Loading...
HomeMy WebLinkAbout21869-z 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) I~ Date 19....1... j N® 21869 Z Permission Is hereby granted to: .`T~i......... >%x....s........ ......~iz............a.. to ........(.fA? <d•':.......... f."' r rR~ . 1.......fl~n/~?/1r~6 G t~ r/f ...~r d , ~9 ~~:.......-'.:.y`~.d':..o©?/.. I T e~~........ a :rdi...... d ll~.f ~ at premises located at `5~/............... t!/ rw/....../e County Tdx Map No. 1000 Section .....7a Block ~ Lot No. ..3............... pursuant to application dated Aoe - r°.q................. 19.....1. and approved by the Building Inspector. QcL/ GO Fee $.....9.5~1i..%m B ildin Inspector Rev. 6(30(80 i i ~~gOFFOL,~co ~o Gyk ti x Town Hall, 53095 Main Road p • Fax (516) 765-1823 P. 0. Box 91971 y~Ql ~ao~ Telephone (516) 765-1802 Southold, New York 1 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD September 26, 1995 Mr. & Mrs. Fergus 5 Haig Drive Dix Hills, NY 11746 Re: Building.Permit #21869-Z Premises: 1854 North Bayview Road, Southold Suff. Co. Tax Map #1000-70-12-39.3 Dear Mr. & Mrs. Fergus: During a review of our files it was noted that the above building permit has expired, and construction was never started. According to the Code of the Town of Southold, A building permit expires in 18 months from date of issue, but work must begin within a 12 month period or the building permit becomes void. We have voided out this permit. If you have any questions regarding this matter, please do not hesitate to contact this office. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. ~(DAT COMMLNT° 1 . I .9 m~ FOUNDATION ( 1st) c FOUIJDATIOid (2nd) 2. z ~ ROUGH FRAME & PLUMBING y 3. tq m C INSULATION PER N. Y. m H STATE ENERGY CODE S a 4. H FINAL ADDITIONAL COMMENTS: m x a a ` o a ' r I x d m H m ~ N a m 3 o z D 0 m c aO CD O _0 CD O CD CL 0 (D (D c 3 7 ~cn _0 is ~0E=c3 R - CD ~ ~ CD n0-n~(°c= CD r4- w 0 =3 CD :3 r+ O r-+ Z oCL O rmtm c f-4. :3 0 It CD Kim= - 07 1 00 =3 0 0 m cc °=~NOO ITI(D (n aa3~ CD O XCD 3 < _0 X Ill ~ CD vi c Q r+ Cl) 3 O O O n = --h r- . F CD C/ CD CD ~i- K 51) CD CD * ' CD m m 0o -n fir 3 0 0 r-4. - 0 CD w CD 0 ~ 0 0 0 CD 0 m 3 ~cQOCD(nm cn 0 CD 3 ~a~,u~i~ a sv _ =3 ° C F -u CL CD 0 o -0- CD CD FRANK A. KUJAWSKI, JR., President ALBERT J. KRUPSKI, JR., Vice-President TELEPHONE (516) 765.1892 JOHN M. BREDEMEYER, III JOHN L. BEDNOSKI, JR. HENRY P. SMITH ' y BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD - Town Hall, 53095 Main Road 0S ~ P.O. Box 728 4- Southold, New York 11971 October 16, 1989 En Consultants 1329 North Sea Road Southampton, N.Y. 11968 RE: SCTM 1000-70-12-39.3 Dear Mr. Haje: The Trustees reviewed your application submitted on behalf of Edward Fergus to construct a single family dwelling with associated sanitary system, deck and pool outside of 75' from wetlands on property located on Goose Creek, Southold, NY. After an on site inspection by the Board of Trustees it was determined that this project is out of Trustees jurisdiction. All other approvals that may be applicable should be secured prior to the commencement of the project. Very truly yours, Frank A. Kujawski, Jr. President Board of Town Trustees FAK:jas cc: Bldg. Dept. file Cq~ ! p OAT I ,-J New York State Department of Environmental Conservation Building 40-SUNY, Stony Brook, New York 11790-2356 (516) 751-1389 came AMENDMENT TO PERMIT 67Iwa.