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FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-25223 Date SEPTEMBER 3, 1997 THIS CERTIFIES that the building NEW DWELLING Location of Property 4725 ORCHARD STREET ORIENT, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 27 Block 2 Lot 2.6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 4, 1996 pursuant to which Building Permit No. 23531-Z dated JUNE 25, 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 DECKS & PORCHES AS APPLIED FOR. The certificate is issued to JAMES F. HAAG, JR. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-10-96-0026-AUG. 28, 1997 UNDERWRITERS CERTIFICATE NO. N-394094-8/15/96 & N-42595-7/17/97 PLUMBERS CERTIFICATION DATED AUGUST 1, 1997 - KING PLUMBING Q, —/,ew Suj ding Inspector Rev. 1/81 FORM NM 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° 23531 Z Date .......x/41 ................................... )qz Permission is hereby granted to: .....42................... .................................. ` . ................. s ... ....... .: . . . . ................... ..................... ... ... ... . ....... J atpremises located at ...... 2�..� . ..............F.� 1 ..��......... .................................... .........................................................G0.0 0 1!.f.��...............................................0.......................... ................................................................................................................................................................. County Tax Map No. 1000 Section .... '27........... Block .... .1.?Z.........!. Lot No. ........................ pursuant to application dated ..... u"�F �....................... 15a<.��, and approved by the Building Inspector. Fee $ lSj�0..:.t0',4*0.. )&Gor; g Inspector Rev. 6/30/80 -- - Form No. 6 Post-It'"brand fax transmittal memo 7671 #of pages �a �OUTHOLD D R I )EPARTMENT L5 Co.lam AIP.Sp!r Dept. Phone# : �2L rIVV ' �I Lot Fax R Fax# p 1. T. O FICATE OF OCCUPANCY BLDG.DEP 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 of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 17 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 Buildin¢ - $100.00 3. Copy of Certificate of Occupancy - .25V 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15. 0, Commercial $15.00 s Date . . . . . . . . . .' ��(/��. . . ��. /:" . �. . . . . . . . . New Construction. .K . . . . . . Old Or Pre-exist' Building. . (Y. . . . . . . . . . . . . Location of Property. . . :! Z . . . . .. . . . . . 1 w"9?0. . .t1. . . . . . . .67<xf;✓.7 .�y1/1:5 House No. Street Hamlet Onwer or Owners of Property.. . . . . . . . . . . F/°? ,r. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . . . .a.?. Block. . . . .U.. . . . . . .Lot. . . . . . . f; .( . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Fi/led Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . .� Permit No. . 153j. . .Date Of FPeermit. . ./� .'`.lq /. . .Applicant. . . . . . . . . . . . . . .�.. . .. . . . . . . . Health Dept. Approval. . . . . . . .�P1lih.� . . . . . . . .Underwriters Approval. . . . . . . 1fl.f✓•..• • . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . / Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. .G/. . . . . . Fee Submitted: $. . . . '. . . . . . . . . . . . . . . . . . . . G �. 5333 . . . . . . . APPLICANT C 6 z�9,saa3 August 28,1997 Office of the Building Inspector 1997 i Town of Southold Town Hall, 53095 Main Road P.O. Box 1179 Southold, NY 11971 Inspector: As requested, this provides you with the Health Department approval as requested on the attached. I would very much appreciate your quick handling of this since I am about to embark on a long overseas business trip and I need to finalize my final mortgage. Anything you could do to help would be appreciated. Upon completion, I would appreciate your sending the Certificate to me at my New York City address as follows: 45 West 11th Street #3D New York, NY 10011 If you have any