Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
40367-Z
�o�O�V�1 �, Town of Southold 6/28/2016 �� P.O.Box 1179 t 53 A..„ 'ft 53095 Main Rd ••�yfj01ao�', Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 38370 Date: 6/28/2016 THIS CERTIFIES that the building OTHER Location of Property: 1400 Youngs Ave, Southold SCTM#: 473889 Sec/Block/Lot: 60.-2-10.4 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 12/17/2015 pursuant to which Building Permit No. 40367 dated 12/23/2015 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: ALTER AN EXISTING OFFICE BUILDING(OIL TO GAS CONVERSION), AS APPLIED FOR The certificate is issued to 1400 Youngs Ave Corp of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 40367 06-14-2016 PLUMBERS CERTIFICATION DATED r zi 2 Author'Xgnature TOWN OF SOUTHOLD ,,,efour-t:-• BUILDING DEPARTMENT tea s a'. TOWN CLERK'S OFFICE tie' MI •.%)e, ,, , 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#: 40367 Date: 12/23/2015 Permission is hereby granted to: 1400 Youngs Ave Corp PO BOX 457 Glen Head, NY 11545 To: alter an existing office building (oil to gas conversion) as applied for. At premises located at: 1400 Youngs Ave, Southold SCTM # 473889 Sec/Block/Lot# 60.-2-10.4 Pursuant to application dated 12/17/2015 and approved by the Building Inspector. To expire on 6/23/2017. Fees: COMMERCIAL ADDITION/ALTERATION $250.00 CO -COMMERC . $50.00 Total: $300.00 i 1 Bu ding In - a - 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� Temrary Certificate of Occupancy-Residential$15.00,Commercial$15.00 Date. `21 (-) New Construction: Old orPre-existing Building: �/ (check one) Location of Property: 1400 Yw,ui S Ave SG- 0LO House No. Street Hamlet Owner or Owners of Proert �1 . l�do Yoon P Y� nn -11J Suffolk County Tax Map No 1000, Section la, 0 Block O� ���1111 Lot )d Subdivision Filed Map. Lot: Permit No. 403(/7 Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: heck one) If Fee Submitted: $ 50 �a Ap d lic't Signature C l-�2IC RSp, "0 , , l® Town Hall Annex 4 4111; Telephone(631)765-1802 54375 Main Road ; s Fax(631)765-9502 P.O.Box 1179 : 11C ..8.°.1 G Q �f roper.richertRtown.southold.ny.us Southold,NY 11971-0959 `\'® , �1i �yeOUNTr .'. BUILDING DEPARTMENT , TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To 1400 Youngs Avenue Corp. Address: 1400 Youngs Avenue City: Southold St: New York Zip: 11971 Building Permit#: 40367 Section. 60 Block: 2 Lot: 10.4 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: C. Ragusa License No: 4393-RE SITE DETAILS Office Use Only Residential Indoor X Basement X Service Only Commerical X Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat GAS Duplec Recpt Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel NC Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks Disconnect Switches Twist Lock Exit Fixtures TVSS Other Equipment: Wire New Gas Burner and Boiler Controls, 5- Circulators, 1- Gas Burner, Used 4 Existing 20A Circuits Notes: Inspector Signature: Date: June 14, 2016 z Electrical 81 Compliance Form.xls 11,�O��OF SOUlyolo`. :*yC�,�,, TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [1'j ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: Kc 67/1-s rA-PAW0k3-- -- DATE 6I )4 PINSPECTOR .•�—�. f _. 63 (a -7z--- %app SO(/ro,''', ,f eo\ g2G-w,e,e„,,,p--- ., •c. rc..4_,__. ,,,,s,_,,,, , �Q'�� ____„,..-,.". __ ,,, -7-4 , 77„. TOWN OF , THOLD : • , NGDEPT. 765-1802 8 -? ..-- INSb - [ ] FOUNDATION 1ST- [ ] ROU H PLUMBING [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING /STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION - [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATIONg [ ] CAULKING �� REMARKS: C '/ n Cr ,�1 2 ffiza.„ r• Z_ ► - _ , _ ,0 m viktmoosz,---,,k., if,,, ,fri:4 c-7--A16,?Api Th ),, DATE INSPECTOR ---Tei-L-4-‹ Guaranteed Home Improvement 256-B West Old Country Rd Hicksville,NY 11801 t � � � Tele(516)827-6000 4 Fax. (516)827-0230 customersupport@guaranteedchimney,com MARCH 1ST, 2015 Lynbrook Plumbing 1400 Young Avenue Southold, NY 11971 Nassau License##H07085300 Suffolk License#43556-H NYC License# 1281168 To whom it may concern, This is a letter to certify that on 2/8/10, our company, Guaranteed Home Improvement, installed a custom chimney liner for the heating appliance at the above referenced address. The custom chimney liner is a stainless steel, double-wall liner. The liner is UL listed and is in compliance to the National Fuel Code Requirements. The diameter of the liner installed is sized accordingly to the BTUs of the appliance installed. A stainless steel tee, with a stainless steel bottom cap was installed at the base, and connected directly to the heating appliance. Please feel free to contact our office listed above with any further questions, CRiTFFER ARCHITECTURAL ENGINEERING 6 CONSTRUCTION SERVICES 53 Hill St.#18 206 E. 73rd St. Southampton,NY 11968 New York,NY 10021 Tel:631-353-3370 Tel:212-879-7300 Fax:631-377-3896 Fax:212-879-7302 May 9,2016 Michael J.Verity,Chief Building Inspector Town Hall Annex Building 54375 Route 25 P.O.Box 1179 Southold,NY 11971 Via email and fax:mike.verity(utown.southold.ny.us;631-7.55-9502 Re: 1400 Youngs Avenue,Southold,NY 11971 SCTM#473689 260.000-0006-032.000 Memorandum for Chimney Liner Inspection Dear Mr.Verity: This memorandum shall serve as a summary for our findings in connection with a chimney liner inspection at the above mentioned property. We found that the chimney liner was installed in an adequate fashion in accordance with the applicable codes. If you have any questions,please do not hesitate to give me a call. Sincerely, F NE iv '�/. •oicr ,1dr Ma ert,P.E. o 'kV T:917-656-9166 1, `"` z/� c:/ (a� E:marcaccenginecringdesign.com att) 088130 y `O MAC:mpr ` p ESstO�P cc:Michael J.Verity,Chief Building Inspector,P.O.Box 1179,Southold,NY 11971 Enclosures:Photosheet from chimney liner inspection. -- • q:11400 young's avenue,southoldlsouthold • 05092016.docx page 1 n kk g. n \ /' 4.4. � � olt-45 &01 g4 ` ""yrt '� fiva 'e }y _Y , '110,,,.,ielolPtit `/ : - 2-1 2-2 2-3 ,,, 411 , , . , ,. ,, , .. fie th ', '''''''''4, . k M 0 vs -Iii 2-6{ ai!' ,. . ,` 1 2-52-4 Ci ii FFEFT4.19.2016. 140 0 Young Avenue Southold, NY 11971 - fN".'CEi1�+�5:[ASThL .t:;.�n.iE5 E �� ", a ".,,• i_2 ."s}4^'.