HomeMy WebLinkAbout45506-Z f FBI
Osu °y. Town of Southold 3/28/2021
P.O.Box 1179
N 53095 Main Rd
010r,�4� �{}`� Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 41937 Date: 3/28/2021
THIS CERTIFIES that the building GENERATOR
Location of Property: 295 Maiden Ln,Mattituck
SCTM#: 473889 Sec/Block/Lot: 140.4-7
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
11/16/2020 pursuant to which Building Permit No. 45506 dated 11/30/2020
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:
accessory generator as applied for.
The certificate is issued to Polen,Lauren&Benjamin
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 45506 2/18/2021
PLUMBERS CERTIFICATION DATED
Authorize Signature
Su��ni TOWN OF SOUTHOLD
BUILDING DEPARTMENT
CM
TOWN CLERK'S OFFICE
oy • SOUTHOLD, NY
dal �a�7�
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#: 45506 Date: 11/30/2020
Permission is hereby granted to:
Polen, Lauren
295 Maiden Ln
Mattituck, NY 11952
To: install a generator as applied for.
At premises located at:
295 Maiden Ln
SCTM #473889
Sec/Block/Lot# 140.-1-7
Pursuant to application dated 11/16/2020 and approved by the Building Inspector.
To expire on 6/1/2022.
Fees:
ACCESSORY $100.00
CO-ACCESSO $50.00
ELECTRIC $85.00
Total: $235.00
Building Inspector
Form No.6
TOWN-OF SOU MOLD
BUIJI,DINQDEPARTMENT-
TOWN HALL
765-1802
APPLICATION FOR CERTIT'ICATE`OF OCCUPANCY
This,application-must be filled'in=by typewriter or ink and submittedoto-thc Building-Departmient withfthe 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.ofwater supply andisewerage-disposal(S=9 form).
3. Approval.of,electrical,installation-from Board-ofFire Underwriters.
4. Sworn statement from plumber.certifying that-the solder used in system contains less than 2110 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. SubmitTlanning Board Approval'of completed site plan requirements.
2. For existing,buildings(prior to April 9i 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,properlycompleted application an&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 f �s
Date. f ! 7y
New Construction: Old=or-Pie=existingBuilding: I PPA) Rc'heck one-
Locationrof Property: L/jo`
House No. Street Hamlet
Owner or-Owners of Property: e3 Pxj
Suffolk County Tax-MaphNo 1000, Section 04 0 Block l Lot �
Subdivision I Filed Map: Lot:
t�
Permit No. 15 �5 0 Date of Permit.. Applicant:
Health Dept:Approval: Underwriters Approval:
Planning Board Approval: /
Request for. TemporaryCertificate Final,"Certificate: ►/ (dhgck one)
Fee Submitted: S 50
plicant Signature
oF so���®�
Town Hall Annex ® Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 sean.devlin(cD-town.southold.ny.us
Southold,NY 11971-0959
CouM��'
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Lauren Polen
Address: 295 Maiden Ln city.Mattituck st: NY zip: 11952
Building Permit* 45506 Section: 140 Block: 1 Lot 7
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: DAK Electric License No:
SITE DETAILS
Office Use Only
Residential X Indoor X Basement Generator X
Commerical Outdoor X 1 st Floor Pool
New X Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt Ceding Fixtures Bath Exhaust Fan
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors
Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO
Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches 4'LED Exit Fixtures [] Pump
Other Equipment 20 kW Generator w/ 200A Whole House Transfer Switch
Notes: Generator
Inspector Signature: Date: February 18, 2021
S Devlin-Cert Electrical Compliance Form As
lafso yO� HQ— lis-. t Vele bi
# # TOWN OF SOUTHOLD BUILDING DEPT.-
ca 765-1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING-
[ ] FRAMING/STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS: ��
1A,A WZ&Z La
DATE , u ` .INSPECTOR . `
FIELD INSPECTION REPORT TDATE COMMENTS
b
FOUNDATION(IST) j
-------------------------------------
FOUNDATION(2ND) M
� � O
C�
"1
ROUGH FRAMING&
PLUMBING 6
S •
INSULATION PER N.Y.
STATE ENERGY CODE
i �
FINAL
a
ADDITIONAL COMMENTS
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TOWNyOF SOUTHOLD, BUILDING-PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMNT Do you have or need the following,before applying?
TOWNMALL Board of Health
SUUTHOLD;NSC 11971 4 sets of Building Plans
TEL:(631),765-1802 Planning Board approval
FAX:(9l)-765-950i 5�-�6 Survey
Southoldtowuny.gov PERIYIIT NO. Check
Septic Form
N.Y.S.DY—C.
