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27899-Z
FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28721 Date: 08/21/02 THIS CERTIFIES that the building ALTERATIONS & ADDITIONS Location of Property: 1825 BRIGANTINE DR SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 79 Block 4 Lot 60 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 12, 2001 pursuant to which Building Permit No. 27899-Z dated NOVEMBER 14, 2001 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 ADDITIONS & ALTERATIONS TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to THEODORE H PARASKEVAS (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 1055638 08/12/02 PLUMBERS CERTIFICATION DATED 04/08/02 MATTITUCK PLUMB.&HEATING Authorized Sig ure Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 27899 Z Date NOVEMBER 14, 2001 Permission is hereby granted to: THEODORE H PARASKEVAS 27-20 27TH STREET ASTORIA,NY 11102 for CONSTRUCTION OF ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING at premises located at 1825 BRIGANTINE DR SOUTHOLD County Tax Map No. 473889 Section 079 Block 0004 Lot No. 060 pursuant to application dated NOVEMBER 12 , 2001 and approved by the Building Inspector. Fee $ 348 . 60 zi Authorize ignature COPY Rev. 2/19/98 Form No. 6 TOWN OF SOUTHOLD ^�ll h`1� BUILDING DEPARTMENT`S 27 TOWN HALL -- - 765-1802 , g APPLICATION FOR CERTIFICATE OF OCCUPANCY -> This application must be filled in by typewriter OR ink and submitted .©-4+cl buildingrt�t 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. 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. 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. 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 Buildine - $100.00 3. Copy of Certificate of Occupancy - .25%P 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certific�,atte of Occupancy Occupancy - Residential $15.000, Commercial $15.00 Wim" n \r� C-P Date .V(_9-V1zV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ew Construction. . . . . . . . Old Or Pre-existing Building... . . . . . . . . . . . . . . I J ocation of Property. . .��j?�. . .. �44�M1� . "!2. . . . . . . . . . . . . . . . . AQ. . . . . . . . . . . . . . . . . House No 11VV Street Hamlet ewer or Owners of Property. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ounty Tax Map No 1000,rSection. . . .� . . . .Block. . . . . .. . . . . . .Lot. . . Lo. . . . . . . . . . . . . . ubdivision. . . AA. 4�5� . . .`�� i,. . . . . .Filed Map. ?1U A . . .Lot. . . . Lnn�. .��...... . .(/. . . ermit No. . . ..,�AA . . .Date Of Permit. . . 1 .�l .1.0.1. . .Applicanc.—. . J)4nM1`�S DIQ. l ealth Dept. Approval. . . .. . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . lanning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . equest for: Temporary Certificate. . . . . . . . . . . Final C ticate� . . . . . . nn 0 ee Submitted: $. . . . . .eA . . . . . . . . . . . . . . . . At 6 � y . . . . . . . . . . . . . . . . . . . . . . . . . . . Co.