Loading...
HomeMy WebLinkAbout17668-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 218336 Date AUGUST 31, 1989 THIS CERTIFIES that the building CONVERSION, ADDITION, ALTERATION Location of Property 195 GUTS, POND LANE GREENPORT House No. Street Hamlet County Tax Map No. 1000 Section 35 Block 04 Lot 09 Subdivision FORDHAM ACRES Filed Map No. 3519 Lot No. 13 conforms substantially to the Application for Building Permit heretofore filed in this office dated DEC. 2, 1988 pursuant to which Building Permit No. 176682 dated DEC. 7, 1988 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is 15sued is CONVERT EXISTING STORAGE BUILDING INTO ONE FAMILY DWELLING WITH ALTERATIONS & DORMER ADDITIONS. The certificate is issued to BARBARA B. PICREN (owner, } of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 88-SO-135 AUG. 21, 1989 UNDERWRITERS CERTIFICATE NO. PENDING SLIP 7/27/89 PLUMBERS CERTIFICATION DATED MC SHAKES PLUMBING 8/24/89 uilding Inspector Rev. 1/81 $osas xo. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT ffHIS PERMIT MU5T BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N G 17 6 6 8 Z Date ....l~P~~.~ 19~~i'. Permission is hereby granted to: ~ .....ylJ......,~~,.... ~i~s y ~i' ~J /f . ~ ct premises located at . /.~..~~....G,?:.~,r ~,~I.ZfJk.C~ . ..........................................~~.....~.r....~/.I/r~~~.~............ . County Tax Map No 1000 Section .`.-~.?f Block ...........Y'.... Lot No .......1... pursuant to applicotion dated .1~..~ 19 and approved by the Budding/~inJspect~r Fee $ . ~yr~.~.. ..5...~ . uildi Inspector%~ Rev 6/30/60 0~ 1°'_ ` 1 ~yv'- P~ ~ TOWN OF SOOTIIOLD { ~ BUILDING DEPART2ICNT JUL 27 ~ TOWN IIALL 'OUTIIOLD, NEW YORK 11471 BLDG.DEPi. TOWN OF SDUTHOtD 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCIIPANCY DATE . ~.~t.~s~.:',Z 4 1Q 5~' . NEW CONSTRUCTION ...._..OL/D Oc,R PRyE-E%ISTING BUILDING_.+C.._VACANT LAND......_. Location of Property.l"~.Y..'N:~~.(1:h~_~~`:~:.......:%~"~.~.°:~6'E~......._._ BOUSE NO. STfR?nEET D MLET Ovner or Ovners of Property.. f i4~~u^:'.... County Taa Map N~~fo. 1000//~~~~Sectioa .35.. Block Lot Subdivision. ~r~? nQr?..lS[4l.eS.. _ _ _ . Filed Map . ..Lot..... I . Permit No. ~~~~.~._..?ate of Permit~°?,~7/.SS ~ r`. ._._Applicant 4`~k-R... Health Dept. Approval Underwriters Approval._....___.__.. Planning Board Approval Request for Tempora~rJyeerr^^Certificate Final Certificate Pee Submitted: ?:?:.d. U a!.1 C,~~ z ~ ~33~ QQ l~s/~G APPLICANT. E~.1~L'G+lr.2.~'..