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HomeMy WebLinkAbout23435-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. No. Z-24823 Date: DECEMBER 26, 1996 THIS CERTIFIES that the building NEW DWELLING Location of Property 425 FAWN LANE CUTCHOGUE, N.Y. House No. Street Hamlet County Tax Map No. Section 103' Block 4 Lot 20 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 1, 1996 pursuant to which Building Permit No. 23435-Z Dated MAY 13, 1996 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ONE FAMILY DWELLING WITH ATTACHED GARAGE FRONT COVERED PORCH & DECK AS APPLIED FOR. The certificate is issued to: INLAND HOMES, INC. OWNER of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-95-0067-DEC. 9, 1996 UNDERWRITERS CERTIFICATE NO. PENDING - DECEMBER 6, 1996 PLUMBERS CERTIFICATION DATED: JULY 26, 1996-GAL KASRE B ilding Inspector 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) NE' 23435 Z Date ............... ...X ......................... , 19....�� Permission Is hereby granted to: .... ...... �..7..... - ............... / .......... ........... s�> _��` . to . ........ ............ . �........��.. ...............�. ............ ........... .. ........ �,w-s . (.L�'r.�- .... . �r... ........../ ......... ........ ... / i�/1�....... ..�� �!1�...... .......e� .......................................................... .................................................................................................................................................................. .... ................................................................. atpremises located at...... �..... I ................................................................................... .................................................... Z' 4.......................................................J.................. County Tax Map No. 1000 Section ....103........... Block.......� ....... Lot No. ............................ pursuant to application dated .............S ,l ................................ 19...,�� .., and approved by the Building Inspector. Fee$.. 11.�� ..... �( .r �'! ............................... ... ... . .. . .. uilding Inspector Rev. 6/30/80 THE NEW YORK BOARD OF FIRE UN`DE'RWRITERS PAGE .i 1 9�)O q BUREAU OF ELECTRICITY F_ 85 JOHN STREET, NEW YORK, NY 10038 Date L�' iT1�''w :�' i Application No.on file 1'927096I96 N 408349 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 I INLAND HOf-MS, 425 FA&IN LFAE, CUTC".H�GUE, N.Y. in thefollowinq location; ® Basement El, Ist Ft. 0 2nd Ft. GAR/PTTICIOUT Sertion 103Elock 4 Lot 42 was examined on nEMBER 06,1996 and found to be in compliance with the National Electrical Code. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS ECEPTACLES SWITCHES INCANDESCENT1.FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. 3S 43 30 37 1 1 1O.5 1 1,2 3 F DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. SYSTEMS NO.OF FEET AMT. WATTS 2 F 2 - 1 1 600 SERVICE DISCONNECT NO.OF S E 'R V I C E AMT. AMP., TYPE METER 1.0 4W 1 0 3W 3 0 3W 3.0 4W NO.OF CC.COND. A.W.G. NO.OF HIAEG A.W.G. NO.OF NEUTRALS A.W G. EQUIP. PER 0 OF CC.COND. .OF HIAEG OF NEUTRAL 3. 150 CB 1 X 1 1 OTHER APPARATUS: WELL PUMP-1 PADDU,' FAN-1 I4OTORS:1-F H.P. ,1-F H.P. SMOI4E DETECTOR:-6 L L JIM SkGE ELEC. INC. LIC.#3635 I 350 MARINE VIACE GENERAL MANAGER GREENPORT, NY, 11944 a5 Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. 0 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ENERGY CODE REVIEW (non-electric) 7814 (Part 5) 6,000 degreerdays For �DY �d 1 ��Z Per Dw s A17,11 .