^d Thomas C. Jorling J hR75 ~r•i Commissioner p,ic ll-yIS,N~I li~~/6 Date: tiov%o,l~/G,/99r Re: Permit No. & Location: [tif~~~~C,>j~j~-O.•-J (fa~m~ly ~a :F,`~'/0.7'x/) :t ~ w'1 5,11 3'1 -J Dear ky, 1-efjw X Your recent request to extend the above permit has been reviewed pursuant to 6NYCRR, Part 621. The expiration date is extended to ?~c v« +r ~~l9! Your recent request to modify the above permit has been reviewed pursuant to 6NYCRR, Part 621. It has been determined that the proposed modifications will not substantially change the scope of the permitted actions or the existing permit conditions. Therfore, the permit is amended to authorize: This letter is an amendment to the original permit and as such, shall be posted az the job site. All other terms and conditions remain as written in the original permit. Very truly yours,, DeL"lit.1 Regid'nal Permit Administrator CC: SUS fv F, (c w V+s :r N m -o 0 x CD 3 w a o z c cnDp a CD moa-~ C° 0 CD 3 O ~ CD 6 ~3.0!~*30 ~ CD h a O n -IN c• 3 cn 0- c: 3 3 N (D " CD \t- 0 a:) =3 CD :3 C/) 0 0 SD SD 0 ~ ~ X0=3 CD CL z I NZ ( CL CL m O 00 CD 0 CCDD O n ° Z ~a C=j 3) ~'~~o MCD I CD 0 0 =3 =3 0 C7 x Ill = O- n0° O F CO0'+(no0 T o ~ OOU.= 0 3 CD (n I A) CD P-1. cD = :3 r-+. CD * =3 ~R CA N D + O -n < O 3 0. 0 0w 2) --CD =T 0 CD 2) c: =3 O -0 M ~ CD -O =r 3 a CD CD Cn M CA < " CD n CD D 3=3 am < CL D) 0' (n CD -pa N Ito 0 r Cn o N 3 O 0 CD r+ `G : a M618 Z 3jo FRANK A. KUJAWSKI, .1R., President . . TELEPHONE ALBERT J. KRUPSKI, JR., Vice-President (516) 765.1892 JOHN M. BREDEMEYER, III JOHN L. BEDNOSKI, JR. a HENRY P. SMITH BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 r y October 16, 1989' ,a En Consultants 1329 North Sea Road Southampton, N.Y. 11968 w,._._. RE: SCTM 1000-70-12-39.3 Dear Mr. Haje: The Trustees reviewed your application submitted on behalf of Edward Fergus to construct a single family dwelling with associated sanitary system, deck and pool outside of 75' from wetlands on property located on Goose Creek, Southold, NY. After an on site inspection by the Board of Trustees it was determined that this project is out of Trustees jurisdiction. All other approvals that may be applicable should be secured prior to the commencement of the project. Very truly yours, Frank A. Kujawski, Jr. President Board of Town Trustees FAK:jas cc: Bldg. Dept. file cqe 1 4 < w New York State Department of Environmental Conservation Building 40-SUNY, Stony Brook, New York 11790-2356 ddlllllbj~- -Add (916) 751-1389 AMENDMENT TO PERMIT ~u Q f P~h~s Thomas C. Jorling l~a7y , Commissioner D,ic tpls,Nd //?Y( Date: tiu,~r,l, r Re: Permit No. & Location: DEC 2 8199:3 ease ~~Ye &2f1k lrucc,' S6 tG~/c{ f......- Dear IltI "11W X. Your recent request to extend the above permit has been reviewed pursuant to 6NYCRR, Part 621. The expiration date is extended to ?~c va 1. /9 9Y Your recent request to modify the above permit has been reviewed pursuant to 6NYCRR, Part 621. It has been determined that the proposed modifications will not substantially change the scope of the permitted actions or the existing permit conditions. Therfore, the permit is amended to authorize: This letter is an amendment to the original permit and as such, shall be posted at the job site. All other terms and conditions remain as written in the original permit. Very truly yours, 066 tr Regidnal Permit Administrator cc: 5Gi6dv fhd~ sum S } 1 X01/` New