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HomeMy WebLinkAbout22981-z FORM No. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24396 Date JUNE 5, 1996 THIS CERTIFIES that the building NEW DWELLING Location of Property 525 TERRY LANE SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 65 Block 01 Lot 22 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 18, 1995 pursuant to which Building Permit No. 22981-Z dated AUGUST 30, 1995 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 COVERED FRONT PORCH & REAR DECK AS APPLIED FOR. The certificate is issued to LESTER J. STEPHENS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL RJO-95-0086-14AY 14, 1996 UNDERWRITERS CERTIFICATE NO. N-287249 - MAY 29, 1996 PLUMBERS CERTIFICATION DATED MAY 9, 1996-H. SMITH PLUMBING & HEATING L � aI - O Building Inspe or 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) Date ................ /!. ................................. 19...93 NG 22981 Z Permission is hereby gr-anted to; J14.QltK✓/`�Er ^�1:...,s �/i. /�j2. . Gr.... G.. sr.��J S.�i°iifs ...... i......................... SS..... , ........ � l/..................... � .�..9�so..... .... .. ,,.f1.N'... .. rte.. /G �t..... s... ��.� a .. .......... 2...... -81113 ol...-o.................................. ..........................................7../... .................................................................... ............................................................................................I.............. ... ...................... ........... at premises located at..............S2S .. �J ... / ✓.. �! ��3 ''�-S j .................................................................. C ........../.......................................................... County Tax Map No. 1000 Section ...4J� Block.......C71.......... Lot No. ...ly.............. ...p............... QQ pursuant to application dated ........ �lo....... 19../,... ...... and approved by the Building Inspector, Fee$...10.7. . Building Inspector Rev. 6/30/80 _ y ?VC. C lg U Sy r r_ T:)wT JUN - 5M - { BLDG.DEPT 'D'=- =--0\ _OP. ___ OF oc=L NC'_ � TOWN OF SOUTNOLD =LS= Je _—___ — be L'T�eG.T_=_= OP. _ 2nd subm_==__ C.. __e 'c L' C_r= =s=>_c_o= -.__c _he _o__ow rg: 'new cu-_C—g or few use: —.c_ su=Je, c o=cDe= accu=2=e -OCa=_CII Of 2'_ bL'__d_gs, o➢e _'Iles, s==ee=s, and crus` u2_ II2C11L.--_' or =oocg=2D C1C __c=_==s. _. —_c_ 3oD=ova_ from Hea_=:ea.!:-'- of :.cC� suocly and setae=age-..-SJCS- (s ri=OVa_ .._ _____.c2_ .SL= a=-- Or =Com Board C= _ __e 4. suo—_ s_ _e9e__ from ,_.woe_ ___ _ —o _:aC =he so1Ce= uses — vs=em _.,_ -s ss C ' of _n __3C. v0ffie___.— OL—_—�� �CIIS C=_� JL'_C=:..I mL`___]Le =es-GeIICes 2IIC s�Z=2= �7L'_C=-1=5 2IIC izsCs__ =fors, Ce______3L0 o= Code Comp_-ante from =�_____ or __g-nee_ _ =esporsbieG_o= =he bur_ S. sub^!'= P'_=-,r4rg 3oa=d Approve_ =0=le7ed s_=e O_aw =ecu_=emeres. �. • �__s==� bu�_--'fi's '�J _.. _= a , =�c IIOr-C:,..=C-`.u1: _,ses, ou-,-__cc a?a i=c uses: _ . dccuca E sa-_ ev c= o=cpe= show—g :� r=ope==? --Iles . s==ee=s, ou--=_g =-c uliL'sual .. ___ai _ =onoara=n__ _. .. c COL[o to_eC CDD_-C2=-0II aIIC - ...OLS eII= =D _r5bec= S-wed by :°he ZJD____..C. -= a Oce . mcg __ ao"�ec , =he 3u___r, _=spec_.,= shall s=2=e =_e =_asor_s -tee=e:c= 4_2 w_=-rs =he - =4a� of Occupaace - Nev d-aei'__rg S__5.OG, ddd_==ors _we< g S25.00 , .