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jF Town of Southold Annex 10/8/2014 Yy P.O.Box 1179 : 54375 Main Road Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 37200 Date: 10/8/2014 THIS CERTIFIES that the building GENERATOR Location of Property: 1755 Sigsbee Rd, Laurel, SCTM#: 473889 Sec/Block/Lot: 144.-2-13 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 6/27/2013 pursuant to which Building Permit No. 38152 dated 7/2/2013 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: accessory generator as applied for. The certificate is issued to Condon, Barbara (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 38152 7/31/2014 PLUMBERS CERTIFICATION DATED —� Authorized Signature TOWN OF SOUTHOLD F0 2 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#: 38152 Date: 7/2/2013 Permission is hereby granted to: Condon, Barbara 1755 Sigsbee Rd Mattituck, NY 11952 To: construct an accessory generator as applied for At premises located at: 1755 Sigsbee Rd, Laurel SCTM # 473889 Sec/Block/Lot# 144.-2-13 Pursuant to application dated 6/27/2013 and approved by the Building Inspector. To expire on 1/1/2015. Fees: ACCESSORY $100.00 CO -ACCESSORY BUILDING $50.00 ELECTRIC $85.00 Total: $235.00 Building Inspector 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: 1. 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). 3. 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. B. For existing buildings(prior to April 9,1957)non-conforming uses,or buildings and"pre-existing"land uses: 1. 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 1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2. Certificate 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 of Occupancy-Residential$15.00,Commercial$15.00 Date. l4-l New Construction: Old or Pre-existing Building: (check one) Location of Property: f �!vf ���g �'� �t�-r"VM- HouseTNo. Stre6t Hamlet Owner or Owners of Property: © ,t7 &"A" Suffolk County Tax Map No 1000,Section /LCX Block 2. Lot Subdivision Filed Map. Lot: Permit No. Date of Permit. —/ _Applicant: 1--e,g Health Dept.Approval: Q/ZQ Underwriters Approval: Planning Board Approval: AU Request for: Temporary Certificate Final Certificate:_� (check one) Fee Submitted: $ ature O��OF SOUTyoI � o Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 �Q roper.richert(-)town.southold.ny.us Southold,NY 11971-0959 UNTY,Nc�' BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Condon Address: 1755 Sigsbee Road City: Laurel St: NY Zip: 11948 Building Permit#: 38152 Section: 144 Block: 2 Lot: 13 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Nicholas Kerzner Electric License No: 42972-me SITE DETAILS Office Use Only Residential X Indoor X Basement Service Only Commerical Outdoor X 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph 200a Heat Duplec Recpt Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel 200a A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks Disconnect 200a Switches Twist Lock El Exit Fixtures f] TVSS Other Equipment: 200a overhead service, 14KW stand by generator with 200a transfer switch Notes: Inspector Signature: Date: July 31 2014 81-Cert Electrical Compliance Form.xls OF SOUTyo�o N _ TOWN OF SOUTHOLD BUILDING DEPT. J f ,4� 765-1802 v)� INSPECTION FOUNDATION IST ROUGH PLUMBING [ ] [ ] [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE 3I INSPECTOR s� ' • 1' 11 • • Af INOU"TION ;A• N.Y. �I �1 �I I� _I �I � Y JL TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST AUILANG DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631)765-1802 Planning Board approval FAX: (631)765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO. .3 t l�gw Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Examined T 20_$ Storm-Water Assessment Form I� Contact: Approved X20 ! Mail to: Disapproved a/c 24 Phone: CQ Expiration 20_,2 G. DEP. TOW O�� Building Inspector JUN 2 7 2013 APPLICATION FOR BUILDING PERMIT Date 6',-2 0 ,20-/,3— BLDG. 01BLDG.DEPT. INSTRUCTIONS TOWN OF SOUTHOLD 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 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 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,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. (Signature of applicant or name,if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee,agent,architect,engineer,general contractor,electrician,plumber or builder Name of owner of premises (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: i ' 45i;A575,XW Qaw A&Mn4e- House Number Street Hamlet County Tax Map No. 1000 Section /41� Block Z Lot !3 Subdivision Filed Map No. Lot s 10 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy &&I Fe'6L- b. Intended use and occupancy '16�0 eyP'r0Z'6- 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other (Description) 4. Estimated Cost Fee Fee (To be paid on filing this application) 5. If dwelling,number of dwelling units Number of dwelling units on each floor If garage, 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 Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front_Q2 Rear /00 Depth �' 7 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law,ordinance or regulation?YES NO.S'<—:�' 13. Will lot be re-graded?YES NOV-,,Will excess fill be removed from premises?YES NO 14.Names of Owner of premises Address Phone No. Name of . t O4/A*gP -5ww4:c 4VatAddress /7-35:31/968W Phone No929L—AiR- 0/�_ Name of Contractor 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 10 feet or below,must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES NO * IF YES,PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF ) being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the ,440-iVr (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 knowledge and belief;and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this day of 20 Notary blit LINDA J COOPER pp scan NOTARY PUBLIC,State of New York X10,01C04622563,Suffolk Count_y / Perm Expires December 31,20.,L 2qa-- (91�6 of sol/ryol -Z-4 - , o Town Halt Annex J Telephone(631)765-1802 54375 Main Road • O eO6 0U�hP.O.Box 1179 ro er.richert SO4pd .nV.US Southold,NY 11971-0959 ��yy BUILDING DEPARTMENT TOWN OF SOUTIJOLD APPLICATION FOR ELECTRICAL INSPECTION ' REQUESTED BY: Date: Company Name: Name: License No.: Address: Phone No. ' JOBSITE INFORMATION: (*Indicates required information) *Name: �os� *Address: /*Cross Street:Street: �� *Phone No.: 1z Permit No.: f Tax-Map District: 1000 Section: 'Block: 2 Lot: *BRIEF DESCRIPTION OF WORK(Please Print Clearly) (Please Circle All That Apply) Is job ready for inspection: YES/ NO Rough In Final *Do you need a Temp Certificate: YES/ NO - Temp Information(!f needed) *Service Size: 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 I 82�Request for fnspection Form i of SOF ryo Town Hall Annex O 4 Telephone(631)765-1802 54375 Main Road .ayg Q� P.O.Box 1179 ron nrichertdIOxW(17.SOuCt1S.ny.us Southold,M'11971-0959 ��/ � BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL. INSPECTION REQUESTED BY: �lf.�� � � Date: 3V Company Name: Name: License No.: 14a Address: 340 6L /-l) "I Phone No.: JOBSITE INFORMATION: (*Indicates required information) *Name: *Address: 12-c 1 *Cross Street: *Phone No.: awa Permit No.: Tax-Map District: 1000 Section: Block:` Lot: 77�— *BRIEF DESCRIPTION OF WORK(Please Print Clearly) _ kM11J6D 16/11�. � G (Please Circle All That Apply) *Is job ready for inspection: ES NO Rough In Final *Do you need a Temp Certificate: E / NO Temp Information(!Lneeded) *Service Size: 1 P 3Phase 100 150 00 300 350 400 Other *New Service: Re-connect .Underground Number of Meters Change of Service rh 1 Additional Information: PAYMENT DUE WITH APPLICATION C' 82Aequest for Inspection Form (t S 20038'00" E 100.00' Scope of Work Generator Electrical Notes: I I I The project has two phases. Each Phase is to be separately billed. * All wiring and equipment are to be be provided and installed by I SHED 12'-6"--� P j P p Y �` I the Electrical Contractor(EC) in accordance with the National Generac Model QT025 25KW ; Phase I Electric Code(NEC)and Local Electrical Codes. Generator on 42"X75"X6"P.C. / Slab on Grade /' O *Order and installed New 120/240 volt 200 amp service and disconnect existing 120 1240 volt 100 * The Owner will file for and secure the necessary building permit amp service. from the Town of Southold . The electrical contractor will arrange for all inspections and secure a Fire Underwriters certificate which *Connect new service panel to existing service panel as shown. is to be turned over to the owner at the completion of the work. *Transfer existing circuits from existing panel to new panel as detailed on this plan. *All foundation penetrations for entry of directly buried feeders are to be equipped with galvanized steel sleeves. The penetrations are I / / I * Remove existing meter pan and conduit from point of existing service drop to meter and existing also to be sealed on the exterior with silicone sealant to block water 1 '� % I panel. infiltration. Phase II * Install poured concrete foundation in the location shown on the / * Install a new Generac Model QT025 in the location shown on these drawings and in accordance site plan. The size of the slab is to be 42"x 75"x 6"thick. The Slab with the manufacturer's specifications and the Residential Code of New York State. is to have an opening for routing wiring and the gas line to the generator. See manufacturer's installation instructions. *The generator is to be wired to a Generac Model RTS automatic transfer switch. * Furnish and install new Generac Model QT025 in accordance with *Wire the automatic transfer switches to the 120/240 volt 200 amp main panel. the manufacturer's specifications. r , * Install a natural gas supply pipe from the building to the generator as shown in the plans. * Furnish and install a new Generac Model RTS automatic transfer 1 % I switch as show on the drawing. * Install a Square D Model D223NRB (NEMA3R)disconnect