York State Department of Environmental Conservation Building 40-SUNY, Stony Brook, New York 11790-2356 (516) 751-1389 777 77 i €111 Thomas rling 1~~'~~~"`" Commissi onneer April 24, 1991 UCC 2 8 1993 Edward Fergus 5 Haig Drive Dix Hills, NY 11746 AMENDMENT TO PERMIT RE: Permit No. 1-4738-00281/00001-0, Location: Goose Creek, North Road, Southold - SCTM 1000-070-12-39-3 Dear Mr. Fergus: Your recent request to extend the above permit has been reviewed pursuant to 6NYCRR, Part 621. The expiration date is extended to 1/31/93. The permit special conditions are amended to include: During construction, no wet or fresh concrete or leachate shall be allowed to escape or be discharged, nor shall washings from transit mix trucks, mixers, or other devices be allowed to enter tidal wetlands. To protect the values of the tidal wetland, a permanent vegetated buffer zone shall be established. There shall be no disturbance to the natural vegetation or topography within an area extending 50 feet landward of the tidal wetland boundary. Any debris or excess material from construction of this project shall be completely removed from the adjacent area (upland) and removed to an approved upland area for disposal. No debris is permitted in tidal wetlands and protected buffer areas. The storage of construction equipment and materials shall be confined to within the project work site and/or upland areas greater than 50 feet landward of the tidal wetland boundary. A row of staked hay bales or approvable erosion control devices shall be placed 50' from the seaward property line at commencement of regulated activities and remain in place until project is completed and all disturbed areas stabilized with vegetation. There will be no draining of swimming pool water directly or indirectly into tidal wetlands and protected buffer areas. All fill shall consist of "clean" gravel and soil (not asphalt, slag, flyash, broken concrete or demolition debris). Dock or timber catwalk shall not be greater than 4 feet in width and be a minimum of 4 feet above grade* over vegetated tidal wetlands Odistance is measured from ground to bottom of dock sheathing). x,.. 5 NLM NOR6 ST 6-41 ULPARTMEN I, Of INFIRONMENFAI CONSERVATION DkC PEYiATIT NUMBER Am FFFLCrIVE DATE 10-89-1054 folaw 1/4/90 IAC11111'IPROCRAM NUMBER(sl Ul.( .rlF'r~ (LXPIRATION DAIEIS)_-- Under the Environmei9ntaT Conservation Law 1/31/91 a Article 15, Title 3; 6NYCRR 327, 6NYCRR 608: Article 25: 328, 329: Aquatic Pesticides I Water Quality Certification EKI Tidal Wetlands Article 15, Title 5: Article 17, Titles 7, 8: Article 27, Title 7; 6NYCRR 360: rr~~ Protection of Water SPDES Solid Waste Management` t~ Article rr Supp~ytle 15: AirlPollution Control' Hazardous Title 3 Water Waste Management f~ Article 15, Title 15: Article 23, Title 27: Article 34: u Water Transport Mined Land Reclamation Coastal Erosion Management Article 15, Title 15: Article 24: Article 36: Long Island Wells Freshwater Wetlands Floodplain Management Article 15, Title 27: N-New, R-Renewal, M-Modification, 7--] Articles 1, 3, 17, 19, 27, 37; u Wild, Scenic and Recreational C-Construct (`only), 0-Operate ('only) 6NYCRR 380: Radiation Control Rivers PERMIT ISSUED lO Mr. Edward Eprqu-q AUDRE>h UI PERM11 II L 5 Hai Drive Dix Hills, New York 11746 AGtNi IOR PERMITIILI(ONTACT PERSON iFLE PHONE NUMBER En-Consultants, 1329 North Sea