HomeMy WebLinkAbout30828-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-30782 Date: 02/18/05
THIS CERTIFIES that the building NEW DWELLING
Location of Property: 33705 CR 48 PECONIC
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 74 Block 2 Lot 12 .2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 6, 2004 pursuant to which
Building Permit No. 30828-Z dated DECEMBER 6, 2004
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 SINGLE FAMILY DWELLING WITH ATTACHED GARAGE & DECK AS APPLIED FOR.
The certificate is issued to VALENTINE J & ERIKA PUST
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 86-SO-134 05/06/93
ELECTRICAL CERTIFICATE NO. 2042486 02/11/05
PLUMBERS CERTIFICATION DATED 11/18/04 GEORGE J. BERRY, JR.
A thorized Signature
Rev. 1/81
00 3 ;I-f^
Form No.6 h/
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. 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.
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 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-_$100.00
3. Copy of Certificate of Occupancy-$.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00
Date.
New Construction: v Old or pre-existing Building: (check one)
Location of Property: _,J 3 70.5` CR ki� P G o k t G
House No. Street Hamlet
Owner or Owners of Property: 416h /Yl e
Suffolk County Tax Map No 1000, Section Block Lot
Subdivision / Filed Map. 1 ! Lot:
Permit No. 3c) a., 5' ;2- Date of Permit. /'LV1 / ��'/' Applicant: c7�f 2 001 w B' �145`
Health Dept. Approval: 6�16 ! Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: y (check one)
Fee Submitted: $
,./ Applicant Signature
C0 ia_ 9o9
cv
5 BY THIS CERTIFICATE OF COMPLIANCE THE S
S NEW YORK BOARD OF FIR 5
5 E UNDERWRITERS
5 BUREAU OF ELECTRICITY
S
40 FULTON STREET — NEW YORK, NY 10038
5 CERTIFIES THAT 5
5
Upon the application of upon premises owned by S
S 5
VALENTINE PUST VALENTINE PUST
S5 P.O. BOX 324 33705 COUNTY ROUTE 48 5
PECONIC, NY 11958 PECONIC, NY 11958 S
S c�
Located at 33705 COUNTY ROUTE 48 PECONIC, NY 11958 5
`j Application Number: 2042486 Certificate Number: 2042486 rj
5 5
�j Section: Block: Lot. Building Permit: BDC: nsl1
Described as a occupancy, wherein the premises electrical system consisting of
electrical devices and wiring, described below, located in/on the premises at: 5
5 Basement,First Floor, Second Floor,Attached Garage,Outside,Attic, c5
A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed 5
herein, was conducted in accordance with the requirements of the applicable code and/or standard 5
5 promulgated by the State of New York, Department of State Code Enforcement and Administration, or other
authority having jurisdiction, and found to be in compliance therewith on the 11th Day of February,2005. S
5 Name OTY Rate Rating Circuit Type
5 Miscellaneous 5
SAS BUILT-1987 S
S5 Alarm and Emergency Equipment S
Sensor 3 0 Smoke 5
e] Appliances and Accessories 5
Exhaust Fan 3 0 F.H.P. 5
SAir Conditioner 2 0 40 Amps
5 Furnace 2 0 Gas
5 Hydro Massage Tub(Therapeutic 1 0
Oven 2 0 6.8 KW 5
5 Dish Washer 1 0 1.2 KW
5 Pump Motor 1 0 1 H.P. C,
Panels 5
5 1 60 5 L�'5
1 60 7 C
Wiring and Devices 7
Outlet 54 0 Fixture seal
Fixture 54 0 Incandescent
Continued on Next Page I of 2 S
j This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
5 S
c�
5 BY THIS CERTIFICATE OF COMPLIANCE THE 5
S NEW YORK BOARD OF FIRE UNDERWRITERS 5
S S
SBUREAU OF ELECTRICITY 5
5 40 FULTON STREET - NEW YORK, NY 10038
5 CERTIFIES THAT
S
CSa Upon the application of upon premises owned by
5 5
5 5 VALENTINE PUST VALENTINE PUST
P.O. BOX 324 33705 COUNTY ROUTE 48
PECONIC, NY 11958 PECONIC, NY 11958 5
S 5
SLocated at 33705 COUNTY ROUTE 48 PECONIC, NY 11958
Application Number: 2042486 Certificate Number: 2042486 S
�j Section: Block: Lot: Building Permit: BDC: ns11 S
S
Described as a occupancy, wherein the premises electrical system consisting of
C electrical devices and wiring, described below, located in/on the premises at: S
Basement,First Floor, Second Floor,Attached Garage,Outside,Attic,
CS5 A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed 5
, herein, was conducted in accordance with the requirements of the applicable code and/or standard
Spromulgated by the State of New York, Department of State Code Enforcement and Administration, or other
Sauthority having jurisdiction, and found to be in compliance therewith on the Day of
11th February,2005.
