HomeMy WebLinkAbout46535-Z �e�OSUFF�t'�coGy Town of Southold 11/13/2021
P.O.Box 1179
o _ -R1 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 42529 Date: 11/13/2021
THIS CERTIFIES that the building ALTERATION
Location of Property: 1240 Glenn Rd., Southold
SCTM#: 473889 Sec/Block/Lot: 78.-2-30
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
6/25/2021 pursuant to which Building Permit No. 46535 dated 7/6/2021
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:
"as built"first and second floor central air conditioning units as applied for.
The certificate is issued to Bloom,John&Lorena
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 46535 7/20/2021
PLUMBERS CERTIFICATION DATED d
A o 'zed i nature
S�fFo 1 � TOWN OF SOUTHOLD
000 , BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
o . SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 46535 Date: 7/6/2021
Permission is hereby granted to:
Bloom, John
1240 Glenn Rd
Southold, NY 11971
To: legalize "as built" HVAC units as applied for.
At premises located at:
1240 Glenn Rd., Southold
SCTM #473889
Sec/Block/Lot# 78.-2-30
Pursuant to application dated 6/25/2021 and approved by the Building Inspector.
To expire on 1/5/2023.
Fees:
AS BUILT-SINGLE FAMILY ADDITION/ALTERATION $400.00
CO-RESIDENTIAL $50.00
Total: $450.00
Buil ing nspector
so
Town Hall Annex ® Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 a sean.deviin(cb-town.southold.ny.us
Southold,NY 11971-0959
Own
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To- John Bloom
Address: 1240 Glenn Rd Tow Southold st: NY zip: 11971
Budding Permit#: 46535 section. 78 Block. 2 Lot: 30
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: AS BUILT License No:
SITE DETAILS
Office Use Only
Residential X Indoor X Basement Service
Commerical Outdoor X 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt 1 Ceding Fixtures Bath Exhaust Fan
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel A/C Condenser 1 Single Recpt Recessed Fixtures CO2 Detectors
Sub Panel A/C Blower Range Recpt Ceding Fan Combo Smoke/CO
Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches 4'LED Exit Fixtures 11 Pump
Other Equipment.
Notes, " AS BUILT NO VISUAL DEFECTS " Air Conditioner
Inspector Signature: Date: July 20, 2021
S.Devlin-Cert Electrical Compliance Form
# # TOWN OF SOUTHOLD BUILDING DEPT.
�conm '� 765-1802
INSPECTION
[ ] FOUNDATION IST [ ] 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:
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ley, �`-7�
DATE INSPECTOR ` � `
�o���F SO(/lyo6
# TOWN OF SOUTHOLD BUILDING" DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PL13G.
.] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING/STRAPPING [I/(FINAL;J-5 13(,1 Gr'' 44�
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ °] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:
DATEzI- INSPECTOR
FIELD 1NSEECrION REP-ORT DATE
CU PtT3
FOUNmDATION(IST)
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TOWN OF SOUTHOLD—BUILDING DEPARTMENT
y, Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone(631) 765-1802 Fax(631) 765-9502 https://www.southoldtowm.,Aov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only JUN 2 5 2021
PERMIT N0. Building Inspector:
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Name: l oe—e �IT'�1J SCTM #1000-
Project Address:
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❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other - $
Will the lot be re-graded? ❑Yes El No, Will excess fill be removed from premises? (]Yes ONO
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Zone or use district in which premises is situated: Are there any covenants pd restrictions with respect to
this property? Dyes)6o IF YES, PROVIDE A COPY.
