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HomeMy WebLinkAbout19727-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22262 Date APRIL 16, 1993 THIS CERTIFIES that the building NEW DWELLING Location of Property 8580 COX LANE CUTCHOGUE NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 83 Block 3 Lot 3.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 12, 1988 pursuant to which Building Permit No. 17348-Z dated AUGUST 24, 1988 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ONE FAMILY DWELLING WITH ATTACHED GARAGE & DECK AS APPLIED FOR The certificate is issued to ANTONE BERKOSKI (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 87-SO-225-APRIL 8, 1993 UNDERWRITERS CERTIFICATE NO. N-269328 - MARCH 15, 1993 PLUMBERS CERTIFICATION DATED MARCH 17, 1993 - TIM HORTON ~L uil ing Inspector Rev. 1/81 "Ru NO. a 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) N2 19727 Z Date .cV.l 193/ Permission is hereby g nted to: ®I to . W-a , . ;~7- 2 at premises located at f'l. op . ...........nom . County Tex Map No. 1000 Section w?....... Block ,-I Lot No...... A.A.......... pursuant to application dated .......t.//.'11k 19........, and approved by the aer, Building Inspector. Fee ..er........... uildi for Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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, 04k _ streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial. building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) 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 Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ..,(.°..'z~~ New Construction.:/ . Old Or Pre-existing Buildin Location of Property.~3580 COIL ~ C~Y~' G~1QAlA2- House No. Street Hamlet Onwer or Owners of Property..... ~ }Ong. e : ~e VbS County Tax Map No 1000, Section. ag~> Block 3.......... Lot.... ta Subdivision ...................................1.nFiled Map............ Lot...... ........L............. Permit Nol.Njaq..... Date Of Permit. .2~'a lV!~......Applicanh?)DRt. 5yr?. Health Dept. Approval....... ..................Underwriters Approval ...7~X1.8.19/........ Planning Board Approval Request for: Temporary Certificate........... Final Certicate..~/.... Fee Submitted: $ C~ex• yS~~(~ APPLICANT . TEL. 765-1802 Vff GClrCTOWN OF SOUTHOLD ~c OFFICE OF BUILDING INSPECTOR P.O. BOX 1179 TOWN HALL SOUTHOLD. N.Y. ) 1971 C E R T I F I C A T I O N Date Building Permit No. ~"1~oZ7 z Owner BerKOS K i (please print) Plumber I Irn 1^?TDri (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. a plu er's signature) Sworn to before me this t 771~-day of 19, Notary lic Notary Public, ~U Sow-county MOAA&Ft EGPX 10my Public, Stlee of New Yak No. 473019, 1C*Wk .19 3 Term to" ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS eAr; .1 11 1]077 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date HlARen 15,1993 Application No. on file '72x9 5391f37. N 269328 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant namedon the above application number in the premises of ANTONP, B9P.WQ'1KJ,, COX T.,14HG,, (NI'TCHOGH, NJ, yy~--~~ in the following loco i 8 ent ~ lxt F1. CJ 2nd F!, GAR/OUT Section 1!!xk Lot was examined on and found to be in compliance with the requirements q( this hoard. FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER AM? K W AMT. K. W AMT KW AMT. K W. AMT. H P 34 3?i .S3 1 I. 3,.4 ~ DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS NO. SYSTEMS FEET AM AMT WATTS T K. W. OIL H. Tff AMT NO. A. W. G AMT. AMP. AMT. AMPS. TRANS. AMT H P. OF 1 it 1 SERVICE DISCONNECT NO.OF S E R V I C E METER NO OF CC COND. A. W. G. A W. G A W G. WT. AMP, TYPE EQUIP, 1 q 1w 1 ,F' 311 3.e' 311 3 fe 411 PER % OF CC. COND. NO OF HI-LEG OF HI-LEG NO OF NEUTRALS OF NEUTRAL 9 L ~1A) CI? 1 R 4. L L l OTHER APPARATUS: ROTOR"; 1.