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"ttFai ' Town of Southold 12/14/2015 1 a,' P.O.Box 1179 14:3k,;-; f ' 53095 Main Rd , Via`,- , Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 37961 Date: 12/14/2015 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 28775 Route 25, Orient SCTM#: 473889 Sec/Block/Lot: 18.-6-25 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/17/2015 , pursuant to which Building Permit No. 39608 dated 3/23/2015 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: ADDITION AND ALTERATIONS TO EXISTING ONE FAMILY DWELLING AS APPLIED The certificate is issued to Hanlon,Robert&Frankel,Jessica of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 39608 10-08-2015 PLUMBERS CERTIFICATION DATED 12-08-2015 King Plumb&Heat f4, rize Signate >�'SUFFoI� TOWN OF SOUTHOLD ,���o� �ooy� BUILDING DEPARTMENT TOWN CLERK'S OFFICE )o SOUTHOLD, NY - 4 r o t �" 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#: 39608 Date: 3/23/2015 Permission is hereby granted to: Hanlon, Robert & Frankel, Jessica PO BOX 178 • Orient, NY 11957 To: Addition and alteration to an existing single family dwelling as applied for. At premises located at: 28775 Route 25, Orient SCTM # 473889 Sec/Block/Lot# 18.-6-25 Pursuant to application dated 3/17/2015 and approved by the Building Inspector. To expire on 9/21/2016. Fees: SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $344.00 CO -ADDITION TO DWELLING $50.00 Total: $394.00 M „-----.--- • k f -Bil. ng Insi ector 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. 3// 410/1-- New %/`- New Construction: Old or Pre-existing Building: I/ (check one) Location of Property: 2- q-75 ' A 1 P6tb G z16-Pir House No. Street / Hamlet Owner or Owners of Property: 713irr E . I4 -D// A-etc,' J f3!(C1. A A . ��gNf6,- Suffolk County Tax Map No 1000, Section Block Lot ' Subdivision_ - Filed Map. Lot: Permit No. Ze,tpoDate of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) ,1 ,av � Fee Submitted: $ (J &C,:d.-------"N Applicant Signature ��,,,4c SO(/lyOl Town Hall Annex I ~ ® : Telephone(631)765-1802 54375 Main Road % ar iiii , Fax(631)765-9502 P.O.Box 1179G% zr Southold,NY 11971-0959 1, ,oly .OQ 01� roger.richert(c�town.southold.ny.us e®UNI'( I 0 i BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Robert Hanlon Address: 28775 Route 25 City: Orient St: New York Zip: 11957 Building Permit#: 39608 Section: 18 Block. 6 Lot. 25 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Home Owner DBA: License No: SITE DETAILS Office Use Only Residential X Indoor X Basement Service Only Commerical Outdoor X 1st Floor X Pool New Renovation X 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt 11 Ceiling Fixtures 1 HID Fixtures Service 3 ph Hot Water GFCI Recpt Wall Fixtures 2 Smoke Detectors Main Panel NC Condenser Single Recpt Recessed Fixtures 10 CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks Disconnect Switches 9 Twist Lock Exit Fixtures TVSS Other Equipment: 1- Exhaust Fan, 3- ARC Fault Circuit Breakers Notes: ler Inspector Signature: , A,' %� Date: October 8, 2015 r Electrical 81 Compliance Form.xls ��, t / p� SOU1 ti Town Hall Annex 11 , . .;»`i. ; Telephone(631)765-1802 54375 Main Road 1 ; Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 ri�l1®Ultl1� `�`v tt .i • ii1� BUILDING DEPARTMENT TOWN OF SOUTHOLD , ni DEC - 82015 II HLD Drpi Tnivr (i! ,0111:01r, CERTIFICATION Date: / / /5 Building Permit No. 3 e Owner: tee 4¢-,)/)(J (Please print) Plumber: 'l Pc t- NC • - f (Please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. /QIN(/2 (Plumb ignature) Sworn to before me this 8-th day of be2 emb, - , 2015 Notary Public, 50 Tv IK County TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY tOINISSION EXPIRES JUNE „2 Nu' ���,,%pp SOpTHp'; � to ,, __ (532._. ,* * - L ��_ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 //INSPECTION ' , [ , OUNDATION 1ST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: Lab,..,...k..._,.. . 