� �� � � Town Hall, 5:1095 Maln nood ,■ (s 1 r,) 7�5•t';l t P. o. [lox 1179 � l rrlaplr7n9 (515) 7G5.le02 Southold, New York 11971 ✓' ',> OFFICE OF TI IE BUILDING INSPECTon TOWN Or SOU1•I IOLD •_c � it �t_ i [- I r t► 'r t n ri - un�rr:��o z— g --- Pu l 1 d i ng`Perm1L Pio. Owner. : �1e.iL��- . . (pleAse pr. lnt) Plumbers ��i�-•r�_�=__X_�v�� .�L�{�F:, (please print) I certify Lhat the solder used in the welter supply system contains less than 2/10 of J % lewd . A'I ri 45ern Slyn,3 .0 1: - Sworn to before me this day of Notary Publico - ur.mnly SARM M Mlllt 1Votery__ __ _ rsrm a l�ifoi.lWpm D crPJL3 rL3 rL3�r��rJ�PrJrJcn�nrJr�rJJ1PPr�rJjJ:IrMJ�r �FL3@n�PPJEffaPPPrJ�rJ�rJ@PrJ�� J�nJr : JL �LErrJ�rJ�rJ��PrJ�rJ� 5 BY THIS CERTIFICATE OF COMPLIANCE THE 5 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 S BUREAU OF ELECTRICITY ' r- r" 9 -rr 5 c 40 FULTON STREET — NEW YORK, NY 10 46 RC- 16 55 5 CERTIFIES THAT 5 : y 5 Upon the application of upon premis 5 JIM SAGE ELEC. INC. THEODORE PARA KEVIs 5 5 P.O. BOX 38 1825 BRIGANTINE DR 5 5 5 GREENPORT, NY 11944-0038, SOUTHOLD, NY 11971 5 5 Located at 1825 BRIGANTINE DR SOUTHOLD, NY 11971 5 5 Application Number: 1055638 Certificate Number: 1055638 5 5 55 Section: Block: Lot: Building Permit:27899 BDC: NS11 5 Described as a Residential occupancy,wherein the premises electrical system consisting of 5 electrical devices and wiring, described below, located in/on the premises at: 5 First Floor,Second Floor,Outside, 5 5 5 c5 was inspected in accordance with the National Electrical Code and the detail of the installation,as set forth below, was 5 found to be in compliance therewith on the 12th Day of August,2002. 5 5 Name OTY Rate Rating Circuit Tvne Amount 5 5 5 Alarm and Emergency Equipment 5 Sensor 2 0 Smoke $1.50 5 5 rj Wiring and Devices 5 Receptacle 21 0 General Purpose $5.25 5 SSwitch 10 0 General Purpose $2.50 5 5 Fixture 7 0 Incandescent $1.40 C5� 5 Paddle Far. 3 0 $6.00 5 5 Receptacle 1 0 GFCI $1.00 5 5 Invoice Total $50.00 5 5 5 5 5 5 5 5 5 seal 5 5 5 5 This certificate may not be altered in any way and is validated only by t%e presence of a raised seal at the location indicated. 5 5 D rJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�rJffl�rJ�rrrJ�rJ�rJ�rJ�rJ�r�rSrJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�rJr�rJ�rJ�r nrJ�rJ�rJ�r�rJ�rJ�rJ�rJ�rJ�rJ�rJ-r�rJ�rJ�rrcPrJ�rJ�rJ�rJ�rJrJ�rrrJ�rJ�rJ�rJ�r� o LIC.#'25245III PHONE 631-765-9105 FAX 631-765-91.05 COUNTRYSIDE HOTWECRA TERS Inc. PO BOX 238 PLCOPQC iNa' 11959 To: Building Department of Southold RE: Building Permit # 27899 Please forward Certificate of Occupancy, upon completion, directly to owner. Owners Mailing Address: Theodore H. Paraskevas 27-20 2711' Street Astoria IN :11102 Thankou, on Do suer L•'NC1tGY CODE CALCULATIONS (Lor Non-Electric Heat) Design Criteria G , 000 Degree'.Days � //// O. A. /lU°r I .A. 70°C FOR!: _ QYq,5eeV4, S PER: -?eAA /. �M��` 220 .9 182,!r o DATED: 6 2 . DESIGN T T1CRMCL REMARKS SUBSYSTEM ARCA "U" RATING 1;xL'erlot: Walls (OE)a(lue) 7z u ♦ 05- fi 77 GlaZltly 211 a2 2 . 