questions, please call me at 212-210-7280 (day) or 212-255-3808 (night). Thank you for your help. Sincerely, ?ames F. Haag, Jr. Town Hall, 53095 Main Road h Z Fax (516) 765-1823 P. O. Box 1179 ® Telephone (516)765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD JAMES F. HOAG JR. 45 WEST 11th ST. NY NY 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. i1 f� No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984 ) . BUILDING PERMIT # 23531Z Please contact our office on this matter. Thank you for cooperation. < SOUTHOLD TOWN BUILDING DEPT. ��1�7��,�ti ✓�_' c. ,.,��.iryz � _ lea �— 03 0,3� o��gUFFU(�-Co Town Hall, 53095 Main Road y Z Fax (516)765-1823 P. O. Box 1179 T Telephone(516)765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD 14 JAMES F. HAG JR. 45 WEST 11th ST. :NY, NY 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. 0+-:�XX The check is (not on file. ) $25.00 v XX No Health Department Approval on file. 0 No final inspection has been made. N o G No Plumber Solder Certificate on file. (All permits involving plumbing being pGZo issued after April 1, 1984) . BUILDING PERMIT # 23531Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. 'o�05Uff0(K�OGy�� Town Hall, 53095 Main Road y N x H Fax (516) 765-1823 P. O. Box 1179 4.�+ Telephone(516) 765.1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T I O N c DATE: � 11 Building Permit No. / Owner: �0 Al e-0 ✓� � � (please print) Plumber: L/l (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers Sig a ure) Sworn to before me this kl�-4 day of Aue, Qs-� 19 27 Notary Public, ��� County ROBERT 1.SCOTT.JR. Notery PuWk,Stete of New York Qualilled N 01 SCC472 Suffok p,n,.. 1Mtalt f8xyirse Meir 81. THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1175003 BUREAU OF ELECTRICITY Date JULY 1'/,9.997 85 JOHN STREET, NEW YORK, NY 10038 Application No.en file 13254297/97 N 425959 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 MR. JAMES HAAG, 4725 ORCHARD STREET, ORIENT, N.Y. in thefollowing location; ® Basement ® tat Fl. ® 2nd Fl. ATTIC/OUT ,Seetion Block Lot was examined on JULY 9.4,1997 and found to he in compliance with the National Electrical Code. FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES . COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER AMT K W. AMT I K.w I AMT I KW I Ami I K.W. AMT. H.P 47 38 45 1 47 1 1 1 5.5 1 1 7.6 1 1 1 1.2 2 F DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL 4EC'PTj TIME CLOCKS I BELL UNIT HEATERS I MULTI.OUTLET DIMMERS MIG K.W. Olt H.P GAS H.P. AMT NO. A W.G. AMT AMP AMT. AMPS TRANS. AMT H v NO,OF FEET SYSTEMS AMT. WATTS 3 F I 1 2 SERVICE DISCONNECT NO OF S E R- V 1 C E MIT AMP TTpF METER 1 N tW 1,e'SW ]0 SW S X AW NO OF CC.COND A,W G NO OF HbIEG A.W G NO OF NFUTRAIa A.W G. EQUIP. PER e' OF CC.GOND OF NI-LEG OF NEUTRAt OTHER APPARATUS: WELL PUMP-1 MOTORSt1-F H.P. G.F.c.I:-10 SMOKE DETECTOR:-7 Q.C. ELECTRIC INC. LIC,#3823 L� tc......_. L, L P.O.BOX 518 LAUREL, NY, 11948-0518 GENERAL MANAGER 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. I- ,;)- , 6 THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1175003 BUREAU OF ELECTRICITY F 85 JOHN STREET, NEW YORK, NY 10038 Date AUGUST 15,1996 Application No.on file 12255496/95 N 394094 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant nomedon the above application number in the premises of MR, JAMES HAAG JR. , 4725 ORCHARD STREET, ORIENT, N.Y. in thefollowing location; ❑ Basement ❑ IRE F1. ❑ 2nd Fl. OUT .Section Block Lot was examined on AUGUST 08,1996 and found to be in compliance with the National Electrical Code. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. I K.W. AMT I K.W. AMT I K.W AMT. H P DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL R6C'PTj TIME CLOCKS I BELL UNIT HEATERS MULTI.OUTLET DIMMERS SYSTEMS OIL I H.P. GAS H.P. AMT. NO. A.W.G AMT. AMP. MAT. AMPS TRANS. AMT. N P NO.OF FEET AMT WATTS SERVICE DISCONNECT NO.OF S E R V I C E MIT. AMP. TYPE' METER L A tW t,e 3Wjj1 3 0 3W 3 p AW NO.OF CC COND A.W.G. NO.OF 111-LEG A.W.G. NO.OF NEUTRAL$ A.W G. i EQUIP. PER 9 OF CC.GOND. OF HIAEG OF NEUTRAL 1 20 CB 1 X 1 4 1 4 OTHER APPARATUS: Q.C. ELECTRIC INC. LIC43823 P.O.BOX 518 II ULF NY, 11948 GENERAL MANAGER 16 Per 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. . : JUDITH T. TERRY Town Hall. 53095 Main Road TOWN CLERK P.O. Box 1179 +� P' Southold, New York 11971 REGISTRAR OF VITAL STATISTICSt. u✓� .