switch l` on the exterior wall of the building. I I ` I * Furnish and installed all wiring between the generator and the 1 I 1 �� I disconnect switch, automatic transfer switch, and the main panel. % * Install a water proof sign on the wall of the building adjacent to the Existing Meter Deck it i New(3) No.3 AWG meter with the following message of This building is connected to a / nd (1) No.8 generator with an automatic transfer switch. Use disconnect switch I Disconnect Main New(3) No.3 AWG ani J THHN,THHW I Service Ifeeders and (1) No.8 THHN THH �' on this wall to disconnect generator" I Generator Gas Notes: Con ert Panel to Sub-panel % * Piping and equipment are to be be provided and installed by the f / 1 1/2"Polyethylene Pipe Electrical Contractor(EC) in accordance with the Fuel Gas Code of SDR 11.0 New York State. CV I _ I Existing 100 Amp Circuit ; I reaker Panel in 1 ,' / I * The Owner will file for and secure the necessary building permit 6 C ) Cellar Generac Model �� from the Town of Southold . The electrical contractor will arrange RTSX10 ; for all inspections and secure a certificate of completion from the Existing New Transfer Switch / - building department which is to be turned over to the owner at the 100 200 ;� I completion of the work. Amp Amp New Two Pole 100 #1755 / C ) I Breaker Amp Breaker in Breaker Panel Slots 38 nd 40 Existing Existing 2-Story isconnect Switch C ) *The EC will contact National Grid to increase the size of the Panel Electrical Residence , existing gas meter to handle a maximum demand of 750 cfh W Drop Wire % minimum. New Two Pole CU - Connection 100 Amp `V I 0 I -------------------- --'-- I New Meter and I * Replace the existing 1"0 Black pipe from the meter to the Breaker in Slots O - New Wire �j I southern wall in the cellar. Connect existing 1"0 black pipe gas 37 and 39 I t;V I Connect 1 2 1 Black Pipe to P Replace Existing c lines to the new pipe as shown in the plans. New(3) No.3 AWG N Meter-Tota existing gas service in cellar CD nd (1) No.8 New(3) No.3 AWG (3) Demand=750 cfh C) Connect and run underground from the building to the generator THHN,THHW nd (1) No.8 New /New HHN,THHW "Tt I I N I with 1 -1"0Polyethylene pipe. Generac �V 1 Z I New 200 Amp Service 1 0 1 RTS Main Breaker Panel * Install turn off valves in the pipe to the generator at the point of Automatic CC) exiting the cellar and at generator. Transfer Square D Switch odel D223NRB *All foundation penetrations for entry of directly buried gas line is Disconnect Switch I 1 1 to be equipped with a galvanized steel sleeve. The penetrations are 1 I I I also to be sealed on the exterior with silicone sealant to block water New Lot 69 infiltration. #1755 QT025 Lot 7 Tracer tape is to be installed above the gas line. Sigsbee Road Generator Residence New(3) No.3 AW I ( ) I ' i 1 — ,�_�. I *The gas line is to be checked for leaks prior to backfilling. Back fill and 1' No.8 APPROVED AS NOTED. 956.8 SCTM# 10 0-144-2 ` ` _ = 13 the excavation with material free of rocks and other debris. DATEB.P. # �Tf Electrical Riser Plan FEE -4io BY N 20038'00" W 100.00' NOTIFY BUI�DING DEPARTMENT AT 765-1802 8 AM TO 4 PM FOR THE FOEC : 1. FOUNDATION -TV-v,." REQ UIREDS'�Jbee Road FOR POURED C0N -RI=TE 2. ROUGH-FRAMING,PLUP,IP1.1,G. STRAPPING, ELECTRICAL CAULK INS 3, INSULATION 4. FINAL-CONSTRUCTION &ELECTRICAL Drier MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE ! Site Plan REQUIREMENTS OF THE CODES OF NEW - YORK STATE. NOT RESPONSIBLE FOR Scale. 1„ - 101-O11 DESIGN OR CONSTRUCTION ERRORS. U U N 2 7 2013 Boilier BLDG. DEPT. TOWN OF SOMHOLD Range OCCUPANCY OR ElExisting 1" Generator UNLAWFUL Boiler Pipe . I�.",J ��R�� � � - P Oven ,b�... I � � Gas g Meter --------------d4---- ------------------------- ------------� \Existing 1"Q Black Pifpe \\f--xisting 1"0 Black Pi ---------------- ------------------ New 1 2"ff� Replace Existing Pol eth len ELECTRICAL Replace Existing 1 V Black Pipe with y y E n eter-Total Pipe INSPECTION E UIR ATS Demand =750 cfh 1 ''z"ID Black Pipe Natural ser an P1 a To Generator Ntl GRiser Plan Replace Existing Meter-Totaeplace IExisting 1"Q Black Pipe with 1 z V Black Pipe Demand= 750 cfh Plans are prepared by Condon Engineering,P.C. It is a violation of the New York State Education Scale: 1/4" = 1' Condon Engineering, P.C. Condon Residence V"/A Interior Gas Pipe Pian Law,Article 145,Section 7209,for any person unless acting under the direction of a licensed Professional Engineer,Architect,or Land Surveyor,to alter any item in any way.If an item bearing the seal of an Engineer,Architect,or Land Surveyor is altered,the altering Engineer,Architect,or Drawn b . JJC 1755 Sigsbee Road 1755 Sigsbee Road Scale: 1/4" = 1�-0" Land Surveyor shall affix to the item his/her seal and the notation"Altered by followed by hismer Y Eml signature and the date of such alterations,and a specific description of the alteration. Mattltuck, New York 11952 Madituck, New York Date : 6-26-2013 (631) 298-1986