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Home My WebLink About38641-Z " pl Town of Southold Annex 3/25/2014 P.O. Box 1179 54375 Main Road Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 36818 Date: 3/25/2014 THIS CERTIFIES that the building WOOD STOVE Location of Property: 475 Ackerly Pd Ln, Southold, SCTM 473889 Sec/Block/Lot: 69.-5-11.4 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 1/13/2014 pursuant to which Building Permit No. 38641 dated 1/27/2014 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: WOOD STOVE AS APPLIED FOR The certificate is issued to Antonelle, Carmine (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Allot ed gnature TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE * 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 38641 Date: 1/27/2014 Permission is hereby granted to: Antonelle, Carmine 475 Ackerly Pond Rd Southold, NY 11971 To: construct a Wood Stove as applied for At premises located at: 475 Ackerly Pd Ln, Southold SCTM # 473889 Sec/Block/Lot # 69.-5-11.4 Pursuant to application dated 1/13/2014 and approved by the Building Inspector. To expire on 7/29/2015. Fees: SINGLE FAMILY DWELLING - ADDITION OR ALTERATION $200.00 CO - ALTERATION TO DWELLING $50.00 Total: $250.00 Building Inspector Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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: I. 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 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 $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 Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. ff.L7~R~e~ / .o_n: ? Old or Pre-existing Building: (check one) Location of Property: e_zmL 66, JANE _ 5=77tno _ House No. Street Hamlet Owner or Owners of Property: e ARM i NE ~NT ?cLLE Suffolk County Tax Map No 1000, Section Block Q _5~ Lot [J, Al Subdivision tt Filed Map. Lot: Permit No. Svo ~O `t Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: check one) Fee Submitted: $ So o0 Applicant Sign ire 4 / oof SOOT ~v e '~~b1O11'1 TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING WfooFol'NAL [ ) FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ) ELECTRICAL (ROUGH) ( ] ELECTRICAL (FINAL) REMARKS:-Aw-A, 10, /tzoo DATE / ` INSPECTOR- FIELD IIQ3P MON REPORT DATE COMMENTS W CP L FOUNDATION (1sT) a FOUNDATION (ZND) s z J p y ROUGH FRAMING & PLUMBING t INSULATION PER N. Y. H STATE ENERGY CODE r FINAL ADDITIONAL COAMNTS • rb r0 ~ z m p 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 South oldTown.NorthFork.net PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees Examined, Flood Permit 20~ Storm-Water Assessment Form ontact: RS S Approved 2014- Mail to: 4-1S Acker) (~ry,~f Disapproved a/c JAN 1$ 200 Line 5.,41,01J ,NY 11121 Phone: q 1 7 S 0 1 3 `i 9 a ?T Expiration 20 O' 6fl?ilJG G D DOLPT10L0 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 shal I 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 iscues 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. (Signature of applicant or name, if a corporation) 4?s- Acke~~~ Pond 6-e Jw4,01J NY I I Cr 7/ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder k. S N! C Name of owner of premises Ca r- ~ h e SAD h t? I i e DATE P. # ,~Swy/ (As on the tax roll or lates¢ooegL2 tW-g C _ If applicant is a corporation, signature of duly authorized officer NOTIFY B'.,iG DEPAr, 765-1802 0 ~r.t TO 4 PNI . Cir. (Name and title of corporate officer) FOLLOVdi~dG '`ISPECTIONS_ 1. FOWJD<,1ION-TWOREOUI1ir:', Builders