� X ../.;.77,y,4.• -- r" 'r3 s 3 4�i �.�_:�` ,d�-�x..�^°",. a.. rw^¢ F5 1 ".�.'. 6 ,..j▪ y'4 P*.�r ':3;;i�,� & �.N 3 w �o L r° ',"`'' A, ,sem y.v a`,. ,, a'{`6, °S�,, tgio. 4. __ s, f., 1.'.,Z.- ,11.°A.,..'.%41-,."'P: - �a�+.-'` ,< �•:_ • 3' �u� •+tea, a%� ,t., e } -ti,<a„,m, v,,,.,.,r a ��` ei-' 4, ,. 1; `. t t r. �z..;!c •• i: :s:r g.,a „ .�ti # ..; at l';''''e§. „,,,,4z4...„.1,7.,,,, , .,,.cmc m».�',4'4,,4-',..==.-�i, ‘Swe:‘,,Ix'';',.,' "'''''”''Aft.,V.,:% m' 4 3/0 _. x .A. t. �ao'. 4YS cf .3 R( Y .,$ Wp asi` '��, i / k: r, �F ,�-� • eF • v. K! '1,,,:-,---;-- g i''''-'"'-- �, �2 $:.-;,...c.,',' ,..fin, a r d r.= F -«,;�` c,• s �m ,� 4�a�. ' � 222 i _ r > „„‘.;.:4-.;,%?gait.gt,,,ttgr?'..-1,4s-, , ,-, � gym.» � •. - If 1 1-2 1-3 i. , , . , # ktoiov4rir,!,:f. ... . His • IR „..,„„....„,.....,,,,x..1.,,,, ,, Ito: .1, ,,,,r,„ . .,.„.. ... ---,, i.� gywi,p #.e3r. � � : ‘......7 a • i fix: ''4 , s• to 4.4%411 • ��aaWkgG .."-tis u LAS rY#. �.: Mw� Mf!w„ Vii..-, .�" :-, , : ',' .. ' x 1 ,..„,./i t. . , . ; k, il. .1 ,,,, 1 ,-- . 1-4 15 1-6 • ■■�������� 4.19.2016. 1400 Youn Avenue AaCIIITECTURFSENGINEERING$CO%STRUCTIDRSERVICES g enue Southold, NY 11971 • ,• - , FLELD INSPE�C}N I1ED00S� DATA ANTS Y • • FQUND,A. ION(1ST) .. . . , . a , , • p CS FOUNDi,TION(2ND) -- -� .. . • �t=i 4- ' • . 8 ..._... ROUGH FRA.MQ•IC#'& ' • r J • • . • r, 1 PLUMBING • _ , , , . 0 INSULATION Pn N.Y. • STATE ENERGY COBE { , ;r r. r , , , , . <b d -ri9 ..(—e 1-N• . '' •A.I,mil.roti ' +-wit, T5 ...-•• (.:••.-, .:.-s-..-::-.(%-. -.! •,. .eect,01 Z�J .• . •rf ,15-0 ....'s(� `� . ,i .-c 01-2.7.7 _,.............,....,......._.„_____„.„<„ . , 0„. , i.: . ... ./ . .1_ . . 0, . . . .Itti ii, _ . .. . , ,. . .. • . .. . ,. .., 0% Fii . . ,.) . . — / . . /, , . t a(/ P P ` . �,.. , �. VO.7 J� ��� �' ,�r�, it 4 _ • , ,.. . s 'G\ 2 . „ . . . . 0 . . , „ , •• •, ., : . . , . . . .. • . I, ,k 5, o • ....rw..,..•-- 1, . . ' = x • • ,••••••••••••.,. .r.-........_.�..� { v . .. 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 SoutholdTown.NorthFork.net PERMIT NO./7027 2 _ Check Septic Form N.Y.S D.E C. Trustees C.O.Application Flood Permit Examined / ,20 Single&Separate / Storm-Water Assessment Form Zc / S Contact: Approved ,20 Mail to: Disapproved a/c ---— — Phone: Exptrauon- it FF talk�' .:.:,• :ut,s ector DEC 17 2015 APPLICATION FOR BUILDING P oi DEPT Date_ ,20 Tr`'if' (1' ,.11 i';, !, 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 demo tion as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code,ho 'co d regulations,and to admit authorized inspectors on premises and in building for necessary inspections. I A CU-kis ?Zp.4.25A (R W t C o J 2 t' (Signature o plicant or name,if a corporation) t:`{NCA2.20ay._ iu j (63 (Mailing address of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder Name of owner of premises ) R { (As on the tax roll or latest deed) If applicant's a�.c'orporation,signature of dy authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work wilLbe done: ►fes yovN,6ls. ODD House Number Street Hamlet ( — , 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 C9FF t CC g c t 1, D e a-)CT- b. Intended use and occupancy b t=c 'L(r J 1 LQ t N Cr 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work OIL Tv Cr d.S Co r.D 1 ts&Si o tJ °"e"-- � (Description) 4. Estimated Cost / 0/ 0 O U Fee_ (To be paid on filing this application) 5. If dwelling,number of dwelling units n1 1 i Number of dwelling units on each floor N I A If garage,number of cars NII A 6. If business,commercial or mixed occupancy,specify nature and extent of each type of use. (D LA M L-V-e 7. Dimensions of existing structures,if any:Front S D Rear 5b Depth 2 2-o Height Number of Stories- 2- Dimensions of s me structure with alteration or additions: Front NA Rear 1.-) 1 A. Depth 1.1 t>< Height 0,-) I Q Number of Stories N) i 8. Dimensions of entire new construction:Front p. Rear tv I (a Depth t0 ( A Height N I P Number of Stories N I 9. Size of lot:Front (20 Rear 1 20 Depth ( 0 0 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 X PO do a 457 14.Names of Owner of premises DIAN G- 5IV MA _ Address C r.1 1-tm,o N Y Phone No. S 1 b • (4-71 - bB 13 Name of Architect Address 115'4 C Phone No Name of Contractor CI-tars Q P•Lr)s!1 Address Phone No. cito-5-c13- 4 00 o q0 ?l.uwtg cv-'(,c 4- IS-`-s-T, - 4- I ItLu)ta1 C OJo-T 1-11.“ f_.00re- t V t15-V5 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 1/4 *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 ) �G 1 '�ii� U i tt . JA- _ being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing.contract)above named, (S)He is the O (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 As owledge and belief;and t t tile work will be performed in the manner set forth in the application filed therewith. Sworn tp this n anielle R. Mistretta - v� / before dayme of f 20 ) ty Public,State at New York No.01 MI5083324 Queued In Nassau County Cion Expires 8/111,[ J Scott A. Russell � .,�� ° FFQ IQ STORMWA\TlER SUPERVISOR 'MAN AGEMENT ' Z SOUTHOLD TOWN HALL-P.O.Box 1179 O ' Town of Southold 53095 Main Road-SOUTHOLD,NEW YORK 11971 , 0� ,*� s •�44''1tiiuriw'311' CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET (TO BE COMPLETED BY THE APPLICANT) i DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWING: ! , Yes No (CHECK ALL THAT APPLY) IE ❑ A. Clearing, grubbing, gradingor strippingof land which,affects more i than 5,000 square feet of ground surface. l ❑M B. Excavation or filling involving more than 200 cubic yards of material I within any parcel or any contiguous area. ❑1 C. Site preparation on slopes which exceed 10 feet vertical rise to � f ! 100 feet of horizontal distance. ; ! ❑® D. Site preparation within 100 feet of wetlands, beach, bluff or coastal , I i erosion hazard area. ! ❑ e E. Site preparation within the one-hundred-year floodplain as depicted li on FIRM Map of any watercourse. € ; I El F. Installation of new or resurfaced impervious surfaces of 1,000 square , E { feet or more, unless prior approval of a Stormwater Management I Control Plan was received by the Town and the proposal includes 1 _ i I ; in-kind replacement 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 C+eck List Form to the Building Department witfyour Building Permit Application. -APPLICAT:T (Propel �rre�,1----------=-=oral ' =-- vE S•C.T.M. *- 1000 Date p y 'gent.Contractor,Other) ! • District iitrict st (� l/ / NAME v % \ coo /O c 1 �{l 'l aef,sdir" Section Block Lot .FOR BUILDING DEPARTMENT USE ONLY''';;;TI 1 i Contact Information CS- ' (°) �� Ch 2 I 11 %./ 1 .Telmhme\usMrt !