNATION: ' DIST SECT. BLOCK PCL. I"1pF PWPEI4t T 1000 55 2 25.3 # — — + OWNERS ADDRESS: 4M ITWJ�SH AVE. l H1 ti 1.) 51 t Z:tKING. JQ 1 iiP t f I N I ANIP11 'E"XG1 S k I E?�ED: L. P. f C ! TE HOLE VAMP AT 4OUTkIXD vaik i Swt f `l�.h�f�i #gip .J::_s9 ncADa�orlsa'Saeed r WW + :k. �11�[y PLEASE NOTE Y Minidistance between well z ,: . • C3 mum la u.i and cesspool'is to be 150 feet. " -� . ° ) 'S > I , I cn 1 SEAL md MUMW •_ Attirt�NLtEii A'L1e. �48 G EVAN TIJYL.P,C. ;lAfi: 127 `"." LIQ LAS SU*t ORS 1 QPMENPORT NEW YORK i y{ rte. .ID.as ,0.." .p .�. :. :r., ,. naT $ - _ i�'-_•+0. 1 ',. ,.:� ...: .i Ep'^z .._ - {I o\A rt. ... I .. . - - 7 IT quilt 7.1 f - MO K OPENIRCS FOR ENMENCY EECJIPE AS REQDIREOAMR *Of - _ LUMINKMOK MpLEEO"T" MMItsoo+�T — - -- Ws 9W A"ROM ' I APPROVED AS NOTED. Fp TME14T AT ` --- - - .. ___ _ _ - TO 4 P -,a _ - - " . . _ - —- �� s { - - - FOLLOWING INSPECTIONS: R THE 1' -� -- - - - - - 1. FOUNDATION TWO REQUIRED FORPOI CONCRETE 1 Y i 1 1 2. ROUGH - FRAMING d PLUMBING 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. L MEET - ALL CONSTflMt1CT10N SHAL II ' - - - E REQUIREMEATS OF THE N.Y. UCTION CODES.STATEC NOT RRESPONSIBLE ENERGYFOR .. _ •,,. '.'„ - : ' ON ,p SIGN OR CONSTRUCTION ERRORS 3&C9 p U OCCUPANCY (A DF BE9y yo J a 'c� �/ USE IS UNLAWFUL TE. " a`E T� '* OUT CERnFlCA 4 �� KUMBER CEffnA�GATIOIV J W 17 �,� , �qf UPANCY Nvlllm .ww cwmADcmmffBEFd1E s.�% owae�us� �Fo sm 1s1w0�edto0irwlq CE IMITEOfOCCUAAN�CY "aFESSIDN�� SOLDER USED JIV WATER J? aye, MMwr�r1ry�wr SUPPLYSYSTEMCANNOT � �LIrZ for q EXCEED 2/-10 o/'1%LEAD, MMIC pWM dMR M 1 ' UIDEIIIMID[q - I E, . ly rl , Zl CD `-`�� i •,� SAM `� � 9� � K 1T .� l _ � � � '� ' CI- till '-rt ". fD . d , i o � . 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'N `'..yaf :L t.r,,, ..r.m.�. .. 1 . _ .._u..,w. . . ,. n, r _ , L....� �.-..c."'k:_:c. _ 1y .ki .u.e t. .,1 .... . ,. .. _„c 1_r .�..0.. _.��t .. - Lt.l�.:.t.v_J'::l:f ..a..m -r.._.be ",..e.v'-i...�v.. •'eit...f'�o.. ,: _ ♦_r _ :. r. ,..,...,_.__�.,_._...,.._ 1 .a. i_ .aW ' ' I �f Ti ^- � " _ r �, �-- �� � ��D� __ � R. yJSy• �l ""-' :. � - to ��a�, l �� (�X- � i 1- '� -�� ' . - ', .' - - -"- ' " �� - - � - l`a 77 �t10 JL I arygsa 'Ce��i.�i!'ri4` �goF NEW yo a t p90FE5510NCp � - v 41 'h v � 1. $UO,PdLR CO, HEALTH 00T, APPRCJVAL p' N S. NO. SUFFOLK 170101'( DEPT. QF HEALTH ,ERYICES ekesw,k, RIYrRHEA0 !�Y119901 SINGLE FAMILY DWELLNG ONLY 1' FROM DATE OF APPR E11PI ES ' HREE YEARS bYAL '95 FEB -8 All :26rs� STATEMENT OFI INTENT �I- ! THe, WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS Pog , TH)`i R�SIOENcE wl" �l �Nk4L .J r CONF'OR.14 TO 'FHE STAAND.A OF, 7E1E .y SUFFOLK T OF HEALT SER'fl4ES. , �. S1 � f F cJ ! Yil PL[C NT SCALE_`100'`j SUFP LK COUNTY DEPT. OP HEALTH AQEA 2,I�y,AC_ SERVICES,— FOR APPROVAL FOR (k)ACAI`!Fj + "ry, I CONSTRUCTION:ONLY [DATE. MAR D.8 IM, SUFF04K CQ TAX MAP DESIG(JATION: .-t '` .i➢F c ��j; l OfST SEG F. BL0CK PCL ERTY t �o,y� �4s��'� t1A�',r.��a,,,' `�,�y ,• iarJGVk Y4h? _!='41'l _ (oWN'�gREss t 4z H I� t( p v` � t .,aIlE V fa v� as eew t�s(i Avg L . ) curcr}o� + { y`�'. r7'139 � �Q� L•�%:�'2' ' L, 'fYf(-C� 1 \ ✓I'� 1 ANI 1" 11 TESD :STAMP 'VP1 G� I`A{•ErN� � �: SI�"` i Alf m tU J t - t ��( - C ";."III Ot PLEASE NOTE A � $ - MlrnMom distance between well ! ' F� and cess ool'is t( be lee feet T l4tN0 sq ( • . lJjr•f �t�lf yj I] Y SEAL ' TE5 "a k , 1k3�r�I1S (fZ 'Clkf�IJiIC} aEJ i7jyf` Iraf`I t4A� .r7i2.S1 A,M;�tXtCA\1 fkTLE INSUf2AtJCF, +rkT f f y MARS FntZ t IJANI (W 3 e _N �'CI 4 ha3F(?AFE ANCA TfSTNtiFSNN4 =} r AA7 �A1A 4Er"7) ,5 2a 3 f 1 �1� 4� ROOEr�ICK VAN TUYL P.C.. ` gk,V¢oNtGclf 5 t k�Ni I,li<a ro OP .t`A�.R,IAG h -x `� `<_,»•-, .':r ..' jl 1SC,%icQ°d ` r'-.,. ,u .<. _-.�r-- r•:_ � w '•' L(CENS'ED, LAND SU YORS �...,. �' t `• GREENPORT NEW YORK