HomeMy WebLinkAbout51927-Z 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#: 51927 Date: 05/16/2025
Permission is hereby granted to;
Edward W Graham
PO BOX 1083
Southold, NY 11971
To:
legalize "as built" HVAC system to existing single-family dwelling as applied for.
Premises Located at:
695 Rogers Rd, Southold, NY 11971
SCTM#66.-2-42
Pursuant to application dated 04/08/2025 and approved by the Building Inspector„
To expire on 05/16/2027.
Contractors:
Required Inspections:
Fees:
As Built Alteration $500.00
ELECTRIC -Residential $200.00
Co-RESIDENTIAL $100.00
Tota I S800.00
n g Inspector
rVr 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 htti)s://www.southoldtownny.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO, Building Inspector; APR 8'
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted.,Wh r the Applicant i' ttil * D pp p Where e pphcant is not the owner,an •pee,
Owner's Authorization form(Page 2)shall be completed. Town Of Southold'
Date: 1 -z S
OWNERS)OF PROPERTY:
Name: SCTM # 1000-
Project Address: T SJ Rp e-r-s kqo-d
Phone#: 3 /- `� & S - O 7 9 Email:
Mailing Address:
CONTACT PERSON:
Name: �d GJ a f"G� tt-/Lce.Vr
Mailing Address:
Phone#: Co 3 1 - S? 'F - 9- 0 / / Email:
DESIGN PROFESSIONAL INFORMATION:
Name: KU 1-
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: 11 rl ZU-r-0-W-Vki'
Mailing Address: �/u/6 ri1a��i fu CJC'
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure [--]Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
XOther _ VAC s. 1km $
Will the lot be re-graded? ❑Yes ONO Will excess fill be removed from premises? Dyes ❑No
1
.M
i
PROPERTYINFORMATION
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? Dyes ❑No IF YES, PROVIDE A COPY.
Check Box Afte e ( t t w� /rt t r r d � sI is is respons r Ott dur n d �x r f pr vi d
, way W t6*0 SWIA104 tivortw�e4 for day 1, 4�, f it puriu rs to , �u t ati
t"i a�j Y a �p to ,yof i�i,4; 'aye'fk�� ytf q1 t�� T r�rr N an o f �gaW��d{fa y-
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rypurwls r t I; t�s rr t rf�r era e r fr a arrt afw"" d l i t5 ark a �, ti P' /
Application Submitted By(print name): a-nt 14. 64r' & g°'"), ❑Authorized Agent Yowner
Signature of Applicant: 1,��� ( , ,,- Date: � �5
CONNIE D. BUNCH
STATE OF NEW YORK) Notary Public,State of New York
No. 0 1 BU6185050
SS: Qualified in Suffolk County 7
COUNTY OF ) Commission Expires April 14, 2 �'��
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 20
Notary Public
PROPERTIOWNER AUTHORIZATION
(Where 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
, tf � 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
- N `amesh southoldtownn . oar— eand @southoldtownn . ov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: ,0 _2S
Company Name: gel GcJ� c��ski� l e ems,cJ
Electrician's Name: CCr) s i
License No.: 01 Elec. email: �r C P�Yis 't' ���►4 UA@
Elec. Phone No: G 5 7g-Z_y ❑I request an email copy of Certificate of Compliance
Elec. Address.: P6 6 S �` A
JOB SITE INFORMATION (All Information Re uired)
Name:
Address:
Cross Street: ,
Phone No.: 9
Bldg.Permit#: �" ' email: s
Tax Map District: 1000 Section: Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
i
Square Footage:
Circle All That Apply:
Is job ready for inspection?: YES E] NO E]Rough In F Final
Do you need a Temp Certificate?: YES NO Issued On
Temp Information: (All information required)
Service SizeF�1 Ph F]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 MN
Additional Information:
PAYMENT DUE WITH APPLICATION
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Pontino, Susan
Sess��
From: Sandy <esgraham@optonline.net>
Sent: Tuesday, April 8, 2025 12:04 PM
To: Pontino, Susan
Subject: Condenser form
Thank you for your explanations and help...
ATTENTION:This email came from an external source. Do not open attachments or click on links from unknown senders or
unexpected emails.
�ooE� MUIKE120 — 53A NORIAL 1624F21571
�o
FOR OUTDOOR USE VOLTAGE RANGE
IrM AGE PHASE MIN. MAX.
2Q8 M 1 197 253
MINIMUM CIRCUIT AMPAWY : 14.6
MAX. FUSE OR CKT. BKR.�MGR TYPE PER NEC} : 25
SHORZ -CIRCUIT CURREN * 5 ARMS 63MMETLKCAL BOOv 160xlMPH HZ
DpMPRESSOR: 10.9 R 63 HP to PHYHZ
FA11 MOOR: 1.0 FEA
116
HIGH SIDE DESIGN PRESSURE : 448 PSIG
v w SIDE DESIGN PRESSURE ; 236 PSIG
REFRIGERANT :HFC-410A
FACTORY CHARGE: 81 OZS.
DESIGN CERTIFIED TO UL 1995 41h Edi east andn and SSo hwest
Install Prohibited in South
I CERTIFIED
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us
int k
30`163ba uc,
ALLIED AIR ENTERPRISES.
Sent from my Phone
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