(i �— V V �/') i I Reviewed By: t 1 � Date: l Z 11 1/ ( 1 Property Address I Location of Construction Work: I roved for processingBuildingPermit. F 1�c�u 0 "fl \e ' � Ertormwater Management Control Plan Not Required. (.- "T '1 1` ❑ Stormwater Management Control Plan is Required. ( I ' (Forward to Engineering Department for Review.) , FORM # SMCP-TOS MAY 2014 — — r♦ fy _,,,,,,,„.„, ,, 1� sV,1/_/yam' • 'fawn MU Atex D +a75 Matti&me t,,i,:i) ,►,C ca A �:;. an1a 2016 P.O.F3aY 1179 ra er,rlr x t � Sndfholrl,N?t l71.495�J '..i. -• � , . zpr,richg�P'eg li it �;?y,t�b �'� ;--'4.4..r.44.4.4+-4'� UP , O�' B�D1NG D TGWN UP SO BP 6 , OThOLD auti.DINc.: ok,a.mt:r,ti::: 'r -y TOWN OF8011111101,1() t\pPticA1. _ Q 1 -6 1..INaPEglION y.: .�.Y�..,.wrFun•P _,..''�i!Yr,r,„,,,,+_w.v.Pl.rorW .-.htnW,.t...•��.,F;.+..w w .r....rh,...n."r'rw'h_d�y. REQUESTED BY: �� Company Name: -- �A/24 �r _ 4.oe-65:4-A[ 4-ref A-1 oirjat�; /_�.�..1-.-� _ _w.. _._r _ - -,r_License Na.. •-- L..31X7a --•,. EZ3. QL___. i_.--." .. _ _______..,Adss: __ mac....- , ,Gat.- _/yzrlD .4X.1s3_ ........ _ .. .. . ' Phone No.; JOBSITE INFORMATION: ('Indicates required Inforinatic;la) *Name: f2� .-.. L / a. 4 :S 1 _GR . __ , _- .....r ...,. ..... . . ..._Address:"Cross Street: .Z._ - _ - Tax Map District: c /r --- �._. ..,. _ Permit No.: i 0 alck! 1. N OF WORK(MeEise faint Clearly) 604',TV'er ,,,a. 601 Ns- Co- -It1/4No (.5.4„..c..,21 Ler,,L,,,I p:2......frEs„.<,Lp rs(40.,-j--ors QA),., , (Fiekiee Cireie Ail That Apply) - - �- __�__ _..._— 'is job ready for Inspection: 0 NO ,*Do you need e Temp Certiffoaie: YES/ NO Rough in Ffnc,1 Temp information (if needed) 'Service Size: 1 Phase 3Phsse 100 1502 COQ .340 SSD 400 Other New Service: Re-connect Underground Number of Meters Change of Service Overhead Additrortei information: PAYMENT POE,Wi rt-j ?..a..:0(c) J2-Request for Inspection Form --''.-. - - a.;---:7"--7---- --- --- :----,--;7--7-7-- ----- - - - - - - y _ y Q . - TOWN OF SOUTHOLD PROPERTY RECORD ' CARD _ LIP. ` _ "y`� 4, ,%OOo- t t) 2 10, _ ;,- , OWNER STREET /A//90 VILLAGE- , ' - DIST. SUB. 'LOT- - _ 1. '-. 7-10 O 21• 0 te--y2m' riit..71,12.1'".0 Or e..' Y go-ua4 /1. 1. ,.„,--, , FORMEY OWNEI•Ab9itit-i-i-) ro rIC- �/ N . E "-' ? ACR. iL . t, ,p.,..,;(y-i-,;),.„.k . ,,, , , ----- a e.,4- �coc(,tI''7oo SGVI/J� A?talc S �' ..2. W TYPE OF BUILDING r.8121.1 4 r.rric..s.c./7.c ir''' .. ,6 -4 i:?Y l @•( --'G\HG, . a cr!A9V,2 tic :RES. SEAS. VL. FARM ' GGOMMC CB . MICS. Mkt. Value '�r-' LAND IMP. TOTAL DATE REMARKS / -- - -- _ .; - per ✓ / s16664C... 2- y/,s 3/O-6 4lZ6-0 73 eTh 7/x6' 7F/72- oli ?.2. so- /r .5-67 147,81:4 .Ss3rra s - S',)„-e,,,. '/S ,,,„..,c;. ,'67,4.t.-' / O O /o _= J / Q�`-Q elf-''�-7.".!r7•` + ?14 , ,,/,„/,:„:„._ -,_:;9.-p.,/,,,,So„f.,:'L ,,./. V /'7 cir �, OO 41 , Zc 49„4 '..a-y -1'I`ik'f .t:-.:". /31A-7- ( rs.i1iroc 2 r=rx - I. / , 60c�c. 144c,�t� 1g i-2..,oc) s�: J./ 5- 7E ,✓' 702.1/At-c)- gp /? ) , i, Re ,/P a.te`�'-�tio0s, tns- . ecoh'retif.106,14Xc, '-. N. ..s-61 �::s` 1-4:_ i . it/'/1a- lkiaft�' -Timaila - }1k +-R,SS -M Nr- - - �% q4--1'nu lel- q if ci'.�/9°7 934- 74,72.5 , - I i 11514/.1Q4,--L /179847 700,- if F /' \/ fj if rt r-, .Si.00 £// /ii 7\ 'oust• -! PY - v /, ;/O/1i --31,0 -teds - , , PNe, - 12(0'23 , TillableFRONTAGE ON WATER _ . Woodland `FRONTAGE ON ROAD, i �. Meadowland DEPTH 44p,p / House Plot - BULKHEAD • Total _ '.`"_- "7 --s--- R, _ _ _.. _ _ ! _ .._ --_�__ __-� -_}� !.. :-.:II,....„,-- ---*-7-_-:-....-_--_-....:-,-1,-....., - :�- - �;"TOWN OF SOUTHOLD PROPERYY"Y RECO_ �R®; C s►RD ` -• I OWNER STREET VILLAGE - `? - DIST. , ' SUB. LOT " ` d:, = l•• ,-L7,5_,-_1!3),'41,1,,'{ ,0 .5 t �p 'I'4! . O1A1.1 cs_ p.1 v ,; - Esc.. FORMERyOWNER f-lt,,�s.rf�t W5 N '. , E,i' ,�,/ ACR.:_ =r [': 19 M • -1- F-�,C.,ti !' 1,, ,%� w� ' C� rel r , r/'•,.�+-_66,2 1 rt -64wo"r/ 'C'' -co,F,ie_ .G Ci _ S� >g`eC � =1C4-4 • W.1.4 A TYPE OF BUILDING 1 (r'1, CA'a s✓rs'C b r'i 'V00 i:4.,/C/-:11- 1.�' ' 'e e:( A9 4-4eI/+Q , .gi RES. SEAS. VL. FARM CO,MI�A� CB. MISC. Mkt. Value /h_', Ci - CD LAND IMP. TOTAL DATE REMARKS ( r ;6? e"--1) 1 ,A 0e) _ /o g iJ 5A LE 67/ 3 /7,1-:, �?2:. // 6, e a c ' G .. 7 6 1 0 e, / G.41® e) ✓ 4'//gy/�$-' - S',4-,CC /�/ , CS-tri)-;e3 - -. . ,. ) 1f 4. ri/A _ l _5dt iicsir .�- J ?. /v-4 / g 0-7) 6f1-/‘-1 / / 5,11c1e..`�c1.?al ? :-07 e,8.M.. 11st6 cd lTO s r-v,rif's e wir. , 'P-4./ a a S era (} a v. / / ) ' 4L)(244,-,-0-1/6.i 0-1 o--.+d.,..41/-/-e/4., /e,''''v,k & / 0-D 4 2 a-iai /`'.e6 d I'' . //7 AA- .5/4/94. 7_9.55,), ,SG a..1.T3'NI As' s ,4-_,.. .6 PA Se crt cst n - Hts AGE BUILDING CONDITION / 1 i)rs • '�-�''�) c3-D _..1, lac 7:-/7.-_,- liefn r /me-Rfli rr 77 CO .3/Z ..r/P 5 /1"-- -.6rC4 NEW NORMAL BELOW ABOVE gyt �A. - I:9 �Q r 0. Pr-secc,1 wen -ro t-114117 t�f l� .l:rt'II-, . 1wc_ I gq,-ejt FARM Acre Value Per Value4/2J Acre �i ,Q J /So L3 demo/ l Pi . — Tillabge 1 /21ia,( "R`PF-�\5578 C'ocU k,t77. . 7E.� � , c _ _ t;'C., Ie ';-0./e:10 Tillable 2 i0/t5/a6-L 1014.646.g Be m 1-4c tri 4.4 loci -6 _ r(,--f-� W S,-v. :- I5O. 6 Tillable 3 2(1 I IPAU"1 507 J r Sion,,6.G e___C L..cltG. Mc . - 4:11,00, "`7' ' Woodland Swc.mpl,and FRONTAGE ON WATER Brushland FRONTAGE ON ROAD 10,0 i House Plot DEPTH I/PP P , BULKHEAD Tota: . rt DOCK ,. 4 , 1 - - ' a"-" _ ...+.-...:v-.._�-..-." -_ - � 4Y3o'.+t • �F ���a.+,.. <ek�f%Tx'. ?�y;:+ _ .,.:. 1 r,:',.,''.."';'.. "r:'..,'; '4.:'';.,:•-= ,',1,-,,,'S,'i.'''‘,,,,S,:"''‘,...-;,:".:':.! ,I."-1„ :'.7:„-.,',-.--,-'', ',,,,.-,',..'.:-.'...% -.,-.,:,,.'_',..:';''' ;',!„i.:''' • :'''-:' ',,s:='.- ., ss„ ../ .. „ I , . .. , :1-:C , ' • . . . . • ..-- , . - , . . 7 t) . . .., .....___ •—... , 1 --....1 • , COLOR- „..... .___ . . . , . . „I . ,,,3....,„ . , , • . ,- -,......„,..' -_ . - , ,..„,„ i ., • •._.. ' ' , ' ''-'..."..• , ,),0 ' . . , , k.'-', t) I; I :, :-.,..- I it -14:,-,_ • . ,i • , _ . . ... . ... .,. . , , - •.0 /7_,...