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HomeMy WebLinkAbout23896-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-25076 Date JUNE 10, 1997 THIS CERTIFIES that the building NEW DWELLING Location of Property 3400 HAYWATERS RD. CUTCHOGUE, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 111 Block 11 Lot 11.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 18, 1992 pursuant to which Building Permit No. 23896-Z dated JANUARY 22, 1997 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 & OPEN PORCH AS APPLIED FOR. The certificate is issued to RICHARD & MARIA CHERRINGTON (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 92-SO-74-JUNE 3, 1997 UNDERWRITERS CERTIFICATE NO. N-417143 - APRIL 15, 1997 PLUMBERS CERTIFICATION DATED APRIL 10, 1997-PECONIC PLUMBING & HEATING Buik6ing Inspe or Rev. 1/81 FOSS[ NO. 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) O 23896 Z Date .......January..22............................ 19.97.. ............... .. Permission is hereby granted to: Richard & Maria Cherrington ................................................................................ 661 Hawkins Rd. East ................................................................................ Coram, N.Y. 11727-1812 ................................................................................ to ......CONSTRUCT.A.ONE .FAMILY DWELLING WITH ATTACHED GARAGE r DECK AND OPEN ............................................................. ........................................... PORCH AS APPLIED FOR. ................................................................................................................................................................ at premises located at .....3400HAYWATERS RD. CUTCHOGUE. N.Y....... .................................. .......... OWNER OF PREMISES: SUFFOLK COUNTY NATIONAL BANK ................................................................................ ................................................................................ ................................................................................................................................................................. County Tax Map No. 1000 Section ......�.�.�............. Block ......�.�............. Lot No. ....>>:�............ pursuant to application dated ......,AUG: 18;.,_1992.... ................. ........ , 19 , and approved by the Building Inspector. *REPLACES BP #22017-Z Fee 5.......7.65.,75..... ........ .::�` ........................... i ldin.. Inspector Rev. 6/30/80 Form No.:'6 TOWN OF SOtTHOLD 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, 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. ,V. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 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 - .25c,. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . .fl�l.�.�. ���. f 9Y7 . . . . . . . . . . . . . . . . . . New Construction—/ . . . . Old Or Pre-existing Buii�l�dd/ing. . . . L .. . . . . . Location of Property.. ��' P.Q... . FI�LL:gAri .'A.Gz..•. � . . .(fGCTG./JA.�j: e.. . .. .. . . . . . . . . .. . .. . �l House No. Street Hamlet Onwer or Owners of Property. to' . �/CIC�?l . Get?4� /: �J:/Q ( :�IP�:/[o . . ... . . ... . . . . . . . County Tax Map No 1000, Section. .