5 Name QTY Rate Rating Circuit Type f5
5 Outlet 123 0 General Purpose Ij
Receptacle 73 0 General Purpose S
SSSwitch 70 0 General Purpose S
Receptacle 1 0 20 amp Laundry
5 GFCI Circuit Breaker 4 0 20 amp Appliance 5
GFCI Circuit Breaker 1 0 15 amp General Purpose
5 Paddle Fan 3 0
5 5 Receptacle 9 0 GFCI 5
Service
1 Phase 3W Service Rating 200 Amperes 15�
Service Disconnect: 1 200 cb
Meters: 1
5 An as built visual inspection,of the delineated electrical installation,determined that an obvious hazard is not present and the installation is S
believed to be in comformance with the applicable reference standard for the estimated period of construction of the premises wiring system.
C seal
L S
2 of 2
LN
Lcertificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
NpLffl
o��gOFfO�,�coG
y�
2
Town Hall,53095 Main Road Q • Fax(631)765-9502
P.O. Box 1179 y�O a�� Telephone(631)765-1802
Southold,New York 11971-0959 1 �►
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATION
Date: / W/o v
Building Permit No.
Owner: Py
(please print)
Plumber: Gev Ge-C 0C60Id�
(please
te-
(please print)
I certify that the solder used in the water supply system contains less than 2/10 of 1%
lead.
'(FAnters Signolgr
Sworn to before me this /8
day of �OdG,,,���, 20 a
Notary Public, County
VICKI L.LOPER
Notary Public,State of New York
No.O1L06070081 I n
�m ua n E in Suffoik��`''
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. 30828 Z Date DECEMBER 6, 2004
Permission is hereby granted to:
VALENTINE J PUST
PO BOX 324
PECONIC,NY 11958
for
CONSTRUCT ONE FAMILY DWELLING AS APPLIED FOR. THIS PERMIT REPLACES
15194 .
at premises located at 33705 CR 48 PECONIC
County Tax Map No. 473889 Section 074 Block 0002 Lot No. 012 . 002
pursuant to application dated DECEMBER 6, 2004 and approved by the
Building Inspector to expire on JUNE 6, 2006 .
Fee $ 1, 012 . 50
Author ze Signature
ORIGINAL
Rev. 5/8/02
44fttl
3aga� z
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS: or
DATE / - /� � �� INSPECTOR /�'
I LD I;,hl'FC:IG:1 (DATE
FOUNDATION ( 1st )
FOUNDATION ( 2nd ) _ — m
2 . f �xlp
z
o div
P,OUGH FRAME
(>
PLUMBING �.
3 .
t
N
H
INSULATION PER N . Y.
STATE ENERGY d Gl
CODE
x
4 .
a
o iL fti v 5 E
FL a RoTtt ca 'tiL 41 NQS is toTrr- _
FINAL "moi Y VAL06 jifEbS ptpe- To k &X lJ
Urck-s U eb ,r s b Cl ic-�2 Ft ooie. iQ c[ b
v CtAco�-5 NoCT04 rwiFsT ce-L(- 4+- w r✓c.S z
C
ADDITIONAL COMMENTS : x
'S f 1
IV
q I.Q 1,1,. CD Z U.l z C. S
.b .
A&o
tJL k b PE C.L- D p L L L S" 2 Po vL oc-k- "b
H
r-.- !c O f-s FLA v L) " ULL nre4Ia &-
z
NkUk u 3 RIA� a T.2
sem. �� P,�6 � � • -- y �'
_y
FIELD INSPECTION REPORT DATE COMMENTS
FOUNDATION(1ST)
------------------------------------
FOUNDATION(2ND)
11LV z
� o
ROUGH FRAMING&
PLUMBING
00
r
INSULATION PER N.Y. --- -- y
STATE ENERGY CODE
_r-
• FINAL
1:7
ADDITIONAL COMMENTS
N
<o
m
[11 �►
1 ,b
1
O
---- z
0x
x
'FORM NO. 1 AM
1986
TOWN OF SOUTHOLD 6
BUILDING DEPARTMENT
TOWN HALL BLDG.DEPT.
