HomeMy WebLinkAbout50916-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
7,g
� SOUTHOLD, NY
r,wu•
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 #: 50916 Date: 7/9/2024
Permission is hereby granted to:
Kellc, Barbara
315 Riverside Dr Apt 11 E
New York, NY 10025
To: Legalize as installed HVAC unit at existing single family dwelling as applied for.
Additional certification may be required.
At premises located at:
680 Locust Ln, Southold
SCTM # 473889
Sec/Block/Lot# 64.-2-54
Pursuant to application dated 5/15/2024 and approved by the Building Inspector.
To expire on 1/8/2026.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $500.00
ELECTRIC $200.00
CO-RESIDENTIAL $100.00
Total: $800.00
Building Inspector
�� ry TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 htt t :// ww. out oldtomm . ray
r
[5ate Received'
For Office Use Only
u
PERMIT NO. 50471& Building Inspector:;
Applications and forms must be filled out in their entirety. Incomplete ?ME 7ME 1.
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: Barbara Kellc SCTM#1000-64-2-54
Project Address:680 Locust Lane, Southold
Phone#: 917-573-6522 Email: barbarakellc@yahoo.com
Mailing Address: 315 Riverside Drive, Apt. 11 E, NY, NY 10025
CONTACT PERSON:
Name: Pat Moore
Mailing Address: 51020 Main Road, Southold
Phone#: 631-765-4330 Email: pcmoore@mooreattys.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:
D Other condensor for central airconditioner(existing HVAC-forced hot air) $
Will the lot be re-graded? ❑Yes iNo Will excess fill be removed from premises? ❑Yes *No
1
PROPERTY INFORMATION
Existing use of property: single family dwelling Intended use of property: Same
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R-40 I
this property? ❑Yes ®No IF YES, PROVIDE A COPY.
8 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 n tncia C. Moore BAuthorized Agent ❑Owner
Signature of Applicant: "` " Date: S /�
STATE OF NEW YORK)
SS:
COUNTY OF Suffolk )
Patricia C. Moore being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the Attorney
(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 Z0z
Notary Public
KYLEE S DEFRESE
OWNER NOTARY PUBLIC-STATE OF NEW YORK
)��Dw' �(�� RTY MITI,,,1 , RI ,,,°"r) No.01 DE6420156
(Where the applicant IS not the owner) Qualified in Suffolk County
My Commission Expires 08-02-2025
Barbara Kellc residing at 315 Riverside Drive, Apt.11 E
I,
NY, NY 10025 Patricia C. Moore
do hereby authorize to apply on
my beh�#to the Town of Southold Building Department for approval as described herein.
46"/ C'1-r 5-13-24
Owner's Signatilre Date
Barbara Kellc
Print Owner's Name
2
off 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
m arnesh southoNdtownf ov - seand southoldtownn ov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: 5-14-24
Company Name: OWNER
Electrician's Name:
License No.: Elec. email:
Elec. Phone No: ❑1 request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name: Barbara Kellc
Address: 680 Locus Lane, Southold
Cross Street:
Phone No.: 917-573-6522
Bldg.Permit#: S021 email: barbarakellc@yahoo.com
Tax Map District: 1000 Section:64 Block: 2 Lot:54
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
air conditioner condensor for existing HVAC forced hot air system
Square Footage:
Circle All That Apply:
Is job ready for inspection?: 21 YES F-] NO F�Rough In F� Final
Do you need a Temp Certificate?: E YES R]NO Issued On
Temp Information: (All information required)
Service Size®1 PhE]3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 1 FJ2 0 H Frame Pole Work done on Service? Y N
Additional Information:
Please call Pat Moore-631-765-4330 (available for access)
PAYMENT DUE WITH APPLICATION
'' -A 0)
5/14/24, 10:56 AM
GL�-; — IMG_7508.HEIC �5JJ ones¢J
OF
XL
1 4 i MFR
fk VOLT
MOO.40. 4TTX4036A1000AA DATE
32 06/2003
- SERIAL N0. 64W1NUZF pN 208/230
MINIMUM CIRCUIT AMPACITY 6O
OVERCURRENT PROTECTIVE DEVICE 21.0 AMPS
MIN FUSE I BREAKER(HACK) USA CANADA _.
MAX FUSE/BREAKER(NACR) 30 30
1 NFC - 410A 35 35
BA 5 LBS. 11 OZ. OR 2.58
065A RE1,IRED INDOORS FOR kg(St)
C��m.luH DureT ml s RATED PERFORMANCE
AMEAICA BUSINESS OF Plnc Fig Ou"k_sn, "-
AN STANUAFta LISTED SECTION OF �{
TYLEfl,TX 75707 ASSEMBLED IN USA LL OS CEN7gAL COOLING
COMP AIR CONDITIONER
G.0 MO MOT. 15.4 RLA 27MF OUTDOOR USE
1-40 FLA 208/230 v 83 LRA /
ME A NG 138—02—E E i2D00/230 v
❑ESIGN PSI -HIGH 480 LOW 480 W101 1/s HP I
Y
ENERGY STAR '•,../.
Af �
1
/ I
x
V�
9
f
https://ddve.google.com/drive/home 1/