{a+ �'^'` - oY Fax (516) 765-1823 MARRIAGE OFFICER � �' �� Telephone (516) 765-1801 RECORDS MANAGEMENT OFFICER r U,t I FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993: RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent regulations of the Code of the Town of Southold: "Floodplain Development Permit Application" [FDP(93)] , and "Certificate of Compliance for Development in Special Flood Hazard Area [C/C(93) ] . BLZ�%3. DEPr. TOWN OF SOJTiiOLD `;�h y`� Southold Town Clerk August 25, 1993 APPLICATION #A p�',� PAGE 1 of 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1: GENERAL PROVISIONS (APPLICANT to read and sign): 1. No work may start until a permit is issued. 2. The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. S. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local, state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable inspections required to verify compliance. 8. I,THE APPLICANT, CERTIFY T ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO THIS APPLICATION ARE, To EST OF ri)l WLEDGE, TRUE AND ACCURATE. (APPLICANT'S SIGNATURE) I V, DATE SECTION 2: PROPOSED DEVELOPME (To be completed by APPLICANT) NAME ADDRESS TELEPHONE APPLICANT BUILDER ENGINEER PROJECT LOCATION: To avoid delay in processing the application, please provide enough information to easily identify the project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark. A sketch attached to this application showing the project location would be helpful. FDP(93) APPLICATION # _ PAGE 2OF4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE ❑ New Structure ❑ Residential (1-4 Family) ❑Addition ❑ Residential (More than 4 Family) ❑ Alteration ❑ Non-residential (Floodproofmg? ❑ Yes) ❑ Relocation ❑ Combined Use (Residential & Commercial) ❑ Demolition ❑ Manufactured (Mobile) Home (In Manu- [3 Replacement factured Home Park? ❑ Yes) ESTIMATED COST OF PROJECT $ B. OTHER DEVELOPMENT ACTIVITIES: ❑ Fill ❑ Mining ❑ Drilling ❑ Grading ❑ Excavation (Except for Structural Development Checked Above) ❑ Watercourse Alteration (Including Dredging and Channel Modifications) ❑ Drainage Improvements (Including Culvert Work) ❑ Road, Street or Bridge Construction ❑ Subdivision (New or Expansion) ❑ Individual Water or Sewer System ❑ Other (Please Specify) After completing SECTION 2, APPLICANT should submit form to Local Administrator for review. SECTION 3• FLOODPLAIN DETERMINATION (To be completed by LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. Dated The Proposed Development: ❑ Is NOT located in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). ❑Is located in a Special Flood Hazard Area. FIRM zone designation is 100-Year flood elevation at the site is: Ft. NGVD (MSL) ❑ Unavailable ❑ The proposed development is located in a floodway. FBFM Panel No. Dated ❑ See Section 4 for additional instructions. SIGNED DATE d j APPLICATION # PAGE 3 OF 4 SECTION 4: ADDITIONAL INFORMATION REQUIRED (To be completed by LOCAL ADMINISTRATOR) The applicant must submit the documents checked below before the application can be processed: ❑ A site plan showing the location of all existing structures, water bodies, adjacent roads, lot dimensions and proposed development. ❑Development plans,drawn to scale,and specifications,including where applicable:details for anchoring structures,proposed elevation of lowest floor(including basement), types of water resistant materials used below the fust floor,details of floodproofmg of utilities located below the first floor and details of enclosures below the fust floor. Also, ❑Subdivision or other development plans(If the subdivision or other development exceeds 50 