3c{ —5 Doors ceiling/ Roof (Opaque) Gf2 ( U7 D Skylights Floor q 2/ 0 S� p Foundation Walls Slab Insulation TOTAL + 2 s Ho Les: Building Envelope Systems to meet requirements of 7015 . 2 HVAC Cquipement to nteeL requirements of-, 7U15- 11 11VAC Systems to meet requirements of 7015 . r2 Duct Systems to meeL• requiremeitLs of 7015 . 13 Venl'ilaL'ions Systems to meeL• requirements of 7015 . 14 Insulation of Yipir►y SysL'ems to meet requiremenL's of 7U15 . 15 Service WaL•er Heating Systems & Equipment' Lo meeL requirements of '7015 . 21 ElecL'.rical & LighL.ing Systems & Equipment- Lo meet requiremetiL•s of 701.5 . 31 PtE of NEW),o To the best of my knowledge, S�Q��'cE •. s�,9 belief, & professional , judgement- , these plans are 1.11 ` 4 cc us compliance w1Lii the code . W v 032254-1 P90f ESSIONP� 7/z b/ syr BUILDING PERMIT EXAMINER CHECK LIST DATE REVIEWED: l /-Lq/01 DATE SUBMITTED: I l/ 1 /01 APPLICANT NAME 004 � AS IAc C af�� SCTM# DISTRICT: 1,000 SECTION: BLOCK:_ LOT:Z 1 140.rboc STREET: l g�5 �a ►.rrw� CITY:C��t��e SUBDIV. NAME: 1,_1ycr5 PROJECT DESCRIPTION: Ac>, ,-,. —D �xt�r t1ryx•�T� At�, -�i i �_ ARCHITECT GINE (v a« FAST TRACK? ,u o SINGLE& SEPARATE CERTIFICATION-REQUIRED? Iu o NOTES: LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconfonning at any time after 7/1/8: ZONING DISTRICT: R-40 CONFORMING? REQ. LOT SIZE:'btoo, ACT. LOT SIZE:'" " REQ. LOT COV. 1001, ACT. LOT COV. REQ. FRONT o Z) PROP. FRONT �� -L REQ SIDE I S/W ACT. SIDE='�6/S/' REQ. REAR so PROP. REAR -0 WATER FRONT? ✓O DESCRIPTION: PANEL #: 6 FLOOD ZONE:_, AGENCY PERMITS REQUIRED FOR REVIEW APPROVALS REQUIRED.- SUFFOLK E UIRED:SUFFOLK COUNTY HEALTH DEPT: YESN , (BED#): DTE:—/ / PERMIT#:R10- NEW YORK STATE DEC: PRE-DEC 9/in5 YES o1 l0 SOUTHOLD TOWN TRUSTEES: YESo TOWN ZONING BOARD APPROVAL: YES o TOWN PLAN. BOARD APPROVAL: YES o TOWN HISTORICAL PRE (SPLIA): YES NO NYS ENERGYR NO EGRESS (18 H min.?4 sq total) VENT(SQ. FT. x 4%) LIGHT(SQ. FT.x 8%) BUILDING PERMITS OPEN/EXPIRED: BP /q C, -Z/C/0 HAVE PRE CO'S : Y OR N -Z/C/0 Z� 4 NOTES: FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR z SF SECOND FLR : a�o SF INIT OTHER TOTAL TOTAL: /_0�0 SF FEE FEE FEE 'OT /5( li- SF)- SF)= SF X$ 30 _$ 91'?.EfJ +$ 1':;D' Y G o TOWN OF SOUTHOLD PROPERTY RECORD CARD 11-7 OWNER STREET �' ( 5 VILLAGE DIST. SUB. LOT rZv�AS o, r6,4 Atrlk _ -DORMER OWNER E ACR. e K ( la S W TYPE OF BUILDING RES. � SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS `9ivy 134 6 77 X68 Pr✓ f'a/e��✓ . . 2 p d .d .1 AA/e / - e ur/ 4" 0 0 V C6 �r �`/ .� 5Ale-g 4 Doa.� -�3aar �Q /Ca�rarre �� W�-moo �d T �f�(.uCfKL G uv trr e a u �s o / /is 6 ,�* C° a / gid oo �20 9z 8 2i —Bp aoo73�o r% o4e�cs� sh �1 _ 0a6, - 3 -(_ IV AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH House Plot BULKHEAD Total DOCK Ci k',V 1a 19 �Pn. Rai}'°,•• ,� a ( .. .. �` k.e.