HomeMy WebLinkAbout48166-Z �ag11ff01kcoG Town of Southold 11/16/2022
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a y� P.O.Box 1179
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N m 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 43594 Date: 11/16/2022
THIS CERTIFIES that the building HVAC
Location of Property: 500 Stephensons Rd, Orient
SCTM#: 473889 Sec/Block/Lot: 17.4-6
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
7/6/2022 pursuant to which Building Permit No. 48166 dated 8/11/2022
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"HVAC system,AC unit and boiler converted togas as applied for.
The certificate is issued to Greene,Charlotte&Lomas,Joanna
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 48166 10/26/2022
PLUMBERS CERTIFICATION DATED
ri d ignature
TOWN OF SOUTHOLD
��o�g0FF01,�� BUILDING DEPARTMENT
fCO/J 2
TOWN CLERK'S OFFICE
"may • 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#: 48166 Date: 8/11/2022
Permission is hereby granted to:
Greene , Charlotte
500 Stephensons Rd
PO BOX 566
Orient, NY 11957
To: legalize "as built" HVAC system, AC unit and boiler converted to gas as applied for.
At premises located at:
500 Stephensons Rd, Orient
SCTM #473889
Sec/Block/Lot# 17.-1-6
Pursuant to application dated 7/8/2022 and approved by the Building Inspector.
To expire on 2/10/2024.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $400.00
CO-ALTERATION TO DWELLING $50.00
Total: $450.00
Builing pector
oF so�ryolo
Town Hall Annex Telephone(631)765-1802
54375 Main Road
P.O.Box 1179 �Q sean.deviine-town.southold.nv.us
Southold,NY 11971-0959 Q�yCOU�'��
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Charlotte Greene
Address: 500 Stephensons Rd city:Orient st: NY zip: 11957
Building Permit#: 48166 Section: 17 Block: 1 Lot: 6
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 X Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel A/C Condenser 2 Single Recpt Recessed Fixtures CO2 Detectors
Sub Panel A/C Blower 2 Range Recpt Ceiling Fan Combo Smoke/CO
Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks
Disconnect 2 Switches 4'LED Exit Fixtures Pump
Other Equipment: minisplit w/ one blower &AC w/AH
Note: " AS BUILT NO VISUAL DEFECTS " HVAC
Inspector Signature: Date: October 26, 2022
S.Devlin-Cert Electrical Compliance Form
SO(/1,��6
# * TOWN'OF SOUTHOLD BUILDING DEPT.
�O • �O
�yco 631-765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] NSULATION/CAULKING
[ ] FRAMING /STRAPPING [ FINAL $Xl j? k0ljht,-
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL
REMARKS:
t�AW��
DATE LO(ti INSPECTORX)#4
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soo � 1/1"z,,T0WNOF SOUTHOLD B O ILDING DEPT.
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co 765-1802
INSPECTION' ' . . ',=
[ ] FOUNDATION 1ST [ ] 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: As, l h W �i
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DATE lei F INSPECTOR
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FIELD INSPECTION REPORT I DATE COMMENTS
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STATE ENERGY CODE
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FINAL
ADDITIONAL COMMENTS
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TOWN.OF SOUTHOLD—BUILDING DEPARTMENT
oGy= Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
� �y�• as Telephone (63:1) 765-1802 Fax(631) 765-9502 https://www.southoldtowM.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only ® E ^Illy"1 E � �'IJ]
PERMIT NO. Building Inspector: -
JUL m 6 2022
Applications.-and forms must be filled.-out in their entirety. Incomplete
applications.will.not be accepted..Where the Applicant is not the owner,an BUILDING DEPS;
.Owner's'Authorkdtion form(Page 2)shall be completed. TOWN OF SOUTHOLD
Date:
OWNER(S),OF-PROPERTY:..
Name: �G C_X0 0. S SCTM#1000- — C
Project Address: 5 0 6 S()— V--e-yl_ Cn , t J'J '-I l S
Phone#: � ' Email: �\� �` CSA K-0 ci
Mailing Address: d 6 6 ��Q - f c( S
CONTACT PERSON!
Name:
Mailing Address:
Phone#: Email:
DESIGN'PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
-CONTRACTOR INFORMATION
Name:.