✓/./. . . . . . . .Block. . . . J/ . . . . . . . . .Lot. . . . . . . . . . . . . . . . Subdivision. . . . .. . . . . . . . . . .. .. . . . .. . . . . . . ./. . .. .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Permit No. . ��,! 942. .Date Of Permit. ./.. 17 . Applicant CAeC��!'d� Health Dept. Approval. . . . . . . .. . . .. . . . . . . . . . ... .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . PlanningBoard Approval. . . .. .. . . .. . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . 1/. . . . . . . Fee Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . . . . .. q�sk. �a 998' APPLICANT c©�a� 6 � � -61 of Town Hall, 53095 Main Road �. N Fax (516) 765-1823 P. O. Box 1179 t Q .c Telephone (5 t 6) 765-1802 Southold, New York 11971Ai,�, OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T I O N DATE: ql& J� 1 Building Permit No . 3 1� Owner: (please print) Plumber: Pt°1`r AI/ /2,11'mhtn�� (please print) �'� " I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ,,1 a P-1 ifnibe11g ure) Sworn to before me this day of 19 Notary Public , S'U o k-0 0L County BARBARA STE?NOWSKI Notary Public.State of New York No.O1ST4 44752 Ouafified in Suffolk County Commission Expires S%X.30,19V THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 11850177 BUREAU OF ELECTRICITY F 85 JOHN STREET, NEW YORK, NY 10038 Date .APRIL 15, 19'97 Application No.on file 13686897/97 N 41*714 3 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of RICHARD (-'HERRINGTON, _3400 HAYWATERS ROAD, C,'UTCHO:sUE, N.Y. in thefollowinglocation; M Basement ❑- lst FL ❑ 2nd F1. GAR/ATTIC Section Block Lot was examined on APRIL 10, 1`397 and found to be in compliance with the National Electrical Code. FIXTURE FIXTURES RANGES COOKING DICKS OVENS DISH WASHERS EXHAUST FANS OUTLETS RECEPTACLES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. 26 40 22 26 1 10.5 1 1, 2 1 r DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS I SELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. .W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT, H P SYSTEMS AMT. WATTS NO.OF FEET F L - SERVICE DISCONNECT NO.OF S E R V I C E AMT. AMP. TYPE METER 1-9 2W 1,W 3W 3 0 3W 13.9 AW NO.OF CC.COND. A.W.G. 1.10,pF HI-LEG A.W G. NO.OF NEUTRALS A.W G. AWP• PER B OF CC.COND. Of HI•LEG OF NEUTRAL � 2pIPl C):3 OTHER APPARATUS: 11tE.LL PUT-111-1 3 TON A/C--1 t10TORS; 1--F H.P. ,1-F H.P. ,1-3 H.F. PAITELBOARDS; 1.-•1 CJR. -X) C.F.C.I:--7 S110KE DETECTOR-4 L L ROSLAK ELECTRIC LI[:. #-3677-E GENERAL MANAGER P.O.BOX 164 CUTCHOGUE, NY, 11.3.35--2453 Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be idpritified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. L A W O F F I C E S Established 1957 SARISOHN, SARISOHN, GARNER LEB OW, BRAUN & CASTROVINCI 350 Veterans Memorial Hwy. Commack, NY 11725-0166 Fax (516) 543.7901 Tel. (516) 543-7667 Areas of Practice April 21, 1997 Accidents Adoptions Business Law Corporate Law Criminaly� Divorce I j/j DWI/Traffic Building Department Elder Law Town of Southold SPR Entertainment Law Main Road Estates&Trusts Family Law Mattituck, NY 11952 Personal Injury Real Estate Re: 1000; 111.00; 11.00; 011.002 Wills Cherrington, Richard & Maria Workers' Comp. Gentlemen: Floyd Sarisohn Enclosed