��. - /2 7 Dated ��✓�S' /�Q�9ti Envelope Component R-Value Exterior Wall R-18 Roof/ceiling R-19 Floor R-19 Foundation Wall R-10 Slab Edge- Insulation R-10 Glazing. R-1.7 Entrance Doors R-2.5 All 11VAC Equipment to meet requirements`of 7814.11 All 11VAC Control�Systems to meet requirements of-7814.12 All Duct::Systems, to' meet requirements of 7814.13 All Ventilating Systems to'meet requirements of 7814.14 . All Piping' Insulation to meet requirements of- 7814.15 ,All Service Water Heating Systems and Equipment to meet requirements" of 7814.21 All .Electric Systems to meet requirements of 7814.31 To the best of my knowledge, belief, and professional judgpmentj these plans are in compliance with the code pf NEWY O LU CE 03225.4 Form No. 6 . TOWN OF'SOUTHOLD 9 _ �c (P 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 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 1q•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 .complefed 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 Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 - " 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . .�2/.1.2/.95. . . . . . . . • • . • • . . . tw Construction. . . . . . . . Old•Or Pre-existing Building. . . . . . . . . . . . . . . . . • . . . . • • • • • • +cation of Property. . . . ... Xaim. 1ane. . . .. Q}itC�Y 9PEA . . . . . . . . • • • • . • • • House No. Street Hamlet wer or Owners of Property. .Ix11.and. C:. SAC•... . . . . . . . . . . . . ... . . . . . .. . . . . . . . . . . . . .. . . . . . . . . unty Tax Map No 1000, Section. . .1p.3 . . . . . ...Block. . .4 . . . . . . . . . . .Lot. . . . 20. . . . . . . . . . . . . . . bdivision. . Moose. .COVO. . . . .. . . . . . . . . . . . . . . . .Filed Map. A.N? . . . .Lot. . . 42 . . . . . . . . . rmit No.#2a435. . . . . . . .Date Of Permit... .5/A! �96 . . . .Applicant. . . Inland Homes : . . . . . . . . . . . . . . . . . .. alth Dept. Approval. . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . anning Board Approval. . . . . . .. . . . . . . . . . . . . . . . . quest for: Temporary Certificate. . . . . . .. . . . Final Certicate. . . . . . . . . . e Submitted: $. . . . . . . . . . . . . . . .. . ... .. ' 2C Inland Homes 11 .APPLICANT TEL. 765-1802 j TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL �ll ®�- SOUTHOLD, N.Y. 11971 C E R T I F I C A T I O N Date Building Permit No. Owner_ h �0.t^� 4oyukC-S (please print) Plumber .. Crlg C_ 'Af i9 5 K t (Please print) I certify that the solder used in the water supply system . contains less,:,than 2/10 of, 1%. lead. (plumber ' s signature) Sworn to before me this 144 day of '..�� �.Y a• 19 /gyp Notary Public Notary Public, 5 tt Frio L& County . MARGARET C.RUTKOWSKI Notary Public,State of New York No.4982528 Oualified in Suffolk County 9 7 Commission Expires June 3,19 765-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING [ j FINAL [ ] FIREPLACE 8 CHIMNEY REMARKS DATE 11' I � INSPECTOR i ass-isos BUILDING DEFT. INSPECTION [ ] FOUNDATION iST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN LATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY -44REMARKS: baOk QYI, 5��k DATE �� � INSPECTOR ass-zao2 BUILDING DEP'r. INSPECTION [ ] FOUNDATION 1ST [ ] ROU H PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: a �6v �r� .9cio r WO� �.�G �✓a,LL, ,,,—,��,on, . car�.