71. '77-A al DATEf/0 �r INSPECTOR , `AL2 , - _ 1,,�o��OF SOUTdolo, O ` - 0€ 0UNT1A TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 • INSPECTION= [ ] FO DATION 1ST [ ] ROUGH PLUMBING [ ] OUNDA N 2N [ I INSULATION • „I [ ] FRAMIN /STRAPPING [ ] FINAL [ ] FIREPLACE & HIII NEY [ ] FIRE SAFETY INSPECTION _ [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH)_ [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: al 116 I1 DATE • INSPECTOR 4 P ' „,,40F SOV., Cb 51 cf„, (!rcoUMY,�;,� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTJON [ ] FOUNDATION 1ST [ ROUGH PLUMBING [ ] F IINDATION 2ND [ ] INSULATION [ FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOL ION [ ] CAULKING REMARKS: DATE t257:2-1/5- INSPECTOR ,1 o'",°��OF SO(/Tyolo`; TOWN OF°SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION id-ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE 57V0 ft INSPECTOR 2 ?G___0 (g _____ 4,c‘fso„,,.,,;...„ ..,,,., f ,,,,, ,. 4.: ,c4-, ,,,, moo,,_ TOWN OF SOUTHOLD BUILDING DEPT:,' 765-1802 INSPECTIOft- [ ] FOUNDATION 1ST [ ] RO H PLUMBING [ ] FOUNDATION 2ND [ NSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: L .//t �,' �'_. /' 7J 517)-/ler "" -i:/,/ ,41111,7-2,4 64334 I' t . ..1) c .L.. . ___ sp �� 4 Jac , , , dew 6 ( .Z / 717 DATE INSPECTOR '-' ;'-e- sarryo Arg va TOWN OF SOUTHOLD BUILDING DEPT. - 765.1802 INSPECTIQN [ ] FOUNDATION 1ST LUMBING [ ] FOUNDA TION 2ND ULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULK, REMARKS:__-/A) .mac 7:, cate;44_4,, 7 DATE r n ,c),"5-‘ ( INSPECTOR 7,1 0f SOU ��,` Ty 9 9 PCC 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) [01 ELECTRICAL (FINAL) REMARKS: 4 46. DATE /6( INSPECTOR 3TGc 8 ct— III,, ''... !it: -11 <11:1 `lyCOUNi`I,t. TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION- [ ] FOUNDATION 1ST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING / STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: e(5— " CI) i i / - / iv . /AWITirlMW DATE (� ® ( INSPECTOR4Lass... 4 I THOMAS A. FARAONE, P.E. CONSULTING ENGINEER 127 S.OCEAN AVENUE,SUITE F PATCHOGUE,NY 11772 tafaraonet gmad corn 917-620-7320 June 26, 2015 Bob Hanlon 28775 Main Road Orient, NY 11957 RE: One Story Addition Frankel/Hanlon Residence 28775 Main Road Orient, NY 11957 Dear Mr. Hanlon: This is to confirm that the as built structural framing of the above referenced one story addition is in conformance will all applicable codes and standards for residential construction. Feel free to contact me should you have any questions or comments, or if I can be of further service to you in this matter. Respectfully submitted Thomas A. Faraone, PE O€ as-cl, tt .r1 \NP4.s.3 ervo0V R 11,, - ,n I � JUN 302015 BLDG DEPT TOWN OF SOUTHOLD FIELD IlV'SPECTQN REPORT T DAT , ,„ . S , . ' V(///1 ' 04,:,-7,---6.-- -,st .t-1/ ) , ,--- �� FQtTND ATIOl�i(15 J7 �1 " "`� ' '� ' C� 1 • FOUNDATION(2ND) . . . �til ..i . • , ' . . . ,0 1?... .1r _ ,,rok 47 . (.,,,,4) • ._ ,/,ote, ZD . . / Ail 1 4---'74,44-1:-0,e-7...9' -7_-_ -v.