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Home My WebLink About51902-Z �o4a°F SO�lyo�o Town of Southold * * P.O. Box 1179 oac 53095 Main Rd Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 46453 Date: 08/29/2025 THIS CERTIFIES that the building EV CHARGER Location of Property: 1210 Arshamomague Ave Southold, NY 11971 Sec/Block/Lot: 66.-2-28 Conforms substantially to the Application for Building Permit heretofore,filed in this office dated: 03/28/2025 Pursuant to which Building Permit No. 51902 and dated: 05/07/2025 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: EV charger on exterior wall of single-family dwelling as applied for. The certificate is issued to: Paul Kesicki ,Kirsten Kesicki Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: ELECTRICAL CERTIFICATE: 51902 08/20/2025 PLUMBERS CERTIFICATION: Autho ' d Signatur Of sou y° 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#: 51902 Date: 05/07/2025 Permission is hereby granted to: Paul Kesicki 1210 Ashamomaque Ave Southold, NY 11971 To: install EV charger on exterior wall of single-family dwelling as applied for. Protection from vehicular impact must be installed. Premises Located at: 1210 Arshamomaque Ave, Southold, NY 11971 SCTM#66.-2-28 Pursuant to application dated 03/28/2025 and approved by the Building Inspector. To expire on 05/07/2027. Contractors: Required Inspections: Fees: EV Charger $125.00 ELECTRIC -Residential $100.00 CO-RESIDENTIAL $100.00 Total S325.00 Building Inspector o��pF SO!/r�ol � o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 CA- Southold,NY 1 1 97 1-0959 '4 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Paul Kesicki Address: 1210 Arshamomaque Ave City:Southold St: NY Zip: 11971 Building Permit#: 51902 Section: 66 Block: 2 Lot: 2$ WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: JFF Electric License No: 49343ME SITE DETAILS Office Use Only Indoor I✓' Basement F Service (- Solar Outdoor (✓ 1st Floor F Pool 17 Spa F Renovation I— 2nd Floor r- Hot Tub r Generator (— Survey rF71 Attic rr-1 Garage Battery Storage I- INVENTORY Service 1 ph F Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph (- Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transfer Switch UC Lights Dryer Recpt Emergency Strobe Heat Detectors Disconnect 100A Switches 4'LED Exit Fixtures Other Equipment: 100A Breaker, 100A WP Ext. Disconnect, Ford EV Charger Notes: EV Charger Inspector Signature: X l Date: August 20, 2025 Sean Devlin' Electrical Inspector sean.devlin(&-town.southold.ny.us 1210ArshamomaqueEVcharger of so to 2 ion # TO\�WOF SOUTHOLD BUILDING °ycou 631-765-1802 INSPECTION [ ] FOUNDATION 1 ST/ REBAR [ ] 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 [ ] RENTAL REMARKS: DATE Aa z INSPECTOR I� �o��OF SOUIyO� TOWN OF SOUTHOLD BUILDING DEPT. orm, 631-765-1802 INSPECTION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I SULATIOWCAULKING [ ] FRAMING /STRAPPING [ FINAL L V [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: `�� C- 0 jb ec c DATE o •a0•a INSPECTOR FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION (IST) ------------------------------------- -- FOUNDATION (2ND) CIO ROUGH FRAMING& PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS 0 o�S�FfojK000 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 https://www.southoldtownn goy Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only EC E O V E PERMIT NO. 5jq� Building Inspector _ MAR 2 8 2025 a �;i��''�`' i r.. �G, u�-' }�� P ��,A+y __i^ l t,�l„a � ,.r ray 4 w 5h. � f,f�:�"� a�;'�r-� •:, sAPplicatlons and farms must be f Iled out�in theirentirety Incomplete r applications wtllrno be accepted Wherethe Applicant�s not the ovi►ner�any z Building Department Owner's Authorization form(Page 2)shall be complgted � "; {_ ` y4r�'�t•T �afr's k c r,,o i�-� r �y y, a yti ,,u�` , -ir F ti b' } w �'">!� .,� r,�,,yr w ,� Town of Southold Date:03/14/2025 O,1I�IN�R S\\OFnPROPERTY"h n r f t a s" ' f x ti �f� i 4 }�}k Y d t S is 44c Pa Fx-r y t at_1�� Name:Paul Kesicki. SCTM#1000- ,t-ble-,7-0�-0?6-.1,�.��,.�,� ;'�. ,' ,�z., Project Address 1210 Arshamomaque Ave, Southold, NY 11911 Phone#:631-492-0507 Email:KESICKIPAUL@GMAIL.COM Mailing Address:1210 Arshamomaque Ave, Southold, NY 11971 �CONTACY PERSON.,.. y a f v. R {g �ifF i oy yA= ( r Nckx ;�F r Z 1 h A 4t p 1 t k t ➢� ap i x"e�'y ,t t`Y^�;•`.., Yr,.. � +'.try�.;:t.+..,w hsiY :i.t',:,-�t��.i,,,b':.:n'h ° ;.'ih.:f, x36:t�t J xy`�.7 �" � '� �.R�?", st � ,�vrgaf f`�ss f k; Name:John Felbinger Mailing Address:20 Clark St East Rockaway, NY 11518 Phone#:516-887-4876 Email Jackjr@Jffelectnc com DESIGN PROFESSIONAL:INFORMATION Name:N/A Mailing Address: Phone#: Email: Name:John Felbinger Mailing Address:20 Clark St East Rockaway, NY 11518 Phone# 516 887-4876 Email ack r ffelectnc com ,p4r �Y DESCRIPrTIO OF PROPOSED CONSTRUCTION r R rr n i 1�}a^? fr{G6 ; �'r�� ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: DOther EV Charging Station $3920 Will the lot be re-graded? ❑Yes IgNo Will excess fill be removed from premises? ❑Yes W No 1 PROPERTY INFORMATION Existing use of property:Residential Intended use of property:Residential/Single Family Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? OYes ❑No IF YES,PROVIDE A COPY. 8 Check Box After heading: 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 hereindescribed.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 Gass A misdemeanor pursuant to Section 230AS of the New York State Penal law. Application Submitted By(print name):'_Yc7\1N e.�� Authorized Agent ❑Owner Signature of Applicant: ' Date: STATE OF NEW YORK) SS: COUNTY OF 2a\.rlo �b� / being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing cco tract)above named, (S)he is the CO r�- VA(�-% (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 Al day of !r , ,20 Notary Public CYNTHIA LARK Notary Public,State of New York No.01LA6421011 Qalified inPROPERTY OWNER AUTHORIZATION commissonExpires August 23 (Where the applicant is not the owner) I, � :•,, t 1=S) * residing at is io A(4,C,-10 SV7 ; C, lI do hereby authorize -� f_' I�cr �� to apply on my behalf o t awn of So old Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 �Ogsffi?t�`o BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD y z Town Hall Annex-54375 Main Road - PO Box 1179 Southold, New York 11971-0959 4! Telephone (631) 765-1802- FAX (631) 765-9502 jamesh _southoldtownny.Qov— seand@southoldtownny.aov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 03/14/2025 Company Name: JFF Electric, Inc. Electrician's Name: John Felbinger License No.: ME49343 Elec. email:jack@jffelectdc.com Elec. Phone No: 516-887-4876 01 request an email copy of Certificate of Compliance Elec. Address.: 20 Clark Street, East Rockaway, NY 11518 JOB SITE INFORMATION (All Information Required) Name: Paul Kesicki Address: 1210 Arshamomaque Ave,Southold, NY 11971 Cross Street: Phone No.: 631-492-0507 Bldg.Permit#: 5*f OW email: KESICKIPAUL@GMAIL.COM Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Install dedicated 100-amp 240v circuit for electric vehicle charging station protected by 100-amp circuit breaker&disconnect.Charger will be mounted on exterior wall of house. Square Footage: 12400 Circle All That Apply: Is job ready for inspection?: ❑ YES 0 NO ❑Fough In ❑ Final Do you need a Temp Certificate?: ❑ YES a 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 E12 D H Frame El Pole Work done on Service? MY N Additional Information: N/A PAYMENT DUE WITH APPLICATION '�`SUFl:O,tK { BUILDING DEPARTMENT-Electrical Inspector � CMG TOWN OF SOUTHOLD z Town Hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 Lamesh southoldtownny.gov - seanda-southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 03/14/2025 Company Name: JFF Electric, Inc. Electrician's Name: John Felbinger License No.: ME49343 Elec. email:jack@jffelectric.com Elec. Phone No: 516-887-4876 El I request an email copy of Certificate of Compliance Elec. Address.: 20 Clark Street, East Rockaway, NY 11518 JOB SITE INFORMATION (All Information Required) Name: Paul Kesicki Address: 1210 Arshamomaque Ave, Southold, NY 11971 Cross Street: Phone No.: 631-492-0507 Bldg.Permit#: �j(q�� email: KESICKIPAUL@GMAIL.COM Tax Map District: 1000 Section: Block: r Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Install dedicated 100-amp 240v circuit for electric vehicle charging station protected by 100-amp circuit breaker&disconnect. Charger will be mounted on exterior wall of house. Square Footage: 12400 Circle All That Apply: Is job ready for inspection?: YES❑✓ NO Rough In ❑ Final Do you need a Temp Certificate?: ® YES a NO Issued On Temp Information: (All information required) Service Size®1 Ph❑3 Ph Size: A #Meters Old Meter# ❑NewServiceFire ReconnectOFlood ReconnectOService ReconnectQUnderground Doverhead # Underground Laterals 1 2 H Frame 0 Pole Work done on Service? Y N Additional Information: N/A PAYMENT DUE WITH APPLICATION PERMIT# Address: Switches Outlets fiord.- cav-� G F I's Surface I G CA- dj�j-c C) Sconces H H's UC Lts Fridge HW POOL Fans Mini Fr. W/D �- Panel -- - Pump Exhaust Oven Sump Heater Trnsfmr Smokes DW Generator Salt Gen. Carbon-' M.i_cro R Grb.Dis Water Bond Lights Heat Pucks ERV 'cr HOT TUB/SPA Inst Hot DeHum Transfer Disc Combo Cooktop Mini Alit Blower AC AH Hood Blower Service Amps Have Used .. Sub Amps Have Used Comments G 4 DWELLING-PUBLIC WATER DWELLING+PUBLIC WATER - - n ' G yrppY�, N 26014'00" W 111.25' PRCtl=RTY LINE !I A„w..Yur..m,.a...w........ � I 'Z z 1 i � rus.Ecr PRcpERTY W � 1 i.MwJWbru-imr � I 1 ,'I�I,, r /! W Q- 1 I f Ui IL I pi.M'�RidH W"�Yn Y ti MY�Mel I M Wnaptwrr�Y�wIi YY 1 -I��ynYrO YlM�nnYew.W Nm PwW•rr rrtrowwr 1 I�r rN rrr r"r/r.w.nr 'I n7•M TANt/01°�.Crd gOlo�FIrF � ' w a°OiY"�-Iri AliMwVwP�rA.p1 � m' PATIO �r�Y�Y LLLL55 f t I Mb.Yw MW.wrerM Mrl £4TirtT t0 vCA6tEAT1IMPAIXCmCD B6rOlK TA)tIOT NO ARGIOIe&} BLAxf I/ rp Wi YllJre rmlrrr+rn wghl 1 nml°n'°oo ura'�"n.wo,oea AUA TMAL LM i r rn.wr PROFOEEp �i�e°tln�•�rau�o°f mrAi.wrAgrA naw"u' G°aT 2-STOW 2-STOW NOW D"9T Iblfi 4Y4/.P /KI rrrr rpn b+r Yuli,ar YarY.[M PIP=PPAhW NOIIse W FRAMED ADDITION INT°N TARWINN Iu PROF09ED ADDITION -. E�aK FV B .. _ yp pYl Wesel -• _ rRROOm A9wneN r.�rr.MVWrgorr bac�wr I t4@OROOW TCtt}IGN+ff70Tf!-0Otl n.w..rwwnm .. r _ _ PP.PL..71�• rrn► EM- -WBt OP bDU ��Nra Yrr�Y.w � 7 ��L9O2NT ELn143' I�/EDIIL PIPUM7 '_��s T�Vla W>mW®TATCIYa°R r` TOTAL AI�H ALL°11YGTACf eOeo OP Ntl •^ MOINO fAlUSLSDn-- P6!ftl NV R!y MAYAL Y f W Yq-9 no.w.sbr•M� __ _� ._.... ._ __ .._ - .. �_ 1._ _. _ ._ _._ - jYypKM µjplrm iJWa ._ •• _•___ i"w"i�wwrlWr�wwriL r}4OW IIAP MTA fltON dRVe'f •I r wnrrruq 1 1 MAw., eY -a gm - „mn.TAl°.m •- - ---'-- 1 I-AM � . Z4,� .r._-_. _I'-- ---• =aeim nimcrlewdaTPSlcdsmn eaf rrno ,§ , �Y omAum.V Rau®er eamaD oPmearo� i 1 V e �wsrNtea/Q�A Irrunarr.snanreu�tm. � f 1.1 r S%!�lm:. ; grrunrMw e..Ir nW .Tm/ _ �17p�1I.rry le+.W.Y rPdM rrMiF"e C68T HA Y fW9�d IrOp'QLL' F /�� Y, •6CYATIOItr Rp9�C/INM IW ' II I"trlr rnr Y• T t / TO MArIT KILISFARATION R f�V`I f "-•. sm- MIYrMn.A w'""rrr ' ' eICET LF 2.- 11O1C :.�inemm err..r ar..ewaanr r.r - I r I ORNMAr lu L.P. soP AVAN AA D" POOLLeACfRas _tV7F' ^L CWJi-0+1 .I.�'-.rs nrVglwa °L Df AD Pve�s S o If ° Y OFNO`NJ -I..rrranrwr/q tr c , p qau- t 2a0�I` t' r •�P05ED 5�G SYSTENf DETAIL .nrrrnvn..yli/..rr.e.nr _ ti Z .rr.w PROJECT: - �ule'.�wn wyao.rryon KESIC '- -- - 7 Rp CLsrJnlme tl '°'am.""r�Gr°"o "°rm' RESIDE =OLK COUNTY HEALTH DEPARTMENT APPROVAL I meeePFA�,®T L�NF Ir/>�S' n :am «�pN I=ARSHAM ✓ SOUTHOLD,N slat:mlLrsrGEeAwMceorlvALTNSEnvloa ' - ..... PoOA AR5HAMOMAG2UE AVENUE i , --►J_ .w ► ®""" ppvurvvaArreevu.�Ce)P'i+EVL7tON , :�, •' 6tIEPlAN rufarwv/waom.r I - aa PROPosEDsrPRca ANVAvea w.wsruna".ow •wswYYrouu®R '••I tA'-"'�'Lr�•:1i NOTF3 517E PLAN -. .,��rY... ; rOIM f17 E?NLOrB I sauw-wu.arieis'wvw��.in r'wu ri.ol+ ar ru.rr.s.mr.ew�r PAGE: 2 eeALe.1'-0'.Iao• I -r rr��r+rsw•w..,.�ur.wu.�.-►.+. ®9GE1AIffi IROYO.ThOi,tyAD-AL { .�awo-ro"a rvw�r�w..s SPA mAm6mnupfod.xamt�usTlGmcc�twotEsawTswplAplW-tefm m0 q Rip A4Mrn - rw a'KAi'orr®Yauarw °Am OB/19/19 (L- I � p i APPR VED AS NOTED DA •� B.P./ FEE- BY- NOTIFY BUILDING DEPARTMENTAT 631-765-1802 8AM TO 4PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION-TWO REQUIRED FOR POURED CONCRETE 2. ROUGH-FRAMING&PLUMBING ELECTRICAL. & INSULATION INSPECTION REQUIRED 4. FINAL-CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OFTHE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTON ERRORS