�'�s�c� DATE 3 �� INSPECTOR 70-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION iST [ ROUGH PLBG. [ UNDATION 2ND [ ] INSULATION ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: AA, 70 .f d DATE l / l INSPECTOR �✓+Nv 765-1802 BUILDING DEFT. ECTION [ ] F NDATION iST [ ] ROUGH PLBG. [ FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ,,L�J��J�� i DATE v�'� INSPECTO 765-1802 BUILDING DEFT. SPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY 112 REMARKS: / DATE INSPECTOR P U1.011 Ill;1'ORT Un"fIS m, l;Ullllhlllri r,r.n AAOX . . -el ._ dnna.t n U �A. n�atan He,avgmnH nalJHHfl d,vnm„ d vc,nv,lrvn ma=, _vvna ..�ndn vnmvmrn vva eav`� d _ a,andcf IU)II(ill I'IlAl1Ii (, � - .'~._. - I'I.Iltllllll(i _••--........... _..___..._... -----------eaa—n—m- a-- ---- _ a„nro-.,an,nnaa.n,rooa�.men..na----dmn—o----Q •,� I IISIII.A'1'I1)II I'lill (l. Y . ��: •----- r/� ���""_''�•..._.-------•--- - -- ......_.._._.__.._. Gs ..._...._. Ir 1;1,1,1= - - ---- nn,,,,�...n....nnn.,n...,m.,r........n.. an.,�r.l .,... �n..ntir„�.,.:.r.r.rn...,..,.Tm.,m�..,,......,........n�...m.. ,,', I'I I I A I. - nn-nnnms-nd. „mebHnn..n..-- ----- .----....--------- ,-------- n...,nndd,c--------- ---------- ADD I'l'I OIIAL (,Ol lllltll'l'S : Cl � L n nnn corn Hnan„�.nn,--- ---- - - -- I ti - - --- --------- -- - -.... .............- - - - - ..... _ - --- - - ------- ---- - ------ - - -- - - t_1 I ... .. ..... . . V ENERGY CODE CALCULATIONS (For Noll-Electric Ileac) Design Criteria 6 , 000 Degree'.Days /O.A./ 1U0F I .A. 7U°F n� PER: J � 17�1 e���n 6Pr 137ZT FOR: �f1/"rh �� RE DATED• &VIS DESIGN THERMEL REMARKS SUBSYSTEM AREA "U" RAT1NG Exterior Walls (Opaque) /(937 s p 1( 4-10e Glazing ? z6 r 3Z _ 53 Doors C:eiliny/Roof (opaque) D Skylights $ Floor �� O O Foundation Walls Slab Insulation TOTAL 'L 4 7 Notes : Builcling Envelope Systems to meet, requirements of 7815 . 2 IIVAC Equipenient to .meet requirements of 7U15. 11 IIVAC SysL•ems to meet requirements of 7815. r2 DucL Systems to meeL requireiiients of 7815 . 13 VentilaL•iotis SysL•ems to meeL- requirements of 7E115 . 14 1:11sulatioii of pipitiy SysL-ellIs L-o meet requirements of 7UI5 . 15 Service Water Heating Systems & EquipmenL to meeL- requirements of '1015 . 21 Electrical & Lighting Systems & Equipment to meeL requirements of 7015 . 31 To the best of my knowledge, e` 0 belief, & professional judgement, these plans are in compliance .with the code. J �- Lu e �Bp'�ESS40��•. BOARD OF HEALTH . . . . . . .3 SETS OF' PLANS . . . . . . . �1 FORM NO.1': SURVEY ' TOWN OF SOUTHOLD CHECK • • - 4'' ' I�FB 1995 �� �/ BUILDING DEPARTMENT SEPTIC FORM . . . . . . . TOWN HALL . 4 � NOTIFY •• ' BLDG,oEPr SOUTHOLD, N.Y. 11971 CALL `r 'rGw�t o� T , , TEL.: 765-1802 • - �— OU.�/Oa_!3 _ MAIL TO Examined . . . . 1./. . . . . ., 19 ./. Approved . . . . . . � o, . .. 19f 6pen,nht No. Disapproved a/c . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .` . . . . . . . . . . . . . . . . . . . . . . . . ��•.<!.,,� i•(Bu'•di• g Inspector) . . . . . . . . ,APPLICATION TOR BUILDING PERMIT'. T. F -T Date . . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector,with 3 .,,:ts 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. 'Tile 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 ,;Ball 'pe kept oil the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part forany purpose whatever;until a Certificate of Occupancy ,zI,all 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. Hic applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ;idinit authorized inspectors on premises and in building for necessary inspections. . . . . � S� .11QmArl .1t1. % . . . . . . . . . . . . . . . . . . . . . (Signature of applicant,or name, if a corporation) PO Box 117,Mattituck,11952 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . . . General ,Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises „ Inland Homes •Ine•.