lots or 5 acres, whichever is the lesser,the applicant must provide 100-year flood elevations if they are not otherwise available). ❑ Plans showing the extent of watercourse relocation and/or landform alterations. ❑ Top of new fill elevation Ft. NGVD (MSL). ❑ Floodproofmg protection level (non-residential only) Ft. NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. ❑ Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in any increase in the height of the 100-year flood. A copy of all data and calculations supporting this finding must also be submitted. ❑ Other: SECTION 5: PERMIT DETERMINATION (To be completed by LOCAL ADMINISTRATOR) I have determined that the proposed activity: A. ❑ Is B. ❑ Is not in conformance with provisions of Local Law # 19 . The permit is issued subject to the conditions attached to and made part of this permit. SIGNED DATE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee. If BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals. APPLICATION # PAGE 4 OF 4 APPEALS: Appealed to Board of Appeals? ❑ Yes ❑ No Hearing date: Appeals Board Decision --- Approved? ❑ Yes ❑ No Conditions SECTION 6: AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance is issued The following information must be provided for project structures. This section must be completed by a registered professional engineer or a licensed land surveyor (or attach a certification to this application). Complete 1 or 2 below. 1. Actual (As-Built) Elevation of the top of the lowest floor,including basement (in Coastal High Hazard Areas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FT. NGVD (MSL). 2. Actual (As-Built) Elevation of floodproofmg protection is FT. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SECTION 7: COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR,) The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO SECTION 8: CERTIFICATE OF COMPLIANCE(To be completed by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY: Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: ❑ NEW BUILDING ❑EXISTING BUILDING ❑ VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW #_, 19 SIGNED: DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19_, AS MODIFIED BY VARIANCE # DATED ' SIGNED: DATED: C/C(93) COUNTY OF SUFFOLK , V ` - ROBERT J. GAFFNEY - c ' ,SUFFOLK COUNTY- EXECUTIVE DEPARTMENT 6F HEALTH SERVICES MARY E. HIBBERD,_M.D M.P,.N.- 3 _ COMMISSIONER - x P'ERMI'T` THE AAAACHED :PLAIV, `WHEN DULY SIGNED BY A REPRESENTATIVE OF THE pEPA '�MENT, CONSTITUTES A PERMIT ;TTll O CO�IST12tJGG�II A WATER SUPPLY AN A SEWAGE DISPOSAL SYSTEM =POR TFE PROPERTY AS DEICrPED. " CONSRUCTION MUST CONFORM WTTH APPLICABLE ,STANDARDS INCLUDING TH& ANDARDS FOR `CON TRUCTION OF UBS ACE SEWAGE DI'POSAL.' YStE S FOR SINGLE FAMILY RE IDENC__S AND S I ANbARI�S AND PROCEDURES :. FORVATE WATER�SYSTEMS. THFi P RMIT (PLAN) EXPIRES THREE (3)`YEARS FTER 'THE APPROVAL DATE:, ANX I ODIFICATIONS -WHICH' MAY AFFECT THE PjtOPOSED SEWA0E DISPOSAL' . SYSTE�vI OR WATER SUPPLY REQUIRE'SUBMISSIONOF AREVISED PLAN AND ANY ADDITION AL FEES, 'PRIOR TO CONSTRUCTION "NO,INSPECTIONS;WILL BE PERE RIMED BY THE>DEPARTMENT ON EXPIRED PERMLTS "< PER S. MAY BE REISSUED UPON -THE SUBMISSIQN OF" NECESSARY; ?,PPLI ATIONS" PLANS ,AND FEES, AND'.'•:WILI "BE REQUIRED.;TO MEET THE . .. 'STAN ARDS IN EFFECT AT THE TIME OF REISSUANCE A.Pf e MAX BE TRANSFERRED INTO ANOTHER I�ARTY!S.NAME UPON RECEIPT OFEN PERMISSION FROM THE.ORIGINALA�TPLICANT ANDTHE I2LCEIPT OFREQUIRED TRANSFER.FEES. .. IN THIS C,'ASE, THE PAR'T'Y FAYING:THE 'ORIAPPLICATION; FEE WILL BE 'CONSIDERED 'I'O BE,'THE ORIGINAL,APPNT. . JUN`- 4 (9 �+ 96 ; -,--M- '05 S T,a �V✓. -.N OF SOUTHO _ . "BLD , FAGS 1 OF 2 DIVISION OF ENVIRONM4NTAL QUALITY ' COUNTY CENTER ri RIVERHEAD. N.Y. 11901-3397 858.2100 � 3� `s" . - ^% '" E. ,. "�a a �r n>� � rte€':' �,• �; ,'�- k �,vx,�-^ 4yi, INSTRUCTIONS FOR EEA A1'PROYAL OF CONSTRUCTED SYSTEMS" " It is the applicant's responsibility tol call the Department to arrange inspections of the sewage