Road, Southampton, NY 11968 i NAME ANU ADDRESS OF I'ROIECT(FACILITY (it different from Permitteej SCTM # 1000-070-12-39-3 LOCATION OF PROIECT;FACILITY COUNTY TOWN/CITYIVILLACE UIM COORDINATES North Road Suffolk Southold DES( RIPtION Of AU}IIURICLU Ai IIbIIY Construct single family dwelling neck, se tir sygtpm- cwimm^ inq tong driveway, 4 ft. x 20 ft. fixed walk, 4 ft. x 16 ft. ram and two 6 ft, x 16 ft, floats according to attached NYSDEC approved plans. GENERAL CONDITIONS By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compli- ance with the LEE, all applicable regulations and the conditions specified herein or attached hereto. 1 1 hr ponnni,•r shill f de in the otfue of the appropriate regional permit admimsimfo,, or other office designated in the special conditions, a nobs a of intention to commence work at bast 48 hours in advame fit the ume of commencement and shall also nofity unifier promptly in writing or the eompleuon of the work 1 be, r.IIInrA wrrk dull he .ubp•i t to mspes nun by an aidhlaved repr-sentatwe o1 the Department of Environmental Conservation which may order the work suspended if the pubtu interest so requires pun cant To E('1 §71-0101 and SAPA §4011) J the Vennatee has aaeptedrxpressiv, by theext-tution of theapplication, thefull legal tesponslbdrly for all damages,din-cf or mduect.of whatevernatun•, and bywhomever suffered, ansmg out of the project described herein and has agreed to mdemmiy and save harmless the State from suits. actions, damages and costs of every name and descnp- tion resulting from the said project •I 4 The Department reserves the right to modify, suspend or revoke this permit at any time after due notice, and, if requested, hold a hearing when' a) the scope of the project is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regulations are found, or b) the permit was obtained by misrepresentation or failure to disclose relevent facts; or c) newly discovered information or significant physical changes are discovered since the permit was issued S 1he permittee a responsible for keeping the permit active by submitting a renewal application. Including any forms, fees or supplemental information which may be required by the Department. no later than 30 days (180 days for SPDES or Solid or Hazarduous Waste Management permits) prior to the expiration date b ThI. prerinn shall not Ti romtwed as conveying to the applicant any right to trespa» upon the lands or interfere with the riparian rights of others in order to perform the permitted work or as authorizing the impairment of any rights, title or interest in real or personal property held or vested in a person not a party to the permit, 7 The permittee is responsible for obtaining any other permits, approvals, lands, easements and fights-ofwapLsh(3i.j1J768ir£FSEB~IrdAIB~Fe~IL'~{~rolect. 8 Issuance of this permit by the Department does not, unless expressly provided for. modify, supersede or resat}Q pTCdjNonIciant lprogW gm*Qn by the Commissioner issued heretofore by the Department or any of the terms, conditions, or requirements contained in such %?W9"Fe>:FYP~~ 51TY OF NEW YORK 4 Any modification or this permit granted by the Department must be in writing and attached hereto. TT EE lJ V iii SAOQV~ N4W XP$ IC ill )1 71t PERMIT ISSUANCE DATE D ADDRk55 J l; 1/4/90 Christine Costopoulos • AUTHORIZED SIGNATURE P I i' -Uwe V Page 1 Df 3 _ t 1 SEQR Negative De-daration Page 2 Reasons ISupporting This Determination: ko C~,`4gi1j rS assocc`Cnn V X04_ `~-Q Wst/ ~e 3 s l cfu'U ~cA~e ( tc Ue9e , , h ~ se I'pc; f11 $ `~c Dm l/~ r-s tct t~l C9J~ ~c~C /N2S' d o Ot r' S . 