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Home My WebLink About34339-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEP~-RTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34360 Date: 05/20/10 THIS c~KTIFIES that the building FURNACE Location of Property: 1275 LAURELWOOD DR (HOUSE NO.) (STREET) County Tax Map No. 473889 Section 127 Block 5 Subdivision Filed Map No. __ Lot No. __ LAUREL Lot 8 (HAMLET) conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 5, 2008 pursuant to which Building Permit No. 34339-Z dated DECEMBER 11, 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 FURNACE INSTALLATION IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to BARBARA A KELLING (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R~,Rt-rKICAL c~KTIFICATH NO. PL~]MBEP~ CERTIFICATION Da'r~ N/A th'i/z~Signature Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. 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 end 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. 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 the applicant. Fees 1. certi~cate ~f ~ecupan~y - New dwe~~ing $25.~~~ Additi~ns t~ dwe~~ing $25.~~~ A~terati~ns t~ dwelling $25.~~~ Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. Certificate of Occupancy on Pre-existing Building - $ [00.00 Copy of Certificate of Occupancy - $.25 Updated Certificate of Occupancy - $50.00 New Construction: 5. Temporary Certificate of Occupancy - Residential $15.0(3, Commercial $I 5.00 / / / / Old or Pre-existing Building: ~ _ (check one) Lot House No. Street -Suffolk County Tax Map No 1000, Section ] ~) Block Subdivision Permit No' '~--~ L~. ~ Health Dept. Approval: Planning Board Approval: Date of Permit. Filed Map. Applicant: Underwriters Approval: Request for: Temporary Certificate Final Certificate: / (check one) Fee Submitted: $ ..~'3%~r/-~) , Sigl~t6re 5~ 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. 34339 Z Date D ER 11, 2008 Permission is hereby granted to: BARBARA A KELLING 1275 LAURELWOOD DR LAUREL,NY 11948 for : INSTALLATION OF A FURNACE AS APPLIED FOR at premises located at 1275 LAURELWOOD DR County Tax Map NO. 473889 Section 127 Block pursuant to application dated DECEMBER 5, 2008 Building Inspector to expire on JUNE 11, LAUREL 0005 Lot No. 008 and approved by the 2010. Fee $ 200.00 ~~A~thorized Signature ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING / STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FIRE RESISTANT CONSTRUCTION [ REMARKS: ~ [ ] ROUGH PLBG. [ ] ~U,.LATION [ ,~,]"FINAL [ ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION DATE INSPECTOR~ FOUNDATION (%ND) pL~G - STATE E~RGY CODE " 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 Wc · 20 Expiration ,20__ PERMIT NO. ,~ ~33 ~? ~ I~.D~. DEPT. TOWN OF Building Inspector BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying'? Board of Health 4 sets of Bmldmg Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form ~ontact: Mail to: Phone: 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 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 inspection~/~/ ~ . ..i(.)L/~J?',t~l'~kd I k,JF'I ~ (Signamreofappl~torname,3~acorporation) .,_L. I,_ UNLAWFUl. IJNDEFll/EIlTEI:I$ CERTIFIO, TE , r.i '*' T r" ' ' APPROVED Nameofownerofpremises FEE: ~¢2e~ _ b,.~. ___~on the ta~/roll or lat~t~, 765-1802' 8AM [0 ;'.:, .OR THc If applicant is a corporation, signature of duly authorized officer FOLLOWING INS!2 Builders License No. Plumbers License No. qq o o c/_ £ ? Electricians License No. Other Trade s License No. Location of land on which proposed work will be done: House Number Street County Tax Map No. 1000 Section / ~"~ Block Subdivision 1. FOUNDNflOH -i JO FOR POURED CO'iO!:,ETE 2. ROUGH - FRAMING & PLUi,'~BING . 3. INSULATION ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR ~ BES~G~OR CONSTRUOTIO~ ERRORS. Hamlet B Lot Fil~ Map No. ~t (Name and title of corporate officer) 3. Nature of work (check which applicable): New Building. Repair Removal Demolition State existing use and occupancy of premises,- .~-,and intended use and occupancy of proposed construction: a. Existing use and occupancy ~_ b. Intended use and occupancy... Addition Alteration Other Work 4. Estimated Cost Fee If dwelling, number of dwelling units If garage, number of cars (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. 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 Height Number of Stories Rear Depth 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__ NO__ Will excess fill be removed from premises? YES__ NO__ 14. Names of Owner of premises Name of Architect Name of Contractor Address Phone No. Address Phone No 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) COUNTY OFFS')_ ~t~. ~' ! k S)S: ' ~.~ I being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing~tract) above named, (S)He is the ~ (Contractor, Agent, 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 tp. Joefore me this ~. r) day of ~_'~L,,,.