-I,0 if P. 4 F 11,t'. t;.F.c,It 7 9Plt>C F WIThCT0 9.1 t [tO EI:t1gTRTC ),TC. H3G77N F.().110 Ot}Tf I64 L'l7yCIfOGUfS, NY, 119$, GENERAL MANAGER 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. COPI FOR BUILDING DEPARTMENT. THIS COPY 0 CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. 7iS-1102 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ) ROUGH PLBG. [ ] FOUNDATION 2ND [ NSULATION [ ] FRAMING [ ] FINAL REMARKS: MAI DATE < 'f/ INSPECTO 4 < M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FINAL REMARKS: DATE ZINSPECTOR i ~Z22/ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INS TION [ ] FRAMING [ FINAL 7 RE ARKS: DATE INSPECTOR r M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. Xj FOUNDATION 2ND [ ] INSULATION /r ~ ] FRAMING [ ] FINAL REMARKS: Y Z DATE O,6 INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [FRAMING [ ] FINAL /~~~c REMARKS: DATE,; k'7 1 2~- INSPECTOR 113W M-18®2 BUILDING DEPT. INSPECTION [,//FOUNDATION 1ST ( ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: co (I DATE INSPECTOR ~ ~ 1 LD EC b:; 11DAi E UMMENT° ~ H y FOUNDATION (1st) gR - - - - - 3 .QTY/ O _ c~te FOUNDATION (2nd) 114 _ m It~ 2. 7 -A- z 0 4n ROUGH FRAME & L o PLUMBING y f0 3. m m H INSULATION PER N. Y. STATE ENERGY CODE At) t 4 S CT; 4. r FINAL e~ t ADDITIONAL COMMENT x~ e r J, -7 fog • x H Al O a v y r ro yN ~ Lk tkTC~ Tvcl~, 6-~• Y. r~Kxr (ooo- s3-3-3.2 Jv~ ~Uz`rP, a;W VICTOR LESSARD „ EXECUTIVE ADMINISTRATOR Fr Town Hall, 53095 Main Road ' (S l6) 765-1602 P.O. Box 1179 Southold, New York 11971 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD August 4, 1988 Mr. 6 Mrs. Antone Berkoski Maiden Lane Mattituck, New York 11952 SUFFOLK CO. TAX N 1000-83-3-3.2 Re: NOTICE OF VIOLATION Dear Mr. 6 Mrs. Berkoski: ' You recently received a Notice of Violation. To date you have not responded to that notice. If you do not remedy this situation immediately, you will have to appear in Court to answer criminal charges for violat- ing the Southold Town Code. Please contact the Building Department of the Town of Southold at 765-1802 upon receipt of this letter. Very truly your'1s, U "Ale k-U) Vincent R. Wieczorek Building Inspector VIA CERTIFIED MAIL e _ Q / - ,/f D Gw d ~va.~r~ ~1.~~ Gl/1~~ ECG (.u V'A ~ . Igo+.o 15ej' C-* ~ s~t 2/8'8 (A_P~ P FORM NO. 5 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION Date June.... 19....88 TO .M.r...Ant,pne„Berkoski (owner or authorized agent of owner) Maiden Lane, Mattituck, N.Y. 11952 (address of owner or authorized agent of owner) PLEASE TAKE NOTICE there exists a violation of: I Zoning Ordinance Cha 100 Other Applicable Laws, Ordinances'or Regulations . ation w . as constructed witho . u t at premises hereinafter described in that A f . o . u . nd . (state character of violation) necessary building permit being applied for from the Building Ins~ector:. in violation of Art. XIV Chap. 100-141 (State section or paragraph of