HomeMy WebLinkAbout41196-Z Town of Southold 6/27/2017
P.O.Box 1179
o • 53095 Main Rd
4,10�. Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 39031 Date: 6/27/2017
THIS CERTIFIES that the building ALTERATION
Location of Property: 965 Champlin PI, Greenport
SCTM#: 473889 Sec/Block/Lot: 34.4-14
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
11/28/2016 pursuant to which Building Permit No. 41196 dated 11/29/2016
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:
gas heat in existing one family dwelling as applied for.
The certificate is issued to Willumstad,Laura
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED 6/20/2017 eal Ross
h ed Signature
TOWN OF SOUTHOLD
�gocot��o� BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 41196 Date: 11/29/2016
Permission is hereby granted to:
Willumstad, Laura
40 Reed Ave
Floral Park, NY 11001
To: make an oil to gas heat conversion
At premises located at:
965 Champlin PI, Greenport
SCTM # 473889
Sec/Block/Lot# 34.-4-14
Pursuant to application dated 11/28/2016 and approved by the Building Inspector.
To expire on 5/31/2018.
Fees:
CO -ALTERATION TO DWELLING $50.00
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00
tal: $250.00
B ilding Inspector
�I
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
i�
APPLICATION FOR CERTIFICATE OF OCC PANCY
This application must be filled in by typewriter or ink and submitted to the Buildilg 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 buildini.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957)non-conforming uses, orb,,4ldings and"pre-existing"land uses:
1. Accurate survey of property showing all property lines, streets,building�nd 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$50.00,Additions to dwelling$ 0.00,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- $100.00 i
3. Copy of Certificate of Occupancy-$.25 ty
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00
Date.
New Construction: Old o re-existin uilding: x,� (check one)
Location of Property: ,] eyL A-w—, 6rf@'y1w+, &b knuw,� j() a r
House No. Street Hamlet
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section Block Lot /q
Subdivision /- Filed Map. Lot:
Permit No. 4 lr( `q 10 Date of Permit. Applicant: DSS— SSS
Health Dept. Approval: Underwriters Approval��
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $ 50. 0 p
Applicant Signature
,
son"�T
Town Hall Annex ' ' �M Telephone(631)765-1802
54375 Main Road s -1 . Fax(631)765-9502
P.O.Box 1179 Y b'
Southold,NY 11971-0959
BUILDING DEPARTMENT I
TOWN OF SOUT'HOLD
CERTIFICATION I
s
Date:___- 4�d 7-
Building Permit No. Ll I t `f
Owner: La oroWt'<<U�(Y15 C�
(Please print)
Plumber: ca-33
(Please print) `
h
I certify that the solder used in the water supply systen)contains Iess than 2/10 of I%
lead. ph// �G� N Ef�v SS riVSria-`��� i � d1� c�:�S CQnld��sian�
i
i .
(Plumbers Signature)
Sworn to before me this o2
day of �( e- , 20 C7
VJOL km2
D
CCC�CO��
Notary Public, Su � Goutity DD
JUN 2 7 2017
VITA ROSS
NOTARY PUBLIC,STATE OF NEWYORK
#4883559-QUALIFIED IN SUFFOLK CT� BUILDING DM.
TERM EXPRES FEBRUARY 9,28J. 1 TOWN O SOUTHOLD
SOUTyo!
� o
cou
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLEIG.
[ ] FOUNDATION 2ND [ ] I ULATION
[ ] FRAMING / STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
nh
DATE ,O' 7� INSPECTOR
l
FIELD INSPECTION REPORT DATE COMMENTS
FOUNDATION(IST)
------------------------=-----------
G
,C
FOUNDATION(2ND)
� 0
ROUGH FRAMING& y
PLUMBING
INSULATION PER N.Y.
STATE ENERGY CODE
tR
FINAL
ADDITIONAL COMMENTS
O
z
Z
m
�z
d
b
H
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying9
TOWN HALL Board of Health
SOUTHOLD,NY 11971 4�is of Building Plans
TEL:(631)765-1802, Planning Board approval
FAX:(631)765-9502 ` y Survey
SoutholdTown.NorthFork.net PERMIT NO. _4 I l „� Chgck
Septic Form
N.Y.S.D.E C.
Trustees
C O Application
Flood Permit
Examined 20 Single&Separate
Storm-Water Assessment Form
Contact: I III
Approved 20 Mlail to:
i
Disapproved a/c
P16ne
Expiration ,20 T � � I
D ��EVE Building Inspector
APPLICATION FOR BUILDING PERMIT Ii14
Nov 2 8 2016 Date + ,20
INSTRUCTIONS
13UMDING D -chis application MUST be completely filled in by typewriter'or in ink and submitted to the Building Inspector with 4
TOVM Oji'S® curate plot plan to scale.Fee according to schedule. I'
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,tl�e 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 or,a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold,Suffolk County,New York,and other aRI�plicable Laws,Ordinances or
Regulations,for the construction of buildings,additions,or alterations or for removal or dei>'olition as herein described.The
applicant agrees to comply with all applicable laws,ordinances,building code,housing d I1 and regulations,and to it
authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant or name,if a corporation)
i
i
(M ling address o applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
KOSS , ane
Name of owner of premises m uxy)a l aoL I�
(As on the tax roll or latest deed
If ap it ant is a corporation,signature of duly authorized offic r
j2DSS— pne9CIe n+OL) o i
(Name and title of corporate officer)
Builders License No.
