The URL can be used to link to this page

Home My WebLink About47644-Z �OS�1FQl�'cp� Town of Southold 3/7/2024 P.O.Box 1179 0 -� 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45031 Date: 3/7/2024 THIS CERTIFIES that the building RVAC Location of Property: 3965 Grand Ave.,Mattituck SCTM#: 473889 Sec/Block/Lot: 107.-1-2.6 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/3/2022 pursuant to which Building Permit No. 47644 dated 4/5/2022 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"central air conditioning to existing single family dwelling as applied for. The certificate is issued to Bergen,Bruce&Leigh Ann of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 47644 5/4/2022 PLUMBERS CERTIFICATION DATED A riz ignature SOFoc,reo TOWN OF SOUTHOLD �y BUILDING DEPARTMENT y x 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#: 47644 Date: 4/5/2022 Permission is hereby granted to: Bergen, Bruce PO BOX 1575 Mattituck, NY 11952 To: legalize "as built" AC as applied for. At premises located at: 3965 Grand Ave., Mattituck SCTM # 473889 Sec/Block/Lot# 107.-1-2.6 Pursuant to application dated 3/3/2022 and approved by the Building Inspector. To expire on 1015/2023. Fees: AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $400.00 CO-ALTERATION TO DWELLING $50.00 Total: $450.00 uilding Inspector pf SOUry�l 0 Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 �Q sean.devlinCci)-town.Southold.ny.us Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Bruce Bergen Address: 3965 Grand Ave city,Mattituck st: NY zip: 11952 Building Permit#: 47644 Section: 107 Block: 1 Lot: 2.6 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 1 st 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 1 Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower 1 Range Recpt Ceiling Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixture Time Clocks Disconnect Switches 4'LED Exit Fixtures Pump Other Equipment: Notes: " AS BUILT NO VISUAL DEFECTS " HVAC Inspector Signature: Date: May 5, 2022 S.Devlin-Cert Electrical Compliance Form r ��OE SOUTyO q -7 66 �rcvxZ Ave # # TOWN OF SOUTHOLD BUILDING DEPT. co 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: 1 L__r_ DATE 15- INSPECTOR FIELD INSPECTION REPORT DATE COMMENTS J � 6� FOUNDATION(IST) y -------------------------------------- FOUNDATION(2ND) S.M z rA ROUGH FRAMING& H PLUMBING t INSULATION PER N.Y. ►�-7. STATE ENERGY CODE 10 FINAL ADDITIONAL COMMENTS 436 16. 1413 3 0 z m (1 0 � � b W z � d H o�SUFFocKcoa TOWN OF SOUTHOLD—BUILDING DEPARTMENT m� y a Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 1-1971-0959 oo�oi �aa� Telephone(631) 765-1802 Fax(631) 765-9502 https://www.southoldtownny.gov Date Received APPLICATION FOR BUILDING PERMIT Office Use Only ® C LE PERMIT NO. � BuildingInspector: p ector: MAR— 3 202z:�.. Applications and forms must be filled out in their entirety. Incomplete BUILDING'DEPT. applications will not be accepted. Where the Applicant is not the owner,an TOWN OFSOUTHOLD Owner's Authorization form(Page 2)shall be completed. Date: J / ,,�) .?0 -�A OWNER(S)OF PROPERTY: Name: SCTM#1000- q?3j-e? 107 Project Address: Phone#: G 3 i �9d' - �o G3 " �' £ Email: -6-.31 -..s-69 - o.3_Y`/ --._� [.L.- ��/�ST6�l @ o!':v✓Cr.v�.a/£� Mailing Address: CONTACT PERSON: Name: - s .J Mailing Add : 0 — . .. --- -- --ress 3o - - -- � - ,,d� s 7.r �/Y_Id4-?slut./� - Phone#: 63 i °6 3 Email: �,,/Es rE S -42 .v DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: Mailing Address: �1�—o o S��M/�. -_ ✓�- - _ /�/✓F.7zr��/L Phone#: G 3/ b�' - SSa -- Email: O ® - - ►U e - Icalk CM- DESCRIPTION OF PROPOSED CONSTRUCTION ❑]New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: LJOther Will the lot be re-graded? ❑Yes ❑No Will excess fill be removed from premises? ❑Yes ONO 1 PROPERTY INFORMATION Existing use of property: t�Eszn•�rr�l Intended use of property: �Gs tars vr�� c� Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes 9No IF YES, PROVIDE A COPY. jl 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): `a Q(3kiM- Q Q� Authorized Agent Owner Si nature of Applicant Date: / STATE OF NEW YORK) SS: COUNTY OF -` 1k-.,) t �o &jggn being duly sworn,deposes and says that(s)he is the applicant (Name of individuiVsigning contraW above named, (S)he is the A-aon+ c —vla- 0 W r)e i'- (Contracto ,Agent, Corporate Officer,etc.) QWV)e-r of said owner or owners,and is duly authorized to p orm 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 rV��^�' �"I ,20 19 CHRISTINE TA ` CHRISTINE 7_AINESI' Notary PuNic,Stet®of NewYa* Notary Public NoWY :•I yo* Quallflml In SuffolkCounty w ;..aa•:ik unty No.524791198 No. , : ; W C4Mmtsslon EVIm Jura 30,20.Z2- tlesrlon My comn Lpiras Jwe 30,2Q,JROPERTY OWNER AUTHORIZATION (Where the applicant