-e- i3 ROUGH PLUMBING .fe‘re'-is ‘C''"fil's'e21244t.e IC.-'" C.N3 . � �., I' - . 0 ' /.......... ,•/f��. , '"`J' - k� INSULATION PES N.Y. 1p STATE ENEI.2,GY CODE - �,.7 , `' ' 9f— . '• , _ I " }• . A /� ir i. ,tt A 1 s, f , c ^ ...„.„;11,,, • FINAL , 1 , , . . ,, , A37I?IT •I '4 ' +•' 1$FLITS tet .. .. _ ,'. .. ' . -3-aLI-JS L1-pO0 d)'��e(• ,re Fb . • • i39lo .e \' 3 o 911 ' l I-uuu5, _brn ie-a.- '1rr rn'k-,��' lS ewe c.< ®6 TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING 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 �C�� Survey SoutholdTown.NorthFork.net PERMIT NO. ( C60. Check Septic Form N.Y.S.D.E.C. Trustees Dsc YED C.O.Application Flood Permit Examined 3/23— ,20Single&Separate MMR 16 20 Storm-Water Assessment Form Contact: / Approved ,20 BLDG DEPT Mail to: Cdt//pt/�re [OWN OF SOUTHOLD a3E/61j //)4/k°1\/ e, Disapproved a/c - / Phone: 63/ Xr d3 'i Expiration 7/.2, t' ,20 / Building Inspector APPLICATION FOR BUILDING PERMIT Date /v , 20/1-- INSTRUCTIONS JINSTRUCTIONS 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 applicaile Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal o demolitio as herein described. The applicant agrees to comply with all applicable laws, ordinances,building code,hou ' . - and r•gulations,a o admit authorized inspectors on premises and in building for necessary inspections. �� (Signature of applicant or name,if a corporation) �a. ea,v / 8 oe/ANT /y //7J (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder CJWna"c Name of owner of premises "A36/Z7 ,QNNo v 1 1g-5:57 CA17 l/J/ 1— (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 d on which proposed work will be done: HA NN ROAD OR(e.137- House e.1 THouse Number Street Hamlet 5-741. County Tax Map No. 1000 Section 1 Q „}. :,,,:;,-Black-8 :�, Lot ::aver±0.Or VOrc.' lAt1(X) Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises an91 intende use and occupancy of proposed construction: a. Existing use and occupancy r�ZSt uu� t S/ii7Le -Pa''u, lii b. Intended use and occupancy i---eSr T[itt , s//2j// Ian'/y 3. Nature of work(check which applicable):New Building Addition / Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost / 3� Orb , Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units / to ber of dm'ling units on each floor / If garage, number of cars /1/4,7A 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. "(A 7. Dimensions of existing structures, if any: Front le•/ Rear 34' o Depth b Height _ /" 36 Number of Stories ,gyp Dimensions of s me structure with alterations or additions: Front �/ e ' / Rear Si,g Depth ' Ay Height ^- 30 Number of Stories ?/ 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories ` 9. Size of lot: Front 3071 Rear 2_73,/g Depth '35 10. Date of Purchase S J 1(1 lip(o Name of Former Owner 'Pe-ter- jlita ((of -- Ma Ycl ?er,C6 11. Zone or use district in which premises are situated R-S17 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO X 13. Will lot be re-graded?YES NO X Will excess fill be removed from premises?YES X NO 'Pobert E•• Rktk(On po•atx 14gp/*� 14. Names of Owner of premises Jess I Cq , • Akk�Address . '4r �pi�/ Phone No. 63( 7'6r-231* Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO X * 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 X * 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 X * IF YES, PROVIDE A COPY. STATE OF NEW YORK) . SS: COUNTY OF ) • A/4 `/ 0 35Xr �. 