Plumbers License No. ►a�S�1nP
Electricians License No.
Other Trade's License No.
1l5 Gaul �S5 l� vaso VVl6LUY1
1. Location of land on w`ich proposed work�will�be�ne:poi
S-�
House Number treet Hamlet
I
CountyTax Map No. 1000 Section Block Lot
I
iY.
Subdivision Filed Map No. Lot
I
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy pleSsf CP,�lil
b. Intended use and occupancy -i-nQ�s agmtrs,D'1
3. Nature of work(check which applicable):New Building AddihonAlteration
Repair Removal Demolition Other Work i I Old - 660, ,
escription) �0
4. Estimated Cost J t ,y RD_00 Fee 49 as�D
(To be p id on filing this application)
5. If dwelling,number of dwelling units Number of dwelling units oq each floor
If garage, number of cars
6. If business,commercial or mixed occupancy,specify nature and extent of each ty�a of use.
7. Dimensions of existing structures,if any:Front Rear i Depth 413CHeight Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
I� A�
8. Dimensions of entire new construction:Front Rear Depth 'l
Height Number of Stories
9. Size of lot:Front Rear Depth 4A
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?YE51L__NO_J!<
13.Will lot be re-graded?YES NO (/Will excess fill be removed from premilses?YES NO
LOAj-*-a- ggS l
14.Names of Owner of premises WJ llu.MS+* Address e� ., Phone No. r�(P'16-T7— 10 a I
Name of Architect Address --LPhone No
Name of C r_be.. IdoSS Address 100 f11;M12 Phone No. oa
?IUT&cf ad ®.rVliddl��flt,;v�LL 953
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. III
16.Provide survey,to scale,with accurate foundation plan and distances to property lines. NIA
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 NO N JA
*IF YES,PROVIDE A COPY.
STATE OF NEW YORK)
COUNTY OF Sutf
9z's being duly swom,deposes and says that(s)he is the applicant
(Name of individual signing
�contract)above
'named,
(S)He is the 1 aJ,lc� `+/ °�Il�u�' 1
(Contractor,Agent,Corporate Officer,etc.) I I
of said owner or owners,and is duly authorized to perform or have performed the said wort I�nd to make and file this application;
that all statements contained in this application are true to the best of his knowledge and be� f;and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn to before me this I— /
day of NO IrElhl Ler- 20 110 VITA ROSS -
i NOTARY PUBLIC,STATS CF _ O,
Notary Public 355T-QUALIFIED IN SUrFULK Signature qfApplicatit
TERIA EXPIRES FEBRUARY 9,20
SO(/T�ol
0
Town Hall Annex Telephone(631)765-1802
54375 Main Road y � Fax(631)765-9502
P.O.Box 1179 G • Q
Southold,NY 11971-0959
COUNTY,�
June 22, 2017
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
NH Ross Inc
120 Middle Country Rd
Middle Island NY 11953
Re: Willumstad, 965 Champlin PI, Greenport
TO WHOM IT MAY CONCERN:
The Following Items(if Checked)Are Needed To Complete Your Certificate of Occupancy:
Application for Certificate of Occupancy. (Enclosed)
Electrical Underwriters Certificate.
A fee of$50.00.
final Health Department Approval.
k, /— Plumbers Solder Certificate. (All permits involving plumbing after 411/84)
Trustees Certificate of Compliance. (Town Trustees#765-1892)
Final Planning Board Approval. (Planning#765-1938)
Final Fire Inspection from Fire Marshall.
Final Landmark Preservation approval.
Final inspection by Building Dept.
Final Storm Water Runoff Approval from Town Engineer
BUILDING PERMIT – 41196 –Oil to Gas Conversion
T01IA! OF - �:
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— y- SOUTHOLD PiOPERTY RECORD CARD
OWNER STREET SUB. LOT
o ii VILLAGE DIST,
a M .. of
F
msin e,,7ka-
-PWNE E ACR.
SS
,v TYPE OF BUILDING
.�G�-r. .cam•ru.�
RES. f� SEAS. VL. FARM COMM, C MICS. Mitt. Value
Co LAND IMP, TOTAL DATE REMARKS-�d
toto
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m AGE BUILDING CONDITION,,,
L
LD NEW NORMAL BELOW ABOVE
t FARM C. Acre Value Per Value
o Ac re
L 0
"Illab�e 94 FROIJTAGE ON WATER f� � ` � o � _�•3
N doodiand o FRONTAGE ON ROAD �^
Seadawland3 � O •n l/•Z
o m a o DEPTH `
N
N I&M W'St 0 BULKHEAD
Loj.otal �
DOCK
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Gas Conversion Specialist L Ujro_ (,tJi I UAT)Eta
Drain Cleaning Home Generators vs-
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Visit our Website for
7'
Money Saving Coupons
1 -866-980-2566
1-f66-980-2566
www.NHRoss.com W
'Cannot be combined with any other offer
Licensed and Insured
www boschheatingandcoohng.com 11
Technical Specifications
�': — +1•..."J.° ;.'.�,F M• ..! -----. (,L .4 ��s.:TYi.i� ,. .��'.'.'.' a.�"�e •�,, s,�.1*w � '4E:"�•Y•,`;�',d E. r.
