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HomeMy WebLinkAbout34327-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEP~qTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPP2NCY No: Z-33509 I~te: 01/27/09 THIS C~RTIFIES that the building ALTERATION Location of Property: 250 WENDY DR LAUREL (HOUSE NO.) (STREET) (HAMLET) County Tax ~4ap No. 473889 Section 128 Block 5 Lot 2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 1, 2008 pursuant to which Building Permit No. 34327-Z dated DECEMBER 3, 2008 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 INSTALLATION IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to MARIA GORECKI & MICHAEL JOSEPH BLACK (OWNER) of the aforesaid building. SUF~LK C~)L~T~f DEPART~T OF }~J~TH ~PRO~i~L E~t-£1ICAL C~RTIFICA!~ NO. PLL~ERS C~RTIFICATION DA-r~o N/A N/A N/A Authbrized Signature Rev. 1/81 BUILDING DEPARTMENT TOWN HALL L 765-1802 ~PLICATION ~OR CERTIFICATE T~s application must be Qllcd in by t~ewdter or i~ ~d submitted to the Building Depa~mant wi~ the following: Ao 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 ii'om 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. Bo 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 thc applicant. Co 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 New Construction: Location of Property: House No. Old or Pre-existing Building: Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Subdivision Permit No. ~q ~D~t] Date of Permit. Health Dept. Approval: Date. Street Block 'check one) Hamlet Lot ~ Filed Map. Lot: Applicant: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ,~, O0 Final Certificate: c&· 13~'g (check one) /Appl}cant Signature FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) P~IT NO. 34327 Z Date DECEMBER 3, 2008 Permission is hereby granted to: MARIA GORECKI & MICHAEL JOSEPH 246 WITHERS STREET APT. 3A BROOKLYN,NY 11211 for : CONVERSION OF EXISTING OIL HEAT SYSTEM TO GAS HEAT PER MANUFACTURE SPECS IN EXISITNG SFD AS APPLIED FOR. at premises located at 250 County Tax Map No. 473889 Section 128 pursuant to application dated DECEMBER Building Inspector to expire on JUNE WENDY DR LAUREL Block 0005 Lot No. 002 1, 2008 and approved by the 3, 2010. Fee $ 200.00 / Authorized Signature ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD . BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown. NorthFork.net Examined ,20.__ Approved Disapproved a/c 120 Expiration ,20__ PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIS~I Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey_ Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form II~, Mailto: ~Lo~, OEpt [ : 31'7' oltt Building Inspector APPLICATION FOR BUILDING PERMIT ALL CONSTRU~ lu,xJ SHALL MEET THE REQUIREMENTS OF THE Date November 25th CODES OF NEW YOrZ, K S~ATE. INSTRUCTIONS ,2008 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 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 inspections. UNDERWRITERS CEFITIFIC,^it OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE Thomas Paquetttk,L.M.p. - KeySpan Plumbing and Heating Inc (Signature of applicant or name, if a corporation) 125 Sehmitt Blvd. Farmingdale, NY 11735 (Mailing address of applicant) State whether applicant is oxy, ~g~NOyect, engineer, general contractor, electrician, plumber or builder Plumber APPROVED AS NOTED DATE: i~t-~JO~ B.P.# Name of owner of premises Maria Goreeki (As on the tax ro~$l~~ DEPARTMENT AT If applicant is a corporation, signature of duly authorized officer 765-1302 8 AM TO 4 PM FO~ THE (Name and title of corporate officer) Builders License No. Plumbers License No. 3549-MP Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: 25O Wendy Dr. FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN _I~..,r3~hJ~][~UCTION ERRORS. House Number Street County Tax Map No. I 000 Section Subdivision 128 Hamlet Block 5 Lot 2 Filed Map No. 473889 Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Private Residence b. Intended use and occupancy. Private Residence 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost $ 7,400.00 5. If dwelling, number of dwelling units If garage, number of cars Fee Addition Alteration Other Work OiltoN. Gas - Boiler, W.H.,BBQandStov¢ (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height. Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Depth. Height. Number of Stories Rear 8. Dimensions of entire new construction: Front Height Number of Stories Rear _Depth 9. Size of lot: Front Rear ~Depth I 0. Date of Purchase Name of Former Owner I 1. 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 __ NO__Will excess fill be removed from premises? YES__ NO__ 14. Names of Owner of premises eq~r~a_ ~;er¢c~c[ Address 2fid tde,~t,. Da. Phone No..t¥7- Name of Architect Address Phone No Name of Contractor ,~/[~,~..~ r%-~.