COMPLY WITH ALL CODES OF dOV h I'C�2 NEW YORK STATE&TOWN CODES AS REQUIRED AND CONDITIONS OF �jl�bG�jlJn SOUTHO TOWN ZBA SOUTH TOWN PLANNING BOARD OLD TOWN TRUSTEES N. ,DEC LDHPC -7 SCF� OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY Ford Charge Station Pro The Ford Charge Station Pro provides level 2 charging capability at home Designed specifically for your Ford EV,and works with all J1772 plugs (EV industry standard) •Backed by Ford Motor Company 3-year limited warranty' The Ford Charge Station Pro provides up to 80 amps to maximize your home charging speed.for your Ford electric vehicle2 •Adjustable power levels to accommodate a range of circuit breakers (20-100 Amps)in situations where power may be limited,to enable compatibility with almost any home electrical systems •Fully charges your all-electric F-150 Lightning Extended Range vehicle ovemIght4 Works with the F-150 Lightning and the Home Integration System to provide Intelligent Backup Power to your home during an outage; Ford's recommended installer is Sunrun. Details Specification •Connector uses industry standard/universal SAE J1772 Output Power Max Weight connector.Compatible with all electric vehicles on Max 80A/19.2kW4 23.6 lbs. the market today(that are compliant with SAE J1772), Input Voltage Weatherproof including Tesla with a commonly used adaptor 240 VAC NEMA 4 rated for •Up to 19.2 kW(240 VAC at 80 Amps)output Input Freq outdoor installation •Bluetooth and WI-Fi capability(5.0 GHz and 60Hz Warranty 2.4 GHz 802.11 b/g/n) Output cord Length Limited Syr' •Dynamic color LED lights show power,bi-directional 25 ft. power status,vehicle connected status and Dimensions charging status 322 mm X 595 mm Installation x 176 mm(WxHxD) •Capable of both indoor and outdoor installation In the box (NEMA 4 rated) •Capable of post-mounting •Ford Charge Station Pro,Including removable •Capable of installation with the Home Integration outer cover System and other home energy management solutions •25 ft.cord and charge coupler •Cord length is 25 ft. •Wall-mounting bracket •Integrated ergonomic coupler dock for storage •Mounting template(cardboard) to keep debris and dust out of the plug •User and installation manual •Integrated cable management system to keep charge •Installation hardware(some installer-specific cord organized and off the ground conduit hardware not included) •Ergonomically designed handle with grip •Impact-resistant replaceable faceplate3 •Flexible wiring options to feed power into unit from rear or either side •Security lock has two screws that prevent the wallbox from being removed without completely disassembling 'See your dealer for limited-warrantydetails.'Ford electric vehicles Include entire unit the F-150 Lightning,Mustang Mach-e,E-Transit,and Ford Plug-in Electric Vehicles.Home charging refers to AC charging(https://www.energy.gov/eere/ electricvehicles/charging-home).38ased on Internal Ford,testing.°Usable amperage Is 800/bof home breaker amperage.Amps x Volts=Watts.5Charging times vary based on household circuit amperage. Vehicle Charge Port 171 Ford Charge Approximately Stat • •