disposal system and wa4r supply facilities prior to backfilling.; These include inspections of the soil excavation for the sewage disposal system and inspections of the water supply well,well lateral,public water supply line, disposal system,piping and final > grading. Other inspections may be equired. I Following satisfactory construction(land inspections: 1. Tire applicant must submit 4 prjutts of an as-built plan (up to and including 11"x17"), by a licensed design professional, of the subject property showing the following: a. the lot location and dimensions; b. the lot number(s) and the name 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 pubic water line, if applicable; f. the exact location of the septic tank and leaching pool(s), if applicable. (sive 2 dimensions from the building corners to the covers of the septic tank and each leaching pool; ' g. the exact location of the sewer line from the dwelling to the street; if applicable; and h. have a clear area at least 31'x5" for the Department's approval stamp. 2. The applicant must submit a certificate from the sewage disposal installer attesting that the system has been installed according to the criteria of the Suffolk County Department of Health Services,when applicable. 3. If a well has been installed as t�a 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 confO.rm to standards,proof of corrective measures will be required. Refer to "Standards and Procedures for Private Water Systems." 4. In those cases where public sewers are utilized for the dwelling, the applicant is also to submit one(1) copy of the sewer line inspection approval jfrom the public sewer district. In districts operated by Suffolk County, two (2) copies of Form S-9, duly executed by the Suffolk County Department of Public Works, are required. 5. In those cases in which the installation and connection of the public water service line has not been inspected by the Department of Health Services, a tap letter from the appropriate water company is required. HEALTH'IDEPARTMENT REFERENCE NUMBER MUST BE ON ALL CORRESPONDENCE OR DOCUMENTS SUBMITTED. SUBMIT ALL NECESSARY FINAL PAPERS AT THE SAME TIME. PHOTOCOPIES OF DOCUMENTS WILL NOT BE ACCEPTED. WWM-058 PAGE 2 OF 2 j 18-380.12/92 d-3 5-3/07 M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ) INSULATION [ ] FRAMING [ NAL [ ] FIREPLACE & CHIMNEY REMARKS: i DATE � � INSPECTOR 765-1802 BUILDING DEPT. f NSPECTION [ ] FOUNDATION IST [ J ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ INAL [ ] FIREPLACE & CHIMNEY REMARKS: t - Y DATE INSPECTOR f 77 M-1802 BUILDING DEPT. INSPECTIO [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] F NDATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY // REMARKS: GL/ Plfee DATE INSPEC 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] RO H PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: _ DATE 0 INSPECTOR M-1802 BUILDING DEPT. PECTION [ F NDATION IST [ ] ROUGH PLBG. [ FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE HIMNEY REMARKS: pig DATEWINSPE 765.1802 BUILDING DEPT. INSPECTION [ FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ } FIREPLACE & CHIMNEY REMARKS: (5),e(5),et/ � e0,7 -� R DATE INSPECTO I I LI Ill li l'I,l,l I llll II I.1'11111 I1P 1 II0II1:11 f IlAilli �---_..._... _ . I'1 111111 11111 - .. - ..--- • m..,...,,,..,, 11INIII.A11011 I'lill 11 . _ - - P IIIA I. ..............u.......,... ... .._ ._ .. _ .. _. - .__ . - ...- - . -_ -. .. �,......................`,,,, AIMI I It)IJAI. 1;(II II II!II I.`i : .,..,..;..,........m....,....................... 1 " I� , v I IJNI12GY CODE CALCUL.AT.I.ONS (Por Non-Electric Ileat) Design Criteria 6 , 0o0 Deyree'.nays y/ P O.A. FOIL: Q Lf C, /A. IO°F L . A. 70° CdA` �Pv J PER: -- UUSLGN 'rnERMEL REMARKS SUBSYSTEM ARIBA "D" RATING t:XLerlor Walls (Opaque) 2i u 1f (� 5' x 2- G - Lf1 G.Laziny g ---�0 Doors —w �U /� - --- ------ Ccil.iny/Roof (Opaque) 12-36 6� SlcyliyhLs _ � Floor Founda L'ioll walls Slab Insul.aL•lon TOTAL + ._ Notes,. Build1119 Envelope Systems to meet requirenle11Ls of: 7015 . 