4✓�'" being duly sworn, deposes and says that(s)he is th- applicant • (Name of individual signing contract)above named, (,B5'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 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 a-f day of arch 201,57-; vor AL , . . Notary Publi TRACEY L.DWYER Signature of Applicant NOTARY PUBLIC,STATE OF NEW YORK • NO.01DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,29_1$ P `.......wlq... Scott A. Russell ,.••'e Su m gTO]PLMWA.TER - SUPERVIS®RMASNAGJEMENT zz S5MTHOLD nRoad-TOWNL NEW4, ���� Town of Southold 53095 Main Road-SOUTHOLD,NEW YORK 11971 .x..'++04„ -it:03e CHAPTER 236 - STORMWATEL2. MANAGEMENT-WORK SHEET ( TO BE COMPLETED BY THE APPLICANT) DOES THIS PROJECT INVOLVE Y OF 111E^FOLL-O ING (CHECK ALL THAT APPLY) Yes No 0® A. Clearing, grubbing, grading or-stripping of land which affects more than 5,000 square feet of ground surface. 0E B. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. D® C. Site preparation on slopes which exceed 10 feet vertical rise to • 100 feet of horizontal distance. ®® D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. O[ E. Site preparation within the one-hundred-Oar floodplain as depicted . on on FIRM Map of any watercourse. 0® F. Installation of new -or resurfaced impervious surfaces of 1,000 square s . feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes ( - in-kind replacement of impervious surfaces. * If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department with your Building Permit Application. - - - -------------------------------------•---- -- S.C.T.M. 1000 Date APPLICANT: (Property Owner,Design Professional,Agent,Contractor,Other) District NAME --gT e . 14,,,w - oil 1 ,' (v a 5 ;--1 --/.5 Amiffrff Section Block Lot �t� ra FOR BUILDING DEPARTMENT USE ONLY"*' - Contact Informat lore C31-76 d-x'36+ (3( `5144f _ (idcpnanc Nvmecrl d',.- Property - Reviewed By: Date �-/�— ��Address/ Location of Construction Work: a -��rrpp�� �/�/ Approved for processing Building Permit_ Go��.r P'tA l/J bt l� L J'-' /� / tormwater Management Control Plan Not Required. Stormwater Management Control Plan is Required. (Forward to Engineering Department for Review) FORM - SMCP-TOS MAY 2014 1 I Town Hall Annex ift; Telephone(631)765-1802 54375 Main Road - (631)765- 5 P.O.Box 1179 • ;G Q I roger.richertrc O`wn.soutf9io� .ny.us Southold,NY 11971-0959 ` 'r .\ BUILDING DEPARTMENT TOWN OF SOUTHOLD • APPLICATION FOR ELECTRICAL INSPECTION - : REQUESTED BY: Date: Company Name: Name: License No.: Address: • -Phone No.: • JOBSITE INFORMATION: (*Indicates required information) *Name: fa?G .k'r E. i4 NJ-0 ti - *Address: 2- .1-75 P'(A t rJ D'/ opt -41T- N'-( 6/5 I S � (p.o- 805( /7g) *Cross Street: ea* 0-C 13(Roin,ws W tuts RD *Phone No.: 631 g361- CO) 9 (4 .75f.efq44 Cc) Permit No.: 3 f Tax•Map District: 1000 Section: • Block: Lot: *BRIEF DESCRIPTION OF WORK(Please Print Clearly) • tdnVerrlOr) ar haH2 ha+I -I-o •C0II ba.-f+ con nitston Of evfrr1 iia(I -to h4v,jrao,�. (Please Circle All That Apply) *Is job ready for inspection: YES/ NO Rough In 3 lr Final *Do-you need a Temp Certificate: YES/ NO � Temp Information (If needed) *Service Size: 1 Phase 3Phase 100 150 200 3 350 400 Other *New Service: Re-connect Underground Number of Meters Change of Service Overhead Additional Information: PAYMENT DUE WITH APPLICATION . 