5w, rn dm G3 t~ a Q is q frc!er `lam. (cR tbs. A-(l (I?df tt~ec~ vvt~1 ` y~ ~QrJ~' n0i1Reru' xi ~no'r4/.~ ~~a ~`~e+ C~rece U01 (I fe dhcfr'"<~"~tJ ) a'r-ec( pope <z ~nrn~ (RPC~~~r~ G"nsv~~~f. For Further information: ; •r" Contact Person:4peq A_ AA Ui2 la Address: 281993 Phone No.. Copies of this Notice Sent to: Commissioner-Department of Environmental Conservation, 50 Wolf Road, Albany, New York 12233.0001 Appropriate Regional Office of the Department of Environmental Conservation Office of the Chief Executive Officer of the political subdivision in which the actkionwill be _ principally located tL~v~(!.c?(~,i~Ot~ SvP_ SO woad kxw 1~JIX Sao?S /ttavi/2 Applicant (if any) eC4i.ja4 F~<~US ~Icl" 9 J~f . ~)y I (.~lS. /~7 /7 -Cb'hz 0of ivy //p Other involved agencies (if any) (/h eVk Ccrsu(itL~~S PtX'1 c 132Y ~'vrYLs (Pd. Snv`r F ~ So`E~UiK Co, ~'~~sa` (Jed(. ~F<I'f'aCP (OU.-I Ctaefl ~r t er1~Qd1 vy I/9Cd~ tl~oi 95-206a'(1/86)-25c ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (Title 5), 24, 25, 34, 36 and 6 NYCRR Part 608 ( ) X10. ThaLf future operations by the State of New York require an al- other environmentally deleterious materials associated with the teration in the position of the structure or work herein authorized, or project. if, in the opinion of the Department of Environmental Conservation 14 Any material dredged in the prosecution of the work herein permitted it shall cause unreasonable obstruction to the free navigation of said shall be removed evenly, without leaving large refuse piles, ridges across waters or flood flows or endanger the health, safety or welfare of the bed of a waterway or floodplain or deep holes that may have a the people of the State, or cause loss or destruction of the natural tendency to cause damage to navigable channels or to the banks of resources of the State, the owner may be ordered by the Department to a waterway. remove or alter the structural work, obstructions, or hazards caused 15 There shall be no unreasonable interference with navigation by the work thereby without expense to the State, and if, upon the expiration or herein authorized. revocation of this permit, the structure, fill, excavation, or other 16. If upon the expiration or revocation of this permit, the project hereby modification of the watercourse hereby authorized shall not be com- authorized has not been completed, the applicant shall, without expense pleted, the owners, shall, without expense to the State, and to such to the State, and to such extent and in such time and manner as the extent and in such time and manner as the Department of Environmental Department of Environmental Conservation may require, remove all or Conservation may require, remove all or any portion of the uncompleted any portion of the uncompleted structure or fill and restore the site structure or fill and restore to its former condition the navigable to its former condition, No claim shall be made against the State of and flood capacity of the watercourse. No claim shall be made against New York on account of any such removal or alteration. the State of New York on account of any such removal or alteration. 17 If granted under Article 36, this permit does not signify in any way 11 That the State of New York shall in no case be liable for any damage that the project will be free from flooding. or injury to the structure orwork herein authorized which maybe caused 18If granted under 6 NYCRR Part 608, the NYS Department of Environ- by or result from future operations undertaken by the State for the mental Conservation hereby certifies that the subject project will not conservation or improvement of navigation, or for other purposes, and contravene effluent limitations or other limitations or standards under no claim or right to compensation shall accrue from any such damage. Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 1977 12. Granting of this permit does not relieve the applicant of the responsi- (PL 95-217) provided that all of the conditions listed herein are met. bility of obtaining any other permission, consent or approval from 19. All activities authorized by this permit must be in strict conformance the U.S. Army Corps of Engineers, U.S. Coast Guard, Ndw York State with the, approved plans submitted by the applicant or his agent as part Office of General Services or local government which may be required. of the permit application. 13. All necessary precautions shall be taken to preclude contamination Roderick Van Tu 1 of any wetland or waterway by suspended solids, sediments, fuels, Su h p roved plans were prepared by s solvents, lubricants, epoxy coatings, paints, concrete, leachate or any .Pig'/~/89 revised 2/18/89, on SPECIAL CONDITIONS 1. There will be no disturbance within 50 ft. of the tidal wetlands. 2. Roof runoff and swimming pool backwash must be directed to dry wells. 3. The driveway is to be of pervious material. 4. No dredging is to be associated with the project.- 5. The catwalk must be a minimum of 3,5 ft, over grade in area of tidal wetland vegetation. 6. Docks are to be constructed according to 6/14/89 plans. Remainder of project is to proceed according to plans by Roderick Van Tuyl, P.C. 4/28/89, revised 12/18/89. Supplementary Special Conditions (A) through (J) attached. DEC 2 81993 is i- DEC PERMIT NUMBER 10-89-1054 PROGRAMIFACILITY NUMBER 2 3 Page of I '4q 3. Nature of work (check which applicable): New Building Addition .........4,.Alte`!'ation Repair Removal , Demolition Other Work (Description) 4. Estimated Cost , . ~.7..~ Fee . ` (to be paid on filing this application) 5. If dwelling, number of dwelling units 1........ Number of dwelling units on each floor / If garage, number of cars 112 . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use pS! v! c~ 7. Dimensions of existing structures, if any: Front Rear Depth . Height Number of Stories . . . . . . . . . . A Dimensions of same structure with alterations or additions: Front Rear : 1 Depth ~ Height Number of Stories .....7~ 8. Dimensions of entire new construction: Front . ~ 9A- ; Rear 7.q L * Depth . `K i .0 Height r ............Number of Stories -2- 9. Size of lot: Front ./~.A e-.. Rear De th 10. Date of Purchase ~ L Y Name of Former Owner e 11. Zone or use district in which premises are situated V. f..'.. ~ . s ! p etiT ~ 12. Does proposed construction v olate any zoning law, ordinance or regulation: 4 . 13. Will lot be regraded _l !*5 Will excess fill be removed from premises: Yes ~VqJ 14. Name of Owner of premises CIo wp Address Phone No. Z,SN ; oz t y, , , , Name of Architect Qew a " " ......