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Home My WebLink About6504-zFOR~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z~i.~6 Date . S.el~.. 19. , 19 ?3 THIS CERTIFIES that the building located at N/S Lupten Pt Roa~ Street Map No. ~ Block No. ~ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this offme dated A~il ~2, 19 ~3 pursuant to which Building Permit No. 6~Z //dated ....... %pmi~. 23 , 19 ?3, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . Pmlvage. one $ami!~ .dwelling ....................... The certificate is issued to J=les & Doris. ~!aenssen~ .... of the aforesaid building. Suffolk County Department of Health Approval LIND£RWRITERS CERTIFICATE No l? 11h:27h. tlOUSt NUMBER (owner, lessee or tenant) · .,.u~...?...~.?.~. Se~t 1.a..!973 Street... Lupron Pt Bo. ad ..... t~y a, vizz. a..' TOWN OF SOUTHOLD' BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 650~1 Z Permission is hereby granted to: ~ ....Z...u~. ~...~ ..~..o~.L ..~.~. ~ea~ a~.,~ ........ .......... ~. ......... ~a.~.~ ...................... ,~ .......... ~ ..... ~-,,..~b~'t~ ......... ~.,-~., .................... to ~,~ ~L .ae~...o:ae...~,,, ~,T.~'.. ~Iv~;t2~,a~ .................................................................................... ................................. .[.a~.r.~.o...v.~...~z.. ~..~rr. na~ ..... .~......tg...t ~.7.3~ ................................... at premises located at ....~/.S...I,%~on...t~ .~.t,..Roa~--(.~PV~--~.) ................................................ .......................................... ~a.t~:L~e.k ........ ~.,~., ............................................................................. pursuant to application dated .......................~..~1.]~ ...... ~ ........ , 19~...., ond approved by the Building Inspector. Fee $1.1.~.,.Q.Q. ......... /E~uilding Inspector t FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Temporary Certificate Of Occupancy No.. Z. ~'3.8.2'. ..... gate THIS CERTIFIES that the building located at . Map No.. xx ...... Block No... xX ... Lot No. ·. N/.S. Lupto~ P. oir~t Rd Street xxx..NaZ.tituck.. It .Y. ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... Apr.. 22 .... , 19 dated ....... April · .22, 19..7-3, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...P.l~ly.a.t.e...oD.e.. ~'~4n.~,ly. c~we li£P~g ................................ The certificate is issued to .. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approvalk~lg..7.. 197~ b~y ..R: .V.i.ll.~. ..... UNDERWRITERS CERTIFICATE No .... .p.e.n.d.t.n.g. ............................ HOUSE NUMBER ............ Street ........................................ Building Inspectori 1~0~ NO. ~ TOWN OF $OIJTHOLD Building Department Torn Clerks Office Southold, N. ¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Hea~th Dept. of water supply and sewerage disposal--($-c) form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Mulhple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te 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 property showing all property lines, streets, buildings and unusual natural or topographic features. 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 in- formation required to prepare a certificate ¢. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancv on pre-existing dwelling or land use SB.00 3. Copy of certificate of occupancy $1.00 Date ................................................ / New Building ~/ Old Pre-existing Building Vacant Land Location Of Property ...................~. 5 .~.~ ..~.. .?..~...JL.o.....~.......~).~.L..~..~.,....~..~....~...~.'[:.~..£~,-- C)wner Or Owners Of Property ...J.UJ..~.~...f~......~..~.~...L..~:~ .......... ~"~..~. ~..L..°~....~'..¥~...S..S...~..~.~ ........... Subdivision ................................................................ Lot No ............. Block No ............. House No...~..~. Permit No.~.~z~.~.~-~ .... Date Of Permit ...... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........ ..~.... ......................... Final Cerbficate .......................................... Fee Submitted $ .................................... Construction on above described building and permit Ir~ets all a p/~,e codes and regulations. Applicant ...... .