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ar,::'a��:- r�$:' ^w .�;�',,:'�,L�.t�4 �isr -. c r a •® n``x"lt. '-'� a: - _.£ ._.��
keln, On.
,'+":f`�• .G� •":�"'"�` .i�' 'i tp�'�'� w.Jr,',:`..'.-`r �S` �':4^n't_� �t ,�a `.��p.'a'.. fib.: �A� 'y'-'t_�. "rv•�^-+; ,..,a.r,+' ���'"'�$.�:
'[§f;••u: `f'-'.,� +i:.X.� ..:$ .4-.: yi .+F?� ta+.•t,-i9"fi y3.v: .t�. -f!r•N."zE
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i 1'#.K4,:e.y' `�"! a.`bt`.'.4 Y `�4' _C,t,.�'y" "ri F' • _
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�':a;t°�-. ,•.” _>^s` ..C.,:. 'K,.a .Y�a',�..�,'moi„a<a ~- :ra '�.'ss�;' °'w=". ::J'w" •`��`: .F:",
a• r°• ®•
C3'• y',i- t�'.- Y.:'r .k,.-!'i'- `,�'.K: £pY N.p�'.'F.. 5 � R•i'
Fuel NG/'LP, NG/LP
Input Nlaximurn(MBH)... (._100,8.� I,i31:9 _ S P151.6. Y9 i•57.2 — T9.2 ii 100.8 I"131:9_ i5i,6` w
Input Minimum(MBH) 24.6 36.0: 36.0 12.9 24.6 24.6 36.0 36.0
T52218"
!E 7 9 _.135F .._
'DOE:Heattng Capacity{MBH): 91 �''1'18 { 135, T
Net 1=B=R{MBH) 79 103'- = 117 45 62 79 103 117
m ' 9yrv'w� -954FU6' ;"" t95I ''95l95°l95% — • 95°l0'
IL
'DHW Flow Max(4T,at 72°F),GPM 2.65 3:2 4.0 not applicable
t.
wat6f Volurrie,'GaI(L) i€ 0.952:(3:5} " : 0.952(3:5)
.,..y.x„^,�.s4 .'p..s.:; �;Y�:v -t`•-,�'„�.W•;'t. �. �''�� "i`s�_',. 'V:.`J it,.y �_......h .-'�.4+_. ...... ._..-^^. <a
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3�i-v.Y. a £. <i�'; "akx„. t' .>"a.�•.'..d� ,z� .�""`.<yr'.::"-Y'=t
Wall Model
►.Weight,Ibs.(without,Packaging,kg 110.2(50) 103.6(47)
►Dimensions,in:(W x H x D) 1721;x 33'Irx 133/m 1716 x 33V/2 x 13e/m
)`Oloor Model' {,
i Weignt>Itis{withritit,P cicaging;Ag) X132(60),
Damen§ions,iii.(Wx H x D}; ' ) 19%x 41x21% i 19 h.x 41 x 21718
Optional•Base Dimensions -Stand dimensions:1331,"deep,by 171A"wide'by 20%"high.Total height of stand and bolter:54'A"
Wall Boiler Supply.&Return Tappings,in.!!
t
Floor Boiler Supply&Return Tappings,in.
__.—.. .._. _..._ ._, .. _.,.-
Domestic Cold Water Supply,in. �i 3fd I not applicable
Domestic Hot Water Supply,In. % not applicable
p Gas-Connection,5ize,in.
Vent Size,in. ?-3 2-3
�.Vint Material` PVG J CPVC J PP J-PP-Flex/,SS PVC/,CPVC/PP[PP-Flex/SS.
•
A., .:,v...:._...._.._..:.. is .._.e._—.__._ .s.. ...e- ...._. ..a.�_... z ....». ».. .. .. ............._.__._...._._._-,......._.
Combustion Air Size,in. 2-3 2-3
High Altitude.dapability ii No De-Rating;;No De-Rating;. De-Rating :No'De-RatinglNo De-Rating',No De-Rating'No De-Rating:i De-Rating tip,
up to 6,0.00'k up to 6,660':; 3%per 1;000' i up to 6,000'r up to 6,0001 up to 6,000"i up'to 6,OO6 3%per 1,OOA"
Permissible Inlet Gas Pressure
►NG in W.0 3.5-10 5"
►LP(propane)in.W.C. 8-13'
Heatonly Greenstar mocels maybe usedwith indirect watertanks to provide domestic hot water
"Gireenstar 151 Pro does not include the internal expansion tankand imegratedcontrol
s Copies of original warranties in their entirety are available at www boschheatingandcoohng com —