applica'b'le low, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the conditions above mentioned IMMEDIATELY The premises to which this ORDER TO REMEDY VIOLATION refers are situated at Cox . ' . s L . a . n . e . , C . u . t c . h o . g . u e County of Suffolk, New York. Suffolk Co. Tax #1000-83-3-3.2 Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law may constitute an offense punishable by fine or imprisonment or both. Building Inspector J ~ FORM NO. 5 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION Date ...........(C~1•s.(!,...@4.......... 19..V.~. TO ,...~..Dat~ j3rlK©S.h.~........... VVV (owner or authorized agent of owner) (W ~ v~91=1.f 6, iA AC u, (address of owner or authorized agent of owner) PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance ....C a Other Applicable Laws, Ordinances-or Regulations at premises hereinafter described in that A...... v l 5. O ~ I+ d+ ~ ~ (state character of violation) k. ~'!!~........!.rl.:.........uG~: af, ::.....1.acs.t F.C: f:?..V. t in violation of .~.~4 Kt.V.....J.0p.:..01 (State section or paragraph of applicable law, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the conditions above mentioned 44~yl~dvikkE~wrd~tcft~R9tt@4~........k.iAtL?t.t,.~?.E.s<S. F,..~.P The premises to which this ORDER TO REMEDY VIOLATION refers are situated at C.O.1<. ....,AM,! .....(u.S?.T.<.':CqC.V........ 4 ...................County of Suffolk, New York. Su(-rot, tc-_ Co , 'TAy- 1000, 8'3- 3-3,x, Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law may constitute an offense punishable by fine or imprisonment or both. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD, NEW YORK STOP WORK ORDER TO: MR. ANTONE BERKOSKI Owner, Owner's Agent or Person Performing Work MAIDEN LANE MATTITUCK, NEW YORK 11952 Ad ress o a ove-named person YOU ARE HEREBY NOTIFIED TO SUSPEND ALL WORK AT: COX'S LANE, CUTCHOGUE, NEW YORK 11935 Address where work is to be stopped TAX MAP NUMBER 1000-83-3-3.2 Pursuant to section 100-141 of the Code of the Town of Southold, New York you are notified to immediately suspend all work and building activities until this order has been rescinded. BASIS OF STOP WORK ORDER: No building in any district shall be erected, reconstructed, restored or structurally altered without a building permit duly issued upon application to the building inspector. CONDITIONS UNDER WHICH WORK MAY BE RESUMED: When a building permit has been applied for and issued in the normal manner. Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law may constitute an offense punishable by fine or imprisonment or both. DATED: May 11, 1988 BUILDING INSPECTOR / COD ENFORCEMENT OFFICER Vincent R. Wieczorek FORM NO. m 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) Na 0 1 348 Z Date .....„l 19Ve Permissi is hereb granted t . 1... I......... , ......1.~.(~... to *---j A% at premises located at ..4?";5 ..o...... ..........6"~ . County Tax Map No. 1000 Section O...s~~...... Block Lot No.......... ~3..!..!;.... pursuant to application dated 19......... and approved by the Building Inspector. Fee S7` y f j~ r..i . / ildng Inspector Rev. 6/30/80 • BOARD OF HEALTH 3 SETS OF~LANS FORM NO.1 SURVEY ? 40 TOWN OF SOUTHOLD CHECK ~.51~........ . BUILDING DEPARTMENT SEPTIC FORM . TOWN HALL BLDG. DEP. V `'OUTHOLD,N.Y.11971 NOTIFY E ~ TOWN OFSOUTH0L0 V TEL.: 765-1802 ALL .I... pp MAIL T0: Examined ~ l~........ 