• ,Aix 'r i��� ..■■■■■■■■■■■■■■■■■..��■■■■■. i,w = ■■■.■■■■■■■■■■■■moi■!�■■■■■■.. MEN■■■■■■■■■■OOMM MMIS■■.. ■ -= MEN■■■■■■■■■11■ol■■S, ■®■ - -- ■■■■■.■■■■■R11■Sl.E1s!NElliE■■■B■■ ■■■■■■■■■■■■a■■■■■■MINE■■■■ Foundation Basement Fire®® I Wells Place ,. Floor!Rooms Ist RecreationRoom 2nd Floor 'Dormer Drive �� 765-1802 BUILDING DEPT. NSPECTION /FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS: 1 4 DATE �V 1 I INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREP ACE A HIMNEY REMARKS. o/c, J i DATE INSPECTOR 'G 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION 91� FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY / / REMARKS: /-� « -�i�cg7r--4 el��c /,Lk opa /1,4d) 7. 0 l i C/U O"` �Cc�y a.�d .47✓�..�D !l/oi/l/i..,a rGri+// r'3 DATE a INSPECTOR M-1802 BUILDING DEPT. INSPECTIO [ ] FOUN ATION IST [ ROUGH PLBG. [ ] F NDATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL [ ) FIREPLACE & CHIMNEY REMARKS: /6- 1,2 DATE ��INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] RO PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS• DATE NSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN TION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY ��----�� REMARKS: DATE Oz- INSPECTO e i �w �_; - iii - ��`,�,. ��►,�,•�' .. I f � w►/ r TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIS BUILDING DEPARTMENT Do you have or sued the following,before applyisy TOWN HALL Board of health SOUTHOLD,NY 11971 3 sats ofBuildinz Plans TEL: 7654802 PERMIT NO. )y 74_ Saptio Farm N Y.S.D.E.C. Examined I1 12- .20 O / Contact:Trustees Approved 16 20 O1 Mail to: Disapproved a/c Phone: 76�_ D � Building Inspeetor- BLDG.DEPT. APPLICATION FOR BUILDING PERMITQF . . . . Date 2Q�2Z 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 waterways. 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 issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. 4 e.No building shall be occupied or used in whole or in part for any purpose what-so-ever until a Certificate of Occupant is issued by the Building Inspector. APPLICATION IS IIEREBY 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 necessaryinspections. (Si stere of ap�plicEitt or name,if a corporation) �6•/3.�x a3� r��niL�.l�._ (Mailing address of applicant) State whether applicant is owner,lessee, agent, architect, engineer, general contractor, electrician,plumber or builder ..+('c_c 11 A, Name of owner of premises —T60 e�(e- Lxn t. (as on the tax roll or latest deed) If t i signature of d o ' ed officer (Name and of corporate officer Builders License No. o? S ayS Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on whised work will be done: ch propo House Number S Hamlet / County Tax Map No. 1000 Section Block Lot !� Subdivision ,n Li!