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HomeMy WebLinkAbout16853-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17494 Date NOVEMBER 7, 1988 THIS CERTIFIES that the building Location of Propert~ 17327 R.O.W. MAIN ROAD House No. Street County Tax Map No. 1000 Section 023 Block 01 BROMMGLOID Subdivision BY THE SEA Filed Map No. 6711 ONE FAMILY DWELLING EAST MARION Hamlet Lot 14.10 Lot No. 6 conforms substantially to the Application for Building Permit heretofore filed in this office dated JAM. 25~ 1988 pursuant to which Building Permit No. 16853Z dated MARCH 23, 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. The certificate is issued to CONSTANTINE & ARIS PAPAMICHAEL (owner, XXXXXYZCfXXXXXXXX) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDER~RITERB CERTIFICATE NO. PLUMBERS CERTIFICATION DATED B.P. ~11792Z EXPIRED Rev. 1/81 11-SO-79 H005752 OCT. 13~ 1988 CONSTANTINE PAPANICHAEL 11/8/85 ui~ldi~n~nspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT Cf'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 16853 N~ Permission is hereby granted to: .... .~.....O..~~..~:~.~ ............. .... ~...'4.~..~.:~.., ...... u.~.~..I ............... _. ,-~ ,.I , ~o..C~.~...~....,~...~0~4..~.~ ....... .~....~~..~ ...... C~ , ~ r~ C~ .#~, i~- i/I - ~ ~ u ~....~(~...~. ~ ........ t.....7..~...~..~ ...................................................................... ot p,e~se, ,oco,ed o,...~.~.~.......~:.~,.~...,....~~..~.., ........ .'.~,..~.., .................. County Tax Map No, 1000 Section ...... ,,~::~,,.,~..,,~ ...... Block ....... ..~..~. ........ Lot No .....,~...~..',.~...~ ..... pursuant to application dated ....... .~.~f~.../...~ .................. , 19.~..~1., and approved by the Building Inspector. Rev. 6/30/80 FOI~M NO. 2 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) N? ~1792 Z Permission is hereby granted to: ' ..... /.7......,~...../.~..;:¥~..,..~zz..., ......... ........ .... ~...~..k~.:.~*~....~..:.~...: ....... /..~::~:~-~' ............. ..................................................................................... ~ ......... ...:~:~/~:.~.~ pursuant to application dated ...... 4~,~. ............. .......... , 19. and Building Inspector. Fee $...~..." ................. approved by the ~ /~Building Inspector' Rev. 6/30/80 ST~V~ G. T~ONTAKIS, I~.1~. Drawer 1446, Middle Rd, Mattituck, N,Y. 11952 (516) 298-4533 July 7, 1982 Mr. E. Hindermann Building Inspectors Office Town of SouthQld Southold, N. Y. 11971 RE: Marks Dear Ed, Enclosed please find form #10 (Development Permit Application) SGT/d Enc1. for the subject project. Yours truly, Steve G. Tsontakis, P.E. NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION TW S74-0074 UND£R ~HE ENVIRONMENTAL CONSERV~,TION LAW ~ ARTICLE15 (Protection of W~er) J~ ARTICLE25^(TidaIWetIands) ARTICLE 24, (Freshwater Wetlands)' ' \ ARTICLE 36, (Construction in Flood ttazard Areas) PERMIT ISSLJED 10 Pav4d and Jac_ ~_~ffn Ma~k4 ADDRESS OF PERMI FrEE 17 East 16th St~e~, Roop~ S~on~ New York NY 10003 LOCATION OF PROJECT (St on of stream, tidal wetland, dam, building) Long Island Sound 267~ no~Zh of M~in Road DESCRIPTION OF PROJECT Cons.f~ue~': one fa~y ~ng ~ ~i~ of 75' lan~d of the mea~ high w~'teJz ~,e and i~y syst~ 100' ~.nd~d of ~ me~, ~gh w~ ~ne~ COMMUNITY NAME (City, Town; Village) TOWN So~thold F~A COMMUNITY NO;' ] DAM NO. eptemb~ 30_z GENERAL CONDITIONS 1. The permittee shall file in the office of the appropriate KeF, loP, al hours m advance of the time of commencement and shale also n~,tify