please find copy of the final survey for the above parcel, which I Bernard Sarisohn(Ret.) understand you need in order to issue the Certificate of Occupancy. Ronald S. Carner Susan M. LeBow Robert A. Braun If any additional information or documents are required, please feel free to Steven L. Sarisohn contact the undersigned. Philip J. Castrovinci Walter G. Steindler(Ret.) V truly yours, Michael Garner Gerard A. DeVita John W.King Joseph R. Mercurio Jocelyn Posser ROBERT A. BRAUN Christine E. Rogers Of Counsel RAB:gr Dominic J. Baranello Enc. Alan M. Barrett Paul Creditor,judge Suffolk District Court(Ret.) Robert T. Krause Marvin Salenger Marvin Waxner Legal Assistant Gail M. Ringrose Elise L. Black Florence Prentiss 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) No22017 Z Date ................ ....T.................................... 19.11.' Permission is hereby granted to; � ... ............ ..........� ;��.......................................... ovwto... 4 ,.. . ..I-atv.. ..... . -f.�� ,... ... ..... . . ..... .................................................................................................................................................................. .................................................................................................................................................................. ........................................................./41: � ............... ... .. ....................................................... at premises located at.... �p.Q... ..................................................... ................................................................... ZP"4 r,k-ee<............................................................... County Tax Map No. 1000 Section ......lel........... Block.........�/,........... Lot No. —11,,.4............. pursuant to application dated .....4/. 1f..9.Z............................. 19................ and approved by the Building Inspector. Fee 7 . :f. ..�.................. Building Inspector Rev. 6/30/80 1 BUILDING DEPT. INSPECTION DATION 18T [ ] ROUGH PLBG. J FOUNDATION 2ND [ ) INSULATION [ ] FRAMING [ ] FINAL N REMARKS: Q' OF DATE INSPECTOR ass-uo2 sun.oINa oar. INSPECTION [XFOUNDATION DATION 1ST [ ] ROUGH PLBG. [ 2ND [ ] INSULATION [ l FRAMING [ ] FINAL REMARKS: DATE INSPECTOR �/�� T65-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 18T [ ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ J FINAL REMARKS: A//A t mw �i�Zla��IoMeA& Qkr f / .41 / DATE INSPECTOR 7 T6S•1a02 BUILDING DEPT. INSPECTION [ J FOUNDATION 1ST [ ] RGN PLBG. ( ] FOUNDATION 2ND [ NSULATION [ ] FRAMING [ ] FINAL REMAR 8: U))' A, 6 DATE IN8PECT0 L X65.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I�k4ULATION [ ] FRAMING [ FINAL [ ] FIREPLACE 8 CHIMNEY REMARKS: DATE 3 �7 INSPECTOR 23 �9�a� 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [V]FINAL l [ ] FIREPLACE & CHIMNEY REMARKS: DATE �� � INSPECTOR 1 MI I1 M. 1 L401 py ♦ rM c\ . BOARD OF HEALTH- FORM NO. 1 3 SETS OF/PLANS . . . . . . . . . . - TOWN OF SOUTHOLD SURVEY Y . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK TOWN HALL SEPTIC FORCI . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL.. 7651802 t:oTIFY ; Examined lr4o 19 9.