License No. FOR POiJitED CONCRETE 2. ROUGH - FRAMING,PLUME!NG Plumbers License No. STRAPPjNG, ELECTRICAL & EAU: Electricians License No. 3. INSULATION Other Trade's License No. 4. FINAL - CONSTRUCTIT: 8 ELEL i; ' MUST BE G'' JP' F- I. Location of land on which proposed work will be done: ALL CONSTP,U ; l7'T /Ackerly Po,cl Laf2 SoJ I{^b~~REQUIREMEN"S YORK STATE ~L" House Number Street HatDLOGNORCOMS,-io,, County Tax Map No. 1000 Section V Block 0S Lot I Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Re e"-44 a : ^5I e Fa t~ b. Intended use and occupancy Rea ; d e L: a / S ; x_91 e Fa I y"~fj~ 3. Nature of work (check which applicable): New Building Addition Alteration ? Repair Removal Demolition Other WorkADP k),VD ;gy,4„iG6e 5ftz-~ (Description) 4. Estimated Cost !Z000 Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units I Number of dwelling units on each floor If garage, number of cars " „A7 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front a y Rear Depth Height a o Number of Stories / Dimensions of same structure with alterations or additions: Front Rear NIc Depth ,(/e,- Height /V/C~- Number of Stories /VA' 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front y t Rear (08, 7.) Depth 0) `l • !0 a 10. Date of Purchase I l k, o 14c' I-) Name of Former Owner 0 6 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 Ga 4e A~A,,,elleAddress4?SR~ke~l7,°o~LA,ePhone No.51'7 301 3494 Name of Architect Address Phone No Name of Contractor ASu„i e&jz Address AVX&kCLL 5r Phone No. 0 1365 D~~Pv~ Ny /i4/5 Sid 5a7-A660 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 restrictionrr~ith respect to this property? * YES NO * IF YES, PROVIDEA COPY. STATE OF NEW YORK) SS: COUNTY OF SuFfio.CK ) C lM,ft Ri l1 Yl -,074 being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the O42n/ER (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 to before me this _ day of 64 \ 2014 c Notary Public 1bTH Si nature ofApplicant Notary NPuOl 1 ~NowYork g 96 Qualified in Suffolk Count Commission Expires July 2 8, 2 01/14/2014 19:11 FAX BROOKHAVEN AGENCY w001 ACC>,q& CERTIFICATE OF LIABILITY INSURANCE = 01n4rm14 THIS CERTIFICATE as ISSUE AS A MATTER OF INFORMATION ONLY AND CONFERS NO f4GHTB UPON THE CERTIFICATE NOLOESL TM CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, WEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S). AUMMED REPREBENTATTVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ANT: If tlN coAHM holder is an ADDITIONAL INSURED, the OWN* must be encased. N SUBROGATION 18 WANK su the tsmw and DorldMans of the Policy, cntsln policies may require an esdomamafL A sbtsmsnt on this cemRode doss not coi IN rights tithe cwdscm holder in lieu of such omf s PRDDLICER BroOIdoVSII Inc LoVullo Associates, kc 6450 Transit Road 1 941-4119 (631) 91 Dow, NY 14043 Mu ANOIMHNe o[ weer A:ESSD( COMPANY 39020 INGURao Askot Entsrpdm me myme- 19 BUrehe11 Street Biwe Point NY 11715 NSURI o: COVERAGES &C I ICATE NUMBER: REVISION NUMBER: THIS 0 TO CERTIFY THAT ,HE POLICIE6 OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATE. NOTWITiSTANOI NG ANY REOUREAIEW, TERM OR CONDITION OF ANY CONTRACT OR OTHP DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRERD HEREIN IS SUILACT TO ALL THE TERMS, VIC UGIONS AND CONDITIONS OF SUCH POLICIES. UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLNMS. Lnr TYPE OF NGRIANR 'R jm~llmsa:I LA A GENER LLAAaaet X 3OPSM 04i25i2013 0412512014 H ODGLRRENCE f 1000,000 X 0" GRCNLGENERAL LI.IYY