• • . . • . • • • • • . • • • • • • • • • • . • • ;, • • „ • • • , , , • , , , , • • „ • • • (as on the tax roll or latest deed) 11-applicant is a corporation, signature of duly authorized officer. Robert E. Hiltz (Name and title of corporate officer) ALL CONTRACTORS MUST BE SUFFOLK COUNTY LICENSED Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . Plumber's License No. . . 2.451 . F.. . . . . . . . . . . . . . . Electrician's License No. ' . 36.35: . . . : . . . . . . . . . Other Trade's License No.. . . . . . . . . . . . . . . . . . . . . . 1 . Location of land on which proposed work will be done. . . .FaT4m. .La. ,Cutehouge: : .. . . . . : . : . . . . . . House Number c : ., i �, t'y:r�:; •,rrt .,Street .�; ,;;I�i ;. :� IianYlet• i �..•t ,,•.r,: ..,,. i County Tax Map No. 1000 Section . . .' 0.3. . . . . . . .. . . . Block . . . .4. . . . . . . . . . . . . Lot . . .20•., • : . . . . . . . . . Moose Cove . Filed Map No. 3230 Lot . 42 Subdivision . . . . . . . . . . . . . . . . . . , . . . . . . . (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction:. a. Existing use and occupancy „ • • Vacant land • . . . • • • . • • • • . • • . • • • • . • • • • • • • . • • • • • • . • , b. Intended use and occupancy . . . . . . . .single• family dwelling . . . . . . . . . . . . . . . . . . . . . . . . . .' 3. Nature of work (check which applicable): New Building ... . . . . . . Addition . . . . . . . . . . Alteration . . . . . . . lZepair . . . . . . . . . . . . . . Removal . . . . . , :' Demolition . . . . . . . . . . . . . . Other Work,. . . . . . . . . . . . . '100,OOO.Od (Description) ;1. Estimated Cost . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . ..... . . . . .. . . . . . . . . ` (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 . .2:Car '.Attached. . . . . . . . . . . . . . . . . G. If business, commercial or mixed occupancy;specify nature and extent of each.type.of use . . . . . . . . . . . : . . . . . . . . 7. Dimensions of existing structures,if any: Front . . . NSA. . . . . . . . Rear , . . . . . . . Depth . . . . . . Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . : . .: . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions-of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . ... . . , . . S. Dimensions of entire new construction: Front. 51. Rear , .51 . . . . . . . . . . Depth ,36 Height . . .24. . . . . ..00 Number of Stories . . . .2 . �00. . . . . . . . . . . . . . . . . . . . . . . .22 . . . . . . . . .9. Size of lot: Front Rear Depth .�. . . • . , . , . . . . • . . . 10. Date of Purchase .8��5. ,? , , , , , , , , ; , , , ; • , . Name of Former Owner• .Helen .Zur.awik. . • . . . . . . . 11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . + , • . . . 12. Does proposed construction violate any zoning law, ordinance or regulation:• . o . . . . . . . . • . . . . . . . . . . . . . . . . . 13. Will lot be regraded ,.,Y,&s.. . . Will excess fill be removed from premises: • • • . • . . Nc 1.1. Name of Owner of'preinises . Iznl.and. HOMeS. .IUC,Address . . . . . . . . . • . . • .Phone No. .?98-9696 , . . Name of Architect .Pemy. 11>X►lber. . . . : : ..,. .:.'. . Address . . . . . . . . . . . . . . . . . . . Phone No. . , Name of Contractor . . . . . . . • . Address . . . . . . . . . . . . . . .Phone No..� . .. . . . . . . . . . 