�-- i � q CALL . . . . . . . . . . . ' o 1� i1AIL TO : XPProv A.1.o�1. . . . .. 19[? Permit No. Q97!:). . . . . . . . . . . . AUG 7 f92 Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . ' 1 (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . . . . . . . . . ... . . . . . . .. 19 . . . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 As 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 r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ition. e: 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 call 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 call 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 uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. he applicant agrees to comply with all applicable laws, ordinances, build*n code, hous' g code, and regulations, and to S inspectors on premises and in building for necessaryins c�' ns/� (Signature of applicanf, or name, if a or ti ) WLA (Mailing address of applicant) ;ate whether appl-cant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. v . . . . . . . ame of owner of premises '!' . . /��!L!/`a', (as on e tax roll or latest deed) applicant is a c tion, sig ture of authorized off' r. . . . . . . . . . . . . . . . . . ��� (Name and title of corporate officer) Builder's License No. . . . . . . . . Plumber's License No. e1�% ��C •1 � ,� /�'+✓ Electrician's License No. 11� . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . / ' r Loc ion of land on which proposed work will be done. �J• • Ce" �sr�t �o . . . . . . . . . . . . . . . . a . T' - - Ilousc Number . . . . . . . . . . . . . . . . . . . . . .. Street Hamlet County Tax Map No. 1000 Section ./41. . . . . . y� Bloc . . . . .//. . , . • , , _ , , • Lot . op �*�� D -r � I'M� Subdivision 1��,b. .�a VW . . ./!/ <(�� Cl Filed Map No. �¢ ` . . . . . Lot . . . D . . . . . . (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Intended use and occupancy . .&.. .,/. . .�r4i9rIl/L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Nal;r;e.of.work (check which applicable): New Building . . Repair Removal . . . . . . . . . Addition . . . .. . . . . . . ' ' . ' ' ' ' ' . . . . . Demolition . . . . . . . . . . . . . . Other Work . 4. Estimated Cost . 0 (Description) 1 ..�`fi° . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. If dwelling (to be paid on filing this application) b,number of dwelling units . . . .�}--(_1 , , , , , Number of dwelling units on each floor . . . . . . . . . . . . . . . . If garage, number of cars . . . . . . . .Z. , 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structures, if any: Front . . . . . . . . . . . . Rear . . . . . . . . . . . . . . Height . . . . . . . . . . Number of Stories . Depth . . .. . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . Rear . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front , pp. . ' ' Number of Stories . . . . . . . . • • • • Height . . . / �. . . . . . . 0 .. . . . . . . . Rear . . .��-d °. . . . . Depth ?y.u. . Number of Stories . .Qp.vL_cam 9. Size of lot: Front . . .//.4: .7 L . . . . . Rear . 5'r7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . Depth . . .3y ����Sr„�( Name of Former Owner -�,<i�. . .jo� � 11. Zone or use district in which premises are situated . . . . . . . 