Mailing Address:
Phone#: l Email: 3
DESCRIPTION OF PROPOSED;.CONSTRUCTION ��_
New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other 04S buflj' HVAC t F'1 C• $ t✓V�a V1
Will the lot be re-graded? ❑Yes I�Nlo Will excess fill be removed from premises? ❑Yes o
1-
PROPERTY INFORMATION
Existing use of property: �,����i Intended use of property: 1 ► _(
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? []Yes �No IF YES, PROVIDE A COPY.
❑ Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
/ Chapter 236 of the Town Code. 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,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(s)for necessary inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210AS of the New York State Penal Law.
Application Submitted By(print name): �o„y(j p d&4oN`�jwne
t-C ❑Authorized Agent Or
Signature of Applicant: — Date:
STATE OF NEW YORK)
SS:
COUNTY OF Su+- Q.llV-- )
o Z4dK C1rg k%Q, Leing 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 J �.�,� 20 2Z
��A�OtJIYAWAIE ODDON
Notary Public,State of New York
No.01OD6251236
PROPERTY OWNER AUTHORIZATION Qualified In Suffolk County
(Where the applicant is not the owne(Fr6mmission Expires November 14,20.!!2;?
i, 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
®�®st fal BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
COD
Southold, New York 11971-0959
Telephone (631) 765-1802 -FAX (631) 765-9502
rogerr(a.southoldtownny.gov - sea nd(bsoutholdtownny gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date:
Company Name:
Electrician's Name: o q-tv-C-an
License No.: Elec. email:
Elec. Phone No: ❑I request an email copy of Certificate of Compliance
Elec. Address.:
JOS SITE INFORMATION (All Information Required)
Name: �P - &Rz- 01 avvp_oL 00
Address: b - 5&— 2 a o_� d rl`Piv� N
Cross Street: d ;�, 13
Phone No.:
Bldg.Permit#: I �-1 10 (� email: p-
Tax Map District: 1000 Section: Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FO AGE (Ple se Print Clearly):
0 Square Footage:
Circle All That Apply:
Is job ready for inspection?: aYES ❑ NO [—]Rough In ❑ Final
Do you need a Temp Certificate?: ❑ YES ❑ NO Issued On
Temp Information: (All information required)
Service Size F11 PhF-]3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect[]Flood Reconnect❑Service Reconnect[-]Underground❑Overhead
# Underground Laterals 1 2 H Frame r Pole Work done on Service? D Y N
Additional Information:
PAYMENT DUE WITH APPLICATION _
g� 1
BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
{y Town Hall Annex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
rogerr@southoldtownny.gov -- seand(cb_southoldtownnV.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date:
Company Name: JI-e-ce_cts2
Electrician's Name: u "4- Q cv--co;n
License No.: Elec. email:
Elec. Phone No: ❑I request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name: ��r g r-- &e4--2 o o� ��ct U-)
Address: G C 5`6v c Ca
Cross Street:
Phone No.:
Bldg.Permit#: '-� 0 email: p ( c1t� G�a�(,e c-\VW. Ca-�
Tax Map District: 1000 Section: Block: Lot: `-"
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FO,( AGE (Ple se Print Clearly):
r 1-,o 0..Tf �ve_ ®`S S
lQ U c �' _c h l `( t--n , -, t.0.l-v-r`c , -(
l�U(� Square Footage:
Circle All That Apply:
Is job ready for inspection?: 2r YES ❑ NO F—]Rough In ❑ Final
Do you need a Temp Certificate?: F-1 YES ❑ NO Issued On
Temp Information: (All information required)
Service Size❑1 Ph❑3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect[—]Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals EL1 2 H Frame11 Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION �
0
PERMIT # Address:
Switches r
Outlets I
G F I's
Surface
Sconces
H H's
UC Lts
Fans Fridge HW
Exhaust Oven WAD
Smokes DW Mini
Carbon Micro Generator
Co bo Cooktop Transfer
Co 1
AC! AH ` Hood Service
I Amps Have Used
Special:
Comments
APPROVED AS DOTED
DATE: �°2 B.P.#�
FEE: cS _ PV:
NOTIFY.-BUILDING 'EPARTMENT AT
765=1602,--6 AM TO k PM FOR THE
FOLLOWING "INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH:= .FRAM!NG & PLUMBING
3. INSULATION
4. FINAL - CONSTnUC—NON MUST ELECTRICAL
BE COMPLETE FO"; C.O. INSPECTION REQUIRED
ALL CONSTRUCT!:N SHALL 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
} I T RA
B ARD
SG 496" R' STEES
Bfl
OCCUPANCY OR
r
USE ISS UNLAWFUL
WITHOUT CERT IFICA
OF OCCUPANCY
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MITSUBISHI
ELECTRIC MicaSUM
--Munn 40
SPLIT-TYPE AIR CONDITIONERS
INDOOR UNIT
MSY-D30NA
MSY-D36NA
i
OPERATING INSTRUCTIONS For user
• To use this unit correctly and safely, be sure to read these operating in-
structions before use.