SOUTHOLD, N.Y. 11971 TOWN OF SOUTHOLD
TEL.: 765-1802
Examined . �'r Q.4, 19 V =3c)n Fr Received . . . . . . . . . . . , 19 . . .
Approve&"T7 .�i ., 19 4. Permit No. S�°1.T. �4. J::Ia�
Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 'A '-- - ` �-
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . `JQ'11 f
(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
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 tions.
. . � . . . . . . . . . . . . . .
(Signature of appl' nt, or name, if a corporation)
1517
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Qwy��2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11// J
Name of owner of premisesVC??/
�!'�e V�. .7�` . �/�. .�l! .�l.els✓. . . . . . . . . . . . . . . . . . . . . . . . . . . .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Name and title of corporate officer)
Builder's License No. . . .��I . . . . . . . . . . . . . . . .
Plumber's License No. .. . . . . . . . . . . . . . .
Electrician's License No. )-ed�. . . . . . . . . . . . . . .
Other Trade's License No. . . . . . . . . . . . . . . . . . . . . .
1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1' . . . . . . . . . . . . . . . . . . . . . .
House Number /Street Hamlet
County Tax Map No. 1000 Section . .P.7%. . . . . . . . . . Block . . . 2 . . . . . . . . . . . . Lot . J 7i ? . . . . . . . . . . .
Subdivision . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy . . . . . . .vjo4o- f . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Intended use and occupancy ��1�+!4°N . ��✓�.�`7�12�Gv /e�/
30
Tse.1�2
BUILDING DEPT.
INSPECTION '
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ CATION
C ] FRAMING [ ] FINAL
REMARKS:
F
7 dg!;�m
DATE llklspwprow�z
F i
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 18T UGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ) FINAL
REMARKS:
DATE � u � —INSPECTOR,d�� /�
ass-1802
3oBUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
FRAMING [ ] FINAL
REMARKS: Do- .3X/I7
DATE 0 / INSPECTOR -�
)�QCl- wrr�
j 765-1802 �U
g BUILDING DEPT.
Wi INSPECTIO
N
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL ��.-f,N�,�, 9 �� Uel
REMARKS:
24
Xr 0
A571POWSli?4!-�
lGl(;711fbl-
DATEINSPECTOR c���
30�sag
765-1802
suauINa DEPT.
INSPECTION
[ ] FOUNDATION 18T [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMINliok[ ] FINAL
REMARKS:
DATE { 4 �ob INSPECTOR
I' 3d�a�s r
7W1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS: t
1 v
(JT
DATE Y INSPECTOR
/q ®r
tu i
1
BUILDING DEPT.
LAA-C�� ,
' , NSPECTION�`� ,
/ /
Le_,
I FOUNDATION 1ST ROUGH PLO 3"k 11
FOUNDATION 2ND INSULATION
FRAMING
REMARKS'PkCZ495 1'
n3iilJ• I ��
MCM
1. . � ; L ./�•_ .
I)UmovXLLW�l—
a
r
/ X��
10115009 THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
85 JOHN STREET. NEW YORK. NEW YORK 10038
Date January 7, 1988 Application No.on file 470101/87 N 849239
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
Val Punt, 33650 middle Rd., Peconic, M.Y.
in the following location; E� Basement ❑ l st Fl. ❑ 2nd Fl. .Section Block Lot
was examined on DoCamber 28# 1987 and found to be in compliance with the requirements of this Board.
FIXTUREXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS ACLES SWITCHES INCANDESCENT[FLUORESCENT I vE AMT. K.W. AMT, K.W. AMT..I K.W. AMT. K.W. AMT. H.P.
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS, ULL UNIT'HEATER$ MULTI-OUTLET DMAM SI
OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS.a' TRANS. T. H.P. SYSTEMS AMI.
M NO.OF FEET
SERVICE DISCONNECT NO,OF S E R V 1 C E
"`'.. AMT.. AMP. TYPE EQUIP. rN 1,B•3W 3 b'3W 3 0 4W NO.OPER COND. OFC W.
G.
NO.OF HI-LEG �•M.LEG. . NO. NEUTRALS OFA.NEUTRAL .
1 200 eb X 2/0 1 2/0
OTHER APPARATUS:
service only
Tait
My land Elec.