„-,,,,,,,,-, (,1 , , • . . , , . . . , . . . . . ., . -II,;;.' • TRIM : _ ____ • , , . . . •` • ,....................4.,,,, .,...,-, • 1 . .......... . ..„„ ___ . ,,, . i __________ terp.„..,,, , • . • ,, , 1 , ...... . ., y• ,,". "7-7--------........ ,.......---7" — .. . ' ......i........-_.' - . . , • . . . _ . • ,,,,, :-.. •„. , . :.-. -',..--- -, '-- • .-- f.. , . • .. - '• - 110. •j • ).- c.„: • .---- , ;4t1Ii,.,,•'.'4,ge-,......,,.....1 ,-,;:',•'•-'.•'.''-,-,"-..'-^'".•. '-• -......--:1-•,-;•. i ..-,',,,-••..--,.-. =.'-,,-,74.", --.,' '---"':.j'•`,`:. " ;-',,,,:.--,-....,,. •, I.... —': . -.„- s - 7 , , . - -' ''. • -., 41 "... '• -,-,*,,',.'...-..,.'.,`- .,., / % - t • ''''''..";?,1,'''';'''''..'''..''-,''',e",,.t.''.7."';.':- -'-,-..-i:-..,.. '.': ,,''','--, '.'..-"+""'Y' -.,,-,-; 2 - ','"'-' .':.;.f 1- - 4-4:' ,: \ . • 1 ',2 -t,,,,yr:-.-fL.•-, .;,!;•:',..,' it;.,,".;:1:-.:•.-,-,,,:',y-,,,,,;,'•,'..... •,. .' J.:--,',..---. .--- . -' •,L-r 'n.-:',.;,,..- ,;„,,.- , \ k . ,. ....-.... . , -,.....-, ,.... ,. . .„......... ,„ .., ,, . , . . , ‘• ., .„ , - - . ' • . : -..i... .. „.,, .! 7.1.''',, ;',..'",-,,,-,•,:..".-Li.-.„,-.".,-.'-.--,..,-..;in?,,,.. ..• '.,'.."....',.'-I, 7".',,, •,,,,',"''.. -.,..-,-....--,/...:1„-..,,,,,,,,..,.,,•'--;:".„,? .. • I . . M-1"-k, ..,`.4.4.4- -•‘:: . .k Bath -: . .Dinette - ' '''''Foundation ---- C....' 1,!",•131d ,, ... - ..... . . . . _ /05' /4?,,,,,09 .„-- , , . ... .--F ,.., itenskon.,/ '',. •„' ,-.,, ••.-- ., c•-,-. ,..., Basement A.....i._ ' ",_ Floors PAtit.-Lui -• (v,,,liskw.r) - •;,-',:`, ,....: ,,,,, • 1•.,,,,:',......4 L.-1.)e, -•'('',"•'.1 • - -,- - --' . „.. . _ . , .. • . . ,.;•:,:,',„..4i-•=,--" ,..--?",':.','-', Ext. Walls Interior Finish LR. •i'a.tc....1C_ hiAiari: ..'''.'. • ----'-^'- . ,-"„ 5 -..•„ ,,, ,,......e . 1 . '. '''''... .• .. - ,„ , ,, ., , ,- ' k'‘, ,t,.,•'t•e-n..;-,.s:.-io,Tn..tT..-f.t .-.0... ,K ' ,,,,•-,,z , .. -.. - •i FirePlace — Heat DR. ,-3„.-'„.•-•' ./ — • - . .. , ••-,,,,,,,....-:„...,;.-• ..— ' , Rooms 1st Floor BR''',.15-""•,,••' --..,- -cL PrT . „ „.,,,..",•,';','"‘,.1,-..,1.,:rf.:'T....-.„,-,"!;',I'l'it:',.,„"",...,,. ?.•:” .,,----;'-,-A*2.•, .... -2 , :' _ . ..,i ,.....,- 1,7;';':'-;, Type oof . ,,. - — FIN2',B. .,,,..,'.-..5.--...i.;:'s,•••••-1;1-,-.'.' !:7. .--„"-.,' , I's'-- Rooms 2nd Floor . , . ,- 'h. .-,.. ,, , ...,:•,,,,,-,;, ,,,c,,,, , .,:,,, ,,,,, Recreation Room . , . . HT ,..-`-- •...,,,,,',,, -,--..,,p..1..'• ''' .. , . . . , . - ..... .. . .. . , rC,Flg'I.;;/,',!:.-',...'; r i-T.:.,-,7—.i, .—'. , • ' Dormer . .. , • -- , „ r:„.. - ,, .i.:,:....!,••.'.....,.., ',.1.-i,../.;" - . . - .., ." . . , , ,-,..,.•.,.,,,...., ..,e,,„;-;;1 *1,'_.„f,`,71.:.;-,,,i .:'• : ' , ,.› • - . ' - , ,‘ , i iir.....ee..‘,z,,,..e....wr.....,-a.,",,...y.,..,y.,•';•!L -S, 2 _-, Driveway . , . ' . , Prag0'6."..',1.%• ,-:;-;;Z:,A.l'4':1,';5'''('",4-5-.....- tCoe(:) Zhi,,I.,, , ,,- • -, , _ ___ , 1,"z...n.,...;,,:192..'.;,.N l...,. .'•-:....,,l'•!..-i.---,' - '- .-'''- . . -- - -'• oho. •-,.., ........-"..,'...„.--.!„..„1'0,,,,, ., ,• ., ,.' I -' ' '". ' • . . '-'..r '-',,,',:-A •• ' •,771.,',/i'',;?.-:''''..CV:', ;,. - ' ' ':.; •..i , •''' -• ''' '' .. ,Z '.‘,-zZ,',..‘1,,, .,,•,- - ' • -; . , -• „ v. Vi/,,,,:n'':',•,,, :„-vzesii':,_:,11;Z;•,,,,:,,,'-,4 „ r 13'',':.Li•,,,,I., ,Z.:;, ,,,, . , . ., . -. , ' ,Il-' A ''1'.::•:•''-',1::('l ., ' :i'''' r'',..•71.•" i-:'''' '''''''''''':''', •••' :-''''1,',f'':',";I i'''''''''. .1 ,%.'•.• '`4.1''', '',,,Z1'...,V'>.:.'.,4:. s'' ;,,..1,:'%•,:.:,,,i.,.:,,':1:.',05i:-.'r:A,..::4,',',',,,;1:!'- .'?,',- '-- -:',„, „'"' .',. ' ‘":;_,-'„{r -"-- •-:;''-"--;....;-1',X...?*',:,.t'-' -','''''''f.s''. -, I:,,'--;:'',c,-,',--7` Z-•:-.:.'4 ?-4,''!,'•.'‘'.'::-;;I.fj.:-'.•''''::2:1'',',',i',''''''--' , 1 .... - . - . Z;-''.,: .:`,1',7r.,,t-e,',17;'1';:"'•::::'•:.:7';.7.::;'7,17;;:-.2:7ZZI::-:',777::',:...1'7,--..-..----T;;,.-*";7;%"--'''-'''''''''.."'''',7 7!;:-.7L-7)-:;:;,"-•i--'',,:,47-.:?'"..17 ,-'.,_-,,,,,``,f...-'',„-;,:_'. ',.,-,i-7,.. ;:-.7.,:.''"4",..,'-...-, .- -,, . .. , tofor,-,,ti!;,-,,,,:r.:,,--, .',,c,,,,,,I,,t,,-, -t,.,. !..-1,T",: -.,,•:-,:.4-',.._ • ,---' -,. -' 1''';.;:-7,,),.,. `,...,,, :-f,e4.4).,f-,,p,—i',-. -,,,:,-,j---r.qr v.',:c,,_,-,i, , -',--,',,,,,,,,,',,;;',1-,-;1=';','.:,,,...; . , ;.,7'.'...- . „ , ,. ,.,. . , , ,.... - -,', -- - .--,---' ,..--.",—,s-:-:'n', ". , , — '..e.:,;t'-',1,t.-vf..r,-,.:','F--=‘' ;2"/"---. -::*‘',`,1,:`,"i'-,' ' •:- .:,.''.. t. :-" ! ,:''''---,,,77.7;7.1.:,...=`t"' ',-. ...":,--;.-'-,,,':. • . .,.t,,-. ,.. ,••,' • "-1,a:,- '',. .'.5:14' 4-,S1 •-t.,, -'4,. ;;!:', .,,,,.'.'''.,'‘)".':.',',''',„i,'•." '1,`,,;•,:o r„,,.'.,,,',.,'.. ,„.„... ,t-,.... „ ,_ „ .. ,.. 9 ..t.., , . ,.. ' 1 1"-,L---;„a';,) . „ ..,-'„f,,,1:.•;'-=', .n...'",-,.:. ,,,J.., „--`‘. !,1:-A----.1-',,$•.!,-i--1'.77A.::.,t,-.1.'-..-:'-.!--'..,--“',,-''''-,' -,:;•'-'-‘,.;-*.,: ..,-' '') '`h ''.-'''''' ;-.1r:”-' -' ''''"- '-'-' ' ::-•-•"---:•47:::,:::.--.-•,;.1...,...e.-- ,,-._.0..',..4r;2—::=.7,,J.:74;,:„. .--A.:,....-:',',..,-;,-.,,,,...4...„,d,!•,.`rF.,‘,.,-.:-.......,.,,,--.--...---,..,-r4.y.,- ,„, ,,,'....:-,-/— '';?' '.,,i,-7'....''-.--'7" . "-,-11',-'A ,','"t7'.7'.----7-7,-*.',777,. 7 ''-',":.! -'---,r.- -- "--i',..*"..,,, l. • ...;1 W`Z.:.'.'-z;-=,f'',;;;,`"-c-;''ii'2-4'''""7,e''.."--4s,- '4,,•.'1"T.:,,-",'-',-..)r-',..,,,'';',,t‘,9,'-' -,-:''`i, .',.. ..-e(---= .l''-'..."-r;".:1-71yri..0". ;t:.2,:';';': t-4.:?,,'-", -..';-:,,.tyi..,',..'',.;('4:' :v..':%'---..-%:'"•-:'':':--,.'';=:.,-,..,,''..,b-:.:--:-...,- ,- ,,-..: - ,, • - • .----z•-••-, -. ..)...).e.. ,,,,,,,,,,..,1,,,,,:\,,, ,,,e,,,,,,. .=":: ,,rsi ......,,,,, .7.•:, •,.1,... ,:•.-1--f•,f--,„ ;„,,,,.,.... ,, .,' ,-,,,, ,...;=,,, ,,.', .„L-,,,•• , ,..:.::: , .,','' '' '..f:'•.'•,:-.',c.•'-''' , . --r:.'. '-` - '''.-,-..:.--...."2,1 E :..t.:744... _.... ..'.,_,..:.1--:.14: -.:_,,,,..L:,-;',:,..--...—... ,---',. . . , , < r ` � ,; r I ;L . R . , .r IL • R ,O _ , . # cnr.,:S./0;Z%. .,44.; ,44. <z o.',,.vE>I",c ecse', -.4rant/0/4G> ."{p 63.9 , rte! ,1kS ( aF . a ii ....,..._-,.y;_..,..,.R.,..... Y cf+sc,,s r.7s." y.8y,.+v:`cr TS? =d3..iR. Y.w- ti a i." ., ., <,- - ' } > ttt eswlrY ,nti' tPn1 •3 n�>;-1 -f . ;� rF 'F,5.�:,#'r` q ., ,. . . _ j+�=,t .a rl°' 'r ' '�i 9 .v._ ' • -' .,'T „!,,,,,,_,"__4,,,,,b+1 .. .7.;3 f� .., ;n} i ".,-! f• a nre a •'�. 