~K 4y ..Address °y^ . Phone No. . Name of Contractor Address Phone No. ' 15. Is this property located within 300 feet of a tidal wetland? *Yes .Y,.. No *If yes, Southold Town Trustees Permit ma be required. ; PLO DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. SL' ~ va- (TrF'~H-n k STATE OF NEW O S.SLN . r C TY OF. being duly sworn, deposes and says that he is the applicant (N e of indivi al signing contract) above named. He is the ..W (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 this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this c~ 1 1 ..........day of. . 19 Notary Public, Co ` y..... . KAY M. DOUGNERTY MARY PUbt1C, State of New York 0 (Signature of plicant) No, 0100W1601, Suffolk Comity j Yarm Expves luly¢Q t 99,~7 'BOARD OF HEALTH , 3 SETS OF PLANS FORM NO. 1 SURVEY TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 CALL TEL.: 765.1802 MAIL 19 TO : ,~',E,7 Approved ...../1...... , 19ermit No........... . Disapproved a/c DEC mry:.. II t~~•r DEC L S l993 \ U y,~ Y (B ng/Inspector) TOWN OF SOU'1'e)C L ; t APPLICATION FOR BUILDING PERMIT Date ~40f.......... 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 occup}ed 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 hIADE 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 i ections d~>.~ 4. 2ar=Sif (Signature oappli ant, o ac rporation (Mailing address of applicant) 117~16 State whether applicant is_ owner,, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (GUMS'... ..uJ . . Name of owner of premises 6~...... . . . . . . ' q.......................... . v (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of co orate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No . . Plumber's License No. i \ Q Electrician's License No. Other Trade's License No. 1. Location of land on which proposeddd work will be done . . ff vleW ~cQ S~ L...IJ.~Y. v -t1rZ-e P House Number Street Hamlet j County Tax Map No. 1000 Section . X6. Block 40 Lot . Subdivision Filed Map No. Lot (Name) 2. State existing use and occupancy of 1premises and intended use and occupancy of proposed construction: a. Existing use and occupancy's b. Intended use and occupana .....Sl,,,, r' S...,.....,•,,,,,,,,,,,,,,,,•„_ y ~ . . . . . . ~ f J J W yj S LA. J ¢ 3 F2• u J O j m ¢ Z p Wu twn j7 19 2;. W Z V > Z _ a 151 :msm~~ ~ J ¢ W (9 WQ of m 0 0 I U LL 4c ova ggs Bg~.gn~ VY B W w~ _ W Z W N p ¢ H a W O~ N ui~~g,c Emmm2 N $2~0 W < 41 S; In Z w a s I~ I _ o i 1w t~ 1 4c w x Z O 0 r w O ¢ AS f m m ill ¢ 0 > f~ k y 0.~1 N W= w Y H= O Z Q C(~ 8.9r j`Nm x W d W Z U. 0 r V CL m 0 ~ 7 0 0 0 U 0 0 Uwl 0 v; m Q T u 'a La uj CA LL 0 0u u w u z D < S x~ n~ft JO > w `g17 ,A! l N w LL w 1-: It w ;w0om 0 >(AW0:0 wN w N ; < g o• LL sil N x>0> >wp<Nd u0i0 Q F f- N u N N N u 0 O 2¢ i 1 i Cl! J It cprli' \ \ \ V; W S•' Cl ; if • t y`~ a_ 4Q1 W 1 > ~ ` ; F \ Ll Ufa I L J l1 ~ , 4 / /,n 1 n \ LL y 3 I5 { f D . l7 iv tb. rR lll pjf y~ z~ a d DI QQ I ~ ~ Q p ~s ~a~ ~ ~R~ I w oll Aksl- J N ee-F' _ 1 42 /2~~ 1^ rn~ j / Mr nl 1 V ' 4Wf /C ' ' /pp u} C /p 00 Y '~1 F lR Y L ' f - r r/ 4Q d W ~ , y Q Ion UU1 r, m y I c ti U VVV l _J k y 7L crram 6rVdr tU OF ~ E (u a. 'Plot "ell I 3. e, 4 I Oil I 000 Q~ SS r L I I \ ~2 ~~2~' `Z ~up•.~•..:.,. r..w .sY.^..r. «MUr.w,,.,.