12. Docs proposed construction violate any zoning law, ordinance or regulation: 0 13. Will lot be regraded tt,� . . . . . . • • • • •.• • • . . . . . . . . . 14. Name of Owner of premises Will Will excoess fill be removy,ed from premises: Yes t Vo Name of Architect .1 •Address Phone No. ')A er"✓.. 4o" /�4 tr +. .//i►�N '' • • Address . . ,d ?�.T7�1�5s. . Phone No.ac -1,?6 sF. . Name of Contractor .`iJt`I?h! . . I,�u; . . . . 15. Is this property within 300eet of Address . . . . . . . . . . . . . . . . . . .Phone No. . . . . . . a tidal wetland? *Yes. . . . . . . . No.tl • . ,• *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and.indicate all set-back dimensions from property Lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK, COUNTY OF S.S 1 . . . . . . . . . . . . . . . .1�? ia-fj . . . . . being duly sworn, deposes and says that fie is the applicant (Name of individual signing contract) ibove named. D p ife is the . . . . . L�QI .Jl1 . .: �`C cert. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) )f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this PPlication; that all statements contained in this application are true to the best of his knowledge and belief;and that the vork will be performed in the manner set forth in the application filed therewith. ;worn to before me this . . . . . . �7 . . . . . . .day of. . . . . . . 9 • � . . . . . . . . . . ., 19 . . .E rotary Public, . . . . !a�� • . .. County CE M.MIXINS \ Notary Public,State of New York . . . . . . . . . . . . . . b No.4952246,Suffolk Cou 3 (Signature of Term Expim June 12,19,11.3 g applicant) Cf-lrY%vNq�av� 3400 A oLva- fms IROO A C��6ye-I Ny 11935 Apr;1 15 , M7 - - - - 13� 4'l � O 531 Square. �ea� C � W7" rjt CESSP09L 4 -WELL SUFFOLK CO.HEALTH DEtrY.A14ROVAl�, 1' 3..,v H.S. NO. M[I[IIod E1 scowdomm Rb1 bard M*IwR X k. f'! dd[rRindoR decd I.'WELL w a •\ L. PNOP. I L150- C�.'.'. 4 I � .� -!n Je ]i � � 7 � �, �1 1 P• I STA EMENT OF INTENT +� m (-)-13 THE WATER SUPPLY AND SEWAGE DISPOSAL \ l •� Z SYSTEMS FOI THIS RESIDENCE WILL SePl'c n y•y • CONFORMAy TA OS THE Iv G- 2:36 p SUF'OLK 5. A , ICA NS)! . - Y� L. _ SUFFOLK COUNTY DE7��3 /CLTH •[Uf SERVICES - FOR P R VALL// OF f is �U4 ' •' ry� \. CONSTRUCTION ONLY -\Y, ` �_�. I. ! �1 w:aw DATE: III aP H.S.REF.NO.: a 0� ` ^ r DWELL M AROV[D: �i PROP.SEFTIC _ _ �.�' f- _ i •t I n.a - aJ ` b-...-.. _ DIST. CO TAX MAP!LOCK T PCL. SECT L 01 OWNERS ADDRESS: •n f L A atz, ,� 24 '56 �CALf �J c- -. r DEED.L.8098P.-iso "leer)_ p�A4E N TE Id M .I M •_.- HOLEA Minimum d• ° ' ` �s"" •�to#le i60he1. ��� and ceSspoDi uuMu 1 ., ..ti,r:•, DIc.6.:vwN I� V`�1!"_ '•1 l I.:N II' .- r_`�' �'11T MAP AMCNOE�cAFR 26,Ic�p .1111 9 im LOAM _- LF SINGLE fA.r OMlELLOO ON-�LY f EXPIRES 3'-' fRpM DATE OFP"P[SIs r ""� eF w � • hEAL 4 SrRVIC,rS CCA:SE i N1 M=_ RO1l'�cli DEMq['VAN TY1(L.P.C. LICENSED LAND SURVEYORS R' OREENPORT NEW YORK <- _DFSgPooL �TT�LL - fT HOLE- � _ _ SUFFOLK CO.HEALTH DEPT.APPROVAL �. Gl�fy��EF'�j�7o�2 c;F=EC.6 NAysAt_Fi�INT CLu6- � - H.S. No. F'giF?�fitrlES N„Fi�ED IN THE SUFE ^ ' �a�C� '�iT-'IC6 ` `• � ci d MAP 1'KJ$t]B .. .-___ �w•EL�. "I LC4L•17�y4FtS.FdBFE2 jR MF.AI:SEA F•__r__. � � '� � T' I r j s Nous6 STATEMENT OF INTENT 1 _ ,Qj•� THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE LSUFFOLK CO. DEPT. Of HEALTH SERVICES. � \ APPLICANT b. 3+•e.