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HomeMy WebLinkAbout39576-Z5%1-44�pG� Town of Southold P.O. Box 1179 53095 Main Rd Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 37652 Date: THIS CERTIFIES that the building OTHER Location of Property: 60125 North Rd Unit 11), Greenport 7/9/2015 7/9/2015 SCTM #: 473889 Sec/Block/Lot: 44.1-1-1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 2/27/2015 pursuant to which Building Permit No. 39576 dated 3/10/2015 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: HEATING SYSTEM AS APPLIED FOR (Unit 1D) The certificate is issued to Wasserman Crown LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 39576 07/01/2015 TOWN OF SOUTHOLD BUILDING DEPARTMENT y z TOWN CLERK'S OFFICE o • 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 #: 39576 Date: 3/10/2015 Permission is hereby granted to: Wasserman Crown LLC 352 7th Ave FI 11 New York, NY 10001 To: Installation of a new heating system as applied for. At premises located at: 60125 North Rd Unit 1D, Greenport SCTM # 473889 Sec/Block/Lot # 44.1-1-1 Pursuant to application dated To expire on 9/8/2016. Fees: 2/27/2015 and approved by the Building Inspector. CO -NEW CONSTRUCTION/ALTERATION/REPAIR $50.00 FURNAC LER - RESIDENTIAL $200.00 T tal: $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: 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 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. '2- - 2- L. Zo !C New Construction: Old or Pre-existing Building: �,/ (check lone) Location of Property: 1, zs L:ycs.) ��1� 6r� P— ` - House No. Street Hamlet Owner or Owners of Property: IM a (-A 9 IN 5 5c,- kkk h nJ . Suffolk County Tax Map No 1000, Section IVY& Block % Lot Subdivision Permit No. ?29- _D Date of Permit. Health Dept. Approval: Planning Board Approval: Filed Map. Applicant: Underwriters Approval: Request for: Temporary Certificate Final Certificate: �n Fee Submitted: $ Lot: (check one) e Applicant Signature Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Telephone (631) 765-1802 Fax (631) 765-9502 roger. riche rt(a-town.southoId. ny.us CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Wassserman Address: 60125 North Road, Apt. 1-D City: Greenport St: New York Zip: 11944 Building Permit #: 39781-39622-39576 Section: 44.1 Block: 1 Lot: 1 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Devaney Electric License No: 4144-E SITE DETAILS Office Use Only Residential X Indoor X Basement X Service Only Commerical Outdoor X 1st Floor X Pool New Renovation X 2nd Floor X Hot Tub Addition Survey Attic - X Garage INVENTORY Service 1 ph Heat GAS Duplec Recpt 45 Ceiling Fixtures 1 HID Fixtures Service 3 ph Hot Water GFCI Recpt 8 Wall Fixtures 18 Smoke Detectors 5 Main Panel A/C Condenser 3 Single Recpt Recessed Fixtures 100 CO Detectors Sub Panel A/C Blower 3 Range Recpt Fluorescent Fixture Pumps Transformer Appliances DW Dryer Recpt 1-304 Emergency Fixtures Time Clocks Disconnect Switches r 64 Twist Lock rl Exit Fixtures TVSS Other Equipment: 6- ARC Fault Circuit Breakers, 1-30A Oven, 5- Exhaust Fans, 1- Steam Generator with 60A Disconnect, Notes: 20KW Stand By Generater with 200A Disconnect Inspector Signature: Date: July 1, 2015 Electrical 81 Compliance Form(1).xls 47 ��pF SOUTyO ��'yCO►►nm 0�� TOWN 'OF-SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION ] FOUNDATION 1ST ] FOUNDATION 2ND ] FRAMING/ STRAPPING ] FIREPLACE & CHIMNEY ] FIRE RESISTANT CONSTRUCTION ] ELECTRICAL (ROUGH) ] CODE VIOLATION [ ] ROUGH PLUMBING [ ] 1 CATION [ FINAL [ ]FIRE SAFETY INSPECTION C ]FIRE RESISTANT aeNe'rannoN I I ELECTRICAL (FINAL) [ ]CAULKING REMARKS: DATE � a� INSPECTOR U V. y FIELD VVEMON I- MY0 T DATE Co FOUNDAION (IST) - ---------- p----- FOUNDATION (2ND) ROUGH FRANDNG & H PLUMBING � INSULATION PEA N. Y. H STATE ENERGY COVE (� • r .. • ... ... �' GJ® it �-zu�c.