—=-=c=_ors zoewe___g S_5.00; C r, Doc_ S25-00, Z�.ccesso— id d_=_ous __r_essc=_ bu—_.g _25.00. 3us:Lmesses .50.00. - o- ucC_2IIC'% on P=e-ES_sC:LaQ 3L'=_=5 - 3100.00 CD9V J= CL_ _____c__ _= Oc=zmcv - _25c �. 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Dep--. _pp=cc23. . . . . . . . . . . . . . . . . . . . . . . . . ./urd=_=:.-_=Acs =, .I-c=ec`. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �,(/,,' ._gL`es= _.._. T2mpcz=r-, Ce- -` " - -c. . . . . . . . . . . �� C = a= __ 2__. . . . L . . . . . . ae eaV39 � s d FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24397 Date JUNE 6, 1996 THIS CERTIFIES that the building ALTERATION Location of Property 525 TERRY LANE SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 65 Block 1 Lot 22 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 18, 1995 pursuant to which Building Permit No. 22981-Z dated AUGUST 30, 1995 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 RENOVATE EXISTING ACCESSORY GARAGE AS APPLIED FOR. The certificate is issued to LESTER J. STEPHENS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A a4i== ';� Building Inspectfr Rev. 1/81 r -111 .Y 737_-3OL BLDG.DEPT. -- ' --""- -- TOWN OF SOUTHOCD —o_ =__ _.E -.+• _ _ec SS:._-.._-s __ =ec -Ise: ____=Z=E 7= `_ 7L'—__Zs, -rope_ - -=aes , s==ae=s, Z=G =ee-=_ Jaz=. :.c=_= >.:7D11' _^..0 seW2=Z?e-C_sDCs�:� ___.,.r . _-..L ==JTi JCZ=C C-- '-ta --"a:: ==e so-=e= eseC — 595=— _.--_—_s _es° Du- .__. —-ces== Je-_=.�, �"...-_____ __S-CenCes �7C S =2= �7L--_--•E'_< =-C =s=_'_� J=s, = ` o; Code -_JOti^'J_ffiCe _`--_--_ o= -nee= _ __--` _ Bcz=c 37W=Cffal _= _ses: S==___s, 7L spp--cz=.7=,-and e =se== __ =spec= ss eC co =e 7--le 3i= _� -Spe_=-= s:.`_ S=a_c Lae aze -_- .Oc, dC-=-o=s _wE--=`- --3 .GC . s_ _we_ ^_ -__-OG, =w— poc- _Czssso- iac==_ons _c a==asst =Sc=_—= =_'�-OG. aes—asses SSC.OG. .._'�_°--_s7=£ CcW9 cf e--__=ca Occ_7anc9 - -25C �Wda=ad cc_ Occ_Waac- - 550-OC _..Wore--- -_- . 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THE NEW YORK BOARD OF FIRE UNDERWRITERS 1001x7 '1 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NY 10038 Date l'VIY =!5' ,1996 Application No.on file T.(A:ifi'f vigc+j`�� N 38 72VI THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in thepremises of 1,F597FR J, STEFHENSf 525 TERRY TAW, SOUTHOLD, N.Y. in thefollowing lacation: ® Basement EN Ixt FL M 2nd Fl. '!JJT .Sertion Block Lot was examined on MAY 22 r1595 andfound to be in compliance with the National Electrical Code. TECEPTACLES SWFIXTURES RANGES COO KING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS ITCHES S INCANDESCENT FLUORESCENL OTHER I AMT. I K.W. I WT 1 K.W. I AML I K.W. I AMT I K.w. AMi, N.P. pka', 1 1 1,2 4 V; G DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS SPECIAI It C PT TIME CLOCKS EEtt UNIT HEATERS MULTI-OUTLET DIMMERS AMT, K.W. OIL H.P. GAS H,P, AMi. NO. A.W.G. AM}. AMP. AMi. AMPS. TRANS. AMT. H.P SYSTEMS AMf. WATTS IF NO.OF RET F SERVICE DISCONNECT NO.OF S E R V 1 C E C AMT, AMP. TYPE MR 1 M M 1 0 T B T X AW NO.OF CC COND. A.W G. NO.OF HIdEG F W_G. NO.Of NEUTRALS A.W