194.8 ~(o c mil'<3 . WorlG Approved . • 19oPermit No.17.3T..0. Disapproved a/c (uildiAdInspector) APPLICATION FOR BUILDING PERMIT Date . . u.. - - 19 rv 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 .Me tions. ".j • (Signature of applic n , r am e, if orp r tr n) .....P.0..... (Mailing address of appl' ant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. e rv .................................-..,.n..l................,..................... Name of owner of premises (as on the tax roll or latest ed) If applicant is a corporation, signature of duly torized officer. (Name and title of corporate officer) Builder's License No. A. ~ a ~421. •A L • • • • • Plumber's License No . Electrician's License No . Other Trade's License No . 1. Location of land on which proposed work wiJ,(,be done. . ......................J........... . mll~ et ~1~ •..1. House Number Street ? County Tax Map No. 1000 Section p. 3• • • • • Block Lot.. f M,',bR + Subdivision . *Of. I ,Mc ~j~~~DJo~ln ~ A7JO- 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 .........I•••••••••••••••-••-•••••......\ ll6ACa py b. Intended use and occupancy • • • • • • („A~,. ?C~ „ ~t .K 1w4, ar"d r 3, Nature of work (check which applicable): New Building V....... Additi 4 1;• Alteration I Repair Removal Demolition s ...V ~(~y Dl7O (D,lscription) 4. Estimated cost . ~ Fee + . , ~..1.=s. . I (o be ~1 pr}:' tlilig th'§'#Vplic#ion) 5. If dwelling, number of dwelling nits~l........ its on each floor . . Nu ber of dwclling`un" If garage, number of cars . 6. If business, commercial or mixed occupancy, spec y natur and extent of each type of use . . 7. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth . Height Number of Stories 88.. Dimensions of entire ne construction: Front... • , , • , , , , , Rear Depth • . Height 1 . Size of . .lot: . . Front N ber of Stories 11. Zone or'u r district in which r Rear Name ~ De t . 10. Date of Purchase I..~9.g7 . , , , . , , ,Name of Former Owner I......... miles are situated . 12. Does proposed construction violate any zoning law, ordinance or regulation: ..1yZ.0.:' . 13. regraded 14. Nameoof Owner of remEeb A { Will ex ess fill be emove m p emises: Yes r. &k ~Zress Q p I , l~ No. ? Name of Architec' , ,Address pXd kk"llt~ hl one No. Name of Contractor 1! t . . Address Phone No. ?Sorg IS.Is this property located within 300 feet of a tidal wetland? *YES.4-r.'Bi0.... *If yes, Southold Towns Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all 11 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. I I III; I I i I I STATE OF NEW YORK , COUNTY OF S -k • • • • • • • • , being duly sworn, deposes and says that he is the applicant (Name o individual signing contract) above named. H e 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 this application; that all statements conta+ned 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 f .....day of I....t 19 A~ Notary Public, .2.. County r IMrIIMMMM~ NIyMMNt . _ . (Signature of applicant) {1MMM~MMNMN~I ~ I E~M~wIrMa?F+/Ma~~M.yt. it>Lt:G SUFFOLK CO. HEALTH DEPT. APPROVAL DAR R (VACAN H. S. No. I SINGLE FAMILY DWELLING ONLY ' CQ S. 1$' Jtl Oo" E. 2~®6.77 N EXPIRES TWO Y q S FROM DATE OF APPROVAL ' -So - N N N r STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISP06AL __65 9 SYSTEMS FOR THIS RESIDENCE WILL tso Q O - - - - - - _ - _ _ - - - - - - CONFORM TO THE STANDARDS Of THE rob SUFFOL CO. T. OFAEAL11 H R VICES. o W&LL t V) (CANT 1 "6 1 Z SUFFOLK COUNTY DEPT. OF HEALTH SERVICES - FOR APPROVAL OF ' - PRQro'6D ~n> - - _ - - Q V CONSTRUCTION ONLY Z 7 5 ~ _ ~i~-- - SbMG K? ?lmPOSe D = - - - - - 5 0 DATE: 1- \...4 H. S. REF. NO. O k- Af / 2S `9.0 ~ 0 3 = V APPROVED: 10 W 0 1 1) p 65 -o - - - SUFFOLK CO. TAX MAP D GNATION: ~~i112MIG1 aAGIC Ll?If~ - ? 