��, . FINAL F 09. s X Do TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Examined BUILDING PERMIT APPLICATION CHECKLIST PERMIT NO.3 (� �� v 20 � Approveo , GU Disapproved a/c Expiration �� , 20_44. �D _ E FED 27 2M5 F. BLDG. DEPT TOWN OF SOUTHOLD ' m I Do you have or need the following, before applying? Board of Health 4 sets of Building Plans_ Planning Board approval Suryey Check Septic Form N.Y.S.D.E.C. Trustees C.O. Application Flood Permit Single & Separate Storm -Water Assessment Form Contact: Mail to: Phone: CATION FOR BUILDING PERMIT INSTRUCTIONS Date Z — a 4 , 20 1 % 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. Sign ture of applicant or name, if a corporation) (MailingUdressof applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises )Dq z ) 9 r (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. /, VA P Electricians License No.` Other Trade's License No. 1. Location of land on which a 11 be done: House Number _ Street/ Hamlet County Tax Map No. 1000 Section 7yo Block Lot Subdivision 2. State existing use and occupancy of a. Existing use and occupancy. b. Intended use and occupancy 3. Nature of work (check which applicable) Repair Removal 4. Estimated Cost 0 q. '�_© a 5. Filed Map No. Lot tendeduse and occupancy of proposed construction: N c. c �u Lncy �: c.,. A--( S1 New Building Addition -Alt ti n _Demolition Other Work.o('.0 Gdas escription) Fee (To be paid on filing this application) If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Rear Height Number of Stories Dimensions of same structure with alterations or additions: Front Depth Height Number of Stories Depth 8. Dimensions of entire new construction: Front Rear -Depth Height Number of Stories M 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_�6' Rear 13. Will lot be re -graded? YES NO'16 Will excess fill be removed from premises? YES NO 14. Names of Owner of premises A -55e+- K,0 -d Address �e %tel l hone No. D 00 Name of Architect Address Phone No Name of Contractor(: ALMS fh2l_, AddressaG 14e ePhone No. /-.S"/� - i 7Z -V1S3-6 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) SS: COUNTY OF ) !✓��� N r34('� being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) 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 to before me this qday of 20 No ary FubTic LYNNEW A. IOTINE Signature of Applicant Notary Public, State @f New York No. 4931641 Qualified In Nassau County Commission Expires May 3.1, 2019 1<3 Scott A. Russell a ') " I��IIA\1 A\�G 1E1�JI)ENr]F SUPERVISOR �, z. SOUTHOLD TOWN HALL- P. C . Box 1179 53095 Main Road - SOUTHOLD, NEW YORK 11971 'lj�� ate. 'own of Southold CHAPTER 236 - STORIVIWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT) DOES THIS I'Ro.IECI' INVOLVE ANY OF THE FOI.LOWIING: 0JECK ALL THAT APPLY) ❑�. A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. B. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area._ 100 feet of horizontal distance. D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. [l f E. Site preparation within the one -hundred -year f loodplain as depicted on FIRM Map of any watercourse. 0 54 F. -ImUllation- of -new -or- resurfaced--impervious-sur-facesof =-1;000--sq-u-are feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes in-kind replacemen-t of impervious surfaces. ..._._.-.._. If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department wish your Building Permit Application. APPLICANT; (Property Owner, Design Professional, Agent, �Contractor, Other) NAlviE; L A -M Contact Information Property Addy ss / Location of Construction.Work: ,< ...