G. EQUIP. PERI OF C .GOND, OF HbLEG Of NEVTRAI V v rip n OTHER APPARATUS: C r n FATIDLE FAN-1 HOT,,-AFz- i-F fi.P. ,1-4 H.P ,1-F H.P. � PANEiLB BARDS:7-'1 C'IR. 50 SMOKE DETECTOR:--5 L r L \ f LL C it rONTRAI'.TO' LSC,#578 E Brix .,15 ARNGENERAL MANAGER :ATP RX, NY, 11971 _ E=_, _ = Per— This erThis certificate must act 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. INSPECTORS o4s; gFFO(�{ O a" ✓� SCOTT I„HARRIS,Supervisor o r'i x Southold Town Hall Thomas Fisher Building Inspector P.O.Box 1179,53095 Main Road '� ' 4'� � Gary Fish ���` a0� Southold, New York 11971 Building Inspectorr Fax(516)'765-1823 Telephone (516) 765-1800 Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD C E R T I F I C A T I 0 N DATE: May 9 , 1996 Building Permit No. 229812 Owner: Lester P . Ste hens • please print Plumber: H. Smith Plumbing & Heating Inc . (please print I certify that the solder used in the water supply system containsless than 2/10 of 1% lead. n /� _Z G%Cdbers Signature Henry P. Smith, President Sworn to before me this day of May 1996 Notary Public., quffnik County (� RR otary Public �] r lJ L5 0 U ETr ' JOYCE M.WILKINS JUN 5 Notary Public,State of New York 4 No.4952246,Suffolk Cou Term Expires June 12,19 BLOO.oEPT. TOWN OF S0l1THOLD a '�NS Iif l71�N_RliitJR'C DATE MIML'NTS SCG-4 1011 NDAT ION ( I,, ) FOUNDATION ----------- ROUGH Z' n it _ INSM,ATCON PER N. Y . STATE ENEROT it----_----- II-----------.------- .—.-- CODE LK I II 1 i NAL I II O ADDITIONAL. COMMENTS: t- --------------^____-_--_ ---- ___--- -------- ------------------_------ - Cie - ----- --- ------- ---- - �i O 7 a r' b1 ,..vu.•'ti4' New York State Department of Environmental Conservation � - Building 40 -SUNY, Stony Brook. New York 11790-2356 Phone (516) 444-0365 ft �+ Fax * (516) 444-0373 5 2 lQ��EMA�t1�~ Michael 0.Zagate xr, Canwralukuser 30 Date: Sone ave 195 ffit7h-Ci&I IV 11036 RE: UP/q-#)-4738-0113:0001-o . terry Lane 5C7�/;l o-65101 Dear /7r Sf���ien5; SautholdlN}� 11971 Based on the information you have submitted, the New York State Department of Environmental conservation has determined that: -1A e- frvfer- y landr.W4(d oTr >t �e �oPo9(G�hK oFthe h1"FF 9r'ecti� -rn 10 � rn C'Jevefi�n✓O,bove ear, Sea level q5 shown an �-l�c 5urveY by Jahn T Mc�z�er dct �e� af�lR5 (evi5ecl ��9I9s i s beyond f1'rl-icl� aSCTida( wetl�nds� jurrSG�ic�"ion, Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NYCRR Part 661) no permit is required under the Tidal Wetlands AcL Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary, as indicated above, without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction which may result from your projecL Such precautions may include maintaining an adequate work area between the tidal wetland jurisdictional boundary and your project (i.e. a 15' to 20' wide construction arra) or erecting a temporary fence, barrier, or hay bale berm. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. Vli yours, Tu �anS Regional Permit Administrator Le(f�ni/P1eri Bui(c1eY� BMHP �-J S 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING 16T—'FINAL [ ] FIREPLACE & CHIMNEY REMARKS:.d2 daaw,.