e~~e 1 100,000 CLAAUI o ?OCCUR MW E7FI ao CN~l S P aADV IkIUTY S 1,000,00D 6F1V=Rq1. ArifiIEDATE f ~ CENLAGGREGA1EUwTAFPUE L : PRODUCf3-CCINJOPAGG f 000000 X POIAGY PRa LOC i SCHEDUIID Flk-m BD DP,YINJURY IPrr l s AUTOS BODILY NJURY EParwuaq j Ur03~ AUTOS j Ipw Is OCCUR FACHOOCURRENCE I Ea{43e UAB pµy,~OS AGOMCA s CfD RETTDmONi S VJURNBMCUNPRMTM AYDMlLDYMIPIUANUTY 'S ANY PeDPMETORWM7NBLE%ELUTNE TIN i =MM, D(CL{I a NIA El IRIAMD M r rNN4 VIISN •6 M018FASE-EA E/A S PLOYIN aePnDN OF OPSIUnONG . DISEASE. PDUDY 61W A 00gtlAIDNCPOPETUTI ILACAT)MIVBSRS WbNIACCRe rN,AUrrIRRr wniwle erlnrlN.eRIN~NNRYYnpl~nq CERTIFICATE HOLDER 18 NAMED AS ADDITIONAL INSURED AS REGARED BY V WTTEN CONTRACT. JOB LOCATION: CARMINE ANTONELLE, 475 ACKERLY POND LANE- SOUTHOLD. NY 11791 CERTIFICATE HOLDER! - CANCELLATION SHOULD ANY OF THE ADM DMCRMPD POLICIES BE CANCELLED NEPORE THE EXPMAnON DATE 7NEIROP, NOTICE WILL BE DEUVMMD M TOWN oFSOUTHhxD ACCORDANCE WITH THE POLICYPROVMIONg. SMS ROUT. AUr iDr®REPRESMLTAIN! SOUT MUTE 25 SOUTHOLO,NY 11971 019 10 ACORD CORPORATION. All rights reserved. ACORD 23 (2010108) The ACORD name and loge are registered marks of ACORD 01/14/2014 13:11 FAX BROOKHAVEN AGENCY 4 002 AGENCY CUSTOMER 10.999141 _ LOCO: A16,_ ADDITIONAL REMARKS SCHEDULE Paso 2 of 2 Brookhaven Agency Inc Aake1 inbrpmum Inc POLICYNIAEA 1Y DumhNl Slrad 30PSMIS Slue POIrl6 NY 11715 e"Mea NaIC eooE Esaaa Insurance Company ff"Mm w,e 940Brl013 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SGEDULE TO ACORD FORM, FORM NUMBER: 2_8(E_1W_S FORM TRL~ 6n9Reab of Llaallhy Insumnw This Page Intentionally Left Blank 1o1( II ® 2995 ACORD CORPORATION. All lighq murnt The ACORD name and logo am nphasmd marks Of ACORD 01/14/2014 19:12 FAX BROOKHAVEN AGENCY 10005 STATE OF NEW YORK WORKER'S COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 11-To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier 1a. Legal Name and Address of Insured (Use abate address only) Its. Business Telephone Number of Insured ASKOT ENTERPRISES INC 516-373-2420 Is. NYS Unemployment Insurance Employer Registration Number of Insured 19 BURCHELL ST. 2712486 BLUE POINT, NY 11715 1d. Federal Employer Identifica icn Number of Insured or Social Security Number 113320874 2. Name and Address of the Entity requesting Proof of Coverage 3a. Now of Insurance Carrier (Entity being listed ae the Cartinate Holder) The Forst Rehabilitation Life Insurance TOWN OF SOUTHOLD Company of America Sb. Policy Number of Entity listed in boa "te^: BLDG. DEPT. DBL134303 5309 RT 25 3c. Policy effeellw period: SOUTHOLD, NY 11971 08101/2013 to 07/31/2014 Policy severs: a. Q All of die employers empldyeeseligible under the New Yak Disability eemfitii Line b. Only this following class or clause of the employer's employees: i Under penalty of Perjury, I certify that I sin an authorized represamative or licensed agent of the insurance carrier Warermed above and that the named insured has NYS Disability Benefits insurance average as cases ibed above. Dace signed 1/14/2014 By (Signecun of Imannneecen,er's audloriaed repreamath2 aNYS Licenecd Inewena Agem of That fnprareacartiw) Telephone Number 516-829-8100 Title Chief Executive Officer IMPORTANT: It IPM '41' is aheaked, and aces fans is signed by the Insurance wrier's euomiasd raprewnattm a NYS Licamed Inelilallw Agent of this Carrier, WseMMpq Is COMPLETE. Mail It dhemy to the esrtifiaa haldar. If bon "410" is chalked, this ecrdngec is NOT COMPLETE fa ate Disposal of section ale, Subd. I