~ _ . _ 3fll S~ rev. t0/i4/88 n 17~ 7&5-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG, [ ]FOUNDATION 2ND [ NSULATION FRAMING [ )FINAL REMARKS: ~ _ ~~~~o . DATE > ~ ~ INSPECTOR 1 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [FINAL REMARKS: ~ ~.a q~ s~ DATE ? D INSPECTOR /~~P (P 765-1842 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST ( OUGH PLBG. [ ] F UNDATION 2ND [ a INSULATION [ FRAMING [ ]FINAL REMARKS: ~~s~-~ p - r7~'~-" 2 DATE 3 INSPECTOR THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1000663 BUREAU OF ELECTRICITY BS JOHN STREET, NEW YORK, NEW YORK 10038 D.a AUGUST 10,1989 APPlkotionNo.onftle 611Q8389/89 N 086337 THIS CERTIFIES THAT molly the o4ctrtcP! puipaaent w daecriMd 6ekne and inereduced by the epptleant nawred on the ohooe ePPlication number in the premiew of BARBRA PICKIN, GULL gPOyN~rDteLAME, GREENP~OryRT, N.Y. in thefolkkNrinE ~eJUL7f 198y nt ~ /At FI. lJ Ynd FI. .Sertiun Block Lot uee esemiwed on and found to he 7n rnmplience with the reyuirementAOJ thit Board. FIX1{ME AQK fYY1TClIlS RX RANOB COOKIIIO DECKf OVENS D15X WASHERS EXNAUST FANS OUTLETS INCANOESCENi.PIUORESOENt OTNEP AMT. K.W. AMi. K.W. AMi. K.W. AMT. K.W. AMT. X.P. 1.7 29 17 .14 3 5 P DRYMS RRINA07 MOTORS FUTUM AFRIANq FEEEEEf fMOAI REC'FT TIME CIOCKf ERt {NNiNUnRE MUlT1-0UT1lT OIARRIERS NAT. K. W. dl N. P. GAS N. P. NAT. NO. A. W.O. AMT. AIM. AMT. AMK. TRANS. AMT. N. P. ~ ~ ~T AMT. WATtS 1 30 SgVK1 OBGOFB~MCT NO.OI S E R V I C E AMT. AMr, me , J eW 1 A ew ] A eW t A AW K~CrCOND. d CC L ~ NO. OF NI.LF6 H NO. d' ~ Ale d"'NWEU1aMl 1 aoo ca 1 x 1 a/o 1 a/o oTNER ARARAIU:, ELEC. BOON NEATERS:a-1.5 K.W.,7-1 K.B.,1-.5 K.N.,2-2 K.W. ELEC. BOON BEATERS:1-.75 R.W. PANELBOARDS:1-18 CIR. 200 G.F.C.I:-5 SMOKE DETECTOR:-1 / / .t~ GLENN R. BRADLEY LIC.i1227 P.O. BOx 602 LAUREL, NY, 11948 OMEERAI'RYIEMpRR+• 11 - ' - Psr ~ This cerfiBtoM pares rat M ahand in a maroMr; Morn a tM offks of eM Roard ff inwtrM. In n m be ideMifiFd 6Y r trRbntiok. COPY FOR 6UILDING DEPARTMENT. THIS COPY OF CERTI MUST !E ALTERED IN ANY R. : ti TEL. 7G5-1802 ~pc~~FFDl~~~Ol~, TORN OF S~~tTTHOd.D - _ ~c OFFICE OF BCSILDII~iG INSPECTOR ~ ~ ~ ~ 0 o „ ; P.O. BOX 728 U yE ~ < TOWN HALL A(fG B ~ U O 0`r SOUTHOLD, N Y. 1 1971 /r~ol ~ TOWR OF SOU HOLD C E R T I F I C A T I O N Date ~5~ d 9 Building Permit No. 6(p y Owner r°` 1,iC .Cr.? (please /print} / Plumper 7 P ~efti~r~ ~~umb/n~ Z~j,~~/D (please print) d I certify that the solder used in the water supply system contains less than 2/10 of 1g lead. . %~P~~ - ~ (plumber's signature) Swor ..o befor^_ me this day of __~~~IgLIS~ 19~_. No ary blic Plotary Yublic,~~/~County JAMES J.CORCORAN NOTARY NPUBl6J2C'NawYaAc Ouaitnsd in 6+Mdk my Commiseien Expires Msrch~'JD; ~1Y ~'AN , f ~ fR 90 ~ ~ 1 TEL. 765-1802 O~~~F~t1~Cpp TOWN OF SOUTHOLU y~ OFFICE OF BUILDING INSPECTOR o Y-„ : z P O BOX 728 c°r~ ` ;~'F~~ : ,,„c TO~~'N HALL `'p~y~0~ SOUTHOLD. N.Y 11971 C E R T I F I C A T I O N Date ®U'. 