7S: DIST. SECT- BLOCK PCL. V e t 1000 oe3 3 P 3 u f/~'~~ ? o OWNERS ADDRESS: Z B o~J` { PjD ec & rob (h1A1'(r~ltit , N .Y, 1 I g 2 3%.44' N . ~e° ?s3' 50' W. 3l9G sow + a9g 'fI&L. 2996 - ~ a9s P. .1 COX S L f E. ~ d DEED: L. P. - TEST L STAMP frs •na.i-M nnrstien sr .d+fdnn to thi+ sunray is o Vwkvdon of A+>i::n 7r of fhn New York SIM •foPsolL r~,xnv.a trw. th, lone 50 MAP Gf PROP&RT1( 6GAI.E q, •~"'d~ in" ~.o - - 3 to be a veli.^. /i,n ogry. 811RVf,YF.p 1'0lk AREA: EXgG44 F1 a+dy:e The W fm v.,wn 00 "rim UO t3TH1Y AN'fd~i t3ERKOSkI 6 wr '~,ft.feff k enWandan *Mothe r• mr dm Smd hw a wdend m Al to ono sn " nd" eo~usE %o gm sm M09 . . cuermww .nesss m fwiiae .e Tr rruf.Tr4 cofC.14aC.UEi SAND 1!` besdltisWkrflsdw0«we«ywec lawt4 Of 500THOL0 N.Y. 6RAVEL SEAL ' .1 t4of i'.5 : PRF M16&5 AR1: St-101.J t~ As L-O T 2 Ot OF NE1.1, L "M11voR sUap~V151ou MADE dR 140RMAV4 M,CULLOU(GH L ANO." P\CKVAy o9 MAPPED ; MAC{ 5, 19a'1 ; 0 :a ~.l~f~Ir0l)R'~ ~RoM SU~FaL Gouty? f P. W. AERIAL 50 RVFiY RODERIC,KVAN TUYL,P.C. 1, 'r A"ci'UM - MEAN 56,A, LfiYF~L - ~ ~k tia ' 'tip LICENSED LAND SUR YORS L ISFO z55J~ GREENPORT NEW YORK LAND THEDYNf "T N61329 - - SUFFOLK CO HEALTH DEPT. APPROVAL ~A R R (~/AGAN T) H S NO I S. 46° 311 00 E• 38G.77' N N STATEMENT OF INTENT N O THE WATER SUPPLY AND SEWAGE DISPOSAL 01 TO - GO _fi _ - _ - SYSTEMS FOR THIS RESIDENCE WILL E15AGF. (°5 ~f CONFORM TO THE STANDARDS OF THE j Q t SUFFOLK CO DEPT OF HEALTH SERVICES. --;--cc0 O I _ Q,C/ -WFiLL t ISI APPLICANT +-----'~Ffj'T NoLE SUFFOLK COUNTY DEPT OF HEALTH I - - - :P60 SERVICES FOR APPROVAL OF CONSTRUCTION ONLY L i 1 55 0 DATE _ 0 P<f H- S. REF NO vL ~'I - - - - - - 1;3 APPROVED- - ul 0 0 55--0 _ v J - _ _ - - - - - _ - I V SUFFOLK CO TAX MAP DESIGNATION n - C - BUILDINCq SETeAGK- LINE - J DIST SECT BLOCK PCL 1000 083 3 v d vi ~9 1 OWNERS ADDRESS. I - - P.o. 50x e cp 8 - - - - 50" W. 306.1 1' MAT'r,TUGK N.Y, 11952 COX S ~A ij E. `n! 6ffL. 298 - 5'130 DEED L P TEST HOLE STAriP 4 +II RfU !~l rlll ' ..LtY -.,In OL - ~n o'. :he xw York Stain _ ( sw ~i QR0P? ~T7 EiII r MbMON I `IQ `rD O r 1 ~G~R-r1 1- - a ? SuRVEY ED FOR h.i1 ca AK r, A . 4¢ F I y and DO ROT HY /4!-sN NTor4 t, 5ERKObK I r,ufc-H0G,L1Fi G7AR'E cars sa ens . 1 -(OWN Or S0LITH(0L0 N.Y. \ SEAL - I RODERICK VAN TUVL PC { LICENSED LAND SURVEYORS GREENPORT NEW YORK a s 3 ORECiotJ ROAr) z Z. 3 ; Z Z A 'LoT 11I 0 s j U n c -1 a McCULLOUCtH ANC) r? p N.41°41118, f;. i m 223.34' {Q ~U 3: 70 O O O 1 I 0 Z n o z 1 .u Z- 41 ~0 W + C Z ° i w 0 co p Do 0y• I 0 Z U O g o 717 ~ 60' U ~ 1 3 N X 1 r D ' i 1 r- Z N C I 1' r ~ 1 0,0 D O g c z I f; A u N, I- s r °a y ` I ")a c TM8 1. r z o pp ' ' Z I (A i -A ' f Q E: A 3 D 661 r i i m Z N z D' Q 1-F i ' J 8 mm B t" 1 m ; J i o 1 z o S. 41°41' lo' W. ; 224.11' F r N I II Lo-r 31, m x o n A 4915 Mcr-ULLOUGH e ANO to n N Y 2, O O Dx On 0M w U1=°- m f'~ £ D O m c C O< S r' Z p in v fn Z m r Z m -C .L~Do lol ° umi o 30 A 0 yr p pAm~y<o -v,00 D 0 m <m A-r r 3D q_- <Oa I1 O x O m." C n A rn -a , r,r? O •M. IT I I O D r c~--0 z n m 9 n 3 r^ ~n it r m N -1 O o ~1 O y n° O -i m A -1 U T cx AOm0 0 1 0 r OOc a D. O m m z c F) n w_ 7c ur n O m z D v m R?z x' Q1 D z o X f -+x m .