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Home My WebLink About36721-ZTown of Southold Annex 54375 Main Road Somhold, New York 11971 10/26/2011 CERTIFICATE OF OCCUPANCY No: 35257 Date: 10/26/2011 THIS CERTIHES that the building Location of Property: SCTM #: 473889 Subdivision: AS BUILT ALTERATION 1150 Smith Rd, Peconic, Sec/Block/Lot: 98.-3-27 Filed Map No. conforms substantially to the Application for Building Permit heretofore 9/2/2011 pursuant to which Building Permit No. 36721 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for winch tins certificate is issued is: "as built" finished basement in an existing one family dwelling as applied for. Lot No. filed in this officed dated dated 9/28/2011 The certificate is issued to Amador, Xavier (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 10/25/11 36721 10/21/11 oseph Kollen Jr. ?n~qz~/~Slgnature 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 #: 36721 Permission is hereby granted to: Amador, Xavier 1150 Smith Rd Peconic, NY 11958 Date: 9/28/2011 To: obtain permit for "as built" finished basement in an existing dwelling as applied for At premises located at: 1150 Smith Rd, Peconic SCTM # 473889 Sec/Block/Lot # 98.-3-27 Pursuant to application dated 9/2/2011 To expireon 3/29/2013. Fees: and approved by the Building Inspector. SINGLE FAMILY DWELLiNG - ADDITION OR ALTERATION CO - ALTERATION TO DWELLING Total: $975.20 $50.00 $1,025.20 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF occUPANcy This applioation must be f'filed in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey 9f property with accurate location of all buildings~ property lines, s~'oets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (8-9 form). 3.. Approval of electrical installation from Board 6f 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 requiren~nts. B, For existing buildings (prior to April 9, 1957) non-conforming useS, or buildings and "pre-existing" land uses: 1. Accurate survey o f property showing all property lines, streets, building and:unusual natural or topographic featuras. 2. A properly completed app}ication 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 1. Ce`rt~~cate ~f ~~eupan~y ~ New dwe~~ing $5~~~~~ Additi~ns t~ dwe~~ing $5~.~~~ A~terati~ns t~ dwe~ling $5~.~0~ · Swimming po01 $50.00, Accessory building $50.00, Additions to accessory building $50.00, Businesse~ $50.06. 2. C. eytificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy - $.25 ' 4. Updated Certificate of Occupancy - $50.00 ' 5. Temporary Certificate 0f Occupancy ~ Residential $15.00, CommerCial $15.00 New Construction: Old or Pre-existing Building: ~) (ch~ck one) House No. Streei Hamlet Owner or Owners of Property: Suffolk .County Tax Map No 1060, Section q ~ ' Sub&ivisi~n Permit No. Health Dept. Approval: .Da~ofPermit. Block Underwriters Approval: Lot- Planning Board Approval: Request for: Temporary Certificate Foe Submitted: $ ,..~7~~._~_._~__ Final Certificate: (check one) Aonlican! Sivnature Town Hall Annex 54375 Main Road P.O. Box 1179 Southo}d, NY I 1971-0959 Telephone (631 ) 765-1802 Fax (63 I) 765-9502 ro.qer r chert~town southo d ny us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION ssued To: Xavier Amador Address: 1150 Smith Rd City: Peconic St: NY Zip: 11958 Building Permit #: 36721 Section: 98 Block: 3 Lot: 27 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 ~ Indoor ~ Basement ~ Service Only ~ Commerical Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Servicelph ~ Heat ~ DuplecRecpt ~ Service 3 ph Hot Water GFCI Recpt Main Panel NC Condenser Single Recpt Sub Panel NC Blower Range Recpt Transformer Appliances Dryer Recpt Disconnect Switches Twist Lock Other Equipment: Ceiling Fixtures ~ HID Fixtures Wall Fixtures Ill Smoke Detectors Recessed Fixtures~ CO Detectors Fluorescent Fixture ~.