~ Notary Public This document MUST be completed and si~ted by the last~Her prior to your natural gas service being turned on by KeySpnn. We apprceinte your cooperation. .-[-STOMER OWNED GAS PIPING INSPECTION CERTIFICATE ' e :.:e.-s~gncd installation con~xactor hereby represents and warrants that all gas piping and rcintcd appliances, apourtanances ~.~-.ed at thc premises described herein have been ip~talled in accordance with all applicable codes, reg~labons and standards ~-= ~:e of this Curtificat~ in¢ludins, 5at not limited to, thc Fuel Gas Code of New York State, the National Fuel Gus .: :.:'a: Energy Dclivery's Blue Book and the original ~luipm~nt manufa~to~r's specifications, guidelines and installation _~c~ ~lgned installation contractor further represents and warrants that all gas piping installed at the promises described heroin and passed thc pressure test mqui~mcnts as outlined in thc Fuel Gas Code of New York State and KeySpan Energy .~.c3t/ons and Requirements for Gas Installations as wrlttan in the Blce Book. The installation comractor IVlUST ·ctch of the under~ound piping location as required per thc Blue Book, Section $,4 with this Certificate ~c~igned installation contractor anknowl~dgc ~mt KeySpan is relying upon the installation contractor's representation and the accuracy of the information contained in this Certificate, as a condition to turning on the natural gas services ut thc aerein. filled out on ail new meter sets and load chau~es) (Please Print) (s~:Ci~) Coumy- Suffolk ~Nassau Historical Sketch Provided? Y N filled out, along with field sketch, on all jobs that have buried customer owned piping) ~oatmctor, MUST check and complete the following information for all underground gas pipin~ that has bean insUdled at the m accordance with this Certificate. Please include thc name of the pipe manufacturer, lot number of the pipe in.vialled and :pc installed. ~e Pipe Installed (~ Minimum Depth of 18"? y N I~ v Manufacturer Lot Number SDR ~: ~mgs Used? Y N Plastic Fussions? Y N__# Made ;, :': :---~alled? Y__ N__ Metallic Caution Tap~? y N__ ~ :-- : Saution Tspeg Y N__ m ,~e - ~.nodc(s) - Number/Weight Cadwcld Y N ~-? 4ppliances Installed - ~. __ N__ Pool Heater Y__ N ~r~: N Water Heater Y N ~ Eaer~ D*live~ Use Only ~mployee N~e / N~r) House Hcut Y N Mctar Hcadcr Y N Meter Number (Date) Residential Non-Residential 81417046R2-7/03 EQUIPMENT LIST Series 2B Gas Boiler 1. Boiler Model2 B: [3 Natural Gas ~3 LP Gas 2. Parts Bag: [3 Intermittent Ignition (HSP) [3 24V Standing Pilot Intermittent Circulation Continuous Cimulation Gravity Circulation Relief Valve, Conbraco #10-408-05, 3/4" NPT, Set at 30 PSI Drain Valve, Conbraco #31-606-2, 3/4" NPT Tee, 1-1/4" x 3/4" x 1-1/4" NPT (Intermittent/Continuous Circulation Only) Nipple, 1-1/4" NPT x 3" Lg. (Intermittent/Continuous Circulation Only) Nipple, 1-1/4" NPT x 4" Lg. (Intermittent/Continuous Circulation Only) Circulator Hardware Bag 3. Instructions Envelope: Equipment List, P/N 81417046 (This form) Installation, Operating, and Service Instructions, P/N 81417032 I=B=R Pamphlet (Hydronics Institute), P/N 81460061 Lifetime Limited Warranty Mailer, PIN 81460135 4. Circulator Carton (Intermittent/Continuous Circulation Only) with Gaskets: [3 Taco 007 ~ Taco 0010 [3 B&G NRF-22 [3 Grundfos UP15-42F [3 Other 5. Vent Damper Carton (Per Size): ~3 Effikal E] Honeywell [3 Johnson [3 None (Export Only) 6. Draft Hood Carton (Per Size) 7. User's Information Manual, P/N 81417029 Packed By Material in this shipment has been checked at the factory. Claims for error, shortages or damaged material MUST be accompanied by this sheet. Burnham' Hydronlcs U.S, Boiler Co., Inc. Town Itall Annex 54375 Main Road P.O. Box 1179 SoutItold, NY 11971-0939 l'clcphone 1631) 765-1802 Fax 1631) 76.5-9502 It[IliA)lNG I)EPARTMENT TOWN OF $OUTHOLD May 12, 2010 Barbara Kelling 1275 Laurelwood Drive Laurel, NY 11948 TO WHOM IT MAY CONCERN: The following items are needed to complete your Certificate of Occupancy: Application of Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. A fee of $25.00. __ Final Health Department approval. Plumbers Solder Certificate. (All permits involving plumbing after 4/1/84) __ Trustees Certificate of Compliance. __ Final Planning Board approval. __ Final Fire Inspection from Fire Marshal. __ Final Inspection from the Building Dept. __ Final Landmark Preservation approval. Building Permit: 34339-Z furnace INSTALLATION, OPERATING AND SERVICE INSTRUCTIONS FOR c( T us [/STGO I For service or repairs to boiler, call your heating contractor. When seeking information on boiler, )rovide Boiler Model Number and Serial Number as shown on Rating Label. Boiler Model Number 2~ Heating Contractor Address Boiler Serial Number Installation Date Phone Number .*Bur. nham® Hydromcs U.S. Boiler Company, Inc. 81417032R24-10/08 Price - $3.00