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suFFot��r 0�0 cpG Town of Southold 7/18/2021 P.O.Box 1179 T 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42168 Date: 7/18/2021 THIS CERTIFIES that the building ALTERATION Location of Property: 1600 Terry Ln., Southold SCTM#: 473889 Sec/Block/Lot: 65.-1-3 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 12/23/2013 pursuant to which Building Permit No. 46126 dated 4/26/2021 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: gas heat and water heater as applied for. The certificate is issued to Owens,Carol of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 6/28/2021 Ger Fredric 0 - 00' -ignature SOFFnt TOWN OF SOUTHOLD �o�° MooGy� BUILDING DEPARTMENT N z TOWN CLERK'S OFFICE Wo . SOUTHOLD NY dol BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 46126 Date: 4/26/2021 Permission is hereby granted to: Owens, Carol 1800 Town Harbor Ln Southold, NY 11971 To: Convert Oil to Gas as applied for. Replaces BP# 38617 At premises located at: 1600 Terry Ln., Southold SCTM #473889 Sec/Block/Lot# 65.-1-3 Pursuant to application dated 4/26/2021 and approved by the Building Inspector. To expire on 10/26/2022. Fees: PERMIT RENEWAL $125.00 Total: $125.00 ding Inspector o�S�FFo���o TOWN OF SOUTHOLD �� Gy BUILDING DEPARTMENT co TOWN CLERK'S OFFICE o . SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 38617 Date: 1/8/2014 Permission is hereby granted to: Owens, Carol 1800 Town Harbor Ln Southold, NY 11971 To: convert Oil to Gas as applied for At premises located at: 1600 Terry Ln, Southold SCTM # 473889 Sec/Block/Lot# 65.-1-3 Pursuant to application dated 12/23/2013 and approved by the Building Inspector. To expire on 7/10/2015. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CO -ALTERATION TO DWELLING $50.00 Total: $250.00 Building Inspector To-cim HaN A== , ic as 1,.feiYi�;�stL���1a 705e180 52333 2�iaia Road ire 15.0.Box a 179 SouLho2d,N-Y 12971.0-059 BUILDING DEPAPMNIEW 'I`clWN OF SOU°l['HOLD CERTIFICATION Date. Building Permit No. Owner: (ivy � Vys��S g�]] (Please print) `( /� Plumber. 1 t�f� � 4-t`Qv,2rc •{ tS )e (Please print) I certify Haat the solder used in the water supply system contains less than 10 of I% !:• lead. m s Signature) It� Sworn to before me this day of `,vv, 20 t l ROBERT F MARKS NOTARY PU13LIC•STATE OF NEW YORK � No.01 MA6364702 `` Qualified in Sufiolk County Notary Public, �. 1� County My Commission Expires 09.18-2021 l I j;. a SoUTyo # # TOWN OF SOUTHOLD BUILDING DEPT. a cou765-1802 INSPECTION [ ] FOUNDATION IST [._ ] ROU H'PL13G. [ ] FOUNDATION 2ND [ V] ULATION/CAULKING 4 Cokvovvl FRAMING /STRAPPING [ FINAL 01 ( 6&s [ ] FIREPLACE & CHIMNEY = { ' ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION' [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: DATE 13 INSPECTOR j �y �'•_�i ' Ali �f 1� f t F St t i S !d S x FIELD MSPECTION REPORT DATE COMMENTS �- FOUND'mozz(1ST) - .................