7. 7 Buil'~d~ing Permit No. tr/~ ]3 OwnerDfl~Qj~1Q.(~ ~iC~<Pv~ (please print) Plumber r .5.~~,,. ~ ~S .,,.,!_S>..-,~ L. i ~ ~v vK Lo~'~/ CJ (please print) I certify that the solder used in the water supply system contains less than 2/IO of 1$ lead. 1.l~t~'. U !,r'~ (plumber's signature) i SworO to before me this ~ p 7 day of ©~7o,G~C~~ ~~z%'~,=s~.~~-~ 19 G~. Nctary blic Notary Public, sUf'1~~GrK County CHARtE&F.Sl+ACEK Notefl' pa~62s-4 0 N Yolk Comm Wei min ~uliPgcCoNMY _ -L::LD i,;:S:'ECTiU;v ~~lli,TE ~ %OMCSENT° ^v - I, t m a - 3. FOUIdDATiON (1st) FOUNDATION (2nd) _ m 2. ~ ~ o ROUGH FRAME & PLUMBING ti 3 . 17 - ~ m m INSULATION PER N. Y. STATE ENERGY CODE x a~ 4, m H FINAL z ADDITI021AL COMMENTS: x ca ' x H \ ]i ' 9\ H H O ~ Z ' T m C a r H _ ~ b m c b w ' ~ f lLlyl~{ ~ ~ BOARD OF HEALTH 3 SETS OF PLA~IIS ~ . FORM NO. 1 SURVEY . TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM ' TOWN HALL SOUTHOLD,NY 11971 NOTIFY ~~~o_!~'~~ C~ TEL.. 765-1802 CALL /a 1-7 G~ hIAIL T0: Examined I. / 190 . Approved /.a~~..... , 19 S~Permit No (?'6'6~~ Disapproved a/c ( uildin^ Spector) TOWN OF SOUTHOLD APPLICATION FOR BUILDING PERMIT t Date IS INSTRUCTIONS a Tlus application must be completely filled m by typewriter or m ink and submitted to the Buildmg Inspector, wi ' sets of plans. accurate plot plan to scale. Fee according to schedule b Plot plan showing location of lot and of bwldings on premises, relationship to ad}ommg premises or public sti or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this a. cation. c. The work covered by this application may not be commenced before issuance of Buildmg Permit. d. Upon approval of this apghcation, the Buildmg Inspector will issued a Building Permit to the applicant. Such pe shall be kept on the premises available for inspection throughout the work e. No buildmg shall be occupied or used in whole or m part for any purpose whatever until a Certificate of Occup shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Buildmg Department for the issuance of a Buildmg Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descnl The applicant agrees to comply with all applicable laws, ordinances, buildmg code, housing code, and regulations, any admit authorized inspectors on premises and in buildmg for necessary inspections. `.