5 Westchester Ave. lic. p2619
No. Babylon, N.Y.* 11704 _ - 084OU Ill AWAO R �.
11 'r
Per
' This certificate roust not be altered in any manner; return to the office of the Board if incorrect. Inspet" may be id ntified by tllleir credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT 4E ALi,A1�lYIER.
C VACA!`J 1" )
4.27 12 30�E.
_. 338.79' E
NJ
LA
1
r
~ C7
Ly U
Z lco Q S
FLn
LI } ;
S
lOfT w+.«b
3��sa�
INSPECTORSg�fFO��
(516) 765-1802 OHO �'OG
VICTOR LESSARD,Principal =� y1 SCOTT L.HARRIS,Supervisor
CURTIS HORTON, Senior y = Southold Town Hall
VINCENT R.WIECZOREK,Ordinance p • P.O.Box 1179,53095 Main Road
ROBERT FISHER,Assistant Fire ?� O� Southold, New York 11971
Building Inspectors � Fax(516) 765-1823 THOMAS FISHER Telephone(516) 765-1800
GARY FISH
OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
March 15, 1991
Mr. & Mrs. Pust
P.O. Box 324
Peconic, N.Y. 11958
Re: BUILDING PERMIT #15194Z AUGUST 26, 1986
ONE FAMILY DWELLING
Dear Mr. & Mrs. Pust:
I am writing to you regarding the above permit for a one
family dwelling. This permit expired Feb. 26, 1988 and you have
have not had all your inspections and you do not have a Certifi-
cate of Occupancy for the dwelling. You are in violation of the
Code of the Town of Southold.
Please contact our office to remedy this situation. If we
do not hear from you in two weeks it will be necessary to take
steps. Thank you for your prompt attention to this.
Yours truly,
va;� 0,4- 64-e._
Secretary
FORM 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)
3 0 fid.
15194 Z Date ... ... -4+�...�:.'P....., 19.. .�
Permission is hereby granted, n
--Y.............. .
to ... r�..... ... ...9�.....f?' LJ4..... ...... ... ......... ....41..x...................
/7N Af
.... .............................................. .........................................
atpremises located at .... ........ ....0............ .......................
................................................................................ ................................................................................
.................................................................................................................................................................
County Tax Map No. 1000 Section ......q7 7....... Block ....... ...... Lot No. ....�.Z .zr ....
pursuant to application dated .... ............... 19114?, and approved by the
Building Inspector.
Fee $.. .......,....
r
... .. ...�..
............ .......
Building Inspector
Rev. 6/30/80
COUNTY OF SUFFOLK
see c
ti�dJOVF�,
9ffi ^c
PATRICK G. HA .2IN "�
SUFFOLK COUNTY EXECUTIVE
TOWN OFSOUTHOLD
A. BARTON CASS, P.E.
COMMISSIONER
DEPARTMENT OF PUBLIC WORKS
S
Date Jaunary 28, 1988
r
Erika J. Pust,.
33650 Middle Road
Peconic, New York 11958
Dear Ms. Pust:
RE: Permit No. 48-28
County Road 48
( Xv) County Treasurer has been authorized
to refund your security in the amount
of $1,000.00
( ) Bond No. to cover work
on this Permit is herewith released
& returned to the Bonding Company.
This is to advise you that work under the above captioned Permit has been inspected
and found to be completed in a satisfactory manner to this Department.