1.5. Is this property: locatedwithin300feetof a•, tidal wetland?. *Yes . . . . . No *If yes, Southold Town Trustees Permit may be required. . PLO-T DIAGRAM Locate clearly and distinctly all buildings,'whether existing or proposed, and,indicate all set-back dimensions front property lines. Give street and block number or description according to deed, and show street names and indicate whetfie: interior or corner lot. See Attached Survey I r.. r _r. r j _n.r STA"TE OF NEW YORK, S.S ('OUNTY OF . . . . . . . . . . . . . . . . . Robert• E.• •Hiltz . . . . . . . . . . . . . . . ...... . . . being duly,sworn, deposes and says that he is the applicant (Name of individual signing contract) '{hove named. : �. r .• .;.•.. . .. Ile is the . . . . CcntraGtor. . . . . . . . . . . . . . . ;'. . . :. : . : . . . . : 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 application; that all statements contained in this application are true to the best of his knowledge and belief;and that the cork will be performed in the manner set forth in the application,filed therewith. Sworn to before me-this . . . . . . ./°V�.� . . . . . . . . . . .day'of . . . . . . 19 'votary Public,. . . . . . . . . � �G�:Q:�U . . : . . . . . . . County , . . . . . . . . . . . . . . . LINDA qJ COQPER ignature of applicant) Notary Pi blic,State of Ne%r vdi , No.4822563,Suffolk County Term Expires®ecembar 31,19 a'x�c�A • I I ,t,,�Y F �F�T1 .�a oo T ))� LU LU en Z- MCP 2xg G�RD[P I � -t-YE(CA = ® � .�� I S a I OK FVOT{ �-(C-- i O- SID — ,8/JI�T .UEC°(� TO J03 DID( lnlhl L,4 �uTC�O�Ut! hlOT ! SUFFOLK CO.-HEALTH DEPT. APPROVAL',.-- R H. S. NO. ZE :-\ a + f S� tu il �f� .L ��i!4 ��'•�'� r' i .�`- v ! � �j ¢'� I ) f,t �,� 1 r'=••, a � f"-.•; e q r"':'f�.�, 1 ., �.... ' 4-1 -f—r 'O i N I cz( STATEMENT OF INTENT i THE WATER.SUP.PLY AND SEWAGE DISPOSAL'' -� �^ � � �)�1 {� SYSTEMS FOR THIS RESIDENCE WILL. _ 1 a ! L G. �•iY CONFORM TO THE STANDARDS OF THE' -----------•- -•----- ..__----_-._ - -------,-___.__M-_ __ _-�- - = __.. .:_. ._---.,_---____.-. SUFFOLK CO. DEPT. OF HEALTH_SERVICES, ,�1 f rJ, (S) i r-, APPLICANT _ \ SUFFOLK COUNTY DEPT. OF HEALTH : SERVICES — FOR APPROVAL FOR CONSTRUCTION ONLY LO 49: DATE': WELL � H. S. REF. NO.: APPROVED: SUFFOLK CO. TAX- MAP DESIGNATION: ! I DIST. SECT. BLOCK PCL. -)� -( C I!c)J 103 2 '. CF00 l-5 / OWNERS ADDRESS: ! 1' '.MIJI EPCUl.1CP,,� —Fob A)%'A. CALL Ad-Ira DEED: L. f,1/ A P. TEST HOLE STAMP to this survey Is a vioiatiai off`" Section 7208 of the New York fttp Education Law. Copies of this summy map not beadarrt the land suroeyorlcedseat or f: LCi a Cam'? f � embossed seal shall not be cons idaved to be a valid We copy, 4{,+'ELL a`? Guarantees tndimWd hereon shalt ny only to the person forwhom the survey Is Prepared.and on his behalf to title company,governmental agesa wj t —--- — -- a� � �� a� � ` � � .»� --------•-.-_--_---.--------._ _ .._..1 -- ---_ •Q- lending institution listed hereon and' . t. . (� 4r� {` ,. '- , i r. -. 'c L4i Tp.F- PJ'�C,✓ [zf;, - p �* GI `i P. rh,M �� to the assignees of the lending insg tution.Guarantees are not transferaw f G to additional institutions or su uead cnseers. L ` u_ SEAL E U 'I;IOTC �1't;<.r�, h)i�) l : ��' �'_: '�_� ? i�t':+�:^::%(/ I�ti�r' ar %e CKR ' ���� A C-A s_0; ►,�Q'c i f �is �U hZr 1� OF MCru_ ��C�7`v'€�� AILED )N 'i{i� �. �� RODERICK VAN TUYL. P.C. � �•6JF� A. 11F {.rt N�� /� 'ir''<�.. l`:� ..r, ' �,lrc. ` LICENSED LAND SURVEYORS r=a, ?= y GREENPORT NEW YORK ` TELEDYNE POST N81729 _ - SUFFOLK CO. HEALTH DEPT: APPROVAL `' Ci' 37•�RES.� H. S.. NO. Jam•;.,k _ � `` �I�f�! �(✓�' 1P.•,, ,-,, Fes-.: ••,,,.\`a lki �•� 4 - f -i tr.•c�..:1 t A.r I^�:. Y tr c'FOOL_ SINGLE FAMILY ®R�YELL6�1�a.:®N'LY { ;"": J i I ;; tk + + . n�,r •,t��`�` ? :i' l,rPr, RES THREE YEARS FROM DATE OF /�P - tJ_ t',1'`'�J I' �`7;' d-' .P 'r I I 4..