~:4-~1 cum. , :~'~r; :~'<c;~?c.C...... . (Signature of applicant, or name, tf a corporation) (Dfailmg address of applicant) ~ State,pwhether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buil~ ....4C4~~.... ~..~QOI.r'?fis!L...... . Name of owner of premises `QJ~O:~`.'. ~~~'C.~~-7L-~ . (as on the tam roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . (Name and title of corporate offi/c~er) Builder's License No..~~C'/`/~Se AFL? . `7l~ h~L Plumber's License No N~S~!'t r~S .~1(hiY1J,/.lC/ . Electrician's License No ~ ~fnn 4'`~~~ l ~ Otter Trade's License No . . 1. Locauai of land on which proposed work will be done 1.~~ ~ t~Jl . P.~n~. 4~.~..~...~.reerlpp~~. . iV~I,~ ~ v~ ~ House Humber 2Street Haidlet q County TJ~ Map No 1000 Section ...~J.S• Block , . ~ , , , . Lot Subdivision Filed Dlap No Lot (Name) 2. State c~tstmg use and occupancy of premises and intended use and occupancy of proposed construcUOn E~isung use and occupancy fU:~4~ 2... . s J~ ~ry a.>:s b I Mended use and occu ancy ~ ! n ~~~t ~ • • ~ u~~{.r p ? ~/FE~MM..,' ~Tr_y.,. . ~ "}/H..`.~ 1~V•~vt. t~IL' IC1r .+n'Y 3. Nature of work (check which applicable). New Budding Addition Alteration . Repair .Removal Demolition Other Work . _ (Descnpti. 4 Estimated Cost ~ .~y (1 ~ Fee . v (to be paid on filing thu application) 5. If dwelling, number of dwelling units J Number of dwelling units on each floor ~ If garage, number of cars b If business, commercial or mixed occupancy, specffy nay ure and extent of each type of use ~ . r 7. Dmtensrons of existing structures, if any Front ....:x.~... Rear ; ::..v? 5 ; :Depth : ~ ~ , , Height . Number of Stones , Dunensions of same structure with alterations or additions Front .;2 ~ , Rear , , , , , D i ~....h........ Height ~o? .J. i... Number of Stones t. , . 8. ~io ntue new construction Front ~ ~•7 .Rear ~ ....Depth . , :?,3.. , Height .7~rx~. ~ .....Numb f Stones .yi , , 9. Size of lot Front f V.?'- Rear . .....(.Q ~ ~ cpth t~. 10. Date of Purchase Name of F,grmer Owner ~t2 ~jJQ.t"~(!i!~/.*,~/. ,(1i(;C>,C,.~t 11 Zone or use distract m which premises are situated tl~ 1 C:..t.'¢4)1 /(r {Y c"l.te_. . 12. Does proposed construction violate any zoning law, ordinance or regulatio/n: A,j,~ 13. Will lot be regraded Will excess Pil b removed from premises. Yes 14 Name of Owner of premises k%Gl~ltil:~ ..~l~t~/.fin.. Address i~f..~4~€~~'1~.J' ~ ~ hone N4~'~ ;3~ Name of Architect y~Jtw)~~-!C~• Ff'•i ~~t'..... Address .~G,f f i `h:4C, (C /.(-!}'hone No.: ~ ~ Name of Contractor .l.~l C~:.~1.=~~ ~d :J].=:~t~'. va Address 1'~11~.17~ i`2 i.~. ~ l4Y. Phone No. r~~nnnnnv~~~~~~l~f,'. 5?(,,~ 15.Is this property located within ~00 feet of a tidal wetland? *YES.y~.NO... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate cleazly and distinctly ail buildings, whether existing or proposed, and, indicate all set-back dunensions t property lines. Grve street and block number or descnphon according to deed, and show street names and indicate whe intenor or comer lot. STATE OF NEW Y~~(~ (1/S S COUNTY OF . L h , , .......~~ba~ C 1.~. ~ ~t~.~ being duly sworn, deposes and says that he is the apph (Name of individual si~nmg contract) above named He is the . . (Con[rac o agent orporate officer, etc.) of said owner of owners, and is duly authorized [o perform or have performed the said work and to make and file apphcatton, that all statements contained m this application are true to the best of fus knowledge and belief, and that work will be performed m the manner set forth m the application filed therewith. Sworn to before me this day of . i `i 19 Notary Public, ~ ounty ~ ly.A.A1RELd1.EYV 'e(J.0?l~{jQ''`~'- ~'G °~~f..a1~ .........o...... PP tlelnyRN o, p~rygrt (Signature of a lie ~fNied hr 3uMoNc Cp+nty (kfmmtsnloq 6iWres oac«nber 8.19 _ _ I 1[ _~yi..° of ~ ,a r' ~ r#Y" r ~ 4 ? 11l mac' y~ w` ( LL, •,ii ~ n ~ ` U1 n- ~ ~~Ob ~'9, t;'; 'f,t. 7. ,yt: }.s blC ~.i ~S ,.r~ r(~, ~tY / ~Y•- { ~ti~ iti'{ ~ ` i r 4 C :i}~~aL;171s r.-` ~ ,,.y^'+~ _ nr~ ~ ~ ,,,,,.~E .t ~i'`I,~ } ~ ~ '~ni:~~a.~~ ,mot ''~,,~4 1'•"Q~-* r..Y tRO ~ 1 ~ ~~.'{}4,t`,aa4~.~ ~f''3'y 4t '4 ~ , ~~~r~ G~ ; ~ ;S `~3r ~ ~j' [t~~i D{~~Fr. s~ii ~`t ^t { 11 ~ } 4~ 1 _ ~ t ~ } rt~-" ~ "5c s t,3 ~ ~'s ? 41. ~ T,,. , ~ c ~ fi ~ ``r^~ ' it ~ ~ ' i'1 tS I;~i1~ ` j : { ~l~ ~4 ~s t4+ ~ _ a .SR, Tw ~C~ ~te"Uy ~T~d ~ ` ~ `y;. s ~ .t r> 'y, ~ a!'4ti r < tr3 ali• ? l•,ys ~ ~ J ~ ~ y 5 } 1' {'?,..1.! ti.. ~ ~"{s~. 'M1 U3. i~~~ NG Cl jq~'^'~~ S 1 a t~ r~.. a» .A r 1 f .aY t ?tr ;~L ~±o .r t14^, i. ~ i ~ ~i~ ~ mow.. , rA, C: ~ • 1 , 4'1 ` _ F~ i 7 #s n, z a i e e ~~r~ ~ ~y~ 7 i' ~7~.! .1 { ! r} • t,y~r 1. ~ ~ ~ 10 xf ~ i > CI f ~ ~ 4 1 ~ 4i"; iii +t`'.. ~r `,~cy ^,?i . _ ~ g~` ~v =F!1 r • `1t t- @ 4(~ is i ~i1ri ~ ~ ~y`Y Y ~ `4 r .r ^1 ~ ~ [ t, ~ n ' X < 'a 111 µ l['f~ ~ 1 }A ~i ff - r' Tr r ~ 1 ,.1• M i~4t"rXX f i~ ~ } [ 1 s ~ ~ y~' ~ ~ w. ~~a tfi~ .,I `l` 1 r\ r- .r is E. "?t-k. ~"Lc fi S+t;w.4% . ~ C;1 ~ - ~ ~ u^ by w1 ~ 'yi l f ~r th 1 ~ ~ ML .,y 1 i S. ~ < ~ 1 ~r~{ 1 %'i 4 \,i w _ ~ 1~ ~ ~ ~ . ~ . ~Vr ~~f y~~%~.~ 1 G . ` _ ~ r~~ T ' .s.,~ N NCQ~4~'n ~ t~i ~t ins C b ~ 3 ~ y^ ~n ~ 1S1 ty ; 3 t~ s`{ p n ,t x z :fit to z } G ~ ~ ~ ~ ~ ~ n ~ zfi S~ s~ ti -t "JS Z O i p w 'u1 x a P o C. =t t. 1 ro d a ~ ~ 1 t p7• • , ~1 ~ ro i 3 ~ ~ tA" ~ f7 AC1 Z O -s7 ,.o .one- ~ ie ^N ~ , 3Y L u ~ y , Y £ ~ ~ ~ ~ r ~ A ~'7~ ~ag4a r3o ~eo~F ~r~, tA,. ~ ~ ~ r !C ~ " `e~"a w °a m ~ 3 '6 2',i 4il' ~ `O rTa„ 'YL 'T, ~t•`f`sY 1~r~5 f 6~ ~ ~ 3 ,,°FyvR " s - eo.6:.' vaoP~. Fiw. d~svE F!ttsr. oe..