~Yw.ryw,. __r i SUFFOLK CO, HEALTH DEF HEALTH DEPT. APPROVAL lll,IECT'I+fCOYMMiTSIW G r HEALTH NO._ HII~~,I~I~JJJ. S NO. r..nv,s . „ (vAGAN'6 1 ~..:w:y. :....rr...r...,•,,,,:.w.•M!_ _---f MAP or r r~oPE re .rev ~+iR35 _ : TFI A. 20A0- _r, F r-Qrr1-~- - ~ , L T Y • r ~3 UI1 -r r T 1..~~33~ SUFFOLK COUNTY DEPART NTOF 6 LTHiEMI^E$ ff-'f It- V'I-/1`r'[_~- vv \90 i.. Y ;ir r lilt ~at't 10 Y a p Tit.A3D Qa1vP \ h-9Y iWE1.L. J) v... ryi "41 avlr J1~ o" At t6 SUFFOLK Oq.O )ajye. O''e' Y lift of Installation of;the 6dwa96 if$ sal _ ? /I1~~: t E „ I i ~w~ syster", aft area large eifosrgN id Ihsta11 n-l STATEMENT OF IN \ leacging Ood yy plug' gff6wohdo for 5004 EMENT OF INTENT ~COVE2 E~EV.~ t.~P20G.T2ENGH---_ t rT~ x rFy iIT'I T( G Iti expAMlYwM etal t313 dup. pu~.f:`fb virgin sand a,sa. r. BA /Vl FW THE WATER SUPPLY AND SEV 'PLY AND SEWAGE DISPOSAL S gravel, ftib#Wf4.*&e6 of t" ON0, 0kon is to Lt., SYSTEMS FOR THIS RE: dewateMMai,id ~fvasaryoWAW6*theexcaWif, . 7-rJWN0-50tJFHCLP CONFORM TO THE STAND THIS RESIDENCE WILL - \ WELLS F'~'~ Y 1 :7 Y w~ NY)Il; Of 4 F r u ' 4S` \ \ t .ra 6 r€~Ilai~lin : tdl.tnll r, i," I a`- to bs 6hr wl rBriilovin¢ 1111d undesileable b4k. i SUFFOLK CO DEPT OF HEA THE STANDARDS OF THE New wEU- / `g2aWN I 3tri Y+J bD14i6tsr 1: at .~~1' X ~z c mod, Dew~l6ling permlis required by otnp :sgenc;a::: ; rEPT OF HEALTH SERVICES. ~~o, ~9~ zMirH v~p°MOU 2N ~ nrt A`d Jliaah•,,ta8,~!~id I. L 4 PL61N O i ' ~M ~•~'i:6~U 4t 'r ~'.~OM$.': 'PG. •i~ l< x "'t F";,3 F'!- ~T ~ .M1dJ~p:N1,tr: 5'Y + .rTYr t.. " are Ow responsibility of the ap licairty, 0l~I /r+ ISI ANT with clean sand and gravel rb.Qii$dMr$¢_,L APPLICANT J ALBINSt9TA. ^_•L=~wt-Y,.,. - ~.r , department standards SUFFOLK COUNTY DEPT NTY DEPT OF HEALTH SERVICES - FOR APF FOR APPROVAL OF ,dw ~ ~ ~~A V Y A Z ! y Xq \ CONSTRUCTI N y Y DATE, "tb A H ~ No. 7 ,('3b sYTr'.H. S. REF. NO.. S8 .S 8 tP v: _ P4D0. _ E O I ~/f~_EVPAN5~ON VOO'=) AP VED: S .el / LAMOUa 300,0 SUFFOLK CO TAX MAP DE TAX MAP DESIGNATION DIST. :T BLOCK PCL. G OF wAY SECT B P_ Z ---:r 5.69 E. LE 9, IOoO 0'70 I2 O 12 39 3 C 9 T H e- OWNERS ADDRESS: )s: t~ _ ` \ ^kw \ 50 _ -\,-30 an~Tau¢s; GCFne ; lj'~e c; 9 C~` Dr4I VE \ •t - I coN oo m. ,''I'\e, ° z/o'°,` ~L SHAIG 01241 VE <1 Ui {'IILLfJ,NI.Y. 11744 1746 ~~TF4' I ' / MPQ~x ~ Qj;.\ `4TFZ.~~-_.. ',acar,~ ~.'•"v'- I °ey? d b86.60yS 4-`v Ic¢ D21vE _p. ~ lz vu.coN~a`--- v v. P.34-7 CREIZ) y.+ yq ww-rEe sE~ NOV9f: \ DEED: L.7323 P.347 CRI +1 TEST HOLE S. \ eO.,v S w` / PER 01 GpNSULThNT+'- _ - _ _ _ R I~.-. mr F6PG5 04 ,J Sa,I°s~ UNE OF 'eIETLA3 aD 1fl CDAR.SE rwoa ro eF S9 BAND iwnJ lmm FDA Ak_kD pJ W ass mm= F 4' x , MP u/ALe i ({m xq CLAY iG ~M1a amso' 4 . 6' 2nM ~ - ,nP ~rRINla'fID s'^J, m,a NOTE: r, 'r ° WELL ROATS _g ~ 4XYCM5 tL 55" I n y~.~ Ao oPQ' l GCL~~ . C[l@LEYifNVR 8 CESSPOOL ~~`~-Y 1n COMPOSITE MAP MADE JAN•29,1991 ARW,L5AG.*- L5 A_ G.± _ _ f I iso` ,.n,'c2 r _ id f G¢ADING PL-AN fLEVISED MAY 23_. 1989; DEC_ 18 13 989 AMENDED PE13.28-1991 ~pFrr>F,.^~o>ma~y F(N. (i llr, - . 'U_, EA AP2. 3 , Iqq I -U-!--QNUMENT encE ~ 57ARY SAND w Q~ 'm c B.e 1'N ¢ it QE.~ C,t~ I JULY 8,(992_ 7NUMENT qe AS ^c i r APfZIL I 1993 PJP YED APQ 28. _,MmµlM TAnt~ , RODERICK VAN TUYL, ,C. -IMCPARSE G _EL..EV.OAQuM: mem, L.D PURL, C5~ Tp' ~~LM: MEp.N SE'A L ?EL,~t+A.fi.V.O.' r ~s Y T _ S&W aF~' o ~O a (~'Z ~S 255ry G¢G~wp 2.8 LICENSED LA$DSURVEYORS Iq' . gF't IAnIP SUT' NFI[OTNl loft NMM - - - - - - - - uru GREENPORT NEW YORK' Mqb rn3" ry ' ~I • ~i161 _