him 8. That the Slate of New Ymk shall in no case be hable for any c,tq or injury to the structure or work hereto authorized wlfich may be caused b' 9, That if the display of lights and signals on any work hereby autf~o~ 95-20-4 (9/75) (SEE REVERSE SIDE) TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No./~~ (please print) ~please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this 19 ~ · Notary Public Notary Public, ~./J~_ County N~ PUBLIC, State ~ New Y~ I~rm Expires Uarch ~, 19 , VICTOR LESSARD EXECUTIVE ADMINISTRATOR (516) 765-1802 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD February 2, 1988 Mr. Constantine Papamichael 4 Calvert Drive Syosset, New York 11791 Dear Mr. Papamichael: In order to process your application ro renew (replace) your building permit for a single family dwelling located at 17327 ROW off Main Road, East Marion, Now York to be used year round, the dwelling is required to comply with the New York State Energy Cdnservation Construction Code effective April I, 1987. Our department will need the calculations from an architect or professional engineer licensed in New York State to bring your dwelling into compliance with this code in regards to type of heat etc. Yours sincerely, SOUTHOLD TOWN BUILDING Building Inspec.tor DEPT. TF:gar VICTOR LESSARD EXECUTIVE ADMINISTRATOR (516) 765-1.802 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 March 23, 1988 Mr. Constantine Papamichael 4 Calvert Drive Syosset, New York 11791 Dear Mr. Papamichael: Please provide us with specifications showing ie furnace, pump etc. are above finished floor. Flood elevations is 12 feet. Yours truly, SOUTHOLD TOWN BUILDING utilities DEPT. Gary Fish Building Inspector, GF:gar COMMENTS FIELD INS~PEC~ON 1. FOUNDATION 1st) FOUNDATION jnd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL ADD~,tTIONAL COMMENTS: OU~4DATION ( OUNDATION ( 2nd ) OUGH FRAME & .PLUMBING ~SULATION PER N. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - [802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. lhis application must be filled in typewriter OR ink, and submitted t ~ to the Building Inspec- tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5.Submit Planning Board approval of completed site plan requirements where applicable, B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic rfeatures. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings, 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: Additions $25.00 POOLS $25 . 00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling,$25.O0, Accessory'i$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ......... ~ .... .~.~. ..... Newc°nstruction . Old or Pre-existing Building Vacant Land Location of Property .... /?.' ~.~ .~ ....... ......... Hou~ No. Street I~am/et Owner or Owners of Property . .~....c~./~.y,,~. ~../4c~,4%..' .~L.... ~..~ ~.,~ ....:r~/~..~,,~/../.~. ~..~.~. ....... County Tax Map No. 1000 Section ... ~. ~...~. ....... Block .. ~. [ ......... Lot .... )..Z~,: .(~.. . Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /.~. ~.0'-.~. , Date of Permit .~/-~> .~..Applicant... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Cer]:ificate ..................... Final Certificate ............... Fee Submitted $ ............................. Construction on above described building and permit ~eets all applicv~ble codesaqd regu lations. Applicant , STEVE G. TSONTAKIS ASSOCIATES Consulting Engineers, P.C. March 17, 1988 Mr. Victor Lessarde Building Department TOWN HALL P.O. BOX 1179 Southold, New York 11971 RE: Papamichael Residence at Truman Beach Main Road East Marion, N.Y. Dear Vic, Enclosed please find the Energy Analysis for the referenced dwelling which I am transmitting to you on behalf of my client, Mr. Constantine Papamichael. Yours Truly, Steve G. Tsontakis, P.E. SGT/bp Enclosures cc: Mr. Constantine Papamichael P.O. BOX 1180, 632 ROANOKE AVENUE, RIVERHEAD, NEW YORK 11901 (516) 727-7411 '1 3 3~ 1%3 765-1802 BUILDING DEPT. INSPECTION ] FOUNDATION ZST [ ] ROUGH PLBG. ] FOUNDATION 2ND [ ] INSULATION ] FRAMING [/.,,~1NAL DATE ~/~/~,INSPECTOR__~~ ~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG, [ ] FOUNDATION 2ND ] ] INSULATION []FRAMING []FINAL DATE //2~/ INSPE~OR.~ ~ 765-1802 BUILDING DEPT. INSPECTION ] FOUNDATION 1ST [ ] ROUGH PLBG. ] FOUNDATION 2ND [ ]~NSULATION ~ 1 '] FRAMING [ ~ FINAL REMARKS: BuiLDING DEPT~ · ~ INSPECTION~ [ ] FOUNDATION XST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION DATE ,, ~ INSPECTOR :, · , /i THE NEW YORK BOARD OF FIRE UNDERWRITERS ~: ' ~007475 BUREAU OF ELECTRICITY ~-- 85 JOHN STREET, NEW YORK, NEW YORK 10038 (X?)'OH~;R 13 198R 581945~8/~8 H 005752 ~IS CE~IFIES THAT P~P~MICHAEL, CONS~IN~[N,~ N/S MAIN ~() .17~27 ~ ex.mi~ on andI~nd to be in core.lance with the ~ulrements ol th~ ~rd. RXTURIS ~ O~qiS DI~EWAIEIIIS FA~qlS SiR~ Dt~C~G~qN~CT MOTOIq $: )- 1 M, P. S ,l R V I C ~o. c~.cc~co~u, o~ ~. w. G.CC. CO.U. CONSTINT[NK PAPAM} .HAI'ZL N/S MAIN RD.]7'~27 M. MARION, NY1 11.939 This cetlifko:~ must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be_identified by their ~mdentialL )UILOIHG D~PARTNENT. THIS cOPY OF mE ALTERED IN ANY J4M41~R, 'FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL g0UTHOLD, N.Y. 11971 TEL,: 765-1802 Examined.. ,~L/].°dP.e~ .~'~.., 19 .~.~. ' %~J.*~'.l.q,.~.~. e~ ~., 19 ,~ .~. Permit No. J.~. ?f.~..~'... Approved Disapproved a/c ..................................... BOA[KD OF HEALTH 3 SETS OF PLANS SURVEY .... CHECK ........ SEPTIC FORM ........ MAIL (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ............................................ Name of owner of premises ~..~...~..~.~..~. ~. ~..F~. (..jflZ~. . ./, .~.~/. . .~. · .d'~7. ................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authori.zed officer. (Name and title of corporate officer) . ALL CONTRACTOR'S I~UST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location ofland on which proposed work will be done. / ~-~7 /~-6--9, (J,,Z. ..~.~ & cZ~ fl~ House Number Street Hamlet County Tax Map No. lO00Section ~ 3 Block /. Lot .... /x/, /d) Subdivision ....................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy o£ proposed construction: Existing use and occupancy ~ ~. Intended use and occupancy ........... ~. dc.e.- .... . ........................... ~ ................ Removal ,; ......... .... Demolition . ............ ........ ..... :k~'g/~L//, r Estimated Cost . .. . . ~ "--. · . ' ....... "..' .... / ...................... " ..... $. If dwelling, number of dwelling umt,'s ............... Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .,..: ............... 7. Dimensions of existing structures, i~ any: Front ............... Rear .............. Depth ............. Height ..... ,., ....... Numbe~of Stories ............... ~. .................. ',. ~ .... : ........... Dimensions'of same structur~ with ~lterations or additions: Front .......... Rear i ...... ' ......... Dep th ....................... Height ...................... Number of Stories .................... $. Dimensions of entire new construction: Front .......... . ..... Rear ............... Depth ............. Height ............... Numbe} of Stories ................................................. , ..... 