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Application Submittety t name): ElAuthorized Agent DOwner
Signature of Applican Date:
STATE OF NEW YORK)
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COUNTY ORS
JP
D being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the
(Contractor, Agent, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make'and file this
application;that all statements contained in this application are true to the best of his/her knowledge and belief; and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
day of.cj �..�� 20�
Noll Public
1111.1111Imm NT E P"I Dawn Johnson
Notary Public,State of New York
NOTAR�
PROPERtY OWNER AUTH0R1ZAT10N!-'. ' --- !*--ENoOIJ06349053
MBLIC Z�
4, :j Qualified in Suffolk County
(Where the applicant is not the owner) ZWun
"';........ commission Expires 10111120:1'1
residing at
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name
2
tJ1FpC; . . L NG DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
ToHall Annex - 54375 Main Road - PO Box 1179
Southold,Tel n (631765-1 02 k 959
FAX 6365-9502
roct�ocaitho'ldtownny.gov — seand(-southoldtownny.gov
APPLICATION O.OR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date:
Company Name:
Name: *1-- kv I (-, = '
License No.: Q email:
Phone No: 01 request an email copy of Certificate of Compliance
Address.:
JOB SITE INFORMATION (All Information Required)
Name: u (l ct- LZJJ:�rbCVM
Address: 12-go en
Cross Street: Mai �p
Phone No.:
Bldg.Permit#: email:7J000.931 M , eye
Tax Map District: 1000 Section: (���,( Block: 02,00 Lot: ��--
BRIEF DESCRIPTION OF WO, K (Please Print Clearl
Check All That Apply:
Is job ready for inspection?: U40S ❑NO ❑Rough In ❑Final
Do you need a Temp Certificate?: ❑YES ❑NO Issued On
Temp Information: (All information required)
Service Size ❑1 Ph ❑3 Ph i Size: A # Meters Old Meter#
❑New Service ❑ Service Reconnect ❑ Underground ❑Overhead
# Underground Laterals ❑1 ❑2 ❑H Frame ❑Pole Work done on Service? ❑Y ❑N
Additional Information:
PAYMENT DUE WITH APPLICATION
0
Electrical Inspection Form 2020.xlsx
,
poa4
AP 'ROVED AS NOT D
DATE. B.P.
P #
FEE: Py:
NOTIFY BUILDING _aARTMENT AT
765-1802 8 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - ,FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONSTP,+(-4 '-)N MUST
BE COMPLETE ;:DF 0,
ALL CONSTRUCTICn SmALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
COMPLY WITH ALL CODES OF
NEW YORK STATE & TOWN CODES
AS REQUIRED AND CONDITIONS OF
au Ian ZW ZBA
�C^I
HOLD TmOW. 4nM BOARD
SMEOL-B49*14UTEES
AI V c ncn
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
ELECTRICAL
INSPECTION REQUIRED
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N MODEL NUJ. AMB— 2JA o' 0 a
a 4 SERIAL N . 6265 M2500 0849 DUTDC� RUSE
VOLTS 208-230 PH ►SE 1 HERTZ 60
S� COMPRESSOR R.L.A. . / i . a L.R.A.
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OUTDOOR F OTO F.L. Q. 2 . U H ATTS .
.. MIN. SUPPLY CIRCUIT P CITE' 2 2 SMR
t a /40 AMP
MAX. FUSE OR CI'T. BRK. SIZE
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MIN. FUSE OR CKT. BRK. SIZE 30 /30 AM R
DESIGN PRESSURE HIGH 3 0 ® PSIG
DESIGN PRESSURE LOW, a PSIG
OUTDOOR UNITS FACTORY CHARGE 96 04. R22
TOTAL SYSTEM CHARG22 E P
SEE INSTRUCTIONS INSIDE ACCESS PANEII
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SERIAL NO./ No DE SERIE W311915852 OUTDOOR USE:/
UTILISATION EN EX1RIEURE
COMPRESSOR COME / CODES DE COMPRESSEUR 4044
VOLTS 20,9/230 PHASE. 1 HERTZ 60
COMPRESSOR/ COMPRLSSEUR R.L.A. 12.8/12.8 L.R.A. 64
OUTDOOR FEIN MOW/ F.E.A. 1.3 H.P. 1/4
MOTEUR VENTIL. EXT.
MIN. SUPPLY CIRCUITAMPACITY/ 18/18 A
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COURANT ADMISSABLE D'ALIM. MIN.
MAX. FUSE OR CKT. BKR. SIZE*/ 30130 A
CAL. MAX. DE FUSIBLE/DISJ* - w
MIN. FUSE OR CKT. BRK. SIZE*/
25125 A ="=
CAL. MIN. DE _FUSIBLE/DISJ* -
DESIGN PRESSURE NIGH/
PRESSION NOMINALE HAUTE 450 PSIG/3102 kPa =
} DESIGN PRESSURE LOW/
250 PSIGf1723 kPa
PRESSION NOMINALE BASSE
OUTDOOR UNITS FACTORY CHARGE/ R410A
/20418
C}TARGE USINE D'UNT.- cS EXTERIEUR 72 az R410A
TOTAL SYSTEM CHARGE/
uiv tGE TOTALE DU SYSTEME
SEE INSIIYOCIIONS INSIDE ACCESS PANEL 7
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