�L 4 Filed Map No. S/ (Name) State existing use and occupancy of premises and intended use and occupancy of VWposed construction: a. Existing use and occupancy t C b. Intended use and occupancyt! Nature of work(check which applicable):New Building Addition_Alteration Repair Removal Demolition Other Work (Description) Estimated Costt25�� Fee (to be paid on filing this application) If dwelling,number of dwelling units Number of dwelling units on each floor, if garage, number of cars i. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures,if any. Front o� Rear o� g Depth 3� Height Number of Stories Dimensions of same structure with alterations or additions: Front L Rear. ,;:P0 Depth Height Number of Storilt ` 3. Dimensions of entire new construction: Front 0 $ Rear a Depth �� Height Number of Stories t ' �. Size of lot:Front Za Rear 1 '�3 Depth 3 5-9 /x.11 AT'� sale v6� 10.Date of Purchase Name of Former Owner 11.Zone or use district in which premises are situated F 12. Does proposed construction violate any zoning law, ordinance or regulation: 2 �� 13. Will lot be re-graded Will excess fill be removed from premises: YES -TPSARi ,SIre 551313!�4,4�e 14.Names of Owner of premises Address Phone No.2(1,!5— 9lo 22 Name of Architect Address Phone No Name of Contractor .P Address •O i3 { ? Phone No, 9� S9//J";— Cr�-5 15. Is this property within 100 feet of a tidal wetland? *YES NO r/ • IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED 16. Provide survey, to scale,with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. STATE OF NEW YORK) Co. BOUNTY OF S L o na/o/ ,� c'na u,e r being duly sworn;deposes and says that(s)he is the applicant (Name of individual signing contract)above named, S)He is the Oo �C 0.0l. (i r (Contractor,Agent,Corporate Officer,etc.) 3f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; hat all statements contained in this application are true to the best of his knowledge and beliet- and that the work will be performed in the maimer set forth in the application filed therewith. Sworn to before me this 2-< day f Seoj 20_ Notary Public Si of Applicant SUSAN K TOOKER NOTARY PUBUIC,State of New YOW No,01TO5078120 Qualified in Suffolk county Commission Expires May 1 q G 20o 3 YUrr..co.NtALTN Ca".A OrO AL H- "Q -- oiIII���-y�. L•Y�l.ST�SCNC� �Zcxyihr�c_ SUFNOLK ,^.OUVTi (?}PrLTF. t R46 `•gooDEC_2 , m OgTL ' Sour 1/9.7t t19:7t �Zl.7f.3-IL39j Iho 3ovq, t.,�,,. E ',ti L tlr1.pJ F " .ri c.�•dt .gs� aald gun$ f1 'A/cMt$/,4ja►'s� * Lo be 77 V. M 1 F .sal y/l� o� IN yckc* As loo 73M W 1Ht,aW rOss sTAii OkAtf*N LAW, 1 �Ilti!OI Tj4s',SUvvvr uAv pOi aFARµW wt V,np SL'JV:ro SIA D S.AL DA iLC;uk SHALL NOi)F'coNsibum " O V ..LIB IPu A'RY ,. NAII RUM '. 4i,iontnFrilEupVf NrJ�e'7'H �3GYrlFIY ��ryyyyLStD :.y ;p 0. A Uanu'Mme iIA+USS[ Hi MQ 0 571. [S!I IHe Lukun01H511• TnTs caT+r,. ypsp r.ft,An,,NO w"Alu)lum m r f MAP Cly L.d7 6-G duaidrtta+d 1b, sYrw �� 77re 't'atF/e-'6L.