9 Size of lot: Front ' Rear Depth 10 Date o'fPurchase Name of Former Owner 11. Zone or use district in which premises are situated .............................................. ; ...... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot beregraded ..... .......,.............,..i Willexeess fill be removed from premises: Yes . No 14 Name of Owner of premises ' Address Phone No Name of Architect [ Address Phone No Name of Contractor ....... ' ...... Address .... : .............. Phone No ........ 15. Is this property located wlithin 300 feet of a tidal wetland? *Yes ..... No ..... *If yes, Southold Town Trus. tees Permit ma~be required. J PLOT DIAGKAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block i amber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S C O[.~ ST~ OF .... being duly sworn~ deposes and says that he is the applican~ (Name of individual ~signing contract) above named. He 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 th~ application; that all statements contained in this application are true to the best of his knowledge and belief; and that tl~ work will be performed in the m,anner set forth in the application filed therewith. Sworn to before me this ............ .. d :s... :...d?y .............. Notary Public ...... '-.~ .... ~ ~. . . Coun y // _ I~ltY. N~ 1707S78,~U~tlC' SuffolkState ~f~W~.~ ~' Y~4 (Signature of applica~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined L/c"F/'?' :. , 19 °c~ Approved. .... o./zz 4 Disapproved a/c ....... : ....... ~ ....... .~ ......... ~ ' (Bu,,ain. ,nspector) ~ APPLICATION FOR BUiLDiNG PERMIT INSTRUCTIONS Application No..¢~. :g.~.. ...... a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. .f b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre~ Or areas, and giving a detailed description of layout of property must be drawn ou the diagram which is part of this ap[ cation. c. The work cornered by this application may not be commenced before issuance of Building Permit. d. Upon app-~.;al of this application, the Building Inspector will issue a Building Permit to the applicant. Such pen] shall be kept on the premises available for inspection throughout the work. e. No buildiug shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance ora Building Permit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. · -~ ~ ....................... . . ~.~' . ., . -( -% <,, '., ~ ~ ~ i. i ~3 t (Signature of apphcant, or'h-am~e-Vff a corporation) ¢ ... 171.. s.$..i.6, s.-h. tg.:L XI. i (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, ....... O..~ O.e._. c ~ ..... ,.~....c.,.v.¢.h ~ .%. ¢.?~ ............................................. Nmne of owner of premises ....... b. ,~..~ .'L .b...."/c. 3 .~.O,w Q.O ~--. ¢.~. ~ ..... .J% .[~'. D,.~', X (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ~...~.::~q -.~.. - Builder's License No...-..v.. :-~-~-.~*-~-~4-~,> .... Plumber's License No. .....'~i3-" Electrician's License No..'.~. Other Trad~'s License No. ' .............. "~" PERHIr INCLUDES APPROVAL TO ;,,Lv'~OVE EXCESS fTO?.~ ABOVE FP, EMISES BY RF,",P,~x; NG LOT Dt;,V WAY CON -rEdUCTION OZ~SPOOL CONS ~ RUCTION CELLAR CONST[(UC] ION OTHER .... r ]. Location of land on which proposed work will be don~,.~, q'.~.~. (~.../3r:,., i.~t~3.1o, ~ ~.,~ .~he, .~q .......... ~ c .Sqa~.~. ~ :I. LI. :cw~ .~,&c . ~,. p. . .s .. ac.~.~ ................ House Number /7~Z~ ~O,~- ~ ,~t~eet L' ' . q, Hamlet County Tax Map No. I000 Section ..... ~. ~ ........ Block .T./~.Z ~.,..4~ Lot ................. Subdivision...~r.l.6 I~[b.l.~..~.~. ~..~ · · . Filed Map No .... ~. 7/.~... Lot... ~ ......... ~ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ~. qk~.cg .B~ .... ~ ~ n & .................................... Nature of work (check which applicable): New Building ~/ Addition ..... Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... ~ 0 .~ff C~,,~.~¢~] (Description). Estimated Cost .... G.. ~. ~ D .O ...................... Fe~../~...~'. ............. * ........... (to be p~d on filing this application) If dwelling, number of dwelling units .... [.., ......... Nmnber of dwelling units on each floor ................ If garage, number of cars .............. Q. ~. .................................................... If business, commercial or mixed occupancy, specify ~oture and extent of each type of use ... ~ ........... Dimensions of existing structures, if any: Front ..... .' ......... Rear .... .......... Depth ............... HeiSt ............... Number of Stories ......... ~ ............................................ D~ensions of same structure with alterations or~dditions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Sto~es ...................... Dimensions of entire new construction: Front . .~q. {~.{.~,'~:~. Rear ............... Depth ............... Height ............... ~umber of 8tohes ..................................... ~ ................... S~ze of lot. Front ................ _ ...... Re~ .... ;..~ ............... Depth .....=' ~ ........ -h'- .... Date of I urchase .... ~ ~ .~. j A. ~. ~ t ........... ~,m: o. · ~, O ..... r ........... Zone or use district in which premises are situated . ' . Does proposed construction violate any zoning law, ordinance or regulation: ...... ~.o ....................... Will lot be regraded ............................. Will excess .fill be removed from p~emises: Yes ( No Name of Owner of premises h ~.t g ~3~%~1~ .~g~ess . [~. ~ 1¢.~ 'Q'3 ~' Phone No. ~.q Name of ~chitect ...~.hB [g ~% h ~5 .... Address. t3. tG.m~3.~N Phone No. Nmne or--or . [ p~0 ~ .~ e'c :~. ....... ~..:... Address Phone No ......... PLOT DIAGR~ Locate cle~ly ~d distinctly ~ bufIdings, whether ex/sting or proposed, and, indicate ~1 set-bhck d~ensions from roperty ~nes. Give street and block number or description according to deed, and show street names and indicate whether tefior or corner lot. ,STATE OF NEW YOBK, IP~ ~a,,'.~tr/*/k, o COUNTY OF.. ......... ~ .~ ~.~ ................. being duly sworn, deposes and says that he is tile applicant (Nah~ 'O.l' ind{~idual signing contract) ~ rove named. ~/ .4. e is the ............ ~...c~-.. ~,~ .~..~. ............................................................. (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 >plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the manner set forth in the application filed tl,erewith. worn to before me this .: '. .... .... Z 1.2 ~t , , I / / // SUFFOLK CO. HEALTH DEPT. APPROVAL ......... = '~= ........ = ............... ~ THE WATER SUPPLY AND SEWAGE DISPOSAL ~ SYSTEMS FOR THIS rESIDENCE WILL ¢~j~,~ CONFORM TO ,THE STANDARDS Of THE ~, ~L_~,.~.