'Y ` 0,1_,.,,.,_ t*i l ,,;C. f, s 1-r«.?` , ,,,`• ,,tti 1Y0.�'i' '�. t, . -.si... .,:..,.... „� '�,'" M•:r-`dr,...:.. ,«.a.:. .._-m= 's��--. '''7•cs Rz^.r�'--- .J '1,--,,,,,i,2',,,'„,-=:., I' , '. }i' - , ` •' =,yb,• ''` Oji`'; - , - _ =(� • 1-..."4.,1,4,/.14-1---',;''tetA•, = • rxra °.. a r^7; I as> : r � ( , 2$3 . Y �_, rl1L: J s'P , , a .t A l. � 1._ r -»...:. __ sr i°ZTeL °"kPy7"c' `.�, "isi ' :.As '$_'�},, Fn.-.e- ._- c9i . Petr! -Y,"..,.. Z, . { W_ • ixpv.s,a 49,4? ” 3 . 4, 0. i = ' •4 E' to hd T =q• '. , el a lett s ., ,s C . s`t qC 1.--.1., d y, L417.,:411,40 _ f s,,sa t,,,en FJ , '$• tc'`i'�. _ , ,<' 1. �,....,,,,,,-,'.e-r?n�:Y s:i x.c.n 3 r 4882 . , _ • . - . . _ . „ - 1 ' . . las : ISLAND RAIL ROAD 00 , .• .. • iti,te .1.....s ,,,aer• er..<90,,e,„ 344,00 (,.6,,,,,,icr 46. et` '5.3 B CiS 4 —..- . . : 490,36 N.56 '5 , ''. 7 00"E< • , .g . . < $ —. — '' - 343 45' 2742‘4'.9e ' s.66” 57' 00 W. . =‘,.. !...,__•--4- - • r••••< - 7...,44.4...tt444.4141:4 . ,.,„,_ —.4-- .-4, ..„,,m S' I.0 - ' - ' ..i. ' ec-ArA:' -7"—j' ----- -"--.' s' , 7"---'-'4----, -11 : . ' . i . • .. . . ' „ • 0 . ' 41 'i\ '' ;''\‘e, -• . . . . . . IA /0/T FREDERIC P. RICH , ,t p.....,,,:,, ,,,ce A .8, P H A '.. '''` - ' ,'•' '7 i. i <' , : ..C7 t ,. 55 "1'...e." ''''' }:1^ :, '.;., , • ' $0 . . ' , A S' !II:'ir,.. ' • , . . .4,i 5,'•.1',1,,,e,,,,,,, a . ,. . .,....„,,,,-...,,... . , , . .. . -.....--,---- --- - , —...._ --..-_,....- -,„.-...-.-,-. . ,,,....,:-. —..:.„...„-----..==,,,-...=,..., • •'[ ' . , . . , . . . , SURVEY' PROPS .. ,.. . . . -4 . ... - , AT SOU', , . P - AS V 'E," AS E 7,3 *i ' ' .. • , .. . ., .. . , .em.e„..,.,,i,,•-6 •, , s. . ,.• •. , —., , , , ., ,.• ,, .`,, . - -b , . . . TOWN 0F5 / SUFFOLK CO i 1000— 60 - i . - _......._.,.........„-_,..-.,---,-„...,...-..........„..---„,.-,.„--,....,„,,...,-.,.....-,,,.-L ..---..---.-7.,:.-.........=.--- ".....m...." ....,m'''rn,-...:. La , . . . , . . . , , Scale, 1,,i. , .. . . . . .... , , . , . Sept 13; . , , '• ' 3 ,. ,CERTIFIED TO, . . . , ' f4ao yry.Rizs AVE, CORP, . . , . . , CiiICTAGO Ti77...E Ar,9f.JRANCE CO-.1.V.a.1,Tr . ADE 1,4INE E"MS'ACAN 0 5., N ./ae F' C,OLONEAL VILL4, 6_E Ali „ 5. - ,•15' 09 0E129 . ' , < . S.Of.1,T HO L 0 .• 1 , , ,, . , . 5 , t • , 154 2,303 ACRES 5 . , . i OR AMMON TO 17...1 WE'VE',S A vralArtcriv OF se—Trot.f rzog or 121 Nnp MIR STA re-4-DucArrow LAO, . EASZ.pr/1$Fa?at'/70iN 7209:514?ir."20-*/2...Al..;.. CEOrOVAT4OM ' i'RE01,ARE VALAT nal TICS 8W'ND TPiEREOF alt Y , . . . SAID WP OR :,AZO SEAR PO'SAPirr.7,5,MX SEAf. Or reez eureErcgr tfP-3--E 3.ZWA 11.R6,:....7E43,,,,Ert.cx i .444' A,. .1.r r, -0n,r'-,,,Ttt 4412",,t...RS. T,:: 7i--Rw'.41..r12471.3r . A,,,,„ ,, .;„.. , u ., ,,,,,c ,.',.. .;:q ..y7S..'t A ' CORI' `4^ 7. 5 7 ;7 7''', * .' ”- •' •:, 1.., ,,,, ft r .- .. :,. b, .' .44 .....,„...,.....44.m . , , - . . , . ... . ,._...�...-..--w..—.�v Vie•.-.. .,_e..,..,..., A....,..-- ,�.ye.�....r........... m.ar,.....,».,.<9....,v--»..�..-...^�...v._ «,,......_. _ .......... . ..... .�-, ..,...f .••-..s rxL ( ' , >, ' J x ( . ,. , ^ e &'. . , `-la x {J , . -0 0 ' , , ' / , .„,, , , . ,.. " , , ,' ;% • ' ', :?.. I:1 ' '344 .00 }} �., , » , ,,- y " _ - " .�,)"v`Y •` d 9 /0'iF "g i3EDE IK p , 7a EY • .A , • k , ., V i . : , S `. T. Q. , J 4 `tat `: # ' ., , ,,i r " ` ., '-r . ,. ' ' t 13, !9981,. , 4 , ',W ri7" D T NNO0 YO JN8$AVP CORP ' ' - - " Liklee t 4 itoo 8 d ro rigs stew,IS A Wrai,..4 rrav } 1 6 a 1 f NO;CJs 07 Y CID CF 174:PIZ,YOITT STATE EDWAi°3CN LAW,_ 3� 62.-scrrl7N vo- ;14s:o..1 a At.t CF.tinFiCA7'A'S Phi C�1 'f7R x d� VALV FC,R TT-,$MAP AND CC,Pa r reZRE0P avg.Y.F- > Ca7Flr.�BENT 4? tP?i'u,3E17 SAL or 97Pc St}RY' . (5161 BOA 79.5--7-5020 9 m „;FxAs s,rti,� '. t f3k 9079 ! ro piu- w'—, sirfi 1,44'Ti r 'CN,1 a,rh eo p-r. 12.30 g.°f_ R 7 T ?7 ' .,_ a ...,. m. :aE _ ir.. .gid h2 - t--T`y' SUFFOLK LICENSING aOQtJa`g1fRAFFAIRS STi1 1 ELECTRICIAN m ac ROBERT B STUART This ttiles that the bearer is duly licensed by the 111111211.1 Cetskty of Suffolk- - 4393-RE 120/1993 EXPRAMMMATE 1201!2017 1 I , Certificate of NYS Workers'Compensation Insurance Coverage Page 1 of 3 STATE OF NEW YORK WORKER'S COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la.Legal Name and address of Insured(Use street address only) lb.Business Telephone Number of Insured Lynbrook Plumbing&Heating,Inc. 516-593-4000 1 Irwin Court,Suite 2R Lynbrook,NY 11563 lc.NYS Unemployment Insurance Employer Registration Number of Insured id.Federal Employer Indentification Number of Insured Work Location of Insured(Only required if coverage is specially or Social Security Number limited to certain location in New York State, i.e.a Wrap-Up Policy) 111646298 2.Name and Address of the Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Rochdale Insurance Company Town of Southold Town Hall 3b.Policy Number of entity listed in box"la": 53095 Main Road RWC3368557 Southold,NY 11971 3c.Policy effective period: 5/1/2015 to 5/1/2016 3d.The Proprietor,Partners or Executive Officers are: O included(Only check box if all partners/officers included) O all excluded or certain partners/officers excluded This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"la"for workers'compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy).The Insurance Carrier or its licensed agent will send this Certification of Insurance to the entity listed above as the certificate holder in box"2". The Insurance Carrier will also notfy the above certificate holder within 10 days IF a policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment ofpremiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate(These notices may be sent by regular mail.)Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent or until the policy expiration date listed in box"3c",whichever is earlier. Please Note:Upon the cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the NewYork State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved By: Henry C.Sibley (Print name of authorized representative or licensed agent of insurance carrier) e 17/.6 Approved By: 12/3/2015 (Signature) (Date) Title: Underwriting Manager Telephone Number of authorized representative or licensed agent of insurance carrier:CarrierPhone Please Note:Only insurance carriers and their licensed agents are authorized to issue the C-105.2 form.Insurance brokers are NOT authorized https://ao.amtrustgroup.com/anawc/PolicyNYCertificateOINcIns.aspx?IndexId=129718&Instanceld=58faebe7-1506-4b1e-gmOrhatir3(? 