Very truly yours,
C. ROGER MEEKER
CHIEF ENGINEER
By: -OC-�O
M. Paul Campagnola
Junior Civil Engineer
CRM/MPC/j f c
CC: Bond Company
Building Department - Town of. Southold Y
c3
w
YAPHANK AVENUE YAPHANK. N.Y. 11980 (5 1 6)924-4300
"n�aa zex,..7"'"a'+c ,--ta�,`,' ,'v:. h "•.'+•c'
- �
,.am.�t a.-,.... .S.S...c��......f hicw
LINE,
cA -
�c
TOWN CLERK
TOWN OF SOUTHOLD " 1§7700
- 1
Suffolk County, New York 516 - 765-1801 j�d 19 7 7(� 1
Southold, N. Y. 11971
RECEIVED OF. C' -ce xc ��.a '
�-
/�. Dollars i
F.or
Judith T. Terry, Town Clerk j
Cash ❑ cLcek /� By. t Ca Cavi _. i
SUFFOLK CO HEALTH DEPT APPROVAL
H. 5 NO 3- '3C 134
1
I I
1 I
N.27 12 -30 E — _338.7y
_ pt, t STATEMENT OF INTENT
Ll THE WATER SUPPLY AND SEWAGE DISPOSAL
SYSTEMS FOR THIS RESIDENCE WILL
�? I ( CONFORM TO THE STANDARDS OF THE
ti I
{ SUFFS LIC EP7�. OF �' SER CES
:
APPLICANT r;
( SUFFOLK COUNTY DEPT OF HEALTH
OT-06R COUNTY DEPARTMENT Of HEALTH SERVICES I S E R v I c E S - F o R APPROVAL OF
t Y DWELLING ONLY CONSTRUCTION ONLY
,j DATEMA`r � W REE. 119 8�-SD-/3�/
DATE
The sewage disposal and water supply i'acddies for this H. S. REF. NO 86 SO 134
r 7 location have been Inspe,ted by this Department and/or
APPROVED _
Q i 1,r other aganc and o�und tr s�s tory. I -..I
J
C41et of Bu u of Wastewater Mena men>
SUFFOLK CO TAX MAP DESIGNATION.
DIST. SECT BLOCK PCL
(WELL 03 —
`,\ I �l OWNERS ADDRESS:
1 I 3370 3 2T E 48
BOX-324
PECCP}IC, N Y. 11958
'j -
734-5327
I y
DEED: L. P
TEST HOLE STAMP
SEPTIC
•1.and on his be,
,U
MAF AtAiFrJ.-t_L, .-OCT, 23,!986 rneJlv'I
dr v in AUG.25 ,992 >ANL,
r MAR.t6y1993 AI., F - -- --�
PC r�!��clg`,' � SEAL ikulu a,SF iq � J` moi:: �..�/.f.F,` �r t ✓ T - -
L.y, .i L _fiAVl-L
r
ANL,
r,
"+ F Ika' AMF'rZ7� MEC
Mt =YETI E (hL5t1JGSt-lC CK v'I ,,
APR ' S 1933 A_ _ .I�`J; r :.. iU' Y 7 :,AND 'r��P d r
1 RO ERICK VAN TUYL, P.C. 4 9.S ;, ^t
�AiSE
S.0 DEFT. OF 1 ,
HEALTH SERV'CES LICENSED LAND SURVEYORS
� (S 266rya
GREENPORT NEW YORK Ott.^I
IlLeoYry1 I ST N.121
SUFFOLK CO. HEALTH DEPT. APPROVAL
� I
f-j.27 12 30 338-75
i
r 1
oo; a 1 STATEMENT OF INTENT
mea 0)1 THE WATER SUPPLY AND SEWAGE DISPOSAL
SYSTEMS FOR THIS RESIDENCE WILL
CONFORM TO THE STANDARDS OF THE
1 7)
SUFFOLK CO DEPT OF HEALTH SERVICES. 'I
r ; (S)
APPLICANT
ui
SUFFOLKFOLK COUNTY DEPT OF HEALTH
' SERVICES FOR APPROVAL OFI
�7 CONSTRUCTION ONLY
i 1�+ DATE
H. S. REF. NO
APPROVED
SUFFOLK CO TAX MAP DESIGNATION
I ' DIST SECT. BLOCK PCL
VI _i OWNERS ADDRESS:
I
I
I
DEED. L. P. --�
P` r r .+ - I)I- `�' k_'•9,S r TEST HOLE STAMP
f` I
I �
jj
T V
;+ 1 SE
, Y
w ...F .. I,. ,i .:: ':� {� - ''' r `�•-. k ;, � �-' Y `jpp P�a'�{"�ti .�qf,
RODERICK VAN TUYL P.C.
LICENSED LAND SURVEYORS
GREENPORT NEW YORK
SUFFOLK CO. HEALTH DEPT. APPROVAL
l�� I
H. S. NO.
Ki tZ.Z.AN
WACANT ) _.g:q _1 +. Lit'.. , r • d
-1- 27 12 30 E. 333.791 -� Q
STATEMENT OF INTENT
AN SUPPLY WATER THE SEWAGE DISPOSAL
U1 E L D
SYSTEMS FOR THIS RESIDENCE WILL
+Inl -- v%v N CONFORM TO THE STANDARDS OF THE
..Y_+_++.- `�(/Q� SUFFOL T, ' H TH �RVICES.
