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HomeMy WebLinkAbout36026-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEP~RTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-34696 I~te: 11/19/10 THIS UI~K'rIFIES that the building AIR CONDITIONING Location of Property: 495 JOCKEY CREEK DR SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 70 Block 2 I~t 17 subdivision Filed Map NO. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 5, 2010 pursuant to which Building Pel~nit No. 36026-Z dated NOI~EMBER 16, 2010 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" AIR CONDITIONING FOR AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JUDITH A MENGEWEIT (OWNER) of the aforesaid building. SUFFOLK CO~TI"fDEPARTMENT OF HEALTHAPPROVAL N/A RLRCTRICAL c~KTIFICATE NO. 36026 11/19/10 PLIERS ~a(TIFICATION DA'r~u N/A Authorl zed Signature Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 36026 Z Date NOVEMBER 16, 2010 Permission is hereby granted to: JUDITH A MENGEWEIT PO BOX 186 SOUTHOLD,NY 11971 for : "AS BUILT" INSTATJ,ATION OF AIR CONDITIONING UNIT AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 070 pursuant to application dated NOVEMBER Building Inspector to expire on MAY 495 JOCKEY CREEK DR SOUTHOLD Block 0002 Lot No. 017 5, 2010 and approved by the 16, 2012. Fee $ 400.00 Authorized Signature Rev. 5/8/02 ORIGINAL Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees I. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy o£Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction: Old or Pre-existing Building: '~'~'~ (check one) Location of Property: q House No. Stre~) Hamlet Owner or Owners of Property: ~_~ ,%"x ~---~ ,,2( ~5 ~ ~,)~. 'FI~ Suflblk County Tax Map No 1000, Section '-~ ~ Block Subdivision Filed Map. __ PermitNo. ~ {~t~72~, Date 0fPermit. [[ - ]~' - tO Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ '~& ~2>/5.,~ Final Certificate: L~ ~ch~e~e) Town tlall Anncx 54375 Mare Road P.O. Box 1179 Southold, NY 11971-1}!}.5!} Tek!phone (631) 765-1802 Fax (63I) 765-.9502 ro.qer, richert~town.so uthold, ny. us BUILI)ING DEPARTMENT TOWN OF $OUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION ssued To: Judith Mengeweit ~,ddress: 495 Jocky Creek Dr City: Southold St: NY Zip: 11971 ~tuilding Permit #: 36026 Section: 70 Block: 2 Lot: 1~ WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: as built DBA: License No: SITE DETAILS Office Use Only Residential ~ Ind°°r [X~ Basement Commedcal Outdoor 1st Floor New Renovation 2nd Floor Addition Survey Attic INVENTORY Service 3 ph Hot Water GFCl Recpt Main Panel NC Condenser Single Recpt Sub Panel NC Blower Range Recpt Transformer Appliances Dryer Recpt Disconnect Switches Twist Lock Other Equipment: 1-as built central air conditioner  Service Only l~ Pool Hot Tub Garage Ceiling Fixtures ~r~l~ HID Fixtures Wall Fixtures I I Smoke Detectors Recessed Fixtures I I CO Detectors Fluorescent FixturE~ Pumps Emergency Fixture Time Clocks Exit Fixtures I I TVSS Notes: Inspector Signature: Date: Nov 19 2010 81-Cert Electrical Compliance Form TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ~] ELECTRICAL (FINAL) / REMARKS: TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. north fork. net/Southold/ / Examined //// ~ 20 Approved I ~?.//'" 20 / ;9 Disapproved a/c Expiration PERMIT NO. ',~ (e a .LC BUILDING PERMIT / Do you have or n, Board ot 4 sets of Plannin Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mai, to:  ! Building Inspector ~---~' CATION FOR BUILDING PERMIT a.' ~ filledli~:;tT;:~t~oNr:n ink and sii~ittld to~tt! ~u~i) [ In.,~cto'r 2~ih 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways· c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required· APPLICATION 1S HEREBY MADE to the Building Department for the issuance ora 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, or 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 for necessary inspections· ~ignature of applicant or name, ifa corporation) (Mailing address