is not the owner) (9 G 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 �oSVFFO( 449, O BUILDING DEPARTMENT- Electrical Inspector G TOWN OF SOUTHOLD o =` Town Hall Annex- 54375 Main Road - PO Box 1179 o ® Southold, New York 11971-0959 y O� Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr a)-southoldtownny.gov - sea nd(cb-southoldtown ny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All information Required) Date: FdsA 9W Company Name: e o-n Cpr 6 coati Electrician's Name: License No.: ,EElle/c. email: p` o : ) � 0 m ant Q Coon Elec. Phone No - LJ 1 request an email copy of Certificate of Compliance Elec. Address.: 00 :SOUVkaAVe, 0 0. Cc- N. a 2 JOB SITE INFORMATION (All Information Required) Name: `1 VfJLChp-Eaen Address: C o y2- Cross Street: C Phone No.: Bldg.Permit#: email: I e iT o 1V1�oVle Tax Map District: 1000 Section: 3 $ Block: Lot: --2 a BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): _;L,S 7.4 L C-,+ C O AJ Q G°5;-,1r G.¢ L. 110.,". fi Square Footage: Circle All That Apply: Is job ready for inspection?: YES 0 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 Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? Y F1N Additional Information: PAYMENT DUE WITH APPLICATION O ®guFFO � BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 �a0. Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr(D-southoldtownny.gov - sea nd(a�.southoldtownny.go i APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All information Required) Date: Company Name: C��1I' ; I Cor p6 c Co i►i Electrician's Name: License No.: Elec. email: fl j d\ 0 VV1 �6�LC0 Q C&} Elec. Phone No: ) V s- a IJ 1 request an email copy of Certificate of Compliance Elec. Address.: pQ 5p A02, I, P,0% 0 04,k(C C d �� JOB SITE INFORMATION (All Information Required) Name: J-Chl2-V-W-n Address: C Ka �2- Cross Street: (�jhr.TCN Phone No.: � aj l ` 70 Bldg.Permit#: 19-7(o q q email: Ar-5 c o ae Tax Map District: 1000 Section: 4 3 $`6 Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): ,cJ S %ALL.ih C 0 AJ C9 C'i�,/T✓G L. / o, f- Square Footage: Circle All That Apply: Is job ready for inspection?: YES❑ 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 Size: A #Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals 0 1 R2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION ` BUILDING DEPARTMENT- Electrical Inspector ®� �� ' • TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 .' Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 LggerraQsoutholdtownnN/.gov - sea nd(a southoldtownri�.cov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All information Required) Date: ,(� 9CR3 Company Name: e-d' oji t'rcl 1 Cor 0E Q VAc Cu C Electrician's Name: License No.: ,EEIe/c. email: W �o �Y\ 0 Cl%1c61 C0. Q � Elec. Phone N463 ) M-`- ` Lt7 I request an email copy of Certificate of Compliance Elec. Address.: L)0 1%(a ` C C JOB SITE INFORMATION (All Information Required) Name: �q_ `1 '('l,�C- Address: t; ,,_h nib C y'J � - Cross Street: "I N CUUIAII Phone No.: ( (pal ( -O'S0 f :G S -70 Bldg.Permit #: "�� email: Tax Map District: 1000 Section: 3 `� Block: Lot:-- BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Square Footage: Circle All That Apply: Is job ready for inspection?: ZYESE] 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 Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION /"PERMIT# Address: Switches Outlets G FI's Surface Sconces H H's UC Lts Fans Fridge HW Exhaust Oven Dryer Smokes DW Service -arbon Micro Generator :ombo Cooktop Transfer ►C AH / Mini pecial: omments. V� x E 12130 - -MFR DATE 12/2000 M00. NO TTP060E100AO VOLTS 208/230 SERIAL NO. R514-"CIF PH 1 NZ 60 MINIMU161 CIRCUIT AMPACITY 38.0 AMPS OVERCURRENT PROTECTIVE DEVICE USA CANADA MIN FUSE / BREAKER INACR) 60 60 MAX fUSE t BREAKER (HACR) 60 60 HCFC - 22 - 10LBS. 14 OZ. OR 4.93 Kp(si) BAYFCCV 092A REOUIRED INDOORS FOR RATED PERFORMANCE HE TRANE COMPANY '{O OUTDOOR USE YLER, TX 75711-9010 ASSEMBLED IN USA C YL COMPR, MOT 28.8 RLA 208/230 V 169 LRA O.D. MOT. 1.90 FLA 200/230 V 1/4 HP M.E.A. NO. 179--93E F. 10.POJ DESIGN PSI - NIGH 300 LOW 300 OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICA- OF OCCUPANCY AP PR VED AS NOTED DATE: 5 B.P.# 611 FEE: BY: COMPLY WITH ALL CODES OF NOTIFY BUILDING DEPARTMENT AT NEW YORK STATE & TOWN CODES 765-1802 s AM TO 4 PM FOR THE AS REQUIRED AND CONDITIONS OF FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED r T, WN ZRA FOR POURED CONCRETETn�n pl e�i�{�G BOARD 2. ROUGH - FRAMING & PLUMBING �'�' 3. INSULATION - •�Gt�dt6'�8ddtd-i�it EES 4. FINAL - CON -: -'-N MUST BE COMPLE-r D. <�v c nGr ALL CONSTRUCT'. flLL MEET THE REQUIREMENTS Or ..,_CODES OF NEW FORK STATE. NOT RESPONSIBLE FOR ELECTRICAL )ESIGN OR CONSTRUCTION ERRORS. INSPECTION REQUIRED