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HomeMy WebLinkAbout28719-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMEN~f Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28839 Date: 09/04/02 1~{IS c~TIFIES that the building CENTRAL AIR CONDITIONING Location of Property: 130 GROVE DR SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 80 Block 4 Lot 17.2 Su]~division Filed Map No. __ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 4, 2002 pursuant to which Building Permit No. 28719-Z dated SEPTEMBER 4, 2002 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 CENTRAL AIR CONDITIONING INSTALLED IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. "AS BUILT" The certificate is issued to JOSEPHINE VRBINAR (OWNER) of the aforesaid building. SI/FFOLK CO~DEPARI~ENTOFI{F~%LI~Ii~PPROVkL ELEt-i~ICA5 CERTIFICAI~ NO. PLUMBERS CERTIFICATION DAT~43 Rev. 1/81 N/A PENDING 08/03/02 N/A FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 28719 Z Date SEPTEMBER 4, 2002 Permission is hereby granted to: for : JOSEPHINE VRBINAR 130 GROVE DRIVE SOUTHOLD,NY 11971 INSTALLATION OF A CENTRAL AIR CONDITIONING SYSTEM TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. "AS BUILT" at premises located at 130 County Tax Map No. 473889 Section 080 pursuant to application dated SEPTEMBER Building Inspector to expire on MARCH GROVE DR SOUTHOLD Block 0004 Lot No. 017.002 4, 2002 and approved by the 4, 2004. Fee $ 300.00 ed Sigr~ture ORIGINAL Rev. 5/8/O2 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: Ao 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 $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy- $25.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction: IX Old or Pre-existing Building: Location of Property: 130 Grove Drive Date. September 5, 2002 (check one) Southold House No. Owner or Owners of Property: Suffolk County Tax Map No 1000, Section 80 Subdivision Permit No. 28719 Date of Permit. Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Street Hamlet Josephine Yrbinar Block 4 Lot I ?. 2 Filed Map. Lot: Applicant: Fee Submitted: $ 25 .O0 Underwriters Approval: Final Certificate: xx (check one) Kolb Mechanical Corp. H~ting and ~Jr Conditioning 11500 Sound Avenue P.O. Box 106 Mattituck, NY 11952 631 298 5527 631 298 5534 Fax August 30, 2002 George Camilleri Josephine Vrbinar 130 Grove Drive Southold, N.Y. 11971 To Whom It May Concern, This is to verify that in 1996 an add on air conditioning system was installed at the above stated residence. The installation included an evaporator coil and condensing unit. This equipment was installed under local and state regulations. System is operating to specifications. Feel free to contact the office at 631-298-5527 should you need further assistance. Sincerely, A. James de Bruin, P.E. & L.S. 200 Grove Drive Southold, New York 11971 Telephone:631-765-3907 Fax Number:631-765-5623 Email:Jdebruin@optonline.net Date: Sep. 3, 2002 To: Southold Town Building Department Re: C.O. for Vrbinar/Camilleri 130 Grove Drive It has come to my attention that your Department wants a licensed professional to attest to the serviceability of the Air Conditioning System at the referenced residence. I neither designed, nor supervised installation of that system, which work occurred some half-dozen years ago. To my recollection, the system was designed and installed by Kolb Mechanical of Mattituck, but I could be wrong. They are a fine firm whose work I respect. I am the next-door neighbor to the cited residence, and have thus seen the system operate for a long, long time. In my opinion, as an Engineer, a neighbor and a citizen of this Town, the subject NC system functions acceptably and is no hazard to human health or safety. I see no reason why it should be an impediment to a C.O. for this residence. A. Jades de Bruin, P.E. & L.S. NY State Licensed Professional Engineer and Land Surveyor # 26960 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ PERMIT NO. Examine~jV~7, ~ Approved _~~r. Disapproved a/c Expiration~~g'c~ /~' ,20 O ~ BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 3 sets of Building Plans Planning Board approval Survey_ Check Septic Form N.Y.S.D.E.C. Trustees Contact: BuildingCI~spector ~ Mail to: Phone: ~'~ I 6~ o,~) Builders License No. Plumbers License No. Electricians License No. Other Tradds License No. (Name and title of corporate officer) Location of land oi1 which proposed work will be done: House Number Street County Tax Mal~No. 1000 Sectj~on Subdivision (Name) Block q Filed Map No. 