~ Pumps Emergency Fixtures~ Time Clocks Exit Fixtures [~ TVSS finish basement, 4 combination smoke/co detectors, 1 heat lamp Notes: Inspector Signature: Date: Oct 21 2011 81-Cert Electrical Compliance Form Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (63 I) 765~ 1802 Fax (631 ) 765-9502 BUILDING DEPARTMENT TOWN OF SOUI'HOLD CERTIFICATION Date: Building Permit No. (Please print) Plumber: (Please print) lead. I certify that the solder used in the water supply system contains less than 2/10 of 1% Sworn to before me this dayof ~C<~-'~[ , 20 Notary Public,---~ [t ~'~?~Y~ County CONNIE D. BUNCH c TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND ] FRAMING / STRAPPING [ ] FIREPLACE & CHIMNEY [ ] ROU~PLBG. [ ] ~ULATION [ ~FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS..~h/L~O~ //~ ~ ~ DATE TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION ¶ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS~JLATiON [ ] FRAMING/STRAPPING Ii. FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] RRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMAI~LS: DATE ~ INSPECTOR INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ] INSULATION [ ] FINAL [ ] FIRE SAI-,'~ ¢ INSPECTION [ ] RRE RESISTANT CONSTRUCTION [ ] RRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ' ~], ELE~. ~siCAL (FINAL) REMARKS: DATE~ INSPECTOR~_.~~~.~-- TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ] INS~JLATION [ ]FRAMING/STRAPPING [*~[FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: ~Y~. ~) DATE -- INSPECTOR ~-~ TOWN OF SOUTHO~-~--?T~ BUILDING D E PART ~Jl~-~-:---:~-~ TOWN HALL SOUTHOLD, NY 119/'lj TEL: (631)765-1802 FAX: (631) 765-9502 SoutholdTo Examined Approved Disapproved a/c Expiration ~]~ .20 13 ' Building Inspector BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey Check ~ /'.~_,'D'x/q/~ Septic Form N.Y.S.D.E.C. Trustees Flood Permit Single & Separate Storm-Water Assessment Form Contact: Mail to: 3~-{5~,x ~'"01 ~ ¢-N APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ~ o a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 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 pan for any purpose what so ever until the Building Inspector issues a Ce~ificate of Occupancy. t. gve~ building permit shall expire if the work authorized has not connnenced 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 prope~y 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 IS HEREBY MADE to the Building Depamnent for the issuauce 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 bnilding for necessary inspections. ~t ff-]Si~ature of applicant or Dame, ifa corporatiqn) ~~ (Mailing address ofapplicant)~t State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ~*~ ~ ~ o C. (As on the tax roll or latest deed) If applicanQs//~l ~ a ~fq~°rgti°~ signa~re[o L /~ of dul~authori~ed~ce~~officer ' ~" (~ame an~ title ofco¢or~te officer) 'ders License No. [ ~ ~5~ - ~. ers LicenseNo. ~ ~ ns License No. ) ~ ~ 's LicenseNo. -) ~ . nd on wh~_P.~d work .will be e: ~rwi,, , ,---. ~-~Street_ ~<:~.~,~,--~ ~ ~'~a,~ \ Q... Hal,~mltet~ Block Filed Map No.. Lot Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~c~[~ .~a,-~',ltt b. Intended use ~d occupancy ~ ~ q ~ ~ ~ ml ~f / 2 ~ ~ _ 3. Nature of work (check which applicable): New Building Addition Alteration Removal Demolition Other Work Repair (Description) 4. Estimated Cos~ I 0[ ~ Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If ~ara~e, number of cars 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 Height Number of Stories Rear .Depth 9. Size of lot: Front Rear .Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated /tot~F[12~~ 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO 13. Will lot be re-graded? YES__ NO ,~..kVill excess fill be removed from premises? YES NO 14. Names of Owner of premises)~jk~l~h~:~Address I~%-'O ,..,~M[kJ~ NameofArchitect klc,_c~ctl"bt,a~i oA _ Address.~otSq~4 ' PhoneNo-'3to~ Name ofContractor'30?.,~,[[ KolLLY,-, ~,?l'. Addressl~-o~ --Cc.M~,}I ~..>P,~h~_neNo.'DO,~-,- 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 ora 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 10 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES · IF YES, PROVIDE A COPY. NO ¢ STATE OF N~W YORK) COUNTY O ~)~: .,_w~.~.