1115 411-4.7 `NYSI.4New York State Insurance Fund Workers'Compensation&Disability Benefits Specialists Since 1914 199 CHURCH STREET,NEW YORK,N.Y.10007-1100 Phone:(212)587-5589 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 113463638 CROSS CHECK MECHANICAL CORPORATION ONE IRWIN COURT,SUITE 2 R LYNBROOK NY 11563 POLICYHOLDER CERTIFICATE HOLDER CROSS CHECK MECHANICAL CORPORATION TOWN OF SOUTHOLD 626 CHESTER ROAD SOUTHOLD TOWN HALL SAYVILLE NY 11782 53095 MAIN RD SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE Q1328 332-0 153718 07/18/2015 TO 07/18/2016 12/14/2015 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO.1328 332-0 UNTIL 07/18/2016, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED,OR CHANGED PRIOR TO 07/18/2016 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING Client#:62576 LYNBPLU ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/03/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Cook Maran&Associates 1856 PHONE 631-390-9700 FAX 631-390-9790 (A/C,No,Est): (A/C,No): Cook Maran&Associates ADE-MAIL certificates@cookmaran.com 40 Marcus Drive,3rd Floor INSURER(S)AFFORDING COVERAGE NAIC# Melville,NY 11747 INSURERA:Liberty Mutual Insurance Co. 23043 INSURED INSURER B:Excelsior Insurance Company 11045 Lynbrook Plumbing&Heating Inc. • INSURER C:Netherlands Insurance Company 24171 1 Irwin Court • Lynbrook,NY 11563 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 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 MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRADDLOF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER (MWDD/YYYY) (MM/DD/YYYY) LIMITS A GENERAL LABILITY Y CBP8158049 09/01/2015 09/01/2016 EACH OCCURRENCE $1,000,000 NTED X COMMERCIAL GENERAL LIABILITY PREMISES TO occurrence) $300,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $15,000 _ PERSONAL&ADV INJURY $1,000,000 _ GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 _ POLICY n!C n LOC $ C AUTOMOBILE LIABILITY BA8158076 09/01/2015 09/01/2016 COMBINED SINGLE LIMIT (Ea aceident) $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY AUTOS AUTOS (Peraccident) $ _ _ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) B x UMBRELLA LIAB X OCCUR CU8158206 09/01/2015 09/01/2016 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED I XI RETENTION$10,000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITYY/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTVE EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ E yes,descnbe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate Holder is Included as Additional Insured under the General Liability Policy when required under written contract. CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Hall ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Main Rd. Southold,NY 11971 AUTHORIZED REPRESENTATIVE c 4 iAt, ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S873258/M823878 BM3 NEW YO Workers' CERTIFICATE OF INSURANCE COVERAGE STATE Compensation Beard UNDER THE NYS DISABILITY BENEFITS LAW B PART 1.To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier la.Legal Name and Address of Insured(Use street address only) lb.Business Telephone Number of Insured LYNBROOK PLUMBING & HEATING 516-593-4000 1c.NYS Unemployment Insurance Employer Registration Number of Insured ONE IRWIN COURT 1789230 ld.Federal Employer Identification Number of Insured LYNBROOK, NY 11563 or Social Security Number 111646298 2.Name and Address of the Entity requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity being listed as the Certificate Holder) ShelterPoint Life Insurance Company Town of Southold 3b.Policy Number of Entity listed in box"la": Town Hall DBL55533 53095 Main Rd 3c.Policy effective period: Southold, NY 11971 01/01/2015 to 12/31/2016 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 authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability Benefits insurance coverage as described above. Date Signed 12/3/2015 By r �/ 1/ - (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Title Chief Executive Officer IMPORTANT:If box"4a"is checked,and this form is signed by the insurance carriers authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE.Mail it directly to the certificate holder. If box"4b"is checked,this certificate is NOT COMPLETE for the purposes 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,328 State Street,Schenectady,NY 12305. 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 Workers 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/her employees. Date Signed By (Signature of NYS Worker's Compensation Board Employee) Telephone Number Title Please Note:Only insurance carriers licensed to write NYS Disability Benefits insurance policies and NYS Licensed Insurance Agents of those insurance carriers are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. Additional Instructions for Form DB-120.1 By signing this form, the insurance carrier identified in box"3"on this form is certifying that it is insuring the business referenced in box"1a"for disability benefits under the New York State Disability Benefits Law. The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder in box"2". Will the carrier notify the certificate holder within 10 days of a policy being cancelled for non-payment of premium or within 30 days if cancelled for any other reason or if the insured is otherwise eliminated from the coverage indicated on this certificate prior to the end of the policy effective period? OYES ONO This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Disability Benefits contract of insurance only while the underlying policy is in effect. Please Note: Upon the cancellation of the disability benefits policy indicated on this form,if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of NYS Disability Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability Benefits Law. DISABILITY BENEFITS LAW §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b)The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits for all employees has been secured as provided by this article. DB-120.1(9-15)Reverse 1110 1 t fs��`yr 'J':�IsHrF-`LLCODESOF APPROVED ASNOTEDr1 T NE�i YC��=,IC �,T�: �& TOV11�9CUD nF DAT: :. ._ \ _ B.P.