Trustees-
C.O.Application
Flood Permit
Examined 20 Single&Separate
Truss Identification Form
6 Storm-water Assessment Form
Contacts
Approved, .20 Moat,
Disapproved a/c
Phone.��
Expinuion .20
000"'u"FAKY OR
d 1 q 1 tom' tl
�.l—J 13 �C�,- Cm.....�. ` M t,�� Buil t4 ` =s
IS UNLAWFUL
L] APPLICATION FOR BUILDING PERMH
L] NO o� p p -:. /k1k ATE- AUT E9T KATE
Date 20. ra
INSTRUCTIONS r U u` u @moi i9V U rf
f` s`.='This tippli{cation MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
of p(atis,l acctlrate.plot'ptan 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,Petmit to the applicant.Such a permit
shall lie 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 pursuantto 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.
I(_:I G.P,;F �` (Si` &-re of applicant or name,ifa corporation)
IDA
.:;y w..�._�s -- �.95 r���$dC�= l�►,, �la�=��.K�lf!���sl.Z
L?J lL� l V C' !: ,' , i!I„ NT �! (Mailing address of applicant)
MOTIF "
765-AA18 wlietihe'r applicda tis tiwner"I lei,agent,architect;engineer,general contractor;electrician,plumber or builder
FOUNDDATiON - T iVO R..C�UlRF L) \ �r ���' WI 'H �� %C i�'`S OF
F,Wu eo)�ownerQfpremises- ( QVw 14 Mr p0 .1� , r c�s r =r11P}r�;ol C-0 ES
RT
2 Dnfir';�s _ � p,pJ?it'dl=a & i'I- %6f,�3 1G (As on the tax rolllorlat=est&ed)'
'-' If ap hcaut is a corporation,signature of duly authorized officer- ASj{E-Q Ll I R F D r,lv D C C N D I T 1 O N S OF
3. INSULA I lKtii\l _
4. FINAL -(14iirie and'title`of coipdiate otlicer) SOU"H'10'1D T C`NN LSA
L$ilildi:is Z'icense Nii�' C Q.
_SUUTHULD TOWN PLANNING BOARD
ALLPJymbefsfLieri�eNo:��'F,i_I_ CL�Lt=1 I -
RE(Ele-Wciaggj..ice sejNo: �(-ZtJNEW QNK Fi,� e tL SOUTHOLD TOWN TRUSTEES
YOhl l � e'sLcense4No�� p(�R
DE,li!G NLotii� +51A UCTIOPJ ERRORS. id,Y,S,DEC
on'olantn which proposed work will be done:
285 -Maiden Lane- `Mattituck _
House Numbe:i Street Hamlet
County Tax Map No.1000 Section .Block-__J_,=Lot
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 1536A1yIC V c5�
b. Intended use and occupancy. sjh�j� U')
3. Nature of work(check which applicable):New Building Addition Alteration
Repair Removal Demolition Other Work Ge-94
4. Estimated Cost ® Fee (Description)
(To be paid on filing this application)
5. If dwelling,number of dwelling units _Number of dwelling units on each floor 1
If garage, number of cars (i
6. If business,commercial or mixed occupancy,specify-nature and extent of each type of use. f�fi Cl
7. Dimensions of existing structures,if any:Front Rear Depth
Height -Number-of Stories C5 CC.•S.r,
Dimensions of same structure with alterations:or additions: Front Rear
Depth.- .Height .Number of Stories AICA CtotaJ_ k
8. Dimensions of entire new construction:Front Depth
Height Number t Stories.
A-K�
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
13.Will lot be re-graded?YES NCQill excess 1H1 be removed from premises?YES,` NQC-�
14.Names of Owner of premises Address Phone No.