82-Requestforinspection Form e I i r N his., i F01K�P� Town Hall Annex I �� ¢ Telephone(631-1802 54375 Main Road !! a Fax(631)734-9502 P.0. Box 1179 t c ' Z Southold, NY 11971-0959 ;` . i BUILDING DEPARTMENT NOTICE OF UTILIZATION OF TRUSS TYPE CONSTRUCTION, PRE-ENGINEERED • WOOD CONSTRUCTION AND/OR TIMBER CONSTRUCTION- . Date: - - ��36f•e _ rr Owner: - pti oj - ✓ r457c1q �� vymL - ., . Location of Property: AC;5- �c1 y O"!!4'Na.,. T !�r � ; ,. i+Rk; i Please take notice that the (check applicable line): • New residential.structure •,-- 'r • Addition to existing residential structure . Rehabilitation to,an existing residential structure •=.., to be constructed or performed at the subject property reference above will utilize - (check applicable line): . - Truss type construction(TT)-, . i� Pre-engineered wood construction (PW) - I/ Timber construction (TC) in the following location(s) (check applicable line): Floor framing, including'girders and beams (F) - Roof framing (R) _ • _ , . . . V Floor a -roof a-ming. (FR) • - Signature: _ - Name (person submitting this fort): a , T/ /�f � &---: - . Capacit (check applicable line): - - . • Owner .,. . . . Owner representative TrussResRegl5.docx Effective 1/1/2015 :.. . ♦ .T •.-•y,rc ....1�. . rf ....i ,tVer`t y1 rr:iNrr 'ter":• :) .k. ` is 6" DIAMETER =` x ,.:.• . i• .. .• '.-. REFLECTIVE RED" - ROMAN ALPHANUMERIC PANTONE 1: : . •••.,V,Ve.:-.:!.-1.= 'W...t (PMS)#1'87 .I " ,.; _ - TYPE BASED:ON SECTION 602 OF THE BUILDING CODE OF NEW YORK STATE : - :.1..;::: .. . ., .. ., I. . 2 'WIN. - REFLECTIVE • WHITE • it • 't 1/2" STROKE - . - - -- - -... -•----•-------------..... .- .. . CAMRONENT,S THAT ARE OF _ " .. • • TRUSS CONSTRUCTION • "F" FLOOR FRAMING, INCLUDING GIRDERS AND BEAMS, • . , - • - "R" ROOF FRAMING ' "FR" FLOOR AND ROOF F.RAMIIIG ' ' • ENO' RUSS IDENIFICIO .SI� 3Se O2 - CU/PUMICE W11-1 191WCRR PART:120S4 '{e. , --:.----------.� • CODES DIVISION : TRUSSNVV -LEIDENTIFICATION��SIGN! DATE08/ f--i- - • NEW YORK STATE DEPARTMENT OF STATE Oak . .• ' DIVISION OF CODE ENFORCEMENT r,`.J. . AND ADMINISTRATION sOEPRj}dENT;OE SCAB• •..�: .. .ua;v- '•YS� )5a� �r�-+c••" >P,.:Yi.::rw_:r.;p.. +.f :'%4ti='.s•}ys g,.,:..a. 1_4c•3;..•st..car+�... ir..-r•.••cwr.. -rr,::`Fri`::: iii• 4041104N-.- . Z yr ci \ W 0 0 k \ 04. It Z03 c . / 1414ililik'''‘. . 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' violation of section ihe Ni�ks: tYEoucst,ion onel.s« : : . 2 �.,..,...,....�: 7 , tr• �... fres the origins) of this surrey �I • ':4N (5 fs': �y�r '_ +`•1' : ;:r .+ Ona fogies ��. r() ,. Al, ` *armed with sn original of the lsttef ^yer•'s .t 11 sta.peo scs3 she)) be considered is be valid true . :...+11-• f . copies' . 4 60P 1 1 .�:- 'CertitSe+etSOns indicated herteA stonily that this 1. bilk. • SyrlltyMe! pt'lpsrQO In OCCOr,ienCR MltR tht tt•............................:........ ; !;; �. istin0 Code el Precuts 1er t.aflr fGurvt": seepttd r,� * ; f Ot thR New park !State essetlOt4O* of Professional + 1 - x+ f rJ� � � -��}��? r �; ACU COi:. ' LIV,;...�1-i ,`,l_.! CODES OF = NEW YO---1-K, Si C ;L & TOWN CODES ` rix.keirt4 - r` AS REQUIRED ^., .�' n 0 • Axc€' l7r \7a"0 t .S FDTE f r i r,vL TON ZEA DATE �?,!2,, ♦ P3.P.;; �c� ". J sou....Jm.. u',''N PLANNING BOARD FEE::,L>.r "t -, t?y.! -- � �, �''�� z _ _.v�, C.^I ---,,t --r--p NOTIi`,� BUILDING .moi ,?rt,'rrdT AT 1-5-4 5-1'2P baa �G t P 1 765-1102 3AM TO 4PM FOR THE Iz 11� 3 i `y' FOLLC`�•i;:Jta INSPECTIONS: 1 I' 12 1. FO'..'•N ATION - TWO REQUIRED l�.vN 1 I _ _� _ _ "WA t To E. .r -Nave FOR POURED CONCRETE I, �G/ I 2. ROUGH - FRAMING & PLCJi..iulPdG U Z 11� 1 ,y4eIw�R 3. INS LArION _ i ,r /, ST �; W 4,-ti 4. FiP'i ,L CG;4_.T"t"?'._1CT!O' P .✓. ��� _