~ /~._ ~ / [ff~ beingdulysworn, deposesandsaysthat(s)beistheapplicant (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 applicatio' that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be pertbrmed in tbe manner set forth in the application filed therewith. Sworn m before me tiffs ~ ~ F'~ day of .,~Z~'37L 20 // ¥""',"'~' ~ ~ -- ' VICKI TOTH \/ I,(L-, ~,.- ~ /~ No~Public.~New~rk ~(~ ~Y ~ N~. 0!Tn~m0696 "~ta-;Ptb,,u ,y c ~in~lk~un C0mm~ssmn ~at!e~o~a t/~ Date: To: Re: JAMES J. DEERKOSKI P.E. 260Deer Drive Mattituck, NY 11952 (631) 774 7355 August 15,2011 Town of Southold Building Dept 1150 Smith Rd. Peconic, NY 11958 To Whom It May Concern: This is to certify that existing septic system at the above mentioned dwelling is in good w°rkingI f;do~r~a~ ~i a°nf~ afl'it ieontn s'~i ~~o; hesi tP°~t~ed tdl cont~c~ e~.. e~th abne~ ;~ nm.. J~e~s ~~,eerkoski FORA~ER O~NER LAND IMP. TOWN OF SOUTHOLD VI.. FARM TOTAL DATE PROPERTY RE4 YJLLAG£ W ORD CARD DISTRICT SUX ? ACREAGE L TYPE OF BUILDING AGE NEW NORMAL ABOVE Form Acre Value !LOT ..~ BUILDING CONDITIOJ' BELOW Velue Per Acre JEst. Mkt. Value oral illable '3 Ioodland ~/ampland mshlcmd ome Plot illable 1 BULKHEAD illoble 2 DOCK FRONTAGE ON WATER FRONTAGE ON ROAD/0 0 ~ REScheck Software Version 4.4.1 Compliance Certificate Project Title: Armador Residence Energy Code: 2010 New York Energy Conservation Construction Code Location: Suffolk County, New York Construction Type: Detached I or 2 Family Glazing Area Percentage: 4% Heating Degree Days: 5750 Climate Zone: 4 Construction Site: Smith Road Peconic, NY Owner/Agent: Designer/Contractor: Nancy Dwyer Design Consulting, Inc. Southold, NY Compliance: 5.6% Better Than Code Maximum UA: 107 Your UA: 10t Wall 1: Wood Frame, 16' o.c. Window 1: Vinyl Frame:Double Pane with Low-E Ceiling 1: Flat Ceiling or Scissor Truss 719 13.0 0.0 57 26 0.320 8 710 19.0 0.0 36 Compliance Statement: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The p~)p~ building has been designed to meet the 2010 New York Energy Conservation Construction Code requirements in REScheckVemion 4.4~xll an~'~ comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name-Title Si~a~ ' ~X~. Datl / Project Title: Armador Residence Data fllename: Untitied.rck Report date: 0gl15/11 Page I of 4 REScheck Software Version 4.4.1 Inspection Checklist Ceilings: Ceiling 1: Flat Ceiling or Scissor Truss, R-19.0 cavity insulation Comments: Above-Grade Wells: Wall 1: Wood Frame, 16" o.c., R-13.0 cavity insulation Comments: Windows: Window 1: Vinyl Frame:Double Pane with Low-E, U-factor: 0.320 For windows without labeled U-factors, describe features: #Panes Frame Typo Thermal Break? Comments: Air Leakage: [] Joints (including dm joist junctions), attic access openings, ponetrations, and all other such openings in tt~ building envelope that are sources of air leakage ara sealed with caulk, gasketed, weatbamthppod or othem~lae sealed with an air barrier material, suitable film or solid material. [] Air barrier and sealing exists on common walls between dwelling units, on extedor walls behind tabs/showers, and in oponings between window/deer jambs and framing, Wood-burning fireplaces have gasketad deem and outdoor combustion air, [] Automatic or gravity dampors ara installed on all outdoor air intakes and exhausts. [] Recessed lights in the building thermal envelope are I ) typo lC rated and ASTM E283 labeled and 2) sealed with a gasket or caulk between the housing and the interior wall or ceiling covering. [] Access doors separating conditioned from unconditioned space ara weather-strippod and insulated (without insulation camprassion or damage) to at least the laver of insulation on the surrounding surfaces. Whera loose till insulation exists, a baffle or retainer is installed to maintain insulation application. Air Sealing and Insulation: [] Building envelope air IJghlness and insulation installation complies by either 1) a post ruugh-th blower dour test result of less than 7 ACH at 33.5 psf OR 2) the following items have been setislied: (a) Air herders and thermal barrier: Installed on outalde of air-pormeable insulation and breaks or joints in the air barrier ara