~ - 4tIFF'OLK CO YAt. l+B~A6TN APP110 ' ~ istarx~ ~_9.br~ 9:z ilhEM. - (yam` - ~ ~ ~ - i 8.9+,4ve i ~ '+`rE. N.S. NQ. riJQ _ _ _ _ _ _2 _ 1 SAN - WA~e ~ru~~~ r~rz `\t ~ l _.o.Yt CrJQ~U1JD W4'T12 - y,o- Mlnl tt1 MIN, t0 _ _ _ rp,r~ y t p' ~~,.A~ 1 y ~ 1~ ~ ~RGT 12 I ACF. IY L~__^~ ~~rr \i 4. ti,.,.r /_r~tf \a TS ~r _ p F..... y'Pub WATEtd L:I~E .J'~I~~TS 5FiC~.i,L fiE A:7 +.LAST 1., 4"!t(,rh• :tE L >kti: T' ,~F STATEMENT OF fNT~T 51A16 ?s~~ ~w~r, t_1rJ~ ~ 5Ew.G-~L i +n~B :BALL BS' ~~NST¢'- ~~j' FHE WATER SUPPLY ANp SE"WA6E d1BliP76A1 op' A+~a~~k'IatS ~R .iOlt.rt6 -rsta'r aGc64u+vi4i.EtJ'X "i+C ~zttA`~~ r~rs:ei 9a3, OF C~-N'S'siZ1J~T'rON, ~^'~-L ~ V~t~I`Y~'(~i SYSTEMS fOR TNtS Ri5tC3ENCE W11.L ~rs> ASS wpctE3°tkfi4?"rtt~_r~ s'sat~4. ~ Ce4t~wf=4t_t',.tt<1fa- CCrNFORM TO THE STANpAt~DS OF TN6 ~1 ~ i~t !~x'HO_~ N.Y. SUFFOLK c0. aEPT. OF Nt~?t.Trt~xvicES. ; i t~ ~ ~ i~ ; wa~ar.fi t,. APPLICANT ~ t?lBfplYtgD Lt~CA.4F+ t.,~w tarecd~u ~C'~.iTEi.~~~`i~~ ~ ~:..,4' xt~ ~ SUFFOLK COUNTY 'DEPT. OF N~iAiTN ' ,U ~ `fir: ~ LPldif, ~ B~~ I t \ a~v.cAeOt~S,reI=C-rEcL~s' _ , r, SERYtGES - FDR APPR~YRl. OF 1 t Cot~sTRUCricitt C3ttILr r. - ~q::; rr+~ _ tr ~ t`+u~n.a:~~c ~~~y 1 ~ N. 5. REF. FIO.' a~- 1 v y, !"ail -f - ~ r } ~ APPR ,q~ " ~ ~ ~ .>,.due. y;,. ~ ! ~ ~ FOLK Cp. TAX MAR Tt ; d i f!', -t1.~ tt ~ e ` ~ - - hF:~ c5 I SEEt. BLOfK PGI. / r ~.-r ~ ~ ~ k - y, ~ ~ j - ,.txuYa~;KV . ,x f 19'5 GI.SC_l. PG~(p tfaNL~ i~} 't ` J£' } ; I~C~A+~.I`~,SCXJt.S.F, GEEt1~t.5 ~ i I _ ~ ~ ~11 ~ l ~ E~ r _ r~ulrs~t~~' H tt11++ 1 woo x r,331 ~ ~ ~ i ~ ~ ~ ati: nre'r a4er~tbnM M 4. ' r 1 F" : ~'3!i,G '+OS'~y7~:. } ~ to- ~ o g , , Av rs o giotaHen os { ~ 7 _"-+~-''Fit.~. r ~ ~ _ ' l}MU.~. .report 4a W. tM New YAtk BteN I / Y Srt ~ _ ~s n4 rfirs s.rtveY Shalt mt MIMlq , t r ~ ~ c lN.ll~t1lit t, A.~? 4.f.:l i ~ _ ~ r~ tc :d surveyor's frdte6 seep d 1 op _ $Qt_. - ~A Y , ro ~:.~a sssl spelt nd[kle OOneNrteO - ! ~ ~ '9 pe a'Blid. tree GORY. ' t I~ ~ ; ~ - ~ 4r ruarantenti indicated hereon ehtdl Mn - ' ` ~ . F. r - or ty to tra parson for wham the sumC' .x: " 1 t - ts. reoared and tm his bshaHtotM r=~' [/J l 1 - t ''~.~ND T. ^:n 'H gowrnmenfePa` afl+ ( At~t~D Ivy/ 9 K~?$B . _ -wry 1~, 4~ , n n misted Mreon.enQ - _ _ _ to the zzai9naee d ~e lending InatF ' ' a - ~ itfiion. Guarantees er~tWttAndRell~ . - ~ tosfnibonil inetitWiene 0r iW4N9dwK , a~i~+.