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES J .N-
(b
*IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY Q
b.Is,this property within 300 feet of a tidal wetland?*YES,' V
*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 anycovenants and restrictions with respect to this property?*YES NO
*IF YES,PROVIDE A COPY. UFC. W DO NALD
Notary Public-State of New York
STATE OF NEW YORK) No.01 MC6224291
SS: Qualified in Suffolk County
COUNTY
��O��F� RR �_"- My Commission Expires June 28,20 Z�
1�^VAN�I p0�CJ" being duly swom,deposes and says that(s)he is the applicant
(Name of inolvidtlial signing contract)above named,
(S)H6 is the Q�.q
(Contractor,Agent,Corporate Officer;etc:)
of said owner or owners,and is duly authorized to perforin 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 thi%
_day of aZG 053 20
Notary Public -Signature of Applicant
I •
�O�SVFFQ(,�-COG BUILDING DEPARTMENT- Electrical Inspector
ti
y TOWN OF SOUTHOLD
H z Town Hall Annex - 54375 Main Road - PO Box 1179
Southold, New York 19971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
rogerr(a-)-southoldtownny.gov - seand(a6outholdtownny.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: }.ZC-Zv
Company Name: P )eAl?%-�
Name: (.JIB Yn
License No.: 51 ZU email: � cd M
Address: , (3 '�.- In'l� � � A)`C r-t Z—
Phone No.:
JOB SITE INFORMATION (All Information,Required)
Name:
Address: qVJ LFA
Cross Street:
Phone No.: (.�(p 1 t t-( 7
Bldg.Permit#: qs6D6 ' email:
Tax Map District: 1000 Section: V-40 Block: I Lot:
BRIEF DESCRIPTION OF WORK (Please Print Clearl ) ,
4
Circle All That Apply:
Is job ready for inspection?: YES / NO Rough In Final
Do you need a Temp Certificate?: YES / NO Issued On l
Temp Information: (All information required)
Service Size 1 Ph 3 Ph Size: A # Meters Old Meter#
New Service= Fire Reconnect- Flood Reconnect- Service Reconnected - Underground - Overhead
# Underground Laterals 1 2 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
Request for Inspection FormAs
SURVEY OF PROPERTY N
SITUATE: HAMLET OF MATTITUCK w d E
TOWN: 5OUTHOLD
SUFFOLK COUNTY, NY / S
SURVEYED 12-21-2015
SUFFOLK COUNTY TAX# W >f.,�
1000 - 140- I -7
CERTIFIED T0:
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Laura Palen Y a, W
Benjamin Palen U � <
Old Republic Title Insurance Company I�?
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'� '�"° JOHN C. EHLER5 LAND 5URVEYOR
wmo reran /
G.EA5T MAID!5TRPET N.Y.5.UC.NO.50202
Area =24,809 Sq Ft. MVERHEAD,N.Y. 11901 369-8288 Fax 369-8287
Area m 0.57 Acres Ion Islandlandsury or.eom
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Generator Only Model 7171 7173 7176 7038 7042 7209
Generator/100 Amp Select 7172 7174 7177 - -
Circuit Switch Model
Generator/200 Amp Service Rated Load
7175 7178 7039 7043 -
Shedding Smart Switch Package Model
Generator/PWRvIew Automatic Transfer
Switch-200 Amp Model 7210
Voltage(Single Phase) 120/240
Amps @ 240V LPG4.7 54.2 66.6 83.3 91.7 100
Amps @ 240V NG 3Z15 54.2 I 66.6 75 81.3 87.5
Engine/Alternator RPM 360013600
Engine Generac G-Force
Engine Displacement 460cc 816cc 2 999cc
Fuel Consumption @ 1/2 Load- I I
NG cu.ft/hr 101 154 182 204* 164 228** 203 203
Fuel Consumption @ Full Load-
NG cu.ft/hr 127 225 245 301* 287 327- 306 306
Fuel Consumption @ 1/2 Load- 86 92
LPG cu.ft/hr(gaYhr) 36(0.97) 56(1.54) 62(1.70) 86(2.37)' (2-36) 92(2.53)- (2.53) 92(2.53)
Fuel Consumption @ Full Load- 54(1.48) 90(2.45) 109(2.99) 129.6 136(3.74) 1421 142(3.90) 142(3.90)
LPG cu,cu.ft/hr(gal/hr) (3.56r (3.90)**
Quiet-Test Mode Yes
db(A)at Exercise 57 55 57 57
db(A)at Normal Operating Load 61 65 67 67
Enclosure f Aluminum
Enclosure Color Bisque
Warranty i 5-Year Limited
Dimensions-If x W"x H"in.(mm) 48 x 25 x 29(1218 x 638 x 727)
Weight(lb) 338 385 1 420 448* 436 466" 445 455
Mobile Link Wireless Connectivity Yes
PWRvIew Home Energy Management Yes
*7038-1&7039-1 specifications
"7042-2&7043-2 specifications
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Generac Power Systems,Inc.
S45 W29290 Hwy.59,Waukesha,WI 53189 ro
www.Gonerac.com 1888-GENERAL(436-3722)
201902144 REV 07/20
G ENERAC
02020 Generac Power Systems.All rights reserved. ---- ao
Specifications are subject to change without notice.