-----...... - -- -• FOUNDATION(2ND) ' - z l �O o ROUGH FRAMNO& y PLUMBING INSULATION PER N.Y. i Y STATE ENERGY CODE FINAL �/ Y PM ADDITIONAL COMMENTS z } TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL:(631)765-1802 Planning Board approval FAX:;(631)765-9502 Survey SoutholdTown.Norffot k.net PERMIT NO. Check E cC E � n 17 E Septic Form H N.Y.S.D.E.C. Trustees y ff Flood Permit Examined / 20 Storm-Water Assessment Form p� DEC � � 4� ontact: p� Approved 0 ,20 % Mad to Disapproved a/c BLDG DEPT. i TOWN OF SOUTHOLD Phone. Expiration 7 rV�/20 (Building Inspector APPLICATION FOR BUILDING PERMIT Date ,20 INSTRUCTIONS a This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans,accurate plot plan to scale.Fee according to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas,and waterways c The work covered by this application may not be commenced before issuance of Building Permit. d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant.Such a permit shall be kept on the premises available for inspection throughout the work. e No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall be required. !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 appl ' �l 0 Of�nye,f lTE D Regulations,for the construction of buildings,additions,or alterations or for removal or demol t rn a$ ibf it s�rh e I(he applicant agrees to comply with all applicable laws,ordinances,building code,housing code,and—afu t� and to admit authored inspectors on premises•and in building for necessary inspections. DATE r B P. # U 4 1� U 1 °�Fq q aL. (SiP,nFa 'li "�I�I'� %'P" rTti0R)iENT AT tr, �, !70 8 8 �M �Vi v 0 R �/ p 11iJ,"IT I ,(),,,U- G R � 1'F1 t 3 � 1 FOUNDATION -TWO REQUIRED State whether applicant isdow" ,le,ele,ag ni q archiltect,engineer,general contractir�eafigffifp`1'uii&i ii�3F-�uTl&r 2. ROUGH-FRAMING,PLUMBING, CGc��I�C�c\ d STRAPPING ELECTRICAL&CAULKING Gr 1 3. INSULATION Name of owner of premises - , TRICAL I (As on the tax roll or latest eeQ'UST BE COMPLETE FOR C 0 applicant�ts a corporation,signature of duly�uthoriz fftcer ALL CONSTRUCTION SHALL MEET THE ame dtitleofcorporate facer) REQUIREMENTS OF THE CODES OF NEW YORK STATE NOT RESPCNISIBLE FOR Builders License No. DESIGN OR CONSTRUCTION ERRORS Plumbers License No. �° Electricians License No. Other Trade's License No. 1. Location of 1 iidon which pro o ed work will be do �j d0 House Number Street rr gHamlet' County Tax Map No. 1000 Section V f�) Block 1 Lot Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and'ntende use and cupancy of pro construction: a. Existing use and occupancy 5 b. Intended use and occupancy 3. Nature of work(check which applicable):New Building Addition AlterationJ ' �-c7 e�S Repair Removal Demolition Other Work (Description) V ` 1-o Y 4. Estimated Cost � ��7S . a 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 6. If business,commercial or mixed occupancy,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 Rear Depth Height Number of Stories 9. Size of lot:Front Rear Depth 10.Date of Purchase 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?YES_NO� 13.Will lot be re-graded?YES_NOlWill excess fill be removed from premises?YES_NO — %$tom`S-a vDn 14.Names of Owner of preinise.Cc c� Address�atT�n r Phone No. S 1 nS--!2�377) Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO *IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED. b.Is this property within 300 feet of a tidal wetland?*YES NO *IF YES,D.E.C.PERMITS MAY BE REQUIRED. 16.Provide survey,to scale,with accurate foundation plan and distances to property lines. 17.If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. 18.Are there any covenants and restrictions with respect to this property?*YES NO IF YES,PROVIDE A COPY. STATE OF NEW YORK) SS. COUNTY OF AJ&- ,a being duly sworn,deposes and says that(s)he is the applicant ame of individual signing contract)abov na d, (S)He is the � L� Contractor,Ageilt,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 this application; that all statements contained in this application are true to the best of his knowledge and belief;and that the work will be performed in the manner set forth in the application filed therewith. Sworn to�efora me day of Q er. 20 1� LeRRAINE lura ` otaryPublic Notary Public,State of New York Si nat pplicant No.4996659 Qualified in Suffolk/Nassau County Commission Expires 5/18/a®t '(his Fired, fli -h-EffffNe nc ,T _ Sealed C®rn�ustl®n Orr P® err VeInted Ar ' .' - ';�- �fir~., •. -- �`.."'��_ �-=' ; .- -_ v —°UpIT6, ®�0AVF�-Wlj ", E ' N., control imp �`I ° Features IQ,Control SystemTM True 'PlugA Play Controls Utilizing '19'0p, ion%Cards; Outdoor Reset ; --) (with Domestic'Hot Water Priority) Auxiliary,High.Lirnit,(manualor auto) Lois.Water Cut-off (manual or auto) Optional LCD Touch Screen 'Display improved-Boiler & Heating System Operation y' o Direct Vent (horizontal or vertical)`.. ' or Power Vent' f. Ott `;:. Efficient Operation Saves ? Homeowners Moneyi -' o innovative Design and Appearance Ideal Replacement for Millions of Existing Boiler Installations i o 7 sizes, 70-280 MBH input 5 or 10-year Parts & Labor Extended Warranty Plans Avai8aWe Nt E3 by 1:3��� COM"ally GREA ER ENERGY 5 ,�W Ratings Intertek O ®',QErr, $•,r CJI=�=�",1(ila�er,.. ,`s=,-�° -_, , _ 1Vlotlel,` In C ut, , <Vietin :� r? •�,,. .<!!,,:v i >=: 'YRiregxs. �lectrieal, INataill;er, 'I PH' Y IViBN Y'''„ =y' iNIB a<`` U * `(. �' { ) v f.. .N)r ' °AE I:,jo; Regrairei�eiits� ESO I 70 60 52 85.5 <2 Amps ESC4 1:05 90 78 85.4 <2 Amps ESC5 140 120 104 85.3 <2 Amps ESC6 175 150 130 85.2 <2 Amps ESC7 210 179 156 85.0 <2 Amps ESC8 245 208 181 84.5 <2 Amps ESC9 280 238 207 1 84.0 <2 Amps * Add suffix"N"for natural gas,or suffix"L"for LP gas models *'"Requirement for controls only,add for amp draw of circulators. -,}•�.," ^i;..,,?,r�"^ .'-'t.="'J.J,': - _ '{.i"f°`'�,X L. - a=3"a:•,,,,r'::n"^4`;":'s'.d::i;',,, .,r,'I111C11QI➢ 10715 InClleS k,.:1,=t:.," ,'rI�0i111eQ�i011 ypc es er- - :,Jf', •,M{t,.?v.' '�" .;i..y nxe°;�-` j�y.,f, =,k,��, 1�,...,_ I rv,+.' <s^ .`,,+„!;: .R,f- =F..x�„ki';.rK,n"..="+.s�:°Au::tr3�=""h 9. .;L- �_, f• a, �, ?:del lid=r; °D'e°'"th"''',; e r°<<:,.r,.., i, { + B. 3<, M!0 11t= ontent;{galj Shppiing Wt:;(ltis),. gid,, �, ESC3 14 41 33 3 +3 2 y 250 � ESC4 i 15-1/2 41 33 3 3 3 300 ESC5 i 18-1/2 41 33 3 4 4 350 ESC6 21-1/2 41 1 33 3 4 5 410 ESC7 24-3/4 41 33 3 5 6 460 ESC8 24-3/4 41 33 4 5 7 510 ESC9 30-3/4 41 33 4 5 8 560 INTAKE VENT VENT INTAKE 12" MAIC 0 347 ELECTRICAL VENTILATION AIR INLET OPENINGS*** 27»SUPPLY 0 0 41„ 18,9 GAS 1579 RETURN 12" MAX FLOOR ®„ FLOOR 11 LINE LINE I--i:'1" 4"o- NOTES ®7 4, 1 5"19722" 33" * Vent pipe minimum clearance to combustible material is(4)inches when vent is installed in a fully enclosed chased application,or(3)inches when vent is installed with at least one side open,similar to a joist bay application * Add height required to maintain 6"clearance from all breeching components *** Area of each opening 1 sq.inch for each 1,000 BTUH input-with minimum - • ” of 100 sq,Inches.Height of opening should be half the width. ©2011 U.S.Boiler Company,Inc.-Lancaster,PA USBL11091 Phone:1-888-432-8887 o www.usboiler.net