N 400 APPLICANTS'
SUFFOLK COUNTY DEPT, OF HEALTH
�QQ SERVICES — FOR APPROVAL OF
CONSTRUCTION ONLY
+ O �; wQ DATE:
!v j �� H. S. REF. NO, S I
JUL 8 1988 APPROVED: 11
-
7 HEALTH �y®� ,}Q\ SUFFOLK CO. TAX MAP DESIGNATION: s
`V i DIST. SECT. BLOCK PCL.
a , 000 0-�4 2 r
I .
W > OWNERS ADDRESS:
Q 1:87 —YCAMA\v'E-
i
EI
'CAL 00 1 DEED: L. P.
- -
A(:'.1-A 4- 98)l TEST HOLE STAMP 1
` 12c1 FwJP. H�46LJ r�riJ--lt,lME. ti i'
r1��. Z ; !1 AM
�...�.!1- i
t,2
L L 2O r I QD ry 5w1 A Y
7-0
L}ZJ
qGa �.. TEST i LE � - N��J 11 iG�' ic'. I C�r.' r'.: P•/l t:'A.�1 SLA r.EVE r.- M 26
COARSE kr thna"an
,.��,:.,.-. ,P.srn,b rrhnr"!Che wn.y �
,..M�nhi•mmmogi£a Goa
gnmr
morKy cm!
, J ••-(I4rt00 j14Y&91100Q1 BAd
.ifi•2+.hyl,.iOt Dt Glfl tOn"�Rj tlNa•
MEDIUM
" 1:. .:r1:.,t.nar.noaramWr.N. :
�. \ ' SAND �.::cr�:IrrtivrtbrgarwAapuarR
5.
A
"' E SEAL
SANC,
Lr.GQAVE(_ 9 OF NE ,
49 MED. RP'J'\CK Vary L0; i
�QF J/G n� Jr�v_vC D J_U_ I7 SAND y o .A t
o p c
�7vC�s) RO RICK VAN TUYL, P.C. COARSE ¢
�, JJ y en..+- T•—�-+r C ND et Zo qb 4r i
LICENSED LAND WR4V►EYORS r7
1 SEo<s 265J�1 s
GREENPORT NEW YORK LANG
iEIEDYNE qR WIHY
1 2 3 4 5 . 6 7 8 9 10
i
,
A 2" A
i -
• � Dl1ati eam ,� � ��
h '
, � l
Z.
f
Zo
B
iI FM
y
z�
•o I�
o N
_ r,
19' SII -- — I►'o"
DRAINAGE
! ItZL T- _ K`IT PLAN
„
eA
C - - I F" % �'�
� I Yo vfiwrc
IV
,-
�
I
IILAVI JV. II
W.4 f i 0
-
/
,f' p” 3 4 I
D ! �� " �IiNi _1 µ D
5TACK X11 LAV. z„ _ sri
2" to F oo OI5YS _----
11111
oz0 wnsrE 2" wa57E
* 21' x10" Hedceq.
CRADE µ°v�NT
ExYeluol2 '�� 0 I �
Gr�AR G'LAPBOARD CEsf Pooh µ" HOUSE DRAIIV
0, HOUSt
TRAP
r— "x to" ,tiJooD GIRDER
-
GA R AGC FL OOR
� 14
POUR EA
CoNc
F1 o 0A
3 of y
w.
_____P__A_ E3T VIEW -- VLIN
�FRoNr )
Ln
W
Q
011 1 ARCH. 2 3
fI
-.,. ,, 1
. ., I
, . " 1 i i—f-� DwN SCALE/ WO
0 1 ENGRG. 2 3
t
cND I
'
DATE
NO. DATE W. DESCRIPTION ET CND ARD F
nD
NET N0, (OLDER N0.
1 2 3 4 5 6 7 8 9 10
2 3 4 5 6 7 8 9 10
U _
n I I THN IE 1N 1 J --- --
�
i
I
A � A
i
I
— _ I
• I
I
_ C
-------------- ----
e
I
i —
— — — —
E E
t,. a
1 l
e
F
ILL. ATK
Jill
ILI,
N
0
O
x yI
W
0 1 ARCH. 2 3
ALE
0 1 ENGRG. 2 3 C2 .1 . 1
cfo 1rJ.•1 J • WO
NO. DATE F/.O. DESCRIPTION MY CEO AFFD AFID DATE F
POD
IN[f N0. FOLOfR NO.
1 2 3 4 5 6 7 8 9 10