`. ._�-_..i_--_'.--�-.,. -•— — .. _----r.`._�____—f_ '__a �.'-�.,,'._ -- ((ZI`S-} STATEMENT OF INTENT _Q n, THE WATER SUPPLY AND SEWAGE DISPOSAL IA - -C U7 Ov-;UG 'i`- SYSTEMS FOR THIS RESIDENCE WILL To",kjm ` f' 50U-;71.401 C CONFORM TO THE STANDARDS OF THE ___._..__ ____..-.••_-- _ }._:_r___".• . .._..w_._.._-___..___.._._._�_ --: _ _.__--.- .�......--_-- SUFFOLK CO. DEPT. OF HEALTH SERVICES. (S) APPLICANT N SUFFOLK COUNTY DEPT. OF HEALTH N 26 SE.R V ICES — FOR APPROVAL FOR I i M. CONSTRUCTION ONLY 1 L► 4 C'fOQl ! wr =iD�W1L.OFDATE: �AY :�.U .. . _ l0 H. S. REF. NO. } ; d2 APPROVED: - - i. SUFFOLK CO. TAX MAP D SIGNATI.ON: DIST. SECT. BLOCK PCL:-. 1 inn jtH j OWNERS ADDRESS: . a, PIVYJiN RI), - © /14 DEED: L. t,1 s-w P. CP —i ? H'vrr, , zr (S � _r_.,tD�j l 5, TEST HOLE STAMP --•._- --_' t j C r Unauthofted alteration OfaddRlon i to this survey is a n of Section 7208 of the Now York S1219 _ ' ; FEB 4 I i liducation Law - 4 _ ; `. ;Is '�y 1 �I Copies of this survey map not bearing i j[ the land surveyor's inked seal or 5� embossed seal shall not be considered +'�.', � ✓' ` BLDG.DEPT. to be a valid We copy. �P, WELL�� •f :,�.1` Clf�' i J WNOFSOUTH LD GuarerdeesIndcatedhereonshallrun ronly to the person for whom the survey \G� -1+- is prepared and on his behalf to the tilie9ompany,governmentalagen and Y^ 1 i �''t r, r^, f� lending institution listed hereon and I �.aJ �.1.fs c.r I:.ir t Li: ;�I t� I3 � u,. O 1 7 k a ► f• !1001 to the assignees of the lending instl tution.Guarantees are not transferable ���� to additional Institutions or subsequent `vr.?`>.! S ;` '� APR e. owners. SEAL U_ ' • E y NE tr t`s. �I ...0+� K Vq NOTE ' ,.h,.t _ _ . ..• �.` L3..; /� O G� t✓{{7O5E-CCO111[._'0 F'1L.CG' IN TTIE RODERICK VAN TUYL. P.C. "� FO 0 _._ _ _ _ . . w._.• ._.--.-._-.. _ _. LICENSED LAND SURVEYORS °F ��.LS2562P�� GREENPORT NEW YORK tis�o taNv sJ TELEDYNE'POST N81329 ' ' . SUFFOLK CO. HEALTH DEPT. APPROVAL H. S NO. 5 ��. N �ANU,1 Y,.'i i,. 7 (.,-, w+• i ' ;.0• 'i ' I # STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL CAST CUT040GUL SYSTEMS FOR THIS RESIDENCE WILL �.}Ot1"FtrGL> 1. Y CONFORM TO THE STANDARD OF THE TOWN O D CO S jj SUFFOLK CO. DEPT OF HEALTH SERVICES. � XI (S) 1 l APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH 't t SERVICES — FOR APPROVAL FOR ' CONSTRUCTION ONLY u t ;: PQQI DATE H S. REF. NO APPROVED C � SUFFOLK CVJtl N DEP.ARW.eDT Os H WES SINGLE FAMILY QWEt,Ui4 ONLY SUFFOLK CO. TAX MAP DESIGNATION �r j DtST SECT. BLOCK PCL. DEC 0 8ki.r�. OWNERS ADDRESS: i own—, L Ipsw -` - T----I .� •'•+� V '. . 1 "r�, i 't'. {S9'Yr. i1 i 1 � 4j ^.• PL Xkm DEED: L P iii Office of wow S j P. �tnit�t GAP, �j T _{�7 - �{,{� � .! _.. TEST HOLE STA M P ••-' . _ .• J iRf�� �14'�y t ?.1 �/lldf'MI"tlwA 1'Owla'm wr Md�y Y Ffy. �. .t to ibis survey vinlatinn Af i Zt� I gd.Kion 7208 0!the New Ynrlc mm. - ,r 'y = Fi htcation Law. Copies of this survey rn.p rrA oeanrxf VMe 4'rnd surveyors in 1._al br jI - •I•� j. JIt l^' errt>osscd seal shall not ba ronsrnms*' • _. ���.. f M be a valid true copy. "" C`j .,•% OLamntcos indiu^tcd hcrocn what-, t .f ;r "to the person for v ._m t e onrvay WELL `1'�. j � �' r kprc red �94t .:. tD ttW i.YELL + ;�'t t4 a 4 r 't ? — -- i — lendr t > I rr k � -r•' } H --.' _-"---- - � �.. to the�� �.', r u� rL ' 4 w 00,0 k'"1 0 tp LI41LE t.i'C� SCR:. ,`. P1lh� h av` .12}i 1 i/� •('{^ r to add.,rl:J insiwu,wri,f W S&OAOwG W1 �: .. t. SEAL GKVqY�jll cam° o ; �rl t V < !► ti Y �. RObERICK VAN TUYL. 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