of applicant) I State whether applicant is owner, lessee, agent, architect, engineer, general contractoA~lt~l~,~rL~builder r' :. DATF' "' Name of owner of premises latesO~P~f eu~cum~ OeP~ENT AT (As on the tax roll or ~2 8~ TO 4 ~ FOR THE If applicant is a corporation, signature of duly authorized officer FOLLO~NG INSPECTI~8: (Name and t t e of corporat fim0-.'ANO,r OR v Builders License No. Plumbers License No. '. r- ....... , *~ -r,- Electricians License No. Other Trade's License No. Lo~ti~/a~ of land on which proposed work will be done: % Crc e I& House Number Street ~3 County Tax Map No. 1000 Section -~ ~'~ Block Subdivision 1. FOUNDATION - TVVO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAlllNG, PLUMBING, STRAPPING, ELECTRICAL & CAULKING 3. INSULRTION 4. FINAL - CONSTRUCTION & ELECTRICAL MUST BE COMPLETE FOE C.O. ALL CONSTRUCTION SHALL MEET THE REOUIREMENTS OF TF~E CODES OF NEW YORK STATE NOT RESPONSIBt.E F¢ R DESIGN OR CONSTRUCTION ERRORS. Hamlet Lot ~ot Filed Map No (Name) 2. State existing use and occupancy of prerr~ses and intended use and occupancy of proposed construction: a. Existing use and occupancy ~-~ C. ~ ~ '~ \ b. Intended useand occupancy 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work Estimated Cost Fee If dwelling, number of dwelling units If garage, number of cars (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height. Number of Stories Rear __Depth Dimensions of same structure with alterations or additions: Front Depth Height Number of Stories Rear 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front /~----------------------------------~x -~ Rear .Depth I 0. Date of Purchase Name of Former Owner I I. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO . 13. Will lot be re-graded? YES NO __Will excess fill be removed from premises? YES__ NO 14. Names of Owner of premises Name of Architect Name of Contractor Address Phone No. Address Phone No Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES__ NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO __ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at I 0 feet or below, must provide topographical data on survey. STATE OF NEW YORK) COUNTY OF~ ¢'~q~: ~"~ (~t L~ 3_ ~. ~ ~ O,5('OL-, being duly sworn, deposes and says that (s)he is the applicant (Name of individual ~igtfirt$1i:bntract) above named, (S)He is the '~'-('~:~:' O'- J~-)('/'q >c~ _ · ' .... ¢O0riim4tor Agent, C r~orate Officer, ere.) of said owner ~'i: &ne~'s,:and:is~Ul'3"aut~orized to perform or have performed the said work and to make and file this application; that all Statements C6fi'taifl~d iri t~i~a~pp[iCation are true to the best of his knowledge and belief and that the work will be performed in the mauner set f(~th in'the application filed therewith. Sworn to before me this .~z7~ day of /,,_)~r~) // ~- _ (Not~y~'ffublic Signature of Applicant Towa 1~11 ~m~ P.O..Box 1179 · .Somhold~ NY 11971-~59 Telephone (6~D ~ESTED BY: Company Name~ · X)WN OF APPLICATION FOR ELECTRICAL INSPECTION· JOBSITE INFORMATION: *Namf~:, *Address: · *Cross Street: *Phone No.: Permit NO.: Tax Map District: (*!ndi~ates required information) 1000 Se~ion: :~O' ~ock: ~ Lot: *BRIEF DESCRIPTION OF WORK (Please Print. Clearly) (Please Circle Alt That.e;pply). *Is.jOb ready for Inspection: .Do you need a Temp Certlficat.e: YES / NO Rough In' Temp'lnformation (If needed}· *Service size: 1 Phase 3Phase 100 150' 200 300 *New Service: Re-connect Underground Number of Meters Change of Service Additional InfOrmation: PAYMENT DUE WITH APPLICATION 350 400 Other Overhead Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY I.OCATIOH: S.C.T.M. #: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A I ~'~ ~ ~ ~ /~ . STORM-WATERF GRADING, O~,AG. ~D ER~ION CO~ROL P~ ~ s~ B~K ~t CERTIFIED BY A DESIGN PROFESSIO~ IN THE ~ATE OF N~ YOR~ sCOPEOFWO~ - PRO~S~ CON~U~ON l'l'~ / WO~S~S~ ~ Y~ No ! a. ~at ~ t~ To~l Ama of ~ Pm~ Pa~ls? (IndUe To~l ~a of all Pa~ls ~t~ ~in ~ ~11 ~ls PmJ~ Re~ln ~ Sto~Wa~r Run~ Generated by a T~ (2") In~ ~in~ll ~ S~? the S~. of Wo~ for Pm~sed ~ns~on) b. ~at b ~e Total Ama of La~ C~ng (S.F. / ~) (~is item ~11 Include all mn~ff ~t~ by s~e clead~ an~ ~nstm~lon a~6~ as ~11 as all ancot Ground Di~a~ ~rthe pm~s~ Site Impmvemen~ and the ~nent ~aflon ~ns~n a~ impewious su~s.) (s.F. ~ ~) 2 D~s the Site Plan ancot Su~ Sh~ NI p~ PRO~E B~ ~RO~ D~ON {~ ~ .