# _.;!®,7 :` �/ AS REQUIRE FE 9' e:--L1 •I I! NO s BUILDING DEPARTMENT��1 ` � � SOUT' ii • 11 .1,11 � :i.. AT 765-1.02 8 AM TO 4 PM FOR THE S�UTHQLDT�W�►TRUSI �S FOLLOWING INSPECTIONS: � � 1. FOUNDA1ION - TWO REQUIRED t.�'�. FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. OCCUPANCY OR ALL CONSTRUCTION SHALL MEET THE = NEW YORKI STATE.I NOT I ES OREUREMENS OF THE NS BES OF FOR USE IS UNLAWFUL DESIGN OR CONSTRUCTION ERRORS. WITHOUT CERTIFICATE OF OCCUPANCY :_ • • ;, r I x nis > Y -7*,';'At ;k'a i �f .x Cy? [sn�k t" +`, yl lS�v�,tt",v^ �i.`�r4 s''1l .' �,“, ! �t X. ,vtYij is T . ` ! •h ,7 fh h,i'p•�. g. ,� Y w(.jt. /1 S J 1- tf ... l ' •x'pW r'w{j* 3j .�.. �Y`~7 --, !*(--1-..%.v 4 J.� - 5 t 4 .4,44;47� s i�! ..a > " ifs "�tia ! 11 t ",,'t4 �,, t. r "r , a .t-,,- . o {1hµ Z ' . [ '}ti'.t�Y'iA.4,i lY �1.1a1. t k:Lfr'N.,.,y.4 1...-- 1. 6f`.Y�.tY Yi {i 1 �S...i l . �•\ .: 1 - - �i' i•y rsr Yf .+,.w-' s, ',. ';:'1E4',,-1-0-t-....,' ' 4: ..} y� �'+'d aw - we 1 e s" . ' . +"f .. �. . y �,r x 4 rr ,�'ae• r ti ,� +,a— • tt, V9A Series 'CAST IRON`COMrcMERCIAL WATER OR STEAM BOILER 1y • mak. * .,.�, Ya. ,i �` .� .�v �� *��4.x .�•���� � ��` �� �$ 4`z,.»,r.��� �, �` �#CK'� iM- is�a... Your Commercial Heating Solution! Available in ten sizes with gross output ratings from 347 to Installation&Service Flexibility 1900 MBH,the V9A Series fires gas,oil or combination gas/oil The cast iron sectional design of the V9A boiler makes it easy and is available equipped with either steam or water trim.The to maneuver through doorways and into the boiler room.In Series V9A has thermal efficiencies up to 82.7%meeting AHRI addition to being shipped as loose sections,the boiler is available certification requirements. with factory-assembled sections or as a completely packaged Cast iron construction,ease of assembly,two venting options and fire-tested unit.Packaged units,fastened to a steel skid,are and stringent testing methods make the V9A Series boiler by easily maneuvered through standard 36"x 80"doorways. Burnham Commercial your commercial heating solution. •HASSLE-FREE SECTION ASSEMBLY American-Made Cast Iron Construction V9A boiler sections have reinforced Burnham Commercial's unique cast lugs that are used to assemble the iron formula has an extremely high ::::a'.44,(1,741:10,.; sections with individual draw rods silicon content,making it stronger 2tiv4 resulting in fast,strain-free assembly. F and more flexible.It offers better ' ' The sections can be assembled thermal shock resistance and greater " ° f using two common tools—a 3/4" %.,q191111111111111! heat transfer capabilities than other , g . � drive ratchet with a 1-1/16 deep t* fika , cast ironproducts. r • .F socket and wrench.The sections areittt- •MANUFACTURED WITH QUALITY surface ground to ensure smooth -r Casting Solutions operates a state- f• surface mating.An elastic sealant of-the-artfoundry,in Zanesville, r' `` and fiberglass rope are used on all <. Ohio,ensuring quality and section joints for a completely sealed • availability of boiler sections. CAST IRON and pressure-tight assembly. �rj casting s .,- •EXTENSIVE TESTING METHODS--ASME APPROVED •CAST IRON NIPPLE DIFFERENCE Zanesville,Ohio s. V9A sections are held together using t Each boiler section is hydrostatically tested at 2-1/2 times cast iron nipples,which are well Quemoy epe�aOn the rated working pressure at the foundry.Factory-assembled known as being of the highest at, sections are tested a second time at 1-1/2 times the rated �:.7 rd.. _..;' r•FrEZ working standard for boiler construction. � � � , gressure.P Unlike gaskets used by many other } •REAR OR TOP VENTING boiler manufacturers,cast iron ` As a forced draft boiler,the V9A s nipples are impervious to flue x; '` �' •. gases,oils,petroleum-based provides optimum draftfor chemicals and other contaminants, controlled efficiency,eliminating — ; which means fewer costly repairs the need for high chimneys or rr..ri and a longer lasting boiler. induced draft fans.A unique feature of the V9A boiler is that it can be vented from the rear or the top.This enables easy chimney or sidewall venting for maximum at �� z ,`..rl,'` installation flexibility.Top outlets �� f venting saves floor space and reduces installation time and materials.A plugged tapping is provided to make flue outlet pressure readings. t ' S • }k *.ey .�, &� { � , +t"�" F .. . 7 H'$ 'k-8rb trr p t4) kC u4,. 9".w rc x gf, ,, ,..*11,4.,..,,,,,,,,,,. '" rte,, =N w . , . y ,„,,y. WW *� n ,,„„ '''''',4:'''q&JD ,, V9A e`rI S COMMITMENTTO QUALITY �' �e � 4'ff"}pltlt' . . -Av r, # %,..t* .1.!.:_-',.1,;:.:;,.:, , � � at k4r vizi s -A' - L `.+,� �""" _ `"" 'rezi ax x4" w.q' a. sem^ ,.t' .'.d'`� -e*-; .a,. M '"p i i V9A Series-Hot Water or Steam Boiler Burnham Commercial,"America's Boiler Company' Maximum Allowable Working Pressure(MAWP): has earned a reputation for quality and dependability. 80 PSI-Water;15 PSI Steam Built for a variety of applications,the V9A Series is right for your next job. Top pr Rear Outlet front Mounted Controls f Withadiustablelock-type fareasyadlustment �, g tenance rr damper(not shown);includes ; and mom ` cAs pluggedtappmgforoutlet FR®ty pressure readings01, ` '� • `� �.`' �roi''zrla' t� �.. ,fig w2 it* name h8 M t • • naop. Removable Side Jacket Panels- =" f i � , Easy access toalicleanouts �' 0 :ri.;:., ' , ": iT,,:.-;•44,,,r:::,., �" v, , ,za Castlron Vertical Design .`�s r" Vertical flue design with pinned r". � . x. heating surface for mawmum... �,, • , heat extraction Optional Iankless Neater t�, . q Providesdomestichotwater n ;,.. I ,!ti'l. t,,fti irt,',.-.'w,...k.::','..R-,-....-....4:4-;,/,..-';''t-• Y� rM � �f " t ' fig, BurnerMountingPlate , r Bear Observation Port _ �; ' } .,t._: ;� s3 ,- :`:- '� ' With flame observation-port - -•Includespluggedtappingforfl;.,,,,'444.' r s t,over-fire draft readings'(nat shown) ' `t� , " u. i Ci ae 'yA417:41:t4,,, : t % L a ,,,11-,..; '.I'tn t r, #, •0_1'10: PSN Ouuvrt Individual Draw Rods ;y ' , .4,,,r,,,.,,,, ,, .....