~r'3^ 1 xmD yU ~ m 7 K sqn S3ry ;,i •$'xa ZOD 3 < Z z J.", OD D r. o m o 0 0 yZ = z x y i D a D rn m 111- 0 0 ~,~~t~ . y,rgTg Sg R ]vc4 r o N .o -t m z m m_' m 5 FOp T 5 A'!i S i r„ f ? W O O Z Q v oN s F C g n ti in C -j v D rn f r O t7 @ 6. {A+'_ 1 A r .ll O D m 1 D D N 8' §y D d,0 0 ~ Z $ gq (Y ~'J` s v > v°r z m om o n tD" m" 9 O 0 < ^ •?',F~oRt. rd~' R Q3 3s4 O v m ID' n -1 r `>1 r a$ V OT S N m r r SUFFOLK CO. HEALTH DEPT. APPROVAL Ft -r H. & NO. 81- so -225 N I 5. 4$' 311 Oe E. 56G.77' SUFi01A COUNTY DEPARTMENT Of HEALTH SERVICES - r" ~5 011 FAt lY DWELLING DNLY IIIIS DATP-4 j KS REF. MO R7 a N STATEMENT OF INTENT N Q 1 The sewage Arsposzl and water supEty r i'i-~~ t~r the THE WATER SUPPLY AND SEWAGE DISPOSAL ISp location have been in;nec j bf this Clor loent n d/2r- - - - - - - - - - - - SYSTEMS FOR THIS RESIDENCE WILL o!trer to SKIS Z" Y- CONFORM TO THE STANDARDS OF THE r ~ -A SUFFOLK CO. DEPT. OF HEALTH SERVICES. Q `b r Chia' 4xenn ra WesteK=> r r ?~a;ir - ' - - } - - - - - - s '41, ISI APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH _ ~ wTe SERVICES - FOR APPROVAL OF CONSTRUCTION ONLY - - ~O ~~~p,. DATE: 0 SEPTIC SYSTEM \ ? ~Q~ 3 H. S. REF. NO.. 87'SC'225 Cly AA ;t APPROVED: =3 6(0 a p p 65-'g - 0 V _ L 9UI~Di °ti6 V SUFFOLK CO. TAX MAP DESIGNATION: {}/1C~1(, LI~~ °@ ? DtST. SECT. BLOCK PCL. t3 re t I Gl7D u 3 3.2 } OWNM ADDRESS: h z 1JQ OM 06010q910.44' 50' W. 3ea.'1~' , ?4' 4y, 1 i9S@' ~ Cu,+thogu~ Cox, S L A tit Ct~t.. )-~I ez DUD: L. P. 71ST HOLE OPSOIL I MAP Of PKOP6*94rY GALE 50 I , II - - - - U LoA~rt 1 3, 6uAVVILo forK AKEA 1 5GIG44 !5Q• F1• f''1NT~ 1: f5&RKosk l 0' PI PE COAFtsb Gu~'rrNa?cu s. 0~~ S,NO VON Of SOW0+0LO ~ N.Y. ppR 8 1993 MAP AMENDED-OC~TZ, 1 ,1988 C4R~tVU SEAL tJo t>: PREM15E.5 ARb St4OI.J O A5 I.O-( 2 Of I C' SER~CES n MINOf, St1lbDlvl'SIOW MAOL, FOK I,IORMAI4 Mc.C.U LLOUG H d ANO. u H MApP&D : MA`( 5 !q$`1 ~601%J oijfZt> rROM~`50 rf;v GOUN'f7 P P W, AERIAL `URv&"f RO_DERK VAN TUYL, P.C. W um: um' ~y 1 fvAN .)VA LVi VV LICENSED LAND SUR YORS GREENPORT NEW YORK wNrrs~w r+e~on r 1 1 X711-Cc n I' -o Q `~'mom' ~ o o 61 I I-Oll - CLR, F r ! 2 k !a -~r_, ! 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FINAL - CONSTMMIIONA )NSTRLKI"ON MIST - Co5Y ALLLCONSIIEICIION14NW.L 1 THE 1160UEYItt OF THE '°ilo~N4WALL MEET 2'" 2~'-b 2'•5' i o -n ' 2 on OF no w.r. - STATE OOIMIIEIe R lik M Ealan ~ Mlor . X71 (a CODEIL NW ~ DEMMORCONNNUCMWM pmxf"mawom _ lO 2„ If copper tubing Is used _ gq0 for water distributing System; piping shall be -il-J~/ _I ? 1.- ~J~ i.~~\`i of tYpes K or L only gb ~F)4T OCCUPANCY OR _ USE IS UNLAWFUL I •!J ( 00 N '/4 WITHOUT CERTIFICATE - To f-r-- OF OCCUPANCY peQj--6-' -JU ld~G. Div, I WIG. ~tw~tY~, l PLUMBER CERnFXAT/ON N .C~YCODE GC~A PLi/sr'IC~ CT ^~r ONLEAD CONENTBEFORE v Wbt ~I~bI~~Z ~~l~rl a~-~-•~F'i'b$~l~ '~,i\G71c1 ; up" Ji CERTIFICATE OF OCCUPANCY z" fi Iu6 I~7 Skl 1?Ctt r a~p) 'LoCT TO MKT ~r n 11 v " P SOLDER USED IN WATER' SUPPLY SYSTEM CANNOT a / EXCEED 2110 Of 1% LEAD. Wr Mour~-EV rl X -fUpi:., ~ L'~.SICoNrA~aLat i~ol~i~"'• ~ox~ r~tzEG c~~,~. ~u~l L K,IT~ ~N17 11N1 5 . 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