((~~~/ ~p~l]a~) j~~~rnh^!ryy~^~~~~ {7j [y~~/yp~~ ~~y/~y~ {r; ~~~+w 1.v1a Ia. t~lri:ai-S~F _T" M.-.." ~ 'J>•~ Mf~ aM~ , >u , 4 o,~ Q~1.7YiE_~: ~ ~,,.:.t',_C'5 C~FiCE A"a,;~'C1,4~ h~1b 3~ 1~'„ erz'c ~.~rrt~. ~ ^t ti 2, Eke ~fitQ~r TG# ~ ~i~"A ~~V~4.!(~`L,G V Q~ i R,,°~ F't~ sf.~ i~'7~c.^~ AS ~Y.~P ,,t~. ;f~ r~ara~ ~ a ~.1a 3EPT4 ~"ia?r t'fiC,~ttJ~Crw~ ~"'C?'ti' .s~: Yltt~r,~Yt. r ?»wt r~ ? . ~ ti yt1~37~ ~.It~~ Y~~"r :.F.1>~3" !f~" ?e~.~r -'...`!i~~'- as~~'__foP 1 16..` #i , t9: t,~3 A U ~ Q1 i~t'{" ML~'Y61RK ~ t ar+~ s , i ' ~ SUFFOLK CO. HEALTH DEPT. APPROVAL ~ ~ \ -..1yt-' - - - - I _ ~ ~ e ~ ~ :t . 1-r _ 9 H. 5. N0. ~ _ ~~,r ~?S?Al~lf.l~ ~0Io-~6't5 wt+Tidit qr ~ ..r, ' . SAN 1- _lti<1H i..~„_ .~l~V~Y~U ~~JI~. ~2' _ J T ~ MIN r0 ~ ~ ..q .Y f ' ~ t -.~.e-- Cvf~GU?JD W4'F~c1Z - _ M1N, rt;' D'.' .r~~ ~ !f"" es~ " 1 ~.o- ~",~cT, t2'z-'~AGT. lr'z + r_~?;E''~~~ li ~ ; l ~ ` p' ~er4'fGt<i ~1NE .;'~tf+ G'3 5ka;..t_ >3t? k;f '.-RA3r +G' ~'t~ - ~lE G,atwrr caF ls" - - ~ STATEMENT OF INTENT } l ;;Cyggt~,'~~~ ~w~ ~.-lt.~ i 5>_v,r~sL t.lb7~ :.~~-s~,t..l. 8~'.~rt5~'~¢;1~ THE WATER SUPPLY AND SEWAGE DISPOSAL •~:1~ ~ ~ OF MA`?~~;+AIS s JCilhl''<5 T14AT ~.'c 6:~111>A~t.F.!`.!'r `1G V.~A,`~G~: r ~ 3 ;N r gTpNC4sz0°_' OF ::.'~S~kJ.k:TrQnf I ~1JD S~:AI.L y~ vg~r~t-~,~ •~-;E•v r 3~~`rrF~• ~ t,• ( SYSTEMS FOR THIS RESIDENCE WILL 1 TU AS'~,ft2F VJl~"T~G:"firNT1V£'.~• *'~t~k. "1^u ~4CEGT$I..~..,M1C7, ~4.G.6f i(r..l CONFORM TO THE STANDARDS Of THE x; ~ r,.,1 rr'~'f#~ ~"~~__..~~~'~~f 4^':: ~"~~.:...N'~' SUFFOLK CO. DEPT. OF HEALTH SERVICES, APPLICANT j ; ` ~~1 ~PS.~I7~ LUCA.OF't +.lF1al t.4TG~S-.. . E~.~CT-~ TiQi-, aERVlCEt ijl3{24t~D 3 +E r:. rf' ~7L7 i ' ~G'~ WATq~ 1~INE., $tJG!;~"(? 5 ! SUFFOLK COUNTY DEPT. OF HEALTH ~ ' T.v.~r,~ty~:.llv,;;l:~,;~~' ,._E / SERVICES -FOR APPROVAL OF ~ ~ ~ z,-~ } °~h t ' CONSTRUCTION ONLY r4 ~ ~ _ ~'~"a'.E~::ttxTt. 1 ~~S'+' .~,y~~ a' rx,r i ~ DATE: C ~ ~ ~ ~ 2_ ~ t H. S. REF. NO.: ~~,~u; 1~,7-w~~~-~k~~;`q'+ if ' ~ t~ APPROVED: "RkIB'f:.ORd"rf~ . a. ~i'rp :..i I J a ' ~ ?8ET . ~ i`1 ~~'AfE+ ~ ~ .g' '..r LK M MAT ~I-a,R } j , ,i Y• 5UFF0 CO TAX AP DE51G ION ~,r, t ~i . ~ DIST. SECT. BLOCK PCL. ~ ~ ~ .ii~6i ~ uGC A45 ( - 'pf 7'" J•a~~'_.':i (rj ~i`~, lQ~ '~J.~.+ 4 ~ _ - cn' a ~ ~f?4, u ~ r,5 J OWNERS ADDRESS: n ~ ~s tl ! ~ 1~. ' ~ r1(c~.~~.~+~,#C'.i`, GEED: L. ~`'~`~L P,%'54 ' , i ~ ~ ~ ~ 1,~ ~ N!~.~I~i'~iCr ti` i~ TEST HOL STAMP Ul ~i F;, ~ nnn nr eC~ition ' ~ r ' M p' i'' .+~l.~f!-: ~rv~7~w~ ~ Q ! ~ ~ : ~ ~e r;aw Yorlt St»to ( nl r ~1TT't';~ C.i;~~. .'fir ~ .aElon~aw. . , i'~' ~~//tt f~ ? 1.11v A l u' ~ F"~ i~1~JS•^.)v a o! thls S~uwAV ratan not bRdrnp ~+APdUY le,id su.