~t~e_ Address /~-s' $,-4,~,'p-/~at0' PhoneNo. ~t7 15 a. Is this property within I 00 feet of a tidal wetland or a freshwater wetland? ~YES NO ~ IF YES, SOUTItOLD 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 I 0 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES · IF YES, PROVIDE A COPY. NO STATE OF NEW YORK) SS: COUNTY OF $,a(~.cv~ Thomas Paquette L.M.P. KeySpan Plumbing & Heating, INC being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, CONNIE O. BUNCH (S)He is the Contractor / Plumber Notary Public State of New York No. Ol~Ubl~bUbO (Contractor, Agent, Corporate Officer, etc.) ,)ualified in Suffolk Coun~ , · ;~,ir~n Exoires Anri114, 20 of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are tree to the best of his knowledge and belief, and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ) ~ -]- day of~2:~c~ o-.[c>_a~ 20 O~f Notary Public Thomas Paquet~.M.P. KeySpan Plumbing & Heating, INC Signature of Applicant TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION ] FOUNDATION 1ST [ ] ROUGH PLBG. ] FOUNDATION 2ND ] FRAMING / STRAPPING ] FIREPLACE & CHIMNEY [ ] INSULATION ~FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ REMARKS: /~~ ] FIRE RESISTANT PENETRATION DATE FO~ATION (1S~ ~ ~ FO~ATION (2ND) ,% ~ ROUG~ F~G & ~ ~ ~ PL~G N' ............ _ ~S~ATION PERN. Y. --- ~ ~ STATE ENERGY CODE ~D~ON~ C0~S ~.~' TOWN OF SOUTHOLD PROPERTY ~.~F~ORD CARD OWNER ;TRE~r EORMER OWNER [ ~ ACR. RES.~O S~S. VL. FARM CO~. CB, MICS. Mkt. Value ~ND IMP. TOTAL Tillable FRONTAGE ON WATER Wo~land FRONTAGE ON ROAD Meadowla,nd DEPTH House Plot BULKH~D Total !OLOR /Y~(~ r~,~ L TRIM 128.-5-2 2/08 J M. Bldg./$~ J Extension Extension porch Breezeway Garage Patio z/--/,I'5'o =/Zd o Foundation /~/C. Beth / Dinette Basement ,~,~ ~.~ Floors ~,_ /.~ K, Ext, Walls Interior Finish LR, Fire Place ,T~eR~f Recreation Room Dormer Heat Rooms 1st Floor Rooms 2nd Floor Driveway DR. BR. FIN. B COLOR Gas Water Heater with the Flame Guard® Safety System Installation Instructions and Use & Care Guide WARNING: If the information in these instructions is not followed exactly, a fire or explosion may result causing property damage, personal injury or death. Do not store or use gasoline or other flammable vapors and liquids in the vicinity of this or any other appliance. WHAT TO DO IF YOU SMELL GAS · Do not try to light any appliance. Do not touch any electrical switch; do not use any phone in your building. · Immediately call your gas supplier from a neighbor's phone. Follow the gas supplier's instructions. · If you cannot reach your gas supplier, call the fire department. Installation and service must be performed by a qualified installer, service agency or the gas supplier. To obtain technical, warranty, or service assistance during or alter the installation of this water heater, call toll free: 1-800-999-9515 When calling for assista?ce, please have the following information ready: 1. Model number 2. 7 digit product number 3. Serial number 4. Date of installation 5. Place of purchase Table of Contents ...................................................... 2 6510300 August 2OO3 SPECIFICATIONS .Burnharri SERIE.5 2 RATIHGS Natural Gas or LP Gas 202* 37.5 80.0 222 4 X [5 202X' 50 80.2 272 4 x IS 203' 62 g0.0 272 4 x 15 204' 96 80.1 316 :5 x 15 205' 130 80.2 364 6 x 1.5 206' 164 80.3 424 6 x 15 207' 198 80.4 468 7 x 15 208' 232 80.4 524 7 x 15 209' 266 80.5 560 8 x 15 210' 299 80.7 618 8 x 15 203H* 62 N/A 274 4 x 15 204H* 96 N/A 319 5 x 15 205H* 130 N/A 368 6 x 15 206H* 164 N/A 429 6 x 15 · When mdcH~tg, add suffix 'N' to indicate natural gas. Substitute 'p' when ordering propane Add 'C' to indicate 24 v ' ' ' ' ..... o[t standing pilot. Add S to indicate Smartvalve intermittent ignition. Smartvalve is standard on 2H. See Burnham Trade Price Sheet for full model number explanation. Water Only - 30 PSI working pressure DOE heating capacity and annual efficiency are based on U.S. Government standard tests. 1. Series 2h high efficiency boiler not available with LP gas. uu~c~ ,*tuie raw or tour percent (4%) for each 1,000 ft. above sea level. 3. Net I=B=R ratings shown are based on normal I=B=R piping and pick up allowance of 1.15. Consult Burnham for installations having unusual piping and pick up requirements such a~ intermiO~ent system of operation, extenaive piping systems, etc. .Burnharri AMERICA'Ei O01LER COMPANy 13umham Corporation Form No. 4170H-S/98-60MsI~ Printed i,n the U.S.A. © 1998 Burnham Corporation - L~ncaster, PA Phone: 717-397-4701 Intemet-- http:/lwww.burnham.com KeySpan Plumbing and Heating 125 Schmitt Blvd. Farmingdale, NY 11735 (631) 501 - 6009 Thomas Paquette L.M.P. Maria Gorecki 250 Wendy Drive Laurel, NY 11948 3/4"drop to Gas Boiler and Water HeaterIst°vl--'e Gas Water Heater i ~ Gas Boiler.I ~ l " x l O' BIk. Gas Pipe from meter to bol~er and water heater - 3/4" to stove and BBQ.. Gas Meter Front Wendy Drive Boiler 130, 000 BTU Water Heater - 35, 000 BTU Stove 35, 000 BTU BBQ 35, 000 BTU Total 235, 000 BTU ,YO NG &:YOUNG 400 0$TRANDEI~ AVENUE, RIVERHEAD, NEW YO SURVEY FOR' ' ~ E~/~-~ . ,. . . ~ ; ~'~. ~:, ,,: · .,.. . .: . , ., , ~x-~.~..~' ~,/~-//