filled or repaired. (b) Ceiling/attic: Air barrier in any drapped calling/soffit is substantially aligned with insulation and any gaps are sealed. (c) Above-grade walls: tasulatlon is installed in substantial contact and continuous alignment with tbe building envelope air barder. (d) Flours: Air barrier is installed at any exposed edge of insulation. (e) Plumbing and wiring: Insulation is Ha(ed between outside and pipes. Batt insulation is cut to fit around widng and plumbing, or sprayed/blown insulation extends behind piping and widng. (f) Corners, headers, narrow framing cavities, and dm joists are insulated. (g) Shower/tub on extedor wall: Insulation exists between showers/tubs and exterior wall. Sunrooms: [] Sunrooms that are thermally isolated from the building envelopo have a maximum fenestration U-factor of 0.50 and the maximum skylight U-tactor of 0.75. New windows and doors separating the sunroom f~om conditioned space meet the building thermal envelope requirements. Materials Identification and Installation: [] Materials and equipment ars installed in accordance with the manofacturer's installation instructions. I~ Insulation is installed in substantial contact with the surface being insulated and in a manner that achieves the r~ed R-valse, Project Title: Armador Residence Report date: 09/15/11 Data fllename: Untitied.rck Page 2 of 4 Materials and equipment ara identified so that compliance can be determined. [] Manufacturer manuals for all installed heating and cooling equipment and service water heaUng equipment have been provided. insulation R-values and glazing U-factors are clearly marked on the building plans or specifications. Duct Insulation: [] Supply ducts in attics ara insulated to a minimum of R-8. All other ducts in unconditioned spaces or outside the building envelope ara insulated to at least R-6. Duct Construction and Testing: [] Building framing cavities are not used as supply ducts. [] All joints and seams of air ducts, air handlers, filter boxes, and building cevities used as ratum ducts ara substantially airtight by means of tapes, mastics, liquid sealants, gaskedng or other approved cfosura systsms. Tapes, mastics, and fasteners ara rated UL 181A or UL 181B and are labeled according to the duct construction. Metal duct cennecbons with equipment and/or fittings are mechanically fastened. Crimp joints for round metal ducts have a contact lap of at least I 1/2 inches and ara fastened with a minimum of three equally spaced sheet-metsl screws. Exceptions: Joint and seams covered with spray poly~rathane fearn. Whera a partially inaccessible duct connection exists, mechanical fasteners can be equally spaced on the exposed portion of the joint so as to pravent a hinge effect. Continuously welded and locking-type longitudinal joints and seams on ducts operating at lees than 2 in. w.g. (500 Pa). [] Duct tightness test has been performed and meets one of the fotiowing test criteha: (1) Postcenstruction leakage to outdoors test: Less than or equal to 8 cfm per 100 ft2 of conditioned flour area. (2) Postcenstruction total leakage test (including air handler encfosura): Less than or equal to 12 cfm par 100 fi2 pressura differential of 0.1 inches w.g. (3) Rough-in total leakage test with air handler installed: Less than or equal to 6 cfm par 100 fl2 of conditioned flour area when tested at a prassura differential of 0.1 inches w.g. (4) Rough-in total leakage test without air handler installed: Less than or equal th 4 cfm per 100 112 of conditioned floor area. Heating and Cooling Equipment Sizing: [] Additional requirements for equipment sizing ara included by an inspection for compliance with the International Residential Code. [] For systems serving multiple dwelling units documentation has been submitted demonstrating compliance with 2009 IECC Commercial Building Mechanicel and/or Service Water Heating (Sections 503 and 504). Circulating Service Hot Water Systems: [] Circulating service hot water pipes ara insulated to R-2. [] Cimulating service bet water systems include an automatic or accessible manual switch