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REGUIREUENT8 OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS Hamlet Lot Lot UNDERWRITERS CERTIfiCATE REQUIRED /?,2_ thorized inspectors on premises and 000[.4l l ya pections. . ' WI (S na~e ofapplic~t or ~e, m0ux c[a [ ca OF OCCUPANCY (Mail'~ State whether applicant is owner, lessee, agent, architect, engineer,general contra~,~pBy:um~_____, ~c~.~oan,1 n~r ~ (~ ~.~ NOTIFY BUILDING D ?R~.IAA~ · Au TO 4 p_u. FO.". l~-~ FOLLOWING INSPECTIONS: (As on the tax roll or latest deec['~°8 g--ROUGH - FRAMING & PLUMBING If applicant is a corporation, signature of duly authorized officer $. INSULATION if a corporation) c,~;!~ - ~ ' '~}-' iAPPLICATION FOR BUILDING PERMIT ~..~ ........ INSTRUCTIONS a: This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance ora 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 rggulations, and to admit 2. State existing use and occupancy of premises and inten, cked us, e. and occ, upanc~( ,of proposed construction: a. Existing use and occupancy _~r,4 .'--~cv~, UH (;l~9~J~,]~.~ J b. Intended use and occupancy ~ fl~z'J/~-~ 3. Nature of work (check which applicable): New Building Addition Repair Removal Demolition Other Work 4. Estimated Cost ~ q IDC'LD . © cD Fee 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars If business, commercial or mixed occupancy, specify nature and extent of each type of use. o Dimensions of existing structures, if any: Front Height Number of Stories Alteration (Description) (To be paid on filing this application) Rear Depth Dimensions of same structure with alterations or additions: Front Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth Rear 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO 13. Will lot be re-graded? YES__ NO Will excess fill be removed from premises? YES NO 14. Names of Owner of premises Name of Architect Name of Contractor Address Phone No. Address Phone No Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO __ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. P ~F:~.I,T~ ~ ~l~i t~UIRED. b. Is this property within 300 feet of a tidal wetland? *YI~S * IF YES, D.E.C. PERMITS MAY BE REQUIRED.i? 1 6. Provide survey, to scale, with accurate foundation plan afiil-zlis~tart~s't° prope~y lines. 17. If ek{~i~Sii it'&}gomt ~ property is at 10 feet or bel[w, must pro~e~opo~apincfil data on su~ey. S~E OF ~W YO~) z,i~t~, L '. C~[ ~ [/ being duly sworn, d~oses ~d says that (s)he is the applicant ~me of ~dual sing comract) above named, (gSHe is the ? ' '.~" ' "' (Contractor, Agent, Corporate Officer, etc.) of~m~l owner 01' owrlers, and ~s duiy ~onzed to perform or have performed the said work and to make and file this application; that fill statemehts cbntained in this application are tree to the best of his knowledge and belief; and that the work will be perfo .nned in' the manner set forth in the:application filed therewith. rnto bef.,o,r.e ze this, * Notar~ Public UNDA J. COOPER Notary Public, State of New Yolk No. 4822563, Suffolk Ceum'v . Term D. xpire~ December $,!, ,~4 Signature of Applicant BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET ~ NEWYORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by GEORGE CAMILLERI GEORGE CAMILLERI & JOSEPHINE VR 1068 WOODFERN TRAIL 130 GROVE DR-RAYDON SHORE HIXSON,TN 37343 SOUTHOLD, NY 11971 Located at 130 GROVE DR-RAYDON SHORE SOUTHOLD, NY 11971 Application Number: 1072931 Certificate Number: 1072931 Section: H Block: Lot: 20,21+1/ Building Permit: BDC: NS11 Described as a Residential occupancy, wherein the premises electrical system consisting electrical devices and wiring, described below, located in/on the premises at: Basement, Outside, was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was found to be in compliance therewith on the 30th Day of August, 2002. Name QTY Rate Rating Circuit Type Additional Charges LOT#'S-20,21& 1/2 OF 22 1-3 ton air conditioner with 60 amp disconn Appliances and Accessories Air Conditioner 1 0 36,000 BTU Wiring and Devices Disconnect I 0 60 amp Appliance seal 1 of 1 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.