� ,evz — DATE SINSPECT 44 765-1802 BUILDING DEPT. ! INSPECTION [ ] UNDATION IST [ ] ROUGH PLBG. 14 FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLAC CHIMNEY REMARKS: cle CA Z- DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [/FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND j ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS: , ,y DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ) FOUNDATION IST [ ) ROUGH PLBG. [ ] F NDATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL [ ] FIREPLACEHIMNEY REMARKS: DATE S tNSPECTO 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ]XRHBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLAC S CHIMNEY REMARKS J y II J DATE INSPECTO M-1802 BUILDING DEPT. INSPECTION _ [ ] FOUNDATION IST [ GH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: � t s DATE 2VI NSPECT d�j� ��SUFfO(,�C Albert J. ICrupski, President ; �O OG Town Hall John Holzapfcl, Vice President o y� 53095 Main Road rn William G. Albertson = P.O. Box 1179 Martin H. Garrell Southold, New York 11971 � • � 4 Peter Wenzel y'Jfp� �,�pt Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD ,,May 19, 1995 John Bertani Builder Inc 1380 Oakwood Drive Southold, NY 11971 Re: Lester J. Stephens SCTM 365-1-22 Dear Mr. Bertani, Based upon the information received in our office, updated survey dated May 9 , 1995 and an on-site inspection, the Southold Town Board of Trustees feel the construction of a new home is out of our jurisdiction based on the measurement taken from the Mean High Water Mark, landward, to the stake indicting deck construction. If you have any questions, please call our office. Sincerely, n Alb Krups� Jr. , President, Board of Trustees AJK/djh BOARD OF HEALTH ✓ FORMN0. 1 3 SETS Qf PLANS . . . . . . . . TOWN OF SOUTHOLD SURVEY / BUILDING DEPARTMENT CIIccK4 .�A.W _ _ . . . . . . . . . . TOWN HALL SEP IC FOR _ _ . . . . . . . . . . SOUTHOLD, N.Y. 11971 -T sE!Tp0 TEL.: 765-1802 NOTIFY ; �lj � p Cf CALL . 2&$ . Examined . . . , 0 /31Q. . . . . , 19 (.5� MAIL TO: - Approved . . . . ./.J�. . . . ., 19/ -2 . Permit No., -Pq.d01 . . . . . . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Buildi7n actor) APPLICATION FOR BUILDING PERMIT Date . . . ie. . . . .. 19&: INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector,with 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 sttee or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appl 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 perm 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 Occupant 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws,Ordinances c Regulations, for the construction cf buildings, additions or alterations, or for removal or demolition, as herein describer The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in building for necessary inspections. -- (Signature of applicant, or name, if a corporation) 1 JJ?. . Ori. . .� .0.(.ta.( J. P.0. . . (Mailing address of applicant) N(-1 (Icl 7/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . bwl �( er . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . . . kf s h C I-) (as o-n the tax roll or latest deed) If applicant is a corporation, signature of duly, authorized officer. (Name and title of corporate officer) Builder's License No. . . i.4 1.l. . .:�. . . . . . Plumber's License No. ��Cn?.