2 RvAC Equi.pement to uteet requirements of 7015 . 11 UVAC Systems to meet requirements of 7815 . 12 Duct Systems to IneeL requirements of 70.1.5 . 1.3 Veitilal:ious Systems to meet requiremeuLs of '7615. 14 Insulation of 1'ip1119 Systems to Illeet requirements of: 7015 . 15 Servl.ce Water IteaLitly SysL-ems & Equipment to mecL requirements of '1U15 . 21 E.LecLrl.ca.l & LiyhUny Systems & Equipment to meet requirements of 7UJ.5 . 31 To the best of my knowledge, belle f:, & professional ice rG judgement- , these plans are i.n compliance w1L11 the code. 4JUN 1,996 f V A9QFESSIO�P�' '� •. c L � � BOARD OF HEALTH FORM NO. 1 3 SETS OF PLANS. Ijy1, TOWN OFSOUTHOLD SURVEY . :.... L!� JUN - 41996 `aI CIICCE '� BUILDING DEPARTMENT . . . . . . . . . . . . . . . . . i TOWN HALL SEPTIC roar . . . . . . . . . . . . . . BLDG. DEPT SOUTHOLD, N.Y. 11971 L - i'OWN OF SO/UTHOLrD TEL.: 765-1802 t:OT I FY Examined . . . . . . .6 //j , �1 CALL . . . . . . - . . . . .. . . . ., 19�j//, MAIL TO : Approved . . . . . . .�as'. . ., 191 Y! Permit No.,7W / Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � 3 — � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ding Inspector) APPLICATION FOR BUILDING PERMIT Date . . . . . . . . . . . . . . . . . .. 19 . . . 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 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. . . . . . . . . . . . . . . . (Signature of applicant, or name, if a corporation) x3�grN; .yt. , itis? . . . . . vE514m-Ee (Mailing address of applicant) State whether applicant is owner, lessee, agent, ahi*Q', engineer, general contractor, electrician, plumber or builder, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises �^r , �M A .,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applico t s a corpion, 'gnature of duly authorized officer. air � . ame and title of co orate officer) Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . �Iectrician's License No. . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ct{ �. 5'r;. . . . . . .a ICT•�< . . . . . . . . . . . . . . . . . . . .. House Number Street Hamlet County Tax Map No. 1000 Section . . . . ' 7. . . . . . . . . . Block '. . . .©4.. . . . . . . . . . Lot . . . A4'. . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . I . . . Lot . . . . . . . . . . . . . . . (Name) ?. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . . .-WcP.eA.- ,r. . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . . . . . .gGti5C. . . . . . .i<. . . . . . . . . . . . . . . . . .', . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 l 3, Nature of work (check which a pplicable): New Building . . . . . . . . . . Addition . . . . . . . . . . Alteration . . . . . . . . . . Repair . . . . . . . . . . . . . . Removal . , . . . . , . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . . -f (Description) 4. Estimated Cost . .��O.� . 4 a;-". . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __MM 11 (to be paid on filing this application) 5. If dwelling,number of dwelling nits . . , , . . , Number of dwelling units on each floor . . . . If garage, number of cars . . . . " " " " " ' 6. If business, commercial or mixed,occupancy, specify nature and extent of each type of use . . . . . . . . . . . . . 7. . . . . . . .. .. . Number any: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . Dimensions of existing structure er of Stories'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , , , , , Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . li . Height . . . . t. . . .M . . . . . . . . . Nufnber,of Stories . . . . . . . . . 8. Dimensions of entire new construction: Front ��.'L0* Rear . .q'Z.'toa. . . . Depth �3. . . . . . . . . . . Height . .10... . . . Number of Stories . T ? �, , , , , , , , , , , , , , 9. Size of lot: Front . . .Q r�a}'"4 Rear . . T: a 1✓�. . . . . . . , Depth . . . . . . . .f . . 10. Date of Purchase . . . . . { J. , , , , , , , , , , , , , , Name of Former Owner . . .' 