MANUAL DE INSTRUCCIONES Para los clientes
• Para utilizar esta unidad de forma correcta y segura, lea previamente
estas instrucciones de funcionamiento.
NOTICE D'UTILISATION A I'attention des clients
• Pour avoir la certitude d'utiliser cet appareil correctement et en toute
securite, veuillez lire cette notice d'instructions avant de mettre le clima-
tiseur sous tension.
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Mill
REGISTER YOUR WARRANTY
Congratulations on your decision to enjoy pristine air,quiet operation and
ultimate comfort in your home.Be sure to protect your investment by registering
for your warranty online.Or simply fill out and mail in this warranty card. It's
practical,quick and easy.Visit www.mitsubishicomfort.com/tbd to get started.
RETAIN THIS PORTION OF T E CARD�FOR YOUR RECORDS PRODUCT INFORMATION
/ )
r=rst �vA,d,� � Last S MSY-D36NA-8
IndUnits)Model#
Address 60
04220
City
Indoor Unit(s)Serial#
Stat Zip
Outdoor Unit(s)Model#
INSTALLATION INFORMATION
Outdoor Unit(s)Serial#
Date of Installation �j��/ / / / /
Installing Contractor Company,k �"�/�-417 r,II 061'
Contractor Phone
Contractor Email JAk MITSUBISHI
ELECTRIC
When requesting waaanty service,please present this portion of the card to your HVAC Authorized Dealer or Contractor.
MITSUBISHI ELECTRIC CORPORATION
1 of 1 7/4/22,4:41 pm
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Grattan's Heating& Cooling
11339 Meday Ave
Mattituck, NY 11952 US
(631)745-5555
grattanshvac@gmail.com
ADDRESS
Wendy Lomas
500 Stephensons Rd
CIL,Odent, NY 11957
EST TE# DATE EXPIRATION DATE
626 05/27/2018 06/27/2018
ACTIVITI,
05/27/2018
Estimate
Furnish and install a new Mitsubishi air conditioner for second floor living
area. Installation includes a new Mitsubishi condenser model #MSYD36NA-8
located outside on mounting bracket located on southside of residence, a
Mitsubishi evaporator model#MUYD36NA-1 located in discussed location
hung from exposed 2 X 4 roof rafters on a painted piece of 3/4 plywood,
insulated refrigerant piping, condensate drain piping, inter unit control wiring,
decoarative lineset cover for exterior of residence, MHKZ-1 wireless remote
controller and start up and testing of new system.
Investment Price
$7200.00 Seven Thousand Two Hundred Dollars
Warranty
7 year manufacturers factory warranty on Mitsubishi compressor during
normal business hours
5 year manufacturers factory warranty on all Mitsubishi parts during normal
business hours
Not Included
Line voltage wiring from outdoor unit to electrical panel by electrician.
(Estimate about $250-$500 for electrical work)
TOTAL
Accepted By
Accepted Date
I I I
7/4/22,4:40 pm
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SERIAL NO. / 7294 M1707 05272 OUTDOOR USE/ r
No DE St RIE
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PRESSION NOMINALE HAUTE pSIG
DESIGN PRESSURE LOW/
PRESSION NOMINALE BASSE 1034 KPA/150
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AWARI�1 NC A AVERlISSEMENT
HAZARD®US VOLTAGE � TENSION DANGEREUSE
_ CAN CAUSE SE�/ERE PERSONAL RISQUE DE:,BLESSURES
{NJURY OR DEATH. GRAVES OU MORTElLES
TURN OFF ELECIRKAL POVJER:BEFOR�REMOVING THIS � � COUPEZ t'ALN�E/JfATtOiN EifClRKi1.FAVMlfd018P
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