- . . . . . . . . . . Electrician's License No. . . .6' r Other Trade's License No. . . . . .�- . . . . . . . . . . . . I. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sa� (ce . . . . . . . . . . . . . .f. . . . �. .(.d.am House Number St Ham. .le.t. . . . . . . . . . . . . . . . . . . . County Tax Map No. 1000 Section . . . . .10 5. . . . . . . . . . Block . . . .0 1. . . . . . . . . . . Lot . . . ?2 . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . . . . . . . . . . . . . Ce.,� lV l . . .ur)i . �� .:: . . . . . . . . . . . b, intended use and occupancy ( l� 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . . Alteration . . . . . ... . Repair .gvSaC . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . J ( efcription) G `P 4. Estimated Cost . . .o��.�.�.G`��U. . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) S. If dwelling, number of dwelling units . . . . . . .I . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . Ifgarage,number of cars . . . . . . . . .�). . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mi d occu cy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structu%Q tf ar4�ront . .ZO. �4. . . . . . . . Rear . . . . . . . Depth . . .ZZ:Y . . . . . Height . . . . . . . . . . . . . . . Number of Stories . . ... . . . 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . ZU) �- . . . . . . . . . Rear . . .'?S' ,�. . . . . . . . Depth . . . . .Z?-.�i. . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . .. Number of Stories . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . . . . . ? iv. . . . . . Rear . . . . . . . . . . . . . . . Depth . . . � . . . . . . . Height . . . . . . . . . . . . . . . Number of Stories . . . . ..Z- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... i . . . . . . . 9. Size of lot: Front . . . 1 O. . . . . . . . . . . . . . . . . Rear . . . .Q9. 140. . . . . . . . . . . . Depth . . :Z r?:2Gt. . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . . . . . bei}t i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . 0i.J. . . . . . . . . . . . . . . . . ... . . . 13. Will lot be regraded . . . . . . . . .Cl.,?. . . . . . . . . . . . . . . . Will excess fill be removedfrom-'premise: Yes 6 14. Name of Ownerofprmiser )cr S �huhP. . . . AddressJVwAV�in�i4� o'rfrNo.°�'a . . . . . . . . . . : Name of Architect �.4! s �CCx ( hny� . . . . Address . Jl l% 0 44�% . . . . . . Phone No. . . . . . . . . . . . . . . Name of Contractor . .Oh .&(AAV). } 1 JY4Cr.Z+ Address . . . . . . . Phone No. 15. Is this property within 300 feet of a tidal wetland? *Yes. . .X. . . No. . . . . . . . . *If yes, Southold Town Trustees Permit may be required. r PLOT DIAGRAM no Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions froi property lines. Give street and block number or description according to deed, and show street names and indicate wheth� interior or corner lot. STATE OF NEjYQ1 C, !� COUNTY OF . �l�t l t (�� t S.S 1�11\ t� �.•. .1J�F Tek\. l . . . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicar (Name of individual signing contract) above named. r i He is the . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor,agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file th application; that all statements contained in this application are true to the best of his knowledge and belief;and that th work will be performed in the manner set forth in the application filed therewith. Sworn to before me this . . . . . . . . . . . . . �.$ day of . ., 19 g� Jotary Public , .�.County HELENS D.HORNS . . . . . . . . . . . . . Notary Public„ State of New York (Signature of applican No. 4951364 Qualified do Suffolk County SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY O DATE. uS. REF. NO. APPROVED Test Boring • ^ ��� O Dark,Btawn o t Lm omv SNy ,o; 3 Pda terown Fk&M 9• 10.4 or. Water • \\� ��� �`9c2 �' Pada Brown '9 L Fbo to Coom sand `C 4 V 'A'14 /tom l� �/ \ c o �O.G "'•J� O ^ c 4—� rS� \\�•� \ y d aA. � p o� \ o '��. \����j9, w, •�o c P '•> mac. 28�a9' � � ., F. 1p V, U 7 I� ,R 30 � pa• 0a 7-o ,�+,r' / 4.3 k r C • hh `J Q7-*, 1b /V ET.EVATIays ARE 8EFEJ*DVCW 717 N.B.V.A F SURVEY FOR' 1 LESTER J. STEPHENS AT SOUTHOLD AREA = 27,553 sq. ft. TOWN OF SOUTHOLD to tie line SUFFOLK COUNTY, N Y 1000 - B5 - 01 - 22' Scale 1" = 40' Feb. 211995 CERTIFIED TOr May 9,1995 (Health Dept. Into J LESTER J STEPHENS 40. Oct. 2, 1995 lFoundalion Location) NATIONS TITLE kVaWAAICE OF NEW YORK lvk-- COOKE ABSTRACT CORP. CAC t0699 S I am famAlfar with the STANDARDS FOR APPROVAL ` AAV CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FA"LY RESIDENCES and will abide by the conditions set forth therein and on the permit to construct. aZE F6j{p / ANY ALTERATM OR ADINTk7N TO RMS SLA4VE'Y IS A VIOLATION �:•_, 'a OF SECTION 7209 OF THE NEW YORK STATE EDUCATMN LAW r_ {• .. -.�i''. EXCEPT AS PER SEC7701V 7209-SLASUA/SIUV 2. ALL CERT7IFICA#TtO a �-- - HOEON ARE VALD FOR Tt#S MAP AAD COPES TAIEWOF ONLY F C, N.Y.S. L1C. NO. 4,4618 SAD MAP OR COPIES BEAR THE AIA'WSSED SEAL OF 771E SL#nrYOYT �s WHOSE SMATURE APPEARS t1ERECAt S EYOtv'S; P.C. A=T10NALLY TO COA*-LY 107TH SAD LAW ThE TERM 'ALTERED BY` ( 5020 A"T BE USED BY ANY AND ALL RRVEYORS UTTL(ZW A COPY �aev aroN 41,1195P. O, BOX 909 Ole• ANOThER SURVEYOR'S MAP. TOW SUCH IIS "MMSPEC7E6•AM *ROLGNT--To-DATE,ARE')MDT AV cNIA- 4NCE 4 7hE LW (Rev/J,o 0 3/3,/95 MARV ROAD CERTFED o3n7196 SOUTHOLD, M)-. 1197-1 SUFFOLK COUNTY DEPARTMENt OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY O DATE _ H& REF. NO. RIO-95-0086 N APPROVED `' fir Test Boring p� \�O �'9 0, Dark Brown Loan app !_ /1 SXfy a Loo c a \ Pok Brown Floe /o Sand Coarse 10.4 Gr. water r o. '9 Pat& Brown Fbe to Coarse Sand 9 r �/�f— ,�, nil �z . ► �, �"// �4k9�� r �_v40� \`t• f, cob ✓ O i zrt� . �I. ryp a e• 'a I?' Sr ° 6I p ,0 �y e z a1 r p pV } 1 � Q ELEVATIONS ARE REFERENCED TO NS:V.D. Si1FFpLdCt10 f i €t k1 �►L 7lrt$ i� g j NN LE FAMILY CV4' LLiNG 4N LY O SURVEY FOoataVAY •ter' 4e�9So� LES TER J. STE HE bw AT SOU D : :, Ito y� ;ARE - 27,553 sq. ft. � TO WN OF SOU -IOLD a A tie line SUFFOLK COUN Y, Nc , � wa. � � 1000 - 65 - 01- 2 ;Oaf , Scale: Y' = 40' Feb. 2, 1995 CERTIF/ED TO, May 9,1995 (Health Dept. Into ) LESTER U. STEPHENS JR. Oct. 2, 1995 (Foundation Location) NATIONS TITLE INSUt�ANCE OF NEW YoRvvc. OE May 3, 1996 (Find) CACI 101699 SACT CORP. I am familiar with the STANDARDS FOR APPROVAL AND CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES hEty pand ermit to abide by conditions set forth (herein and on the 51 oar MErja�4P� l p 141 in 41% ANY ALTERATION OR ADDITION TO THS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW, ;p EXCEPT AS PER SECTION 7209-SLBUWSM 2. ALL CERTIFICATIONS o, SAJD MAP HERE OR VALID FOR BEAR THE MPRESS'T?