+�w�r C��■tshy a , EMAP OF �-t4�2$O!L�/Car+T5E`ST3.-S�e.3`� and i�o t/,�..5ee�'6JiD�Sor/r�Eiasrt Y (S ffo/E Gou rIy mq, No.em 7) a5 ,urrRayctia.':lcily 7.y/4'i''r AT RODRMCR VAN TUYL. P. G . �q YVlEYV IOWA/OF-SO'«THOLO,N A �. Y "�- LIG L ANP SURVRYOR!-0Rt M. N-Y. Srwf}ofk Co.TdR Mai)Oesiynafian foi A-e,rriawal OisfloQo,.?scf.A79,QjNck T!!T HOLT PV".CO.DKPT.Or HEALTH PERVIOp3 •TATiG11YMf. IIrT NT FOR APPROVAL Or CONSTRUCTION ONLY - CIIoi THE W^7%R SUPPLY ^NC •GlWA6s regd.� DATE: OInPo9AL sYdTEYs FOR YNte RC61- D6NC■ WILL. COM.rORY To T}Ijj H.s-Are,NO.: STANDAIIDS Or"SUFFOLK CO. DEI{: ' Y OF HEALTH. SERVIOEl. „ APPROVAD: sl t� ArPLICAMY SUPP.CO.HEALTH DEPT.APPROVAL H.6. NO. owNSR4��ilhlSTAl�l..,r.: lCC7�titvt�.L_ ff•' ? + SUFFOLK ceu�[ f , 1 , -r74!5' .1#101GOM15:'o204D DATA DEC 21 IN ,. n. :•1 Z4 SOf "61 Cl N..Y_ 1197! J r e'e ::j: CTs 1.765-rZ39) The sowwE d:r` % e' ,r '.:.,.•ri., J, u�rAl'✓�/.eF(olo'69 j�. : tnag aL't. �� `.'. L,, �,-.. �"�jd':ound - /tB� - L° bo ss Ssa c?. r, � .✓"'( ftti. .� DEtmL'SSA�;p.)q� Chier of 'Gsn ral`:�ninee 1 Cos k: Waco iii h�JlirJ `y- '`•. •<t LE.,/-. 1" r .. '� I! I. „•. BHT. i� •I'� '., '2�5� � �� � x J --\tel � •>6.`�r -NSL.: = `� � �., � l .. '9�4` / �' , .y,„: .T A� Al ho �•.r�..�l � '.. Jd Y + lob`t I G'•YO .$ s 0'& &.'rrory�.n_rtf O'brpdn z , 1 •a.torr D THIS Is♦ IOUvOf 7m, 1M !WW p1M Of !N!M loE STAR m I IDUCApoM t#we: 4 ” CORU Of 1x11,t11vYn yAp MT NARIMO',: l-wb$11iYtycl S INrzo SEAL OR , hltfl9 SfAI JIL N CNAOi[ IF CQNSmey{q:�, I - O !A YAIID f.:uF00pY/ SMALL Rw .m II1''L 3511 M "'WW IME f,r.Yil A 2 /1/OQ i/{ .r3:+Y✓/E'lU' .., Ilv;SD4tA:n..c.lYt!annr]i. cu+tvN+I • - UOlS 123:41'&1 LST�F I,.:.LOM.•AMD .' . 11IE ASL1141: W 111E L114.,0 JAM'.i., TITLE CERTIP, Prrr6eM A.N HOl Tx MFIlAwu . L�// ..`• - AfSRIgI(A'1p11ilirf1011f w.w LQ- m 104P CC-= J' G� GGta✓dffFg@� �O sYAMP 'MaPOFK4e5OZLJGrt;`5E57%5, 5E::, ' The7if/C,�uart7Arf�o Cgyrr�Ses.p/ SEAL ondfa ti¢.,5cvilffrof .5avi xfz AL (fur /L' Co n!y Mai No,5I4;) P AY 414 :,utl� +ItAlcl 7.y/9T`I.': •&4YV1,5 W r VMDDJ'RRICK VAR TUTL. P. r— � LIC..LAND SURVEYORS.AREEN pT. N•Y. 5� rk Go.7be Mop GICs%q.af%oAr�o�prc ni�ea:CJ at/OaO,.Seef.0T9,$Jock 4A4.;et too— rEST MOLE SUPP.CO,OCPY,OF HEALTH 9GNVICEe1 STATEMENT OF INTENT O' FOR APPROVAL OF CONSTRUCTION ONLY THE WATER SUPPLY ANO SEWAOS DATE, DISPOSAL SYSTEMS FOR THIS Real- PENCE WILL CONFORM TO TMC' H.S.RCF.NO.! STANDARDS,OP'SUFPOLK CO. DEPT. OP HFiRLTH_ SFRVICIE9. APPROVED: ' Is1 ly A.pLIcANT OIA/t+IER 7 ,F, /C BUFF.CO.HEALTH DEPT APPROVAL H.S. NO. SUFFOLK COU:?:Y HEALTH nET'^ ti f745 OK-Oml,5-'szo4o DATE DEC-21�' .1' Sri E A �.!'. . z; 745-/Z_69} The, setii3nv:dad faciliti sa _ °'? A b" s3 ; ot:i . err: 5J dads 1r'. naoct o? by y :' c�hand r�� �� �:ound AREAs , iT. : 'to to sat sfLc'tory �� Chief of GenA~a7''En�lrie3ri>7 f] , Elr�icE;s r , i ,..-•w!�/� � .. ':'' ("�+.