~. ........... ~..~....~~~ ...................... Sworn to before me this ................ doy of ............................................ (stamp or seal) Notary Public .................................... County FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 1985 III1 Instructions ~mamm~t to~ This application must be filled in typewriter OR ink, and submitted m c- 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. Bo 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 features. 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: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling · ,~3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date ..... .~..'~. ?'. fi, .~. ,~..~..~. ..... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ....u% .-~...~......~_..~.p.-~..~yF... % .w. Jo'-~. ........... . .V~.. ......... (r..~.... House No. ~_~ Street Ham/et Owner or Owners of Property ..... ..~..M.~.!...~.~t ~v~v~.~ G ~Xr~v~..C~t~. - County Tax Map No. 1000 Section .. J.l..~.. ....... Block .... ~t. ......... Lot....[ ............ Subdivismn ................................. Fried Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .~.~. .......................... Construction on ab_gve described building and permit meets al~pplicable%d~s a d~egu ,ations. Rev. 10-10-78 FOHM NO. 6 TOWN OF $OUTHOLD Building Depa~ment Town Clerks Office Soutbold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This applicahon must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector 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. F~nal 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 installations, a certificate of Code compliance from the Architect or Engineer responsible far the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For existing buildings (prior to April 19.57), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property hnes, streets, buildings and unusual natural or topographic features. 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 in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3 Copy of certificate of occupancy $1.00 New Building .....:~.. ......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....~.f./.~...~]~.~.g.~...~.gj,~...~gl, ............ ~:~.~.~,J..~,lJ.¢~ .................................................. Owner Or Owners Of Property .~..~.~.~...c.',..g..q~'.$~...~,ct.z'~,f~..~eZts ....................................................... Subdivision ......... ];~.'.<,~ ............................................... Lot No...~... Block No.~r, XZ ..... House No.....L~.~.~. Permit No ..~'..0.~ ...... Date Of Permit~./.~/.~....Applicant ..~..~....D....~..~..~.~.e..~.~..e.,.~. ....................... Health Dept. Approval .... .~..'g.~...~. ..... .'J.~.~..3 .............. Labor Dept. Approval .......... .]~.:.(.~.;. ............................ Underwriters Approval ...~...~.~...bf..~.~. ....... ~./.'J.~../.~._~Plonning Board Approval .........!.,]....,..R..,.. ..................... Request For Temporary Certificate ........................................ Final Certificate ....~ ............................... Fee Submitted $ .~,,.Q.Q .......................... Sworn to before me this ..... .~.9 ...... day of ...... ~.e. 2.t,.......1.g23 .............. Notary Public .................................... County Applicant ............ ..~..~..~r~6~- ....... ~4:~.~ ................ (stamp or seal) ~ ~)'l ~'~ ~'~'~ TOWN OF SOUTHOLD Building Department Town Glerks Office Southold, N. ¥. 11971 APPLIGATION FOR CERTIFIGATE OF OGGUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspector with the following; for new buildings or new use: I. 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 farm or equal). 3. Approval of electrical Installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and simdar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s:te plan requ,rements where applicable For existing buildings (prior to April 1957), Non-conforming uses, or buddings and "pre-existing" land uses: 1. Accurate survey of property showing all property hnes, streets, buildings and unusual natural or topographic features. 