� '� SUFFOLK COUNTY DEPT. OF HEALTH Z �/ i>7•`\ 4 SERVICES - FOR APPROVAL OF '; DONSTRUCTION ONLY rl2g � L �.� � N.S.REF.NO.: 79 APPROVED:45 N: SUFFOLK CO.TAX MAP DESIGNATIO b r>) Y ` I DIST. SECT. BLOCK PCL �_' \ 106 Qy,IP J r W � OWNERS ADDRESS: lozo e�ErlNyrr0nD O N 4r- SCALE-40z '. SCALE4J- /tri. �, r._F DEED:L.5O9B P.-ISO .var.. I G•MC !. C TEST NME STAMP m o-alae MAG E -IAM Q-— I i l /' "'l`, WIfvG.� W BVI -�a � ��� . — —_.-- ANGti AT MAP AMEhIDED-AFR.26,1�0 •• JULY 22,1yL2 '2.5 �..._.. jvA55AU. PQ-- ___-- _-jtJ _"w'9,�4 SEAL MWN OF,L;OUTHQL.V N.'Y'. — C�LArAurtt-g[ ' -THE .._. SECLJ w'rrY TrT-E Al aJAfiANTY:fi. :OAL�f, LL PNp TO SJFFOLK COUNT:'NA�'IOIJAL JLNL ;4',y�1°" `�' >- RODERI VAN TU -1\Y e LICENSED LAND SURVEYORS •T .' >2' 1 . GREENPORT NEW YORK \\•, � m siPr -HDUF l _-_ SUFFOLK CO HEALTH DEPT APPROV T AL r 4 s. jZ1 TF9AD.c,'F'a L.Q hIA.SaAU .NT.'lUB I H.S. NO 9Y-sc -7- �"C4E'S}NC FLED tN 7H&GUFF-CQ.�' t?R,i(,'rl Ji'C1i F. x O ZWf2S� gEFECL,7r}_ A{.. � A Cork- l \ r m - 14 \ iIse ! J_ STATEMENT OF INTENT J' - -- - �t F1 1 i THE WATER SUPPLY AND SEWAGE DISPOSAL _ y�•G ;d _ SYSTEMS FOR THIS RESIDENCE WILL �HBR¢'�uF('lEP \ �'Z CONFORM TO THE STANDARDS OF THE N. �y.��Zi�.- 9A`bwb eru 2'3i.� 1 / �, -- `I SUFFOLK CO. DEPT. OF HEALTH SERVICES. ./ T Sep H.T.W L :F-.. IBt _ V NOR WWIIC Pldlarx+ss 2 s ' 4L— 1+ S APPLICANT y IfL� @ !- ` .j SUFFOLK COUNTY DEPT. OF HEALTH 2� � � —I SERVICES — FOR APPROVAL OF CONSTRUCTION ONLY /� QIS -i Zrlxwroie� , 0 m�5� owe I RP7L . DAVE: yp ! - H.S.REF.NO.: 9`L-SO-'14 APPROVED: Ifl WP c �oLy7 ,,'� - ,�W y �1 1 1 SUFFOLK CO-TAX MAP DESIGNATIO 'flC*Mle l•�f " w+c swm-- D 1 O DIST. SECT BLOCK 11 . C. v- n.c.MO eik'. \ BDFF=CODMTOMARTEW 1134LTH lily ,p 9" OWNERS ADDRESS: or CIS POR . . r JIMI O t c L _ < I Tls ee..C�BIW� :Im wp*RmFIy LldTtn.e 3�sx hrR'aan .m � •.`. �\ ,. eaaa.a l;�aMat,D:�.�rauax•, malawaaa ' I SCAI..9 4D IRIS UM OF O P ml AMEA'4 z4-io -F. DIED:L-5099 P.Asc (CcF TEST HOILE gE:KaTWNer®pWealmaQNmMm® I� � D•FtPB - or f Ir.._ ✓I G'r L'� :� 1 II _ - il SAM •- wsmernama�: 1 s...,.. 121CHAl2D g MA121A CHEQQINGTQN lIw4M_ d MAP AME/}'DED-MR 26 1�0 GLIARIIN'{EE31 TO P.Ic..V/Pp0 t tAA.r _4A55AU_GQtNT -JUE.Y; MACIA C"FMIWTON, FIRST --- ye MY 219 JNION MCfLTGAG� COQO_, A APrz,3 5UFuclo2_A015 Q CT Cpa.F_ Ly •A - ._ ' MAYI 199"1 IWC FIT7GLl�W3T10rU.l,a :Dp,¢5[' � pr � 0 _- -- TITh IhiSURA'VfyB _OMgFN�; SAFr'G i 4 s RQD � (VAN nLvL P.C. Y LICESERID LAND SURVEYORS li a�}e asVg� BREEN►ORT AISW YORK ORyq VII �AIFn', yYJw Vi 5w . .xs%a'+' '`�.�'`,�� t y � 4 I� r jT Y { 1 T. h'SNx' Y I ' I I IMvJV I _�.. _ Yr :ry . „_.............r...m .. �...n_u., .....,.r., ...inti._, d ✓rd 1i _ r .. . , If It _ W ITn It �, - \..✓'j 1 - fr•• r_ 'r-- r�- f x ' ,,{ lY;l, �k ') �! d7,a'xC. \ r / Y I 1 _� f ., at P y tl a tyii;, of - I IT _ ,I 725 1 p _3- ' j . AS NDTE__ _'TI_._ _—I - C pnn �CA0DATEJP VDE D0,Ei NFEE BJ r � �rGV•A NOTIFY BUILDING +DEPARTMENT q! ' j TWO �g _ S FOO WING ON CRSS E l q+ POR POURED © ,10 S G - tE A 4 OR THg ., . __ - --I 7 Q _ FRAMING & PLLMBWG j' ( TIN , EQUIRE _I .. _ ._._ _ / _ MG NSPEC 4, r _ 2 ROUGH � 6 5 FiNA% a ONSTRUC,TION MUST , r, � t . BE COMPLETE FOR'-G'.0 /( U .' 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