~. SUFFOLK CO. DEPT. Of HEALTH SERVICES. APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- for APPROVAL OF CONSTRUCTION ONLY ~m~= ~2,~O ~,~ SUFFOLK CO, TAX MAP DESIGNATION: ~ = [rO~ ~[~ DIST. .. SECT. bLOCK PCL. OWNERS ADDRESS: ~TE~T HOLE STAMP i RODERICK VAN TUYL, LICENSED LAND SURVEYORS GREEN~RT NEW YORK NO?780 s~v~o ~. ., , , ~ . , . _ . ~. . ' ':'" ' ' ...... ~ · ,' S~yE~ENT °F i'~EN? . ~.., - ~ ~,~ .... . ~ . TO~ O~ ~' '~ '~'-~-t~ ~= SUFF~K CO. DEPT. ,OF HE'~T:H SERVICES ......... ~ by ~w~ ,~cc'~ '~,mt ~ fo~d ~ CONSTRUCT-ONON~Y Chief of GenSral Engineer~n$ ~,=~ V ..... I 11% -i VI _.. ..... ~ __a~ ........ Sf 5 ' :% ;V jr the New York State Education Afl,ROVED AS I40TED NOTII'~'-'.',, -rn 4 PM FOR THE FOLLOWI~G IN~ECTIONS: 1, FOUN~ATIoN ' ~0 REQUIRED FOR tOURED coNCR~E 4. FINAL - -- g~ C~?~ET~ FO~ C, O. ALL CONS~U~ION SNALD THE REQufREME~S OF THE N. ~A~ CON~Ru~ION & ENERGY CODES. NOT ~ESPONSIBLE ~I~N OR CON.RuCTION BRRO~ PLAI 2_ '~ c,/c. DATH I .> l, JOl~'7H / ~ e~6n~i~ered ~'a)ic~ copies, A ,_.3 / // I 2_ 2:¢ } ~ 2/`3'/ 13~ ~0/ O// ' :0t~ TH Unauthorized alteration or addition to this document is a violation of section 7209 of the New York State Education, Copies of this document not bearing the engineer's inked seal or embossed sea~ shall not be considered valid coples. %,, Lr · i iddltlon t~ this document is a ~ violation of se~tlon 7209 of the N~w York Stit~.Edu¢~tlon ,law. Copies of this document not bearing the engineer's inked semi ~l~'~mbqsse~ seal shall not be considered valid copitas. _J L ., add!flon to th~s docun~enf violation of section 7209 sea! or em.b~s~ed sea) shall ,I 13'6" - " ~,~,¢?' I 2'5" 3' G~" D¢~5 ~ o'm /'0" I " 0 ~0" I/~}"/ ~ ,, 4-0' O' . Y i~.,~f, U thoriz e? Ion [o vJolafio~ of seCflol/ 7209 ,: ,Unaufk°rized -; ad, dition fo this ~ the New Yeti( Stat& ' b~?n~ the enginee~ , i -f- .i¸ Unauthorized alteration or addition to this document is a violation of section 7209 of the New York State E~lucafion Copies of this document n~f .bearing the englneer's inked seal o~ embossed seal shall n'o~ be col~slderod valid copies,~ ' ( :'/' :9 -i /z ' o/c. (~TY~) NCo ;¢,,AF,:. $ L -~AT-I©>'/.:, A ",¢,~: %' ? ' Nou, u/'k/ ',x/ Ty?-'l(,,~,_ C:,>-IP,~ : !, /I -t addition to this document is a vlol~tion of section 7209 of the New York State ~Educ~tlon I Unauthorized alteration or addition to this document is a violation of section 7209 of the New York State Education Copies of this document not bearing the engineer's inked seal or embossed seal shall not (1~uth°rrzed elter~t on or edd~t~on to this document ~s Yiolation of section 7209 of the New York State Education Copies of this document not bearing the engineer's inked se~l or embossed seal sh~ll not be considered YaJld cop/es. /~-I ,q/x !? 5 II ! C1~/ ~F\~FT-/\.?,z\^~t."ti /v ~0/'/ V'¢,9'~''~ ' ' 1 U Unauthorized alteration or addition to this document is a violation of section 7209 of the Flew ¥od¢ State Education Copies of this document not bearing the engineer's inked seal or embossed seal shall not be considered valid copies. S the New York State Education Copies of this document not seal or embossed seal shall not i~lc,,'¥'/-- SM/I T~J4 dll~dUl~- .Q :Cb )., u /IOt' ~ddition to this document is a violation of section 7209 of bearing the engineer's inked seal or embossed sea~ sba~l not be considered v~lid copies. "1 ~ufhonzed ~lteration or { violation of section 7209 of the New York State Education Copies of this document not bearing the engineer's ~nked seal or embossed seal shall not be considered va~id cop~es. : X 7-/ . V /~C 0 T~ Al addiflon to th~s document is a ~[be New york State Education [bearing the engineer iaked ,5 t 7-~ J t L w Fi",.- ii i' be considered valid copies, L6CAL C~iJES. zp' ~ ~ARS ,3/ 7 Y/--' PITCH ,! LBC&L Unauthorized alteration or seal or embossed seal shall not