� ..._..__..._ __.:- ._ .......... _`..L/ L/ ... ..... .........._.._..... . S.C.T.M. 1000 bale; _4V. __. / District t Section Block Lot FOR. _?ULDIN'fa1D1�PAR": N ENT ! s k. ONLY Reviewed IRv- pprcved for processing Building Permit. 5iQ(rt?`A'<1f'f l'l �l1;8�rti1•`.nt_Control Plat: j lot Required. Stoirn iter Nlvri: en-icnt Control Plan is RequirtA o=vv,ird io Engmrcmig Depar,rnew for Revir::,.i Town Hall ex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631) 7965--11802 roaenrichertf t0 n soutnold ny us BUI DING DEPARTMENT TOWN OF SOUTIROLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: p evc h e E l,i=C-rlZl L Company Name: Name: /M i LA _0 N a . P „ ., 9. e No.. 3s: No.: Date: fl a O l JOBSITE INFORMATION: (*Indicates required information) *Name: *Address: *Cross Street: *Phone No.: Permit No.: M e e— Cor) Tax -Map District: 1000 Section: d Block: j Lot: I �; *BRIEF DESCRIPTION OF WORK (Please Print Clearly) h e 1Z.t -to g , 2.0 v\) 6 IZ t G-0 kri. e � ar-� (Please Circle All That Apply) Is job ready for inspection: YES NO Rough In Final *Do. you need a Temp Certificate: YES / O Temp Information (if needed) *Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other *New Service: Re -connect' Underground Number of Meters Change of Service Overhead ' Additional Information: PAYMENT DUE WITH APPLICATION 82=Request for Inspection Form �� I,..H T. TERRY Y ' '1'0 WN CLERK " �, ' 1±•,,; ItE.GIs,rnAR OF v1TN. ST•ATIS11CS �O. MARRIAGE: OFFICERr�Ol RMI RECORDS MACEMENT OFFICER i FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERIC TOWN OF SOUTHOLD .Imvl) IbIl. 5)O45 nIJlll P.0. n,x 1 17O Stlulhold. NcwtIrk I 1 Foz (5 10) 765•IR�.-,4 Tcicphonc (51(1) )(i5. THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993: RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent. regulations of./, the Code of the Town of Southold: "Floodplain Development. Permit Application" (FDP(93)], and ;'Certificate of Compliance fair Deve�%pment in Special Flood Hazard Area (C/C(93)) _ • � �-f lig I -- :..... _. . • 6;_`.iv. !' TOW:4 OF SO�Ger1OLD h T. Terry Southold Town Clerk August 25, 1993 • I •'I �1 IT _r TOWN OF SOUTHOLD APPLICATION PAGE I of 4 FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION I GENERAL PROVISIONS (APPLICANT to read and siznl 1. No work may start until a permit is issued. 2 The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re=issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. S. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local, state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator -or his/her representative to make imasonable inspections required to verify comp' 8. I, THE APPLICANT, CERTIFY L STATEMENTS HEREIN AND IN ATTACHMENTS TO _ THIS APPLICATION ARE, TO T Y KNOWLEDGE, TRUE AND ACCURATE. (APPLICANT'S SIGNATURE) ' DATE / SECTTON 2: PROPOSED DEVELOP?-,IfE T fT. be completed by APPLiCANTI NAME ADDRESS TELEPHONE APPLICAN- y _ _,. d • I7r rJ rJ // /up.o / 1tJ,�- jtw-�/ . B U ILD ER ;• — A 1014W-1Ais) To avoid delay i'o processing the application, please provide cooup_h information to easily idcat4 the project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-kLand nown mark A sketcb attached to this app8cation showing the project location would be hclpful. FDP(93) APPLICATION PAGE 2OF4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE O New Structure Residential (1-4 Family) O Addition ❑ Residential (More than 4 Family) ,'Alteration ❑ NOD -residential (Floodproofing? O Yes) ❑ Relocation ❑ Combined Use (Residential & CommeraaJ) ❑ DemdGtion' ' P ❑ Manufactured (Mobile) Home (In Manu- ❑ Replacement factured Home Park?. O Yes) ESTIMATED COST OF PROJECT S '5C716700 B. OTHER DEVELOPMENT ACTIVITIES: O Fill O Mining ❑ Drilling ❑ Grading O Excavation (Except for Structural Development Checked Above) O Watercourse Alteration (Including Dredging and Channel Modifications) O Drainage Improvements (Including Culvert Work) O Roach, Street or Bridge Construction } / ❑ SuFk ivision (New or Expansion) / ❑ dual Water or Sewer System J� , Other (Please Specify) �1,�%/5��� After completing SECTION 2, APPL[CANT should submit form to Local Administrator for review. SEC'T'ION I FLOODPLAIN DETERMINATION (To be completed by LOCAL AWIMSTRATOk) The proposed development is located on FIRM Pancl No. . Dated The Proposed Development: O Is NOT located in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). ❑ Ls located in a Special Flood Hazard Arca. FIRM zone designation is 100 -Year flood elevation at the site is:— F(. NGVD (MSL) ❑ Uoavailablc ❑ The proposed dcvclopmen( is located io a floodway. FBFM Pancl No. Da(cd ❑ See Scuion 4 for additional inslrijoions. SIGNED DATE APPLICATION 4 PAGE 3 OF 4 SECTION d ADDITIONAL INFORMATION REQUIRED (To he comnlctcd by LQCAL ADMiNIST RATORI The applicant must submit the documents checked below before the appGcatiorn can be processed: O A site plan showing the location of all existing structures, water bodies, adjacent roads, lot dimensions and proposcd development. O Development plans, drawn to scale, and specifications, including where applicable: details for anchoring structures, proposed elevation of lowest floor (including basement), types of water resistant materials used below the Fust floor, details of floodproofwg of utilities located below Lhe first floor and details of enclosures below the First floor. Also Cl Subdivision or other development plans (If the subdivision or other development axceeds 50 lots or 5 acres, whichever is the lesser, the applicant must provide- 100 -year flood clevations if they are not otherwise available). 0 Plans showing the extent of watercourse relocation and/or landform alterations - 0 Top of now fill cicvation Ft. NGVD (MSL). O FloodprooFing protection Ievcl (non-rc.sidenlial onFt: NGVDMSL. Forly) (MSL). floodproofed structures, %ipplicant must attach certification from r�gislered engineer or architect. j Cl Certification from a -re /gistered engineer that the proposed activit� in a regulatory (loodway will not result in .ate increase in the height of the 100 -year flood. A copy of all data and calculations supporting flus finding must also be submitted. O O(hcr: ,SECTION 5 PERMIT DETERMINATION (To be completed by LOt AL ADMINlUR.A.TQRI I have determined that the proposed activity. A- O Is B. O Is not in conformance wich provisions of Local Law rf 19_. The permit is issued subject to the conditions attached to and made part of this permit. SIGNED DATE if BOX A is checked, the Local Admiaistrator may issue a Development Permit upon payment of d•esigna(ed (cc. If BOX B is checked, the Local Administrator will provide a writteu summary of deficiencies. Applicant may revise and resubmit an appbc-a(ion to (he- Local Administrator or may requcs( a bearing from the Board of Appeals. 7 •III , • APPLICATION A+ PAGE 4OF4 APPEALS: Appealed to Board of Appeals? ❑ Ycs ❑ No Hearing da(e: Appeals Board—D --Appnm0 El Ycs El Me - Conditions SECTION 6 AS BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance is issued The following information must be provided for project structures_ This section mU-st be completed by a registered professional engineer or a licensed land surveyor (or attach a certification to this application). Complete 1 or 2 below. 