of ON Dfsebility Benefits law. h must a milled farearpledam as the Woriwre Co penurion 1100% Da Plus Aeeeptstw Unit, ro Park SV@K Albany, NY 12207. PART 2. To be completed by NYS Workers Compensation Board (Only if box "4b" of Part 1 has been chaff State of New York Worker's Compensation Board Aec ON to Infemectim maintained by the NYS 1110ree11e Compensation Beard, the aeeveyumed employer has mmplfed With the NYs Disability amorks Law with respect siall of hlsMer employees. Dale Signed By ISIRrehesel Y sYOrkec'r Canpanectbn Beard Empl%eq Telephone Number Title Plena Neu: Only inefeanme carriers livellaw to write NYS Diability Elements incuranoe policies and NYS Licensed Inww" Agents of those insurance tamers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form. 06.120.1 (5.05) OWNER'S MANUAL (preliminary edition)2 PETIT GODIN 3730 & 3731 Wood and coal burning stoves To the Purchaser of the Petit Godin Stove This typed preliminary edition of the Owner's Manual is based on our experience and on the reports and advice of dealers and customers who have used the Petit Godin Stoves. We welcome your comments and suggestions, which might help us to make the next fed}tion of the Manual more complete and ~'ielpful. ~CYihen & Peck, Inc. Y F 4 t Importer: Manufacturer: F} •ohen & Peck, Inc. Godin, S.A. ~y m:; Arrow Street Guise, Prance 'ridge, MA 02138 Bin stoves are listed for safety by Gas & 6chanical Laboratories, and have been tested % " yr them to UL Standard 1482. }i deTs 3730 and 3731 are recognized also by 'e three major building officials' organiza- ons: I.C.B.O., B.O.A.C., and S.B.C.C. r, rRecognition for model 3726 is pending. Ada ~"Ten9T 1 r~_afety Notice: ~ 2",t. s- stove improperly installed or operated can set fire to your house or r«.... cause injury. Don't guess ---follow the instructions in this manual. Before installing, ask your building or fire official about local ° restrictions, permits and inspections. Even if not required, ask the 'official to inspect your installation before firing. Do things properly: j It's not difficult, and your safety depends on it. ^a,_ Q Cohen & P i eck, Inc. F MINIMUM CLEARANCES TO COMBUSTIBLES IN INCHES z CEILING PENETRATION BACK WALL PENETRATION i 33 +I t ~3 PENETRATE WITH DL-LISTED °y LDPHEAi APPLIANCE CHIN HEY ~3 JW_ ° J= 24 ;Z 71 1 1 32 24 j 2 1 1 g I I 32 C3 U ; I 0 16 d FLOOR - L a 'PROTECTOR j FLOOR PROTECTOR'' 3 24 36 X 43 26 X !f 72 WALL PROTECTION SHIELD' PENETRATE WITH UL-LISTED- Ix LOW-HEAT APPLIANCE CHIMNEY e 0 4 42 °y 1 40 3 t W 1E ;1~, 16 1 it y 42 1 A2 1 24 2' I 42 . _ I is tae 174 CTO R - ,6( IN FLOOR G FLOOR PROTE PROTECTOR- L -.4 , 10 K' 30X" FLOOR PROTECTOR 30 X U / 30 X A WALL PROTECTION I E L LO• 1E J 36 X TO WALL 22 22 PENETRATE WITH UL-LISTED LOW-HEAT APPLIANCE CHIMNEY ' a 7~ 3 33 1 1 I- PENETRATE WITH UL-LISTED i I 1< LOWNEATAPPLIANCE 1 I CHIMNEY '^JI 1 1a 4E WALL PROTECTION SHIELD' FLOOR PROTECTOR" 3 10 an 'WALL PROTECTION SHIELD MUST BE MINIMUM 20 GAUGE GALVANIZED SHEET STEEL OR EQUIVALENT APPROVED BY BUILDING OFFICIAL, HELD i INCH'FROM WALL AND 1 INCH DOWN FROM CEILING ON NONCOMBUSTIBLE SPACERS 16 INCHES APART HORIZONTALLY AND VERTICALLY. SHIELD MUST REST ON FLOOR AND BE OPEN AT SIDES AND TOP FOR AIR TO CIRCULATE. "FLOOR PROTECTOR MUST BE UL-LISTED, BUT SIZED TO DIMENSIONS ABOVE, AND MAY HAVE TILE, STONE OR BRICK COVERING. FLOOR PROTECTOR DIMENSIONS IN DIAGRAM ARE TO BARREL (BODY) OF STOVE. Illustration 2. Model 3730 minimum clearances to combustibles in inches. 13a