„ ... „,„ "y,� t ;;'''g=,"' • e-,M1 a('��, ...;.,,,,,•!1 S { } ...,a 2 3 4 6}� {kR,;AbF With reinforced lugs for ` % � s w, , strain-free assembly t. `� + x�'"" Y * � , �'� x *, x., Optional SBC �v '% , , ` ° ''S; ' 'y Boiler Control r , Wet Base --- - } Cast Iron Nipples 147 ...,,,,, 4BurnerManufacturers Side wall insulation creates Ensure the integrity of the sectmn Options to best fit your needs •; improved thermal circulation: assemblymand resist petroleum-based cheicals and flue gases Boiler : ;Water -:,•, Steam Water' Steam Model(1) Combustion Thermal Combustion Thermo!----T W Combustion Thermal Combustion Thermal Effinene Efficien Efficient Efficiency Efficiency Efficiency Efficiency Efficiency V903A 82.5% 80.0% 82.5% 80.0% - ' - - - V904A $2,5% 80.1°l0 82.5% 80.1% 86.0% 82.1% 86,0% 82.1% V905A 82.4% 80.14`0 8822:45o/9,06 2.4% 80.1% 85.5% 82.4% 85.5% 82.4% V906A 82,4% 30.1°lo 82.4% 80.1% 85.2% 82.5% 85.2% 82.5% V907A 82.3% 80,1% 82.3% 80.1% 85.1% 82.6% 85.1% 82,6°l0 V908A 82.3% 80.2% 82.3% 80.2% I 84,9% 82.6% 84.9% 82.6% V909A 82.6% 80.2% 82.6% 80.2% 84.8% 82.7% 84.8% 82.7% V910A 82.2% 80.2% 82.2% 80.2% 84.8% 82.7% 84.8% 82.7% V911A 82.1% 80.3% 82.1% 80.3% 84.7% 82.7% 84.7% 82.7% V912A 82.1% i 80.3% 82.1% 80.3% 84.7% 82.7% 84.7% 82.7% , " ),^ ow ba ERTi- � °Y V9A4� erles RATINGS & EQUIPMENT LISTING . ..,,,,,:.,:A,.; `.& a F '% .4 •vi- rgt'"r t` ••,,.,.1„, y��'t.D.ritt°•:4'''t", nil '-'4' .:a 'u -s'"�*.v '; - 41 Av --..0::‘, . , ` . a._.. .. ... . ;>,._,...... r lJ' �"o- ., .•.tiw :e y,.�s,.w....w. P s. Boiler Boiler Gross Output Steam Water "Oil. Gas r` Net Firebox , 'Pressure in Firebox I-B-R ` kt, %,-:; 4,Model(1) H.P. MBH(2) MBH Sq.Ft. MBH (GPH)(4) (MBH) Volume(Cu.Ft.) (In.Wtr.Column) Dia.(In.) .. V903A 10.3 347 260 1,083 302 N/A 447 3.2 0.33 7 - V904A 14.4 483 362 1,508 420 4.2 606 4.8 . 0.38 7 , . V905A 19.3 646 485 2,021 562 5.6 808 6.4 0.31 8 V906A 24.1 808 606 2,525, 703 7.0 1,010 7.9 0.38 8 V907A 28.6 959 719 2,996 834 8.3 1,198 9.5 0.36 8wl'i7iiiii194 V908A 33.2 1,110 833 3,471 965 9,6 1,386 11.0 0.35 10 - V909A 40.1 1,342 1,014 4,225 1,167 11.6 1,674 12.6 0.35 10 ," , V910A 45.6 1,528 1,168 4,867 1,329 13,2 1,905 14.2 0.40 10 .. . 1 "" V911A 51.2 1,714 1,323 5,513 1,490 14.8 2,136 15.7 0.45 12 . V912A 56.8 1,900 1,474 6,142 1,652 16.4 2,367 17.3 0.49 12T17. 445. iC 1.Suffix"S"indicates steam boder,"W"indicates water boiler Suffix"G"ifidicates gas-fired,"0"indicates oil fired and"G0'Indicates combination gas/oil fired. . , i 2.Boiler ratings are based on 12.5%CO2 on oil;9.7%CO2 on gas,and.10 in water column pressure at boiler flue outlet a , , ,r 3.IAB=R net ratings shown are based on piping and pick up allowances which vary from 1333 to 1289 for steam and 1.15 for water. Consult manufacturer for installations having unusual piping and pick up requirements,such as intermittent system operation,extensive piping systems,etc. 4.The 1=B=R burner capacity in GPH is based on oil having a heat value of 140,000 BTU per gallon. ' T ,'.6, -04. Ratings shown above apply to altitudes up to 1000 feet on oil and 2000 feet on gas.For altitudes above those indicated,the ratings should be reduced at the rate of 4%for each 1000 feet above sea level. ' • Note-Maximum allowable working pressure(MAWP): Steam: 15 PSI "` Water-USA. 80 PSI(standard relief valve provided is SO PSI)(30 P51 and 80 PSI relief valve optional) ., Water-Canada: 45 PSI(standard relief valve provided is 45 PSI)(30 PS_I relief valve optional) , M ma Standard Equipmentto kil. ALL BOILERS: Sections unassembled,flush insulated jacket,burner mounting plate,burner adapter plate,rear flue outlet damper(top outlet optional),flue canopy, , = 0- rear observation port cover,target wall(V903A),add miscellaneous plugs,bushing and fittings,L4006B(low fire hold aquastat) -li STEAM TRIM: 15 PSI safety valve,L404F pressuretrol,gauge glass assembly,steam gauge. WATER TRIM: 50 PSI safety relief valve,L4006A high limit,pressure/temperature gauge. OIL BOILERS: Flange mounted flame retention oil burner furnished with two(2)stage fuel unit,ilnmary control and dual oil valves 4440,4;71$1 k . GAS BOILERS: Flange mounted gas burner with standard controls meeting the latest UL requirements,dual gas valves,gas-electric ignition with proven gas pilot,flame rola .• '' on JR burner,ultra violet flame detector on others,electronic programming controls and components are factory wired in a burner mounted control panel .1705t40.4'•` GAS/OIL BURNERS: Flange mounted combination gas/oil burner with standard controls meeting latest UL requirements,manually operated fuel transfer switch for dual fuel z changeover,dual gas valves arid oil valves,electric ignition with proven gas pilot on both fuels(direct spark ignition of oil is optional),ultra-violet flame 014-..'1,1'""- . detector,electronic programming controls and components are factory wired in a burner mounted control panel `` � �r PLEASE CONSULT BURNHAM COMMERCIAL WEBSITE FOR BOILER DIMENSIONAL DATA,PIPING CONFIGURATIONS AND BURNER MODELS/SPECIFICATIONS. "'`,y, 7'...,* v�; a T °is^ t 441 Optional Energy Management interface Optional Equipment , SBC Control - ��, Assembled sections;completely packaged(includes manual Maximizes system efficiency while providing peer-to-peer network, - reset high limit and manual reset low water cutoff);packaged burner modulation,boiler monitoring and diagnostic displays,outdoor air and fire-tested;top outlet flue damper;tankless heaters;side t' .y reset,warm weather shutdown and domestic hot water priority features. inspection tappings with brass plugs;30 PSI and 80 PSI safety - Universal Gateway relief valves(water);combustion and hydronic controls to meet rit,,,,,.41".i-t. t. 44'1' ' • Can be connected to a building's Energy Management System special applications Including F.M.,I.R.I.,and ASME CSD-1. (EMS)using simple menu selections and wring a 4-20mA input. • Connects to EMS using mtidbus protocol • Optional EMS Gateway to BacNet or LonWorks •Allows EMS controls to adjust either the SBC central heating ',404411, 4,r setpoint or the firing rate.' x * 44„,,,), ©2013 Burnham Commercial • P.0, Box 3939, Lancaster, PA 17604 , 4 .43 +1 Phone:888.791.3790 • www.burnhamcommercial.com 1 . 4A Fo-n No PL81401291000-4/11-2 SM; Printed in the U.S A kwr6 . '''11';'::: : f €'§i