11. Zone or use district in which pr rhises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: .t .•. . . . . . . . . . . . . . . . . . . . . . . . ` 13. Will lot be regraded . NAF. . . Will excess fill be removed from premises: Yes No 14. Name of O er�o�f emi es kM �� , , , Addresses lIT. ST.PlYC phone NouZ:25 380 Name of t �eN 1. . . . . . . . . Address P:O.$d��(O.ORt�"r Phone No. Name of Contractor s c e ¢?J�, . . . . , Address t: %*i ' ;pal Phone No. 15. Is this property within 300 Leet of a tidal wetland? *Yes:. . . . . . . No, . . . *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and.indicate all set-back dimensions fromi property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. 'TA ATE OF W YOR S 'OUNTY . . . . . . being duly sworn, deposes and says that he is the applicant Name of in ividual sign ct) bove named. leisthe . . . . . . . . . . . . . . . � �.i. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this nplication; that all statements contained in this application are true to the best of his knowledge and belief;and that the ork will be performed in the manner set forth in the application filed therewith. worn to before me this . . . . y of. '.�? . . . . . . . 19 � otary Public, )a. . . . . . . . . . . . . . . . . . . County joyCE M, LKINSI q of N Term Expires June 12!;lop York No.4952246,Suffolk Coun ' ' ' `' ' ' ' ' ' ' • • ire of applicant) SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES N FOR APPROVAL OF CONSTRUCTION ONLY The locations of wells and cesspools shown hereon are from field observations y" DATE S. REF. NO., RIC-96-0026 and or from data obtained from others. e� Q� a- �aa wp tiP/' APPROVED r rc•9 � _ _ p TEST BORING IP a 40 O BR•OWT LOAMY SURVEY OF , o0 F FNE 00 r - -- LOT 6 OCOOA mz SETTLERS A? OYSTERPONDS SAND 3 0` FILED MAY 4,1984 FIE NO.. 7729 - Q ry fr F 3 a AT OR/ENT W v rQ7.6 =___ ALTH SUFFOLK COUNTY APPROVAL OF CONSTRUCTION 04LY�VICES The 10 0 0110 17 6 Of Wells and cesspools - shown hereon are from field obserMfions RIO-96-0026 and or from data obtained from others. ' s`y GATE wS. REF. N0. F q-� ao°• `v m APPROVED r � c+ 9 � TEST BORING 17`•0 - s`9%r. 15.0+ 0FWA P/ ro G c� 2T LOAMY SURVEY OF Q� r 30.` `O�. B, LOT 6 r`OARSSE SETTLERS AT OYSTERPONDS FZW MAY 41084 FZE NO. 7729 b� k AT ORIENT ti W TOWN OF SOUTHOLD a, a` 7.6® °� ERY SUFFOLK COUNTY, N. Y. i0/ oo a COARSE SAAV 1000 - 27- 02 - 2.6 4' Scale: 1":60' May 25 1995 c s, FEB. 14, 1996. (SCDHS. INFO) 6•>yry APRIL /9, 1996 (SCDHS REVISIONS) v �, ay a^� =. Y / ` P Aug. 27, 1996 (foundation) 01 DO VV 01 r,Q G\ kV 410 \qac Od Ilse �O FLO°? 20Ne LAN // / f 0 1 am familiar with the STANDARDS FOR APPROV\ \ AND CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and w/1/ abide 6y the condlllons set forth (herein and on the �5 permit to construct, - ,� r Al \ ice 0 '<s<. l irs '90. O RAJ n i.e r0ao �• R d x.5 n.e seP rE rae 1 0 ` " ov r75 r A SANITARY SECTION CERTIFIED TO, / - �tE�F NEIYYo JADES F' HAAG, JR. S"'' ,N T• MEI, Hy FIRST AMERICAN, TITLE INSURANCE COMPANY e` �° r ..•. Fo OF NEW YORK ANY AL TERAT/ON OR ADDITION TO THIS SURVEY IS A VIOLATl0.N "i' >•JP) r OF SECTKW 7209 OF YHE! 'W YDRK STATE EDUCATION LAWS�. o IXCEPT AS PER SECTION 7209�SUBDIVISION 2. ALL CER7IFMA�TION6 M�.4PAveasARssC'Eo� i gvEvaR �va�e. PROPOSED CONTOUR LIC. NO. 49618 WMOSE 5/BlJATUPE APPEARS NEREOA! —^- 12 ' �pNpLL T�R,u PECONI S, P.C. �T tlE u6E0 TO ALLs4�.W oRs UTKIZWB A BYE ELEVATIONS ARE REFERENCED TO N.G.V.D (516) 765 - 5020 Q�ANOThIER SuRVEYOR'S MAP. TERMS SUCH As 74PECTED'AAV - P. O. BOX 909 6ROU6HT-TO-aA TE'ARE NOT MV COMPLIANCE WITH THE LAW. FLOOD ZONES FROM FIRM 3608/3 004W AREA = 9.1049 Acres 1230 TRAVELER STREET SOUTHOLD, N.Y. 11971 Inc •T7n SCDHS Ref. # RIO-96-0026 The lacaflans of wells and cesspools shown hereon are from field observations Nand or from data obtained from others. b Leh r TEST BORING s O e` SURVEY OF O S So: BROWN LOAMY 6' — SILT LOT 0 F OOC ARSE SETTLERS AT OYSTERPONDS 1 pyo o yo ® SAND FILED MAY 4,1984 FEE NO. 7728 �r�0 AT ORIENT 3 kb m \ ti . __e/ a 0 76 1 ,4 TOWN OF SOUTHOLD BWA TER IN ROWN FINE SUFFOLK COUNTY, N. Y. TO VERY X h COARSE SANG 1000 - 27- 02 - 2.6 15�n ' 5 14' Scale: 1"-60' B3' C May 25, 1995 e 4 FEB. l /996 (SCDHS. INFO) /�`r //rosGta APRIL 19, 1996 (SCDHS REVISIONS) Aug. 27, 1996 (foundation) Aug. 15, 1997(finial) a Ay NO SUFFOLK COUNTY DEPARTMENT OF Y.EALTH SERVICES APPROVAL OF CONSTRUCTED VJD(M POA A£INC.LE FArh[LV p.E"IDLirC.'E . C� d ip� AUG 2 8 iRs.t�ee.rm. itis q OP{ 110 Datc The savage disposal and wafer supply Ci:ili[ice rt thi vc::icr ucs: Acca h P4 ¢t 17 insprded and/or eenificd by this De;,aran erorSor vre;e e•:_:d tow-n r:. \� be satisfactory FOR N•'ANIl1M OF _ 6FDRQOa1:,. /tr `Or `9F@ Offm ueW ter and WestewataMnGcmnt i O fLOo D ZONE CINE l �� e e�• \ R,> j I am familiar with /he STANDARDS FOR APPROVAL O� �j/ • a�8o AND CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and will abide by the conditions set forth therein and on the perm// to construct. i �o R RO G1723 <ic � {lr. el12.5 �• 0� se ce reoo,gd Fina�, y50��0 25 q.o seP/� u.. i I 5• .M CERTIFIED TO, JAMES F. HNCH R - OF NEW y MERRILL LYNCH CREDIT CORP. � tF. 0 SANITARY SECTION CONGRESSIONAL ABSTRACT CO. pa Received b Sup^�. T�inly ow '• ;i � ¢1 ''" ANY ALTERATION TION TO THIS SURVEY /S A VIOLATION AUG 2 8 1997 NrsS': LIC, NO. 49618 OF SECTION THE THE NEW YORK STATE EDUCATION LAW, EXCEPT AS PERER SECTION TION 7209-SUBDIVI610N 2. ALL CERTIFICATIONS 6cPi.Jt t;;,yfit„�ermces HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF QALY b _ 12 = PROPOSED CONTOUR ' Ofhc'of Nlostevaater M9mo_' PEC r P.C. SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR - (516) WHOSE SIGNATURE APPEARS HEREON ` ADDITIONALLY To COMPLY WITH SAND LAW THE TERM 'ALTERED BY' ELEVATIONS ARE REFERENCED TO N.G.V.D 1 O. 80 MUST BE USED BY ANY AND ALL SURVEYORS UTILIZFJS A COPY 1230 TRAVELER STREET OF MAP. Mr TERMS SUCH AS WITH•PE TED' ANO FLOUD ZONES FROM FIRM 360813 004BE AREA = 9. 1049 Acres SOUTHOLD, N.Y. 1/971 95-179 a m w - w �'f{1l1QlPlk BUILAIt�f�><ty�T�P�- '�= 50 I < Ito eel O :dAETbR -- . NR��°—urvn��c. TRIc go' 1r�T�� Ny - 'CIaSf HoyB iuRN AI 0 _ - r. CACI /6AMNI�d R�51P�;NCP— z :fRci TARP STRI-P,T • oF�I�"N-r, N ,Y, -- N L IT PLAN 1,5-Ft N TPI# �GTi®t15ING }?�SIgENTIA� y�IC�N ORit< -F. N 'y Nc�ftc)ADWAY PLUMBER CER77FICAIYON � OCCUPANCY OR wmelxcvwrR ONLE4DCON7EMBEFORE � NElp � I USE IS UNLAM RRL CERT/f/CATE OF OCCUPANCY coVEMB APPROV D AS NOTED WITHOU ' TE SOLDER USED/N WATER t$DF BEa ro / asr / OF OCCUPANCY DATE: B.P•R } SUPPLYSYSTEM CANNOT x. . . FEF. �:�P• CRY: e y IAV N::i''rY RUILDI G OEPAflT ENT AT EXCEED 2110 of I%LEAD. F(,, I 9 S TO 4 PM FOR THE n C w - Fi„ L'iUNDA ION - IONS: I ; OU NDATION TWO REQUIRED i OR POURED CONCRETE p :DOU,611 FRAMING & PLUMBING eDPv�r ,�,.�.1�N,,�uN�d �N b '3 INSULATIONfwj�uwm for Nam d'�`•'�^ *w 1 V 4 r Opbv shO be HE BE CO - CONSTRUCTION MUST �7� KorL k - -- " BE COMPLETE FOR C.O. 7ffw i:.r.7Lli _ I ALL CONSTRUCTION SHALL MEET 'TETE REQUIREMENTS OF THE N.Y. _ STATE CONSTRUCTION S ENERGY mom CODES. NOT RESPONSIBLE FON DESIGN OR CONSTRUCTION ERRORSPI'1 �+�,C�RhD& t 5'Eyp�`lEWAY - hiIM SLAP '9' flLkV. 77 77777 T — — T=1tJ-'1n TIV i L� y'PLEV YRtNCIPA!- / ull-AIN ErIV91.0 �' $UIIAM YEw Fi I ` �rclNcl�A 4-im SDHs �EVlslcarl5 � ;r4Ev' --� �"o'n"�5 PROVIDE OPENINGS FOR '� ���� G enr c�E vi2E�S 1 �66�09.-(�. 37 TF—FLAN G I`rW G "I I Imo" F90f06FF �S' [� a d i, - U (I fiAAq/\5l�M � di INT N.Y. EMERGENCY ESCAPE AS n /ffv�✓� REQUIRED BY PARI 714 OF ��c���'�, JU�I - 4 1996 �I �� �} SCALE: �7ARIpc�S APPROVED 9V DRAwN R� M.Y.STATE BUILDING CODE y I 3P/i U' --5-775' _- / �' • %o DATE: 5 7 96 W BLDG.DEPT. (eo TowNofsouTHOLD 'AM AOR. 'MC-5SK,. �ME31 PGG Yai�K Tdqp M1B�KCI S W I IST NSW N, ( 10011 &613 I ORAwiNC NumRo . X 31D •QRI�ti rN•Y•, 16 57 �z DILI2GEN TAA6TER FORM MF I3B Vq4f I T A TATK� LA I TTT -LL it IL L I VA-F -NOR'M F-j- QN DI( ITO - '7 - ' T 7w tfFq C) , UMT Wf, AM '5111% Xs MN 7-Zorto" OU 2t� 2 yy _ k 7. i1 . -! IJFI. 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