to turn off the circulating pump when the system is not in use. Heating and Cooling Piping Insulation: [] HVAC piping conveying fluids above 105 degrees F or chi#ed fluids below 55 degrees F are insulated to R-3. Swimming Pools: [] Heated swimming peols have an on/off heater switd~. Pool heaters operating on natural gas or LPG have an electronic pilot light. Timer switches on pool heaters and pumps are present. Exceptions: Where public health standards require continuous pump operation. Whara pumps operate within solar- and/or waste-heat-recovepj systems. [] Heated swimming pools have a cover on or at the water surface. For poots heated over 90 degrees F (32 degraes C) the cover has a minimum insulation value of R-12. Exceptions: Covers ara not required when 60% of the heating energy is from site-recovered energy or solar energy source. Lighting Requirements: 71 A minimum of 50 pament of the lamps in bermanenfly instaltsd lighting fixturas can be cetsgorized es one of the following: (a) Compact fluorescent (b) T-8 or smaller diameter linear fluorascent (c) 40 lumens per watt for lamp wattage <= 15 (d) 50 lumens per watt for lamp wattage > 15 and <= 40 Project Title: Armador Residence Report date: 09/15/11 Data flleeame: Unfitled.rck Page 3 of 4 (e) 60 lumens per watt for lamp wattage > 40 Other Requirements: Snow- and ica-melting systems with energy supplied from the service to a building shall include automatic cootmis capable of shutting off the system when a) the pavement temperature is above 50 degrees F, b) no precipitation is falling, and c) the outdoor temperature is above 40 degrees F (a manual shutoff control is also permitted to satisfy requirement 'c'). Certificate: [] A permanent certificate Es provided on or in the electrical distribution panel listing the predominant insulation R-values; window U-factors; type and efficiency of space-conditioning and water heating equipment. The certificate does not cover or obstruct the visibility of the circuit directory label, sei~ice disconnect label or other required labels. NOTES TO FIELD: (Building Department Use Only) Project Title: Armador Residence Report date: 09/15/11 Data filename: Untitled.ink Page 4 of 4 2010 New York Energy Conservation Construction Code Certificate Ceiling / Roof 19.00 Wall t3.00 Floor I Foundation 0.O0 Ductwork (unconditioned spaces): Window 0.32 Door Heating System: Cooling System: Water Heater: Name: Comments: Date: Town Hall Annex 54375 Main Ro~d P.O. Box 1179 Southold, NY 11971-0g$9 Telephone (631) 765-1802 ro~er riche~ "~" ¢31) 7r~.95~ · r~(c~.[own.soumola .ny.u~ REQUESTED BY: Company Name: Name: License No.: AddresS: B[m :DING DEPARTMENT TOWN OF $OUTHOLD APPLICATION FOR ELECTRICAL INSPECTION Date: Phone No.: JOBSITE INFORMATION: (*Indicates required information) *Name: 'Address: //~ ;~,~ ~. ~.:~- ~.~ *Cm~ Street: *Phone No.: 631 - 7~3 ' 3r-rl~''~ Permit No.: Tax. Map District: 1000 Section: ~ *BRIEF DESCRIPTION OF _WORK (Please Print Clearly) Block: ~,~ Lot: ~- ~'- (Please Circle Ali That Apply) *Is job ready for inspect On: *Do you need a Temp Certificate: YES / NO Temp Information (If needed) *Service Size: 1 Phase 3PhaSe 100 150 200 300 350 400 Other *New Service: Re-connect Underground Number of Meters Change of Service Overhead Additional Information: PAYMENT DUE WITH APPLICATION 82~-Request for Inspection Form __ ~ ~ ~ ELECTRICAL ~ INSPECTION REQUIRED ANDE~EN G45 GLIDING WINDOW ~ ~ LAUNDRY , ~ BATH UNHRATRD, UNFINID~D ' CERTIFICATE OF OCCUPANCY NOTIFY BUILDING D~R~EN r AT 765-1802 8 AM TO 4 PM FOR TNE FOLLO~NG INSPECTIONS 1. FOUNDATtON- T~ REQUIRED FOR POURED CONCR: rE 2. ROUGH - FRAMING, PLUMBING, 8TRAPP NG ELECTRICAL & CAULKING 3. INSU~TION 4. FINAL. CONSTRUCTION & ELECTRICAL ~UST BE COMPLETE FOR ,3 0 YORK STATE NOT RESPONSIBLE FOR - DESIGN OR CONSTRUCTION ERRORS ///,__, ..- ¢ ~,) OF~._ I 3 INSULATION ¢ ~1" DRYWALL EXIDTIN G POUNDATION; OUTLINE OP I=XIDTING~ T ~./~~ UI~B CER~,,~('~¢',%~ Z~ FAATITION; ~" D~ALL ON L1'2~, b U ~ z b " ¢ERTIFICATE OFOcc, I ':BLUMBING ALI_ PLUMRIN¢~ WABTE & v,,,:. , ~ TESTING 8EFQRE CO~/EHiNG PAGE: