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HomeMy WebLinkAbout27572-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27915 Date: 09/05/01 THIS CERTIFIES that the building HEATING SYSTEM Location of Property: 12115 MAIN RD EAST MARION (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 31 Block 5 Lot 3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 17, 2001 pursuant to which Building Permit No. 27572-Z dated AUGUST 22, 2001 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 INSTALLATION OF NEW OIL BURNER IN EXISTING ONE FAMILY DWELLING AS, APPLIED FOR. The certificate is issued to ROBERT & GALE WALSH (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. PENDING 09/04/01 PLUMBERS CERTIFICATION DATED N/A r Authorized Sit ture 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) PERMIT NO. 27572 Z Date AUGUST 22, 2001 Permission is hereby granted to: BURTS RELIABLE, INC. A/C WALSH 1515 YOUNGS AVE. SOUTHOLD„NY 11971 for INSTALL NEW OIL BURNER IN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. at premises located at 12115 MAIN RD EAST MARION County Tax Map No. 473889 Section 031 Block 0005 Lot No. 003 pursuant to application dated JULY 17, 2001 and approved by the Building Inspector. Fee $ 150 . 00 Author zed Si nature ORIGINAL Rev. 2/19/98 Form No. 6 '' I TOWN OF SOUTHOLD s � BUILDING DEPARTMENT TOWN HALL `` •~� 765-1802 L CATION FOR CERTIFICATE OF OCCUPANCY A. 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 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 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. 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 - .25A 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential ,� $15.00, Commercial $15.00 Date . . . . . . :RDI . . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . Old Or Pre-existing Building. .. . . . y .�f`:\1.�. .: °`:�.r. .�-. �. . . ..nom. . .� Location of Property. . . . . �• • • � •, • • • • House No. Street Hamlet Onwer or Owners of Property. . . �':: .. .. . . . . ..^��. .� ^� . . . . . . • • . • • • • • . • • • • • • • • • • • County Tax Map No 1000, Section. . .). . . . . . .Block. . . . :'!� . . . . . . . .Lot. .�. . . . . . . . . . . . . . . Subdivision. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .. . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Permit No. . �'.� .2' . .' . Date Of Permit. . :D. \ .Applicant. .) �\n-\. �. . . W h�� . . � . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . ..Underwriters Approval. . . . .� X. . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Fi"Certicate. . ,Fee Submitted: $. . �- . . . . . . . . . . . . . . . . . . cl c,- ro0 6V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 � o�7 9/,j ANT o��g�FFO��-coG o� y� N Town Hall,53095 Main Road I Fax(631)765-1823 P.O.Box 1179 ifi �� Telephone(631)765-1802 Southold,New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD August 31, 2001 JOHN ROMANELLI PO BOX 696 SOUTHOLD NY 11971 RE : 12115 MAIN RD EAST MARION TO WHOM THIS MAY CONCERN: We are unable to complete your Certificate of Occupancy because of the following reasons: XX An application for Certificate of Occupancy is not on file. (Enclosed) XX NO Underwriters Certificate on file. XX The check is (not in file)$25.00 No Health Department Approval on file. No final inspection has been made. _ No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT #27572-Z Please contact our office on this matter. Thank you for cooperation SOUTHOLD TOWN BUILDING DEPT. THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 8085311 BUREAU OF ELECTRICITY F 40 FULTON STREET, NEW YORK, NY 10038 Date SEPTEMBER 24,2001 Application No. on file �f1^`"­'! �P, H 072815 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of WALSH, 21115 HAIN ROAD, EAST MARION, NY in the following location; ® Basement ❑ Ist Fl. ❑ 2nd Fl. Section Block Lot was examined on SEPTEMBER 04,2001 and found to be in compliance with the National Electrical Code. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS RECEPTACLES SWITCHES INCANDESCENJ FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. N.P. 2 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT.j TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K.W. OIL M.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS 1 F SERVICE DISCONNECT NO.OF S E R V 1 C E METER AMT. AMP. TYPE EQUIP. 1 0 2W 1 0 3W 3 0 3W 3 0 4W NO.OF CC COND. A.W.G. A.W.O. A.W.G. PER 0 OF CC.COND. NO.OF NI-LEG OF HIAEG NO.Of NEUIRAIf OF NEUTRAL OTHER APPARATUS: INSTALL NEW OIL FIRED FURNACE-! BURTS RELIABLE L P. 0. BOX 696 SOUTHOLD, NY, 119791 GENERAL MANAGER it Per This cerOflcate must not be altered In any manner;return to the office of the hoard If Incorrect.Inspectors{may be Identified by their credential. COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. suauiNc DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING I 1 FINAL [ ] FIREPLACE & CHIMNEY R ARKS• A � DATE � INSPECTO P--TS-7,� �z 765-1802 suIwiNa DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING [ FINAL [ ] FIREPLACE fl CHIMNEY REMARKS: L„ DATE � � -INSPECT FIELD INSPECTION REPORT DATE ;.�` COMMENTS saa-a--aa�---a--ssa===s-- �_- -•- x�=�=-xx==mm====s=s=ss=x==s----=aaass=xe=aax==a=a=xas t FOUNDATION OST)'. H Ca FOUNDATION (2ND) -------------_-_ ROUGH FRAME & o Su PLUMBING lfa ;S INSULATION PER N. T.' H STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: so l �SL H`. H\o TOWN OF SOMOLD DTXI 90 PM=APPUCKR014 OMC=". BUILDING DEPARTMENT Do you have or need the following,before applying TOWN HALL Board ofRealth SOUTHOLD,NY 11971 3 sets ofBuddibgPlans TEL: 765-1802 survey PERMIT NO. oC �.5 7 Cheek Septic Form NY.S:D.E.G Trusteos Examined 20� Contact: Approved ?A;6J Mail to• Disapproved ec Phone: 3 Buri ' pe APPLICATION FOR BUUMINGG PERMPr, T, ,N r-SCM-HOLD Date l 2001' INSTRUCTIONS a.This application MUST be completely filled in by typewriter or in and:submitted to the Building Inspector with sets of plans,accurate plot plan to scale.Fee according to schedule: b.Plot plan showing location oflot and ofbuildings on premises,relationship to adjoiningpremises 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 Ipspector 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 a Certificate of Occupant is issued 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 descried The applicant agrees to comply with all applicable laws,ordinances,building code, using code and regulations,and to admit authorized inspectors-on premises and in building for necessary inspections OCCUPANCY OR UND>O RltE CMMM USE IS UNLAWFUL (signature of applicant orname,if a corporation) REik1IRED WIITH/O►/UTCER11RCATE �� Yee � OF OCCUPANCY (Mailing address of apphoant) State whether applicant is owner,lessee,agent,architect, engineer,general contractor, electrician,plumber or builder Name of owner of premises. 1r,r 161a /J AP VED AS NOTED (as on.the tex roll or latest . If applicant is a corporation,signature of duly authorized officer NOTIFY BUILDIN(D�EPA M A 765-1802 9 AM TO 4 PM FOR THB FOLLOWING INSPECTIONS; (Name and title of corporate officer) 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE Builders License No. Z ROUGH - FRAMING & PLUMBING • '• Plumbers License No. l 7 e/� 3. INSULATION 4 FINAL• - CONSTRUCTION MUST BE COMPLETE FOR C.O. Electricians License No.-- ALL ALL CONSTRUCTION SHALL:MEET THE REQUIREMENTS OF THE N.Y. Other Trade's License No. STATE CONSTRUCTION A ENERGY CODES. NOT RESPONSIBLE F"T, 4. 'NI OR CONSTRUCTION ERROR 'i 1. Location of land on which proposed work done: , o ' House Number Street Hamlet County Tax Mals No. 1000 Section 3 l Block e S Lot Subdivision Filed Map No. Lot (Name) state e�d� use and oemanW of M=e d m end use and oca panty of proposed constluc ten: a. Existing use and occupancy L�Ji' rot b. .Intended use and occupancy . Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work C o©(Descrrrption) Estimated Cost Fee . (to be paid on filing this application) if dwelling,number of dwelling units Number of dw g units on each floor__, If garage, number of cars If business, commercial,or mixed occupancy, specify nature an extent of each type of use. Dimensions of existing structures,if.any:Front Rear Depth Height Number of Stories Dimensions of 6 e cture with a rations or ad ons: Front Rear Depth Hei Number of ories- L Dimensions o contra n: Front Rear Depth Height umber of Sto ►. Size of 1 root Rear D .0.Date o hose- Name Former Owner .1.Zon or use district.' Whi premises are ted .2. es ptoposed c on violate any Hing law, ante or regulation: ill lot be re-grad excess fill be removed premises: Yf;S NO- .4. O.4.Names of Owner of premises Address Phone No. Name of Architect Address Phone No Name of Contractor Addres ' i 1 l: one 230. [S.Is this property within 104 f of a tidal wetland? *Yr°m=now 3mmm, 7 YES, Sd TOWN TRU ' . , , . ZED QUIUM 16. Provide survey,to scale, th accurate foundation plan and OAMI; s 17. If elevation at any po' on property is at 10 feet or below,must provide topograpbical data on survey. - ,SS: Tr being duly sworn;deposes and says that(s)he is the applicant gffnd ictaal signing contracty,above named, swe is e (Contractor,Agent,Corporate Officer,eta) >f saidrdWhtrk0IJfttKrWd is duly authorized to perforin or have performed the said work and to make and file this application; hat all statementsIZ&A ffi—i ed 3a thrs a iication are true to the best of his knowledge and belief;and that the work will be lett er het forth in e ilication filed therewith. }y� . ° R �' O F a . .r ?i � , ;womtobe a JbS# - dM M .+far Er /. ZLNotary lit Signature of Applicant LINDA J.COOPER Notary Public,State of New York Na 4822563,Suffolk County Tena;Esgs6rss Deceinber 31, reLgLpo 2___