1. Actual (As -Built) Elevation of the top of the lowest floor, including basement rn Coastal Hizh Hazard Areas bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FT. NGVD (MSL). L Actual (As -Built) Elevation of floodproofmg protection is FT. HGVD (MSL)- NO' Any work performed prior to submittal /of the above information is at the risk /pf the Appl;icanl. SECTION 7• COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete (his section as applicable based oa iD-spcction of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO SECTION 8 CERTIFICATE OF COMPLIANCE(To be completed by LOCAL ADNTINISTRAT R I Certificate of Compliance issued: DATE MW Attachment B /! BAMPILE CERTIFICATE ""F COMPLIANCE for Development in a Special Flood Hazard Area a • � 1 • � 1 1 1 Attachment B /! BAMPILE CERTIFICATE ""F COMPLIANCE for Development in a Special Flood Hazard Area r I, iii I I I I TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HA_Z D AREA (()WrN-n ...... T. R -FT, rN TNiS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: 0 NEW BUILDING O EXISTING BUILDING O VACANT LAND I.s THE LOCAL ADMINISTRATOR IS TO COMPLETE A- OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19_. SIGNED: DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH DIE REQUIREMENTS OF LOCAL LAW # , 19_, AS MODIFIED BY VARJANCE # DATED SIGNED: DATED: C/C(93) Suffolk County Department of Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 DATE ISSUED: 9/28/2011 No. 49288 -MP SUFFOLK COUNTY Master Plumber License This is to certify that GERARD BALDASSARRI doing business as GERARD BALDASSARRI PLUMBING & HEATING having given satisfactory evidence of competency, is hereby licensed as MASTER PLUMBER in accordance with and subject to the provisions of applicable laws, rules and regulations of the County of Suffolk, State of New York. NOT VALID WITHOUT DEPARTMENTAL'SEAL AND A CURRENT' CONSUMER AFFAIRS ID CARD Additional Businesses Director If W 1111V Im Nh��Ll Log I A LI -1 I RV L APPROVED AS NOTEDCH TE TPNIL.I �'" -� INDIRECT wA-reP HEATERS DATE:6116 B:F. # ',•�-�!. TO THE INSTALLER: This manual is the FEE: —BY: �.a. _ property of the owner and must be affixed -fIOTIFY BOLDING DEPARTMENT AT near the water heater for future reference. FOLLOWING INSPECTIONS: TO THE OWNER: This water heater should be 1. FOUNDATION - TWO REQUI �_ inspected annually by a qualified Service Improper installation, adjustment, alteration, service or rhaintenance can cause injury or property damage. Refer to this manual. For assistance or addi- tional information, consult a quafified Installer or Service Agency. :OCCUPANG"11OR USE UNLAWFUL Ill. ■ TE WITHOUT 1 VI Do not store or use gasoline or other flammable vapors and liquids in the vicinity cif this or any other appliance- installation. pplianceinstallation and. service must be performed by a qualified Installer or Service Agency. DIVERSIFIED HEAT TRANSFER, INC. NEIN JERSEY HEADQUARTERS -` 435 MAIN ROAo; TOWACO, NJ 07082 PHONE: a00 -X21-1522 - WESSfTE: WWW_DHTNET.COM PL MBING -.SINAL = CONSTRUCT N MUST BE COMPLETE FOR 0. 'Ll.QONSTRUCTIOW!k S!- ALI, MEET THE r iJIREMENTS OF THE 0 , ES r NEW, Y� .`'' STATE. NOT @ES O PSIBLE FOR -ISN FSR CONS_TRUC!IOq ERRORS. '= E.� w • •v .. Improper installation, adjustment, alteration, service or rhaintenance can cause injury or property damage. Refer to this manual. For assistance or addi- tional information, consult a quafified Installer or Service Agency. :OCCUPANG"11OR USE UNLAWFUL Ill. ■ TE WITHOUT 1 VI Do not store or use gasoline or other flammable vapors and liquids in the vicinity cif this or any other appliance- installation. pplianceinstallation and. service must be performed by a qualified Installer or Service Agency. DIVERSIFIED HEAT TRANSFER, INC. NEIN JERSEY HEADQUARTERS -` 435 MAIN ROAo; TOWACO, NJ 07082 PHONE: a00 -X21-1522 - WESSfTE: WWW_DHTNET.COM