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HomeMy WebLinkAbout35888-ZTown of Southold Annex 54375 Main Road Southold, New York 11971 1/20/2012 CERTIFICATE OF OCCUPANCY No: 35402 Date: 1/20/2012 THIS CERTIFIES that the building Location of Property: SCTM #: 473889 Subdivision: ALTERATION 44835 MAIN RD SOUTHOLD, Sec/Block/Lot: 75.-2-18 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore fded in this officed dated 9/21/2010 pursuant to which Building Permit No. 35888 dated 9/23/2010 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: CONVERSION OF OIL TO GAS BOILER AS APPLIED FOR The certificate is issued to LEOPOLD & CELCIA D'MELLO (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 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. 35888 Z Date SEPTEMBER 23, 2010 Permission is hereby granted to: LEOPOLD & CELCIA D'MELLO 5 FLINT LJINE JERICHO,NY 11753 for : CONVERSION OF OIL TO GAS BOILER AS APPLIED FOR at premises located at 44835 MAIN RD SOUTH-y~-- County Tax Map No. 473889 Section 075 Block 0002 Lot No. 018 pursuant to application dated SEPTEMBER 21, 2010 and approved by the Buildin9 Inspector to expire on MA_RCH 23, 2012. Fee $ 200.00 Author i ~e'd SignaYure ORIGINAL Rev. 5/8/02 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPA JAN 2 0 2012 BfOG DEPL qCY TOWN OF SOLI]HO[D This application must be filled in by typewriter or ink and submitted to the Building Depamnent 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 uausual 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 aud 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: I. Accurate survey of property showiug all property liues, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to respect signed by the applicant. Ifa Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees I. Certificate of Occupancy - New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00, Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy- $.25 4. Updated Ce~Lificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction: Old or Pre-existing Building: Location of Property: 47~ ,~ ]~ ~..~ ,/,,x._ {~ House No. Street Owner or Owners of Property: L-?;~> ?O lq Suffolk County Tax Map No 1000, Sectiou ~7 ~ Subdivision Permit No. 3~g(~ H~alth Dept. Approval: Date of Permit. Date. Block Filed Map. Applicant: Underwriters Approval: Planning Board Approval: (check one) Hamlet Lot /°O Lot: Request for: Temporary Certificate Fee Submitted: $ '2d~)'~'~r2~ Final Certificate: (check one / Applicant Signature TOWN OF SOUTHOLD'BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] F,REPLACE & CH,N.EY [ ] FIRE SAFETY ,NSPECTION REMARKS: ~/~ DATE ~INSPECTOR ~~/-c~/ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ] ROUGH PLBG. [ ] INS~J~ATION [ ~AL [ ] FIRESA~,~'INSPECTION DATE ~~~--INSPECTOR~ FOUNDATION (1ST) ~'otrNo~TIo~ (2N~) · ROUGH ~G & PL~G ~S~A~ P~ N. Y. STA~ E~ CODE TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765e1~0~ ~Cl FAX: (631) 765-9502 www. north fork. net/Southold/ Examined~'~ ' . t,~3 ,20 /O Approved~. o'~ ,20 / O Disapproved a/c SEP 21 20 0 BLDG. DEPT. TOWN OF SOUTHOLD PERMIT NO. ~ ~-'cf $ g BUILDING PERMIT APPLICATION CHECKLIST 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 Contact: Mail to: Building l~spector ( Pho. ne: ~'.~/ -- 7Z '-76 7'0 PPLICATION FOR BUILDING PERMIT Date ',~ PT INSTRUCTIONS ,20//~ OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE State whetheQ~pl~Pr~s~e, agent, architect, engineer, genera, a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 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 promises and in building for necessary inspections. (Signature of applicant or name-, if a corporation) (Mailing address ~f applicant) (As on the tax roll or latest dee N INSPECTIONS: If applicant is a corporation, signature of duly authorized officer Name of owner of premises ~r~ ~,(2/d (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Locatio. nto f. la_..nd_.on_~whic h.~ pr0posed wor. k will be done: '-/ q :d d House Number Street County Tax Map No. 1000 Section Subdivision contractor, elec~l~l~'~r ¢OR THE Hamlet I. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2 ROUGH- FRAMING, PLUMBING, STRAPPING, ELECTRICAL & CAULKING 3 INSULATION 4. FINAL. CONSTRUCTION & ELECTRICAL MUST BE COMlaLETE FOR C.O. ALL CONSTRUCl~ON SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK SKATE. NOT ~ FOR DESIGN OR CON~ffiUCTION ERROr8 (Name) Block ,2. Filed Map No. Lot Lot UI RS CEItTIF IE REQUIRED 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. lntended use and occupancy O;[ ~ 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost Fee 5. If dwelling, number of dwelling units If garage, number of cars Addition Alteration Other Work (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 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 14. Names of Owner of premises~/~r/At Name of Architect Name of Contractor Will excess fill be removed from premises? YES NO__ Address Phone No Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES __ * IF YES, SOUTFIOLD 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. NO 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. STATE OF NEW YORK) SS: COUNTY OF ) d~ T/~/° ,t/',~ (~ ~'~0_ 4 ~,"~''-/t~. being duly sworn, deposes and (Name o/individuarsigning contract) above named, (S).e is the Df'/~.J'~_)V~Je ~ t/~ (Contractor, Agent, Corporate Officer, etc.) says that (s)he is the applicant 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 before me te~s .Z' Z [.~ Notary Public 201~ BRUCE J. GLICK Notary Public, State of New York No. 0iGL5071850 ualified in Suffolk County Co~ission Expires January 21,~0~ Signat~e of Applicant /~o-?F-Z-/£ TOWN OF SOUTI.~OL~D PROPERTY REC:ORD RD .. M bo OWNER STREET /,-,//.,./ ~ ~ ~ VILLAGE DIST. SUB. LOT S TYPE OF BUILDING LES.~/~ S~S. VL FA~ COMM. CB. MISC. Mkt. Value ~ND IMP. TOTAL DATE REMARKS N~ NORMAL BELOW ABOVE ~~ ~ I FARM Acre Value Per Value Acre ¢oodland wampland FRONTAGE ON WATER rushland FRONTAGE ON ROAD / ~ ~ ~ 7 <'~ ~ ~ [Duse Plat DEPTH ~ ~ ~ ~ BULKH~D oral DOCK 'AA. Bldg. Extension Extension EXtension Porch Porch Breezeway Garage Patio Total lo'X 9 X ', ,/ _ //,( & & = TRIM I lJl III I I I I I J il III ~1 I-I I I I I I / Foundation ~ ~ Basement Ext. Walls Fire Place /V' ~ Type Roof ~ E- Recreation Roorr Dormer Driveway Bath Floors nter o( F n sh Heat ~_/gJ~ Rooms 1st Floor Rooms 2nd FIool Dinette K. LR. DR. BR. FIN. B. 'l'o;m flail Annex ,5~375 Mare l/cad P.O. Box 1179 SouthoM, NY 11!)714)959 Telephone (631) 763-1802 Fax ((;31) 7t;.5-9.J02 BI JII~DING DIqPARTMENT TOWN OF SOUTHOLD October 14, 2010 Leopold D'Mello 5 Flint Lane Jericho, NY 11753 RE: 44835 Main Road, Southold TO WHOM IT MAY CONCERN: The following items are needed to complete your Certificate of Occupancy: 'Nj 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 411184) __ Trustees Certificate of Compliance. (Town Trustees #765-1892) Final Planning Board approval. __ Final Fire Inspection from Fire Marshal. Final Inspection from the Building Dept. __ Final Landmark Preservation approval. Building Permit: 35888-Z oil to gas boiler Town Hall Annex 54375 Main Road P.O. Box 1179 Southold. NY 11971-0959 Telephone (63 ! ) 765~ 1802 Fax (631) 765-9502 Januaw 6,2012 BUILDING DEPARTMENT TOWN OF SOUTHOLD Leopold D'Mello 5 Flint Lane Jericho, NY 11753 Re: 44835 Main Rd., Southold TO WHOM IT MAY CONCERN: The Following Item(s) Are Needed To Complete Your Certificate of Occupancy: ~ f'J ~"~ Application for Certificate of Occupancy. (Enclosed) [I)~ t I''~''' ' lectrical Underwriters Certificate. ~'t~A fee of $25.00. Final Health Department Approval. Plumbers Solder Certificate. (All permits involving plumbing after 4/1/84) Trustees Certificate of Compliance. (Town Trustees #765-1892) Final Planning Board Approval. Final Fire Inspection from Fire Marshall. - Bob Fisher Final Landmark Preservation approval. BUILDING PERMIT: 35888 - Oil to Gas Burner Client#: 38051 FIVEAC ACORD,. CERTIFICATE OF LIABILITY INSURANCE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bradley & Parker, Inc. - Comml ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 677 ALTER THE COVERAGE AFFORDEO BY THE POLICIES BELOW. Syosset, NY 11791 INSURERS AFFORDING COVERAGE NAIC # INSURED qSURERA; Peerless Insurance Co Five Aces Plumbing & Heating Corp. ~NSURER B: Zurich Insurance Company Anthony C. Bolen iNSURER C: 18 Cross Road INSURER D: Ridge, NY 11961 ~NSURER E: COVERAGES r THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE iNSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ~4AY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. A A G.~Ee~LUASlUTY ,~BP8676245 05/07/20t0 05/07/2011 EACHOCCURRENCE $11000t000 [ CLAIMS MADE r~ occur MED EXP (An~' ope Oemon} $151000 PERSONAL & ADV INJURY $11000,000 GENERAL AGGREGATE $210001000 A EXCESS I UMBRELLA LIA~ILn~f CU8678247 05107/2010 05107/2011 ~ACH OCCURRENCE $51000,000 X~ OCCUR [] CLAIMS MADE AGGREGATE $510001000 RETENTION $ 10000 $ ~l~a~n~Mo~ E.L. DISEASE - EA EMPLOYEE $ B om,e~ NY Disabilit t687798 05101/2009 Continuous Statutory Town of Southold Building Department is listed as additional insured as respects the written contract under the General Liability. CERTIFICATE HOLDER CANCELLATION Town.of Southold Building Depar{ment 54375 Rte 25 Southold, NY 11971 ACORD25(2009101)l of 2 #8157540/M152815 e 1988-2009 ACORD CORPORATION. AII rights reserved. The ACORD name and logo are registered marks of ACORD SAO STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIJ?ICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1. To be completed by Disability Benefits Carrier or Licensed Insurance Agem of that Carrier 1. Legal Name and Address of Insured (Use street address only) Five Aces Plumbing & Heating Corp. Anthony C, Bolen 18 Cross Road Ridge, NY 11961 DBA: 2. Name and Address of the Entity Requesting Proof of Coverage lb. Business Telephone Number of Insured 631 775-7640 lc. NYS Unemployment Insurance Employer Registration Number of Insured Id. Federal Employer Identification Number of Insured or Social Security Number 26-4796185 Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) To,ma of Southold Building Dept, 54375 Rte 25 Southold, NY 1197l Zurich Insmance Co. 3b. Policy Number of entity listed in box "1 a": 4687798 3c. Policy Effective period: Continuous 4. Policy Covers: a. ~ All of the employer's employees eligible under the New York Disability Benefits Law b. [] Only the following class or classes of the employer's employees: Under penalty of perjury, I certify that I am an authorize~qi.{epr es entative or license~ agen~ of the insmance carrier referenced above and that the namad insured has NYS Disability Benefits i~ee covera~ de~ser ',~d ab~o~ ~ Date Signad 06/21/10 By (Signatu~-~insurance carrier's authorized representative or NYS licensed Insurance Agent of that insurance career) Telephone Number 631 981-7600 Title Administrative Services Manager iMPORTANT: If box "4a" is checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that canSer, this ;erfificate is COMPLETE. Mall it directly to the certificate holder. f box "4b" is checked, this certificate is NOT COMPLETE for pu~oses of Section 220, SUBD 8 of the Disability Benefits Law. It must be mailed for completion to the Worker's Compensation Board, DB Plans Acceptance Unit, 20 Park Street, AIb~a~y, New York 12207. PART 2. To be completed by NYS Worker's Compensation Board (Only if Box "4b" of Part 1 has been checked) STATE OF NEW YORK WORKER'S COMPENSATION BOARD According to information maintained by the NYS Worker's Compensation Board, the above-named employer has complied with the NYS Disability Benefits Law with respect to all of his&er employees. Date Signed By (Signatore of NYS Worker's Compensation Board Employee) ~Gas-fired, Condensing rnance for Hydronic ant Heating Introducing the Alpine from Burnham, a condensing boiler with efficiency ratings of 95%. The Alpine utilizes a stainless steel heat exchanger, designed to extract maximum heat from the combustion process, along with a control system that is designed to enhance boiler efficiency as well as system efficiency. With 7 different models ranging in size from 80,000 BTUs - 500,000 BTUs, there's a model for nearly every job from small residential to light commercial installations. 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