HomeMy WebLinkAbout50549-Z . t TOWN OF SOUTHOLD
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#: 50549 Date: 4/12/2024
Permission is hereby granted to:
DeAlbu uer ue, Se r io
69 Osborne Rd
Garden Ci , NY 11530
To: legalize "as built" AC unit as applied for.
At premises located at:
295 Bennett Ln, Southold
SCTM # 473889
Sec/Block/Lot# 70.-9-19
Pursuant to application dated 3/8/2024 and approved by the Building Inspector.
To expire on 10/12/2025.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $500.00
ELECTRIC $200.00
CERTIFICATE OF OCCUPANCY $100.00
Total: $800.00
Building Inspector
001 t TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold NY 11971-0959
r Telephone(631) 765-1802 Fax(631) 765-9502 httgsa/www.southoldto^wng� ga
;;
Date Received
APPLICATION FOR BUILDING PERMIT
,) EC �
Office Use Only I
PERMIT NO. 5�L: Building Inspector: MAR 8 2024
r.y 9
Applications and forms must be filled out in their entirety.incomplete
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: Michael Linn&Victoria Yeung SCTM#1000- 70.-9-19
Project Address: 295 Bennetts Lane Southold NY 11971
Phone#: (917)439-9088/(917) 822-3156 Email: michaellinn@gmail.com/victoria.yeung@aig.com
Mailing Address: 15 Broad St#3024 New York,NY 1005
CONTACT PERSON:
Name: Bill Walters
Mailing Address: 114 Main St Greenport,NY 11944
Phone#: 631-553-6533 Email: williamwalters@danielgale.com
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
Mother As-Bui1tCAC $,
Will the lot be re-graded? ❑Yes ❑No Will excess fill be removed from premises? ❑Yes ONO
1
PROPERTY INFORMATION
Existing use of property: Intended use of property:
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 stone 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 bulklkwgs,
additions,akerathms or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordlnaoceso buJWkV code,
housing code and reipalations and to admit authrsrited Inspectors on premises and In building(s)for necessary JospecdonL False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 2210AS of the New York State Penal Law.
Application Submitted By rint nam M� G�q.�l ❑Authorized Agent ((Owner
Signature of Applicant: Date: ,.q,
r
STATE OF NEW YORK)
SS:
COUNTY OF
I �� Ili ov��
U11011 ' 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
Uay of
m Notary Pub is
1�07'Af3Y ° RTY OWNER AUTHORIZATION
C lei Mere the applicant is not the owner)
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
" 4 BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
11Y �� Southold, New York 11971-0959
46 Telephone (631) 765-1802 - FAX (631) 765-9502
smash soutoldtownn o seand southoldto +nn ov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date:
Company Name:
Electrician's Name:
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. �• a.�_
Address: '"
Cross Street: . A
Phone No.:(`9(7)
BIdg.Permit#: ` .wad' ' Y(
email:r,.,v ( � c Xn
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Tax Map District: 1000 Section: Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
Square Footage:
Circle All That Apply:
Is job ready for inspection?: YES NO [:]Rough In LJ Final
Do you need a Temp Certificate?: YES [:] NO Issued On
Temp Information: (All information required)
Service Size 11 1 Ph[:]3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 0 1 2 H Frame Pole Work done on Service? Y NI
Additional Information:
PAYMENT QUE WITH APPLICATION
s•.
GOOD•MAN . M
HOUSTON , TEXAS 77008
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MODEL CKT30-1 .. -
.SERIAL NO. 0104 41?96
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A.C.VOLTS 20®/230 1
PHASE HERTZ60 !1
VOLTAGE RANGE MIN. 1
MAX. 253
14.5 � •
MIN.' CIRCUIT AMPS I
MAX. FUSE AMPS OR HACK TYPE CIRCUIT BREAKER 20
(HACK CIRCUIT BREAKER FOR U. S. .ONLY)
s COMPRESSOR 10- {
RLA LRA
MAX. WORKING PRESSURE
FA(�I" MOTOR
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FACTORY CHARGE OZ, R22 104
FACTORY TEST PRESSURE PSIG LOW 1� �0: HIGH 300
HEATING
CAUTION
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AND COOLING ' DISCONNECT THE ELECTRICAL POWER
EQUIPMENT' BEFORE SERVICING.
�Is-jr ATTENTION:
DECONNECTER DU CIRCUIT D'AL-IMENTATION
CENTRAL ELECTRIQUE' AVANT L'ENTRETIEN.
COOLING AIR USE COPPER' CONDUCTORS ONLY.
CONDITIONER THIS EQUIPMENT SUITABLE FOR OUTDOOR USE.
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MEA No 348-96-E PART NO. P14932043
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MAC: 98:ED:5C:8MBUE
MID.TeslaftlConnector ,BMK •
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