�tf to pool-c�us�tr Jgp� � � � 'a7 s ;a •'IV Q� •! C VQC4tT f scA + v _ a f � i i O THIS SURVEY 15 A VIOLATION OF , SECTION 7209 OF THE NEW YORK STATE ! IDUCATION LAW. COPICS OF THIS SURVCY MAP NOT BEARING^ _5D HE LAND SU VEYOf.'S INKZD SEAL OR t MBOSSCD SCALSHALL N-T.H CONSIDERED,' 0 91 A VALID TiUE COPY �� ,.p y ;w , uARANTCfS'1N�1'.A D r.rc4, UJi e HALL RUN MY TO TH C SJ 'F7 /. 6tM'THE SVEY +rte • S FCE:AS.LD /R D J it S C'dALT TO THE OOH.'A:.Y,.t,i:V{µ.dkLK7A1-,AliLNCY..AND ` I� AND:' �._�. - .__.---.._�_.__..,r...._______....._._�._•,,.,.___ .: -- ...._.____.,...... ..� .. A IMASSiG;;.ESS CT THE LfF4UYNG 1NSTl-.,r ' TITLE CERTIFY =ARAUTEES ARE NOT TRANSFERABLE ' .... - , .. •. ._:. .. - O J1CQt7i084htINSTITUTWAIS.OR;SW85E0UENT . 144 14 P 0= L O f 6,S' LJdrdf f7r��`�D h STAMP TI14e !'IL aHd fry L t1 �. ffxaxd.Savirjs 8�rld; - (5uf�=v./L: GavrrfL� Ma�� IYa.5147f _ � it' AT v RODERICK VAN TUYL. P. C. 4 YvIi w rte: Yuri�` 7"t-)wn10 e xrrH,0 L a, LIC.LAND SURVEYORS-GREENPbRT, N.Y. Sulk GQ.Tax M,ar� D<°si9rlrxtit�r�r for�r+rrrFiaee�l: Ort J�Op,..3ect.U79,8fIL�ck 4„L,of'�aQ, . ,,,�. .TEST HOLE SUFF.CO. DEPT.OF HEALTH SERVICES STATEMENT OF INTENT p " FOR APPROVAL OF CONSTRUCTION ONLY C ito1F THE WATER SUPPLY AND SEWAGE DATE: V DISPOSAL SYSTEMS FOR THIS RES1. f DENCE WILL CONFORM TO THEII E H.S. REF. NO.: STANDARDS OF'SUFFOLK CO. DEPT. OF HEALTH. SERVICES. APPROVED: (S) 17 APPLICANT . _ i 7 A T �.. UNDERWRITERS CERTIFiCATE REQUIRED A VED AS NOIEO ; DATE: 6 B.P.! �J Ig.Ea ' N TIFY BUILDING DED^FITMENT 765.1602 9 AM TO 4 i FOR THE ! Fry r rtvm+c INSPECTICt2F: . n_, ' ! 1. r•• - "'�N • 71mn REOLITIFD LII F -;7 Ci?NCr2�E, 6 . - IMArAING & PLUMBING C �' _ 0. FINAL - CONS',RUCTION MUST BE COMPLETE FOR C.O. v a h- ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION i ENERGY -CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS 1 OCCUPANCY OR USE IS UNLAWFUL PROMDEANTI-SCALD AND/OR WITHOUT CERTIFICATE THERMAL SHOCK PREVENTING 12 OF OCCUPANCY DEVICES AS TO PART. 902.6(K) �' — N.Y. STATE BUILDING CODE. , ,. �\ PLUMBER CERTIFICATION ° ON LEAD CONTENT BEFORE _ CERTIFICATE OF OCCUPANCY SOLDER USED IN WATER — W j1 ; ' SUPPLY SYSTEM CANNOT aa EXCEED 2/10 of 1% LEAD. w 'm '-T I • ` i � l � l � � : ! : � � ' ' i11r PLUMBING r ALL v j I I ALCUMBING WASTE Q O INATER LINES NEED It —FORE COVERING p > o i � ! SII I ? I I � I � IiI I { I 7 r i t i X 3 0 I � I I ! f ! � I i I � I lig PROVIDE OPENINGS FOR 2 Z EMERGENCY ESCAPE AS REQUIRED BY PART. 714 OF N.Y. STATE BUILDING CODE. Li��� I � � I� Y"rT` ODI-IG1 70 - If copper tubing is used ! ! 1 I I ' ! i • ' i mat i✓>,�,'rte-( for water distributing sysceni; piping shall be of types K or L onl ---UNDERWRRERS CERTIFICATE REQUIRED PROVIDE SMOKE-DETECTING . ALARM DEVICES AS TO PART.721.1 _ N.Y.S BUILDING CODE. p - aF pF NEW Y0 ice 94 S • . W p - ._ '70FESSIONP• ......_._ � � e � CE CD r t 77-7- 7 7 (D x G a 0 a4 pF NEW ko oli 27 :777 777'� f. i r 1 17 M . 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