*S MAP AND CED SEAi�r E DAL 9 S�� IC. NO. 49618 WHOSE S6MTUBE APPEARS HEREON), ECONIC 5U , P.c. ADDITIONALLY TO COMPLY WITH SAID LAW THE TERM /ALTERED 811' (516) 765 - 5020 MUST BE USED BY ANY AND ALL SURVEYORS UTIUZM A COPYP. O. BOX 909 OF ANOMER SURVEYOIR•S MAP. TrMN SUCH AS 7VSPECTEV AND /aro Ev.3N 6;'81195 1RROLPHT-TO-DA TE'ARE NOT RV CQIPLIANCE WITH THE LAW. r,Qsv/.r/eA0 3/3,195 MAIN ROAD CERTFIE'D 03/17/93 SOUTHOLD, N. Y. 1197/ 95 - 112 SUFFOLK COUNTY DEPARTMENY OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY EAll6 15 19i ?to O DAT -as- 6 !! NS. REF. NO. N \` R 10. APPROVE [� o <C% ti �� \~�Di,� Test Boring .A O 4b 65 O D Brown p 0\, O l Brown Sity Loam 0 Pae Brown `o coni e Sand 10.4 W. Water Pae Brown Ddu�� Fine to Coarse Sand Cr L '\ far x° Z 1ue V � 3a a ° o oA Qt4����• �� yG�cS' 0, C c j r � yA� Esti-�°Q° yto apo VA 01 N a, O n 1 Rh CL lS� •5,9. ,'tib co),ct_ ELEVAT70NS ARE�#FE"RENCED TO ACG.V.IJ. / "; _Lu oiI.y L LU 0 SURVEY FOR LESTER J. STEPHENS AT SOUTHOLD AREA = 27,553 sq.ft. TOWN OF SOUTHOLD to tie line SUFFOLK COUNT I✓ N. Y. 1000 - 65 - 01 - 22 Scale: 1" = 40' Feb. 2, 1995 CERTIFIED TOO May 9,1995 (Health Dept. Info 1 LESTER J. STEPHENS, JR. NATIONS TITLE INSURANCE OF NEW YORKINc. COOKE ABSTRACT CORP. CAC 101.99 S 1 am familiar with the STANDARDS FOR APPROVAL AND CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and will abide by the conditions set forth therein and on the permit to construct. _ . nnlO c.•..: ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION ' OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW, j EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTEICATIONS - HEREON ARE VALID FOR THIS A"P AID COPIES THEREOF DALY !F Y.S. LIC. NO. 496/8 SAID MAP OR COPES BEAR THE AA'RESSED SEAL OF TME SURVEYOR WHOSE SIGNATURE APPEARS HEREON. EtrO • a DRS, P.C. hOUST BE LLLYDTo CA�AMD ALL SURVEYORSADLATHE TEM T7LlZ 'AL�TERED BY' (516)'- 6j 0 OF ANOTHER SURVEYORS MAP. TERAS SUCH AS YVSPECTED' AND COPY P. O. 909 SROUSHT-TO-DATE'ARE NOT NJ COWUANCE MTN THE LAW. ,PEv,.s:off� a;3,;y5 MAIN ROAD CERTIFIED 03/17/95 SOUTHOLD, N.Y. 1/971 95 - 112 .. ., n.,,— '- _•.,--,...:. :,l-j!'„ 77 7: -1•-r e I , M ." ., . er : ;-• 'A n'^) n.' y. r�' -.`I',>f^F,:,t�,P-A- frv-a, "+".,.R.Y"'hm7Sq"5'TPRA A- r'^"""1q,,,CuFip.i ';.,n.,”..'.•.rm�,•-., ,,"�y,$ .M1 . ?r• 'T' mw 4 . r4dfalLF - - - - - - ; is ilr FT a s: .'Q e4r ii v�Ar''n�t�+ s r h IT IT I• c " {�u r'hff ��f I F. J .j 1 Yr,fu � SI Y r �l I I _ I',1, v �" ( - - n t ,I 'S I'Y lnllrta so "f • r y 4i 1; 51. rIT I IITTI ,k r . r,ttd n w PIF I If ryr r .4 pA ,�FpA y4 FSLI"r,9y u (([[ h 1 u rUx a ll"��tt� IIgP f I Io T�F IF IT y4 z '.fid w7W9Airrrl�'yk . '. A ulr r ^ rl A � i i � � S f ✓H � �'� 1 �9y 9N I $� : 1 iy �� iot ' 9 . 'V F IF4 1e1M1�l1MO�M Lw�t wwww a dY[ r�r•S�W h^ _ '• \ �• O JN ;��' • , P �Iry USE I&QW, t >e �. 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