~ ~N~ DmMage ~ Indicting Size & L~fion?  item shall include afl Pw~ Grade Cha~es and and s~iment ~n~l pmcfi~s ~at ~11 ~.us~ to ~n~l see erosion and s~ ~ter discha~es. ~ls item must ~ maln~Med ~m~h~ ~e EnUm Constm~ion PeH~. 4 Will ~is Pmje~ R~uim any Land Filling, Grading or Excavation where there Is a ~ange ~ ~e Natu~ ~isting Grade Involving mom ~an 200 Cubic Ya~s of Matedal wi~in any Pa~l? (5,000 S.F.) Square Feet of G~nd Sudan? 6 Is ~ere a Na~m~ Water Cou~ Running ~mugh ~e Site? Is ~is Pmje~ wi~in ~e Tmst~ Juds~on Gemini DEC SWPPP Requlmmen~: or within One Hundred (100') ~et of a We~a~ or di~a~ ~ ~ (t) ~ ~ a~s; In~ing dl~n~s of ~ss ~n ~e a~ ~8t 7 Will ~em be .Site pmpam~on ~ ~fing Grade Sl~s am pad of e ~er ~ ~an ~ ~ u~i~ db~ one or ~m a~ of ~; ~ich Ex~ Fifteen (15) ~t ~Ve~l ~se to indud~ ~ns~n a~s I~i~ soi'd~ of le~ ~n one (1) acm ~ One ~undmd (100') of Ho~n~l Distant? ~ -- ~PPP'~ S~ll m~ ~ Minimum Requlm~n~ ~ ~e 5PDES ~ml Pe~ 8 ~ll Driveway, Pa~ng ~s or ~ Im~us COU~ OF ~.L2..~.~ ................... SS ~er ~or representative of ~e O~er or O~e~, ~d is duly auto'ed W ~o~ or have ~o~ ~e s~d ~rk ~d to ~e ~d ~e ~s apph~fion; ~at ~1 s~emen~ con'ned M ~is app~on ~e ~e W ~e best of his ~o~edge ~d ~ef; ~d ~t ~e work ~11 be pedo~ed in ~e m~ner set fo~ M ~e ~p~cafion ~ed hem~. ~ Sworn to before me ~s; FORM SUBMITTAL DATA SHEET AFFINITY SPLIT SYSTEM AIR CONDITIONER UNITS 12 SEER 2, 2-112, 3, 3-1/2, 4 & 5 TON MODELS: CMA024 THRU 060 YORK Heating and Air Conditioning JOB NAME: LOCATION: PURCHASER: ORDER NO: ENGINEER: SUBMITTED TO: FOR: REF: APPROVAL: CONSTRUCTION: SUBMITTED BY: DATE: UNIT DESIGNATION: SCHEDULE NO, MODEL NO. PRODUCT DATA Coolina Performance Total Capacity MBH Outdoor Design Temp °F Electrical Data Power Supply. / I Total Unit Ampacity AMPs Power Input Req. KW Minimum Wire Size AWG Maximum Overcurrent Device E] Fuses [] Circuit Breaker Unit Weioht Unit Weight LBS CQUS LISTED DIMENSIONS - INCHES All dimensions are in inches They are subject to change without notice Certified dimensions will be provided upon request. Unit Dimensions Refrigerant Connection Model (Inches) Line Size A B C Liquid Vapor 024 29~1/2 37 31 030 29-1/2 37 31 036 29-1/2 37 31 3/8" 042 33-1/2 37 31 7/8" 048 39-1/2 37 31 060 39-1/2 37 31 7/8" * Expander fitting required for 1-1/8" line set. Unitary Products Group 036-22855-001 Rev A (0404) FEATURE~ UL approval (units & accessories) CSA listed and ARI certified 5-year limited pads warTanty 10-year limited warranty on the compressor Copper tube/aluminum fin coil Hi and Lo pressure switches standard Durable construction Powder-painted steel cabinet Factory wired R-22 total system charge (thru 15 tt of lines) Sweat refrigerant connections Re-usable service valves Slide down electrical compartment for easy access Stamped coil guard Composite base pan Full service access panel MATCHING AIR SIDE EQUIPMENT Model No. (_ ) Submittal Form No (. ) FIELD INSTALLED ACCESSORIES Dehumidification Control (2HU16700124) ( _) Thermostat ( ) Thermal Expansion Valve* ( ) Low Ambient Pressure Switch Kit (. ) Hard Start Kit (. ) * Must be installed for proper pen~ormance (Refer to form 036-21554-001 for detailed specifications on the unit and its accessonos ) CLEARANCES Front of Unit ...................... 24 inch All Other Sides ................. 12 inch Above Unit .................... 60 inch Below Unit 0 inch *Must be installed for proper performance NOTES: Subject to change without notice Printed in U,SA 036-22855-001 Rev. A (0404) Copyright © by York International Corp. 2004. All rights reserved, Supersedes: Nothing Unitary 5005 Norman Products York OK Group Drive 73069