^.eY~ i~nG Saar a. I o0 ~ - 5Q - v - ,s;:M, sa91 shall nat. be consiAere6 ~ ~ n'x a +zlid 7ua occY~ " „ ~ _ p r~ LQAMY r. = rat=eY ms',rz+~~; hereon shall nln . ~ _c ~ ",rm fra prrson Tor wMm ~Y 1 _ ' ~ ~ r _ ~'~h~~G a .d on his behalf tD t'te I. p frt ~.rD1Mf9d, r v, 1 to f ' q`_~F~~Ci 1. ~L~~J ,~~'.n r.o+r~;sny, rtDVwnmeni^I ag9ncy 0r~ 1! 'mil- I,.r+,n~, m,flti!+.!Dn lfMe~1 hDraan nnA !n me as;"r,aes of tre lard'+np InTi- r.;,.~ror,ezs ere not fiancfDrehle I r;, ~ ~ ual inatitAtion6 M _ !.t.iV , ! ~ • ~ SEAL --I, l.Q'i ~~.-~~;r • ;4r F-r. ' ~ ~J ` ~~kx1~_ :'r r ;:ll L'I^f~+'~t P~f~k: ; ~ l i - iN r~~~'~t~FF ~'~.`;~~~f4l~'S ~Fi~:.k ~r,:z,^1"t~~~' lti~~:~'a..~__- Z.E?,.~^!l~ti~N_~_ I~~fi~f1 T~ ~EA~-~~~~:A'•.~.Vlr~,(N,G y,G,~ ^~;1'* t rG~.'1`~~ a~~ Ir~1 ~ ~;'~1G `C~ ~ 1G i.,.. ~~t ~ ~~J rl, ~ r ^,-=1. 1.^Sjh~t :~L~' f' l~ ; k ~ r [t r t ~u.~~'~v. R'1';" `~r-~"~ti'1 : r3~1`1"S?~~J¢,:1,...r~ ~s,r'(,}iL: '1'~+~, ROOERICK VAN TUYL P.C.I ~n\,yr~,, p`° ~~--!~=~~1`t~~ I~N.'~.1~E4~Y~, Wfifi~' l.i~~1~,h~1,. r ~ `~~~`1~- ~ J/ , 6.'~1~~ 'S t.IrW II.ET a it" ~ ; LICENSED LAND SUR YORS ~ t i~1•N~ I~~D ~ GRE£NPORT NfW YORK 4~ 1Elf0Yr+E AST NalJt9 i+ ~ ~ t I ~ i • ~ ' i S. 1.. fir. 1`1 ~ r L G}i' `u 1 1 L r :Y i Ziti: i~,~`~,1~ d ,~4+^"0 ~d' p"~'C1i u~4(t ~ t~T .ly ~ . ~ 1 G; -s^. ~r~A iii ~ ~ FFF M ~C~`tp p a e;l G~ eA A i, 4 ~ ~1 „1~ ~~i.r~ j.1 ~ _ ~ ~ y. stn _r~, ~ .a(,~ 1+~ ~y i i In ~ t~ t'~'V ~ ~ 11 'st.s ,r,l f. 1r `'i tC ~ M'' t`. B(~.j^~ ~I' p } ~y[ , 1" ' 1..,. ' i~ jiff ~ ~ .1~ ~ ~ ~ j .ii 1 ~ ~ 1 i .i f? ~i 1, ~'a ~ ' f`n ~ ~ '~6 n'tia tC „9 S~ -l f ~ ~i 7 ~ Y (C ~~.-a+ i + ~ ~ . ,T ' 4' E'rr ti t ~ ~i~ T` ~ l '1 to-~-~~ ~ ~ h ..~Q`,.~ ~j s ~ ~ ~ i ~ ~1'K~ qq '~`i ll~ ~~~b ~ ~ t, ~ i i~ ~ ~1 1 ~ nl,~ r 1. i• ~ t ~ " ~ y ~ 7 1"" ,r. ~ ~ ~1D fi' ,n 7 s.. ~ 1 1 If ~ ~ ul +'S ~ . t r+" ~ jy f ~ ~ ~ R'~y kw ~Y ~ ~ is ~ 6.,~ ~ 5 t' R ~ ~ r 1, y }r e i t` _ ~ ~ z ( '~9 n.. ~,,x .~i N~4J ' ` ~ 1 ~ ~a~? 1{t'ti ~i ^'l 41 .r~ ~ 1 c t ~ ~,~Z 1. - i'i,"r~_ 11 ~ ~ 4"?1;.. M i y 'Z' lit ._Y"~ "M~ ~ . ~~j--,~ 1 1 V 3 iq Rl ~ 1'j? .~.r..~.y i t 7p ~ ~ { ~ ~'R ~,~r ,~1 ~ 1 Z Z "J~ ; R ° -t ~ Q Q 9 sue' ~t ~ 70 } _ ~ y~t~'~, A~ ya ~ ~iZ M~ 4 y ~ ~ C ^Op m ~ ~ ~ ~ ui m "~.i 'v' A ~a m mrt c fix $ o a'^ N> ~ ~ .1 ~ ~ tl` t ice` v, O p ~ N O ~ ~ p ~ u1 1 tti ~t t~ p ' p' Z.. G x0 t n '~j,'1 1. ~ p O ~.a 2 T .y ~ ~ y~ ,.y ,z C\ c~ 1 ~ ~ -n -1 Ct -n J i i ~ tt1 ~ x: si %c ~ ~ 1 C3 ~ ~ Z ~ ~ Z t~ ~ 4 ~ i i p ~ t7 'c -t -r't ~et~~p~. ~ h° ag~ v~ j~,9 . ~ t ~ ~ q ~ ~ Pi F ~ too ArF~ ~ ~ ~ a ~ 3 i' i~' f m r r roe' o~~ ~9 ' °T~` '~s ~ ~ ° i ,p 2 O ~ us m r JCS ~w ~ ~r ~ ~ ~ "S ~ ~1 fY6R ~~K ~ ~ a