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 in- formation required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelhng or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building ....... .,/... ....... Old or Pre-existing Building ............................ Vacant Land ........................... Location Of Property ...... ..~...:~....c.~. ...... .~.~,.~..~.~,~.......~..,./>,..~.,.....~-~j~ .~.k.~..~..C..t..~.. ................ Owner Or Owners Of Property ..,.~..~L\.~....~.....-t....~.C~.~......~ ...... .~.,l'...t, ...... ..'~...v:..~'..~ ......... .~ .................... Subdivision ................................................................ Lot No ............. Block No ............. House No..~..~.~.. Permit No. ~..C'.~..O...~...~..... Date Of Permit ..~..l~.?-.~.~..'~..Applicant .~,~..~....~.. ..... ~..~'..~,..O-....~4.~...~,~.~.?...~... Health Dept. Approval ............................................ Labor Dept. Approval ............................................... Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ....... .~'..i ........................... Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and perm?/lmeets all ap~ab, le codes-andregulatlons. Applicant .~.. ...........///~'..~: .l~,~6/~!....~~/..~..~,.~..r~4../ ///'~/~/'" ~ '~ ~- ~ ............. Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink. and submitted ~n duplicate to the Building Inspector 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 farm or equal). 3. Approval of electrical installation from Board of Fire Underwnters. 4. Commercial buddings, Industrial buildings, Multiple Residences and similar buildings and installations, a cert,ficate 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-ex~stmg" land uses: 1. Accurate survey of property showing all property hnes, streets, buddings and unusual natural or topographic features. 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 in- formation required to prepare a cerhficate. C. Fees. 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelhng or land use $5.00 3. Copy of certificate of occupancy $1.00 E:~te ................................................ / New Building ...... ~.... ........ Old or Pre-existing Budding ............................ Vacant Land .......................... Location Of Property ........ ..L~..~.5 ..... .~t~..~..~....~....m~...i.~?~:t..~%..'~..t......~..~.~:).~.9..~..(...~=¢.. ................... Owner Or Owners Of Property ..... ..~...~.~...'~..~'~-- ..... .~....~...~..'F..k..~. ......... .~.~..~..,.~.'.'.'.'.'.'.'.'.'~.~..~_~...~....'~..~...~..... Subdivision ................................................................ Lot No ............. Block No ............. House No....~.....~...~. Permit No .~..~..6...~....~m... Date Of Permit .-~- ~..~...3'..~.'~.- .~.Applicant~ -- .... .-~....~...~.. ....... 4~..~.~.~.(~..?--,.Yk-~.-~.~....~ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate .. ...... ................................/ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit r~eets all app~,ab-~ codes and regulations. Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County THE NEW YORK BOARD OF FIRE UNDERWRITERS ;l~"~ BUREAU OF ELECTRICITY ~ 85 JOHN STREET. NEW YORK, NEW YORK 10038 N 114274 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by th~ applicant named on the above application number in the premises of Jules ^drigenzsen, n/s Lupton's Oint ~d., 500' e/o Marratooka Ave. Hat t J.t~ck~ L.I. inthefollowinglocation; ~ Basement [] IstFI. ~l~nd FI. O~sld(~ Section Block Lot waz examined on September ~, 1073 andfoundtobeincompliancezviththerequirementsofthisBoard. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT 2t 21 DRYERS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET OTHER APPARATUS: *Furuace~: Oil 1-1/~qhp, ~otor/s: 1-1/2hp 251/1 S E R C NO. OF CC. COND. A.W.G. NO. OF HI.LEG A.W.G. NO. OF NEUTRALS PER ~' OF CC. COND. OF HI*LEG O'F NEUTRAL i ~/0 i i/o ~;attituck, I,.I. Per COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No~ o EASTERN DISTRICT, RIVERZEAD, N. Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS ~ ~~ 1~'~ Approval to construct said systems is requested,pertinent data herewith: Date ~ ~ ~ 1-Applicant ,~)q~/e~:, /~e~ ~ v~ Phone~-t~_ 6-Sub div. Address I ~ r~ ~u~-~ ~- l-~ bOc~ ~_c~ ,~%o~x 7-Section 2-Detailed property iO6ation [o0~ ~-~ ~a~-o~ ~ 8-Lot No.' Hamlet ~44~%oce. ' Tdwn ~.oLko%J ' 9-Private'well? ~=~ . ~ 3-Public water supply name Distance to nearest main 4-Lot Size: Width ft. Len. gth ft. (also enter on Denter plot plan below:) 5-Dwelling: Single Family ;~f Two Family? ! /Cellar? f~//.Slab? f f Crawl Space? / / 10-Proposed system: Septic %ank f /Precast y /Cesspoo~ / /Shallow pools / /Other / / il-Septic tank inside dimensions: VDlume~ Gals. Length ft. Width ft. Liquid depth, fl 12-Precast sections: ~r?Number~quare Ft. Cesspools: Block sizeL___incs.D ins. H in Total blocks below inlet: ~1 ~2 ~ PLOT PLAN Ca pa cityJ~_~'~al· / I I '~ T~st Hol~, ~ ~: Street ~Vto~ --~-~. ~, . ~ Ioata ~eet , I l ~g~ I I~o ~ o ~ [ o m ~ Indi :ate I ] ~6 ~ ~ ~ No ~th The Undersign~ CERTIF~S: "Construction of authorized installations will be in acco~ance with the Suffolk County Health De~rtments' current $tanda~s, Bulletins, and amendments thereto, covering Private Se~ge Disposal Systems". ~//~x O~er or Builder FOR ~ALTH DEPART~NT USE ONLY. Based on the info~ation presented here~th, i~ is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. (10/65 Revis.) Signed TGWN CLERK'S OFFICE sour,O~D. N. Y. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .............. Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... V 1. Location of and on whicht :[ { [~J ~( --Pr°posed work,~w be done M p No ~ ....~.... ........ Lot No. · ' . ~p n ............................ .~. ............... Number ...... ~_~It. ~..'t'~ :C',.......~. ~. x..(~CJC ...i...~...~. ¢/~.~:,..~r.~J.g_~.~ .......................................................... Street and Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Ex.n useand~u anc .~.~.~_~ .... ~....~ a. g p y ................................................................................................ b. Intended use and occupancy .... --...~.~:~.xl~,~.~.,...~J~.~_~.~_,~ ....... ~.~) .............................................. Disapproved a/c ........................... .......................................................................... ~~ ......... ~" ............ ;;'e'~..,,,-m' ~ ,,'/"-.,,,,~ '~'k APPLICATION FOR BUILDING PERMIT Date ~ ............ ~. ............................. ,19 ............ INSTRUCTIONS e. This e~i~tion must t~ ~ompletet¥ filled in by t¥~writer or in ink and submitted in triplimte to the Buildin~ Ins~etor, 3 mt~ o~ IMens, ~'ur~t~ ~ot plen to sc-t~. ~ e~ordin~ to r~h~dule. c. T~ ~ ~ ~ this a~li~tion may not ~ ~m~n~ ~re i~u~m of Building Permit. d. U~n ~al of t~s appli~tion, ~ Building Im~or will iss~ a Building ~rmit to the a~li~nt. Su~ ~rmit ,shall t~ ~mi~ ~ail~e for ins~mion thmug~t the wo~. e. No buil~ ~11 ~ ~pi~ or umd in whole or in ~ for any pur~ whate~r until a ~ifi~ of ~n~ shell ~ln~ ~ ~ ~ildi~ ~U¢~TIOffi 18 ~8~ ~Dfi ~o th* 8uildin~ ~*~nt for t~ i~u~n~ of ~ 8ulldin~ ~rmit ~i?nm of ~ T~ of ~thold, ~ffo~ ~un~, N~ ~p~, .~ot~r appli~bl* ~. Ordinanms or R~ulati~s, for mn~, ~d~tl~s or al~ratmns, or for re~val or ~mhtlon, .~ ~m ~i~. ~ ~l~nt ~ to ~mply wl~ all ordinanms, ~ilding ~, ~using ~, and mgul~ions, ~ m ~t a~horized insm~o~ on ~mi.s and in ~ildi~ for ~m~ ink.ions. ...... X~...~.~.~.~...~:. ............... ~ ~ n (~dm~f a~li~t). S~te ~etber ,Dli,nt Js owner. I~. ,~nt. ,rchJt~t. engin~r. ~ner, I conjuror, el~ricinn, plum~r or builder. a.~..~.~..~...~e,~L..~.~.~.~. ....... , ..................................................................... .,-, of 0,,,, 0,,,.~,., .... .o.~.~....,..~:~.~.~ .......... A~.~.~.~.~s.~ ................................... / 3. Nature of work (check which applicable): New Building ....... ~.. ............. Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... ~. /' 0~ ~)~ (Description) ...... ...................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .~ ......... Number of dwelling units on each floor ......................................... If garage, number of cars ............. ~'~ ......................................................................................................................... 6. If business, commercial or mixed occuoancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ............ ., ............................ Number of Stories .................. ~ .................... 8. Dimensions of entire new construction: Front .~,.~o~~. .......... Rear .~,(~....~.~'. .......... Depth ....~.....'~...~. .................... Height ........ =~.~...t. ............................... Number of Stories ......................................................................................... 9. Size of lot: Front ....q~,.~.~.,..~...~ ............Rear ..x=~..~)..c[,..~..'~ ................... Depth ......~..cj.:..~.O ........................... 10. Date of Pumhase..~....0..~.~.....~..~..~...~ ..... Name of Fq~mer Owner ..~..~.£1~.~l~.w~..i~.~P..~:.. .................. 11. Zone or use district in which premises are situated ...~.......~..k~.~ ........................................................................... 12. Does prooosed construction violate any zoning law, ordinance or regulation: ...L~.'C~..~......c,~ .~'-'.~-- .~ .~. t..~.~ .~-~ ...... 13. Willlotberegreded~----~-.~.~....., .................. ~W~ll excess fill be removed from.premises: [~rYes [ ] No 14. Name of Owner of premises ..~,)J,tJ~_~.....~,~..~.~.C.~,5.~.~x~,~.....t.:~.~.~l~Ll~nc~ ....... ~.(e.,~. ~,,.~,.,~..~...'~ ..... ~,.~ ~ ~'-~_ ire~s,),~ ~,,,,. [ (_(I~Io~e_~N~ ~- (Addr Sl ( ~ ne ~o. ........ . ~ -A t .(A~dress) _, . ~, (Phone No4 .. Name Contr=or PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set.back dimensions from property lines. Gi~ street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YORK, ) COUNTY OF.....~..tJ.. ~.~-~ ....~ ......................... ) '-~ ~J~/['1 Pr~'~M~ ~'~J'f , being duly s~rn, ~,s and says that he is the appli~nt abo~ named. (Na~ of indivi~ sing ~n~t~ ' He is the ........... ~.g.~.~ ....... ,~.~P~.~) ....................................................................................................................................... ( Cont~ctor, a~t, coyote offi~r, etc.) ' of said owner or owners, and is duly authorized m ~rform or have ~rformed t~ ~id work and to make and file this appli~tion; ~at all statements contain~ in this application are true to t~ ~st o~ his knowl~ and ~lief; a~ that the work will ~ ~Hor~ in tbe ~n~r ~t forth in the appli~tion filed t~mwith. ......... ............ .... . .... ....................................... N.78'47'10"~. -~80.~0 ....... A~P OF PROPERTY SURVIEYED FOg I30[/15 SITUATE AT I^~TT ITUCF-.. NE\V YO~ SSENS rg._ T~ST 14 0 LE / / TEST FIOLE t' ~At,,IDY LONtk SCALE ' 30'=I" lEON PiPE I^ONUAENT WELL CESSPOOL SUFFOLK COUNTY HEALTM DATE. AUG 7 1973 ~. ~. ~. The sewage disposal and ~v~ter faoll~+~es for this lo~ inspOC-~¢ bv this deptr~ent g:~d found Chief of Gen~m~ Services EULAND (w, cAN'r) N. 78'47'I0"15. - ZSO. 20 AAP OF P2OP'~lY SUI?VF_.¥E.D F'O~. JULES a,. DOP__.tS ADI2!AENSSENS SITUATE AT IAATT !TUCIL NEW YOP~ TEST "~)LE TOpSOil. SANDY : SCALE ' 30'=i" 63 = IIZOKI PiPE D =/^ONLO!AENT ,.= WELL. - -- CESSPOOL. .... ~ Z/ .-~ I~ULAND (VAC,~T) , ~.78'47'io-~: __ z~o.z..qo , ZS'9. q3 'S...._ The sewage disposal and water re?only facilities for this location have been inspected by this department and found to be a~r2 satisfact or~.~'~ _. ' Cl~lef of Gener Services /AAP OF PROPI:;BTy ~'URVE¥~D FOi:, /AATT ITUCIC TEST SCALE · 30':i" ® = IRON PIPE I~' =/^ONU/AENT .~ = ~VI;LL "CESSPOOL. [ t..q'c-.c-t'o Io fT~l~r~ I i . '7.¢,.4 =. --iL4¢ q 1 4~ APPROVED AS NOTED DATE: FEE: I [ NOTIFY BUILDING DEPARTMENT AT 765-2660 9AM TO,~.PM FOR REQUIR~ ED INSPECTIONS: ~ 1. BEFORE BACKFILLING FOUNDA.~ TION OR START FRAM NG 2. BEFORE COVER NG PIEELINE $. FINAL WHEN JOB COMPLL ~-D OFF CE OF: RALPH M IGlYOlYE A R ~ H' I T E C T 0'i~ E ,. F k R M "~ G ID A t E R O A D ,¸% f/ ,Il ~ B'Y L 0 N , ,:It ~ ¥;0 R ~ (I 1 710 Y,,~O R K OFFI CE 0 F: . RALPH M IGNONE A R C H I T E ..~ T ONE FARM IN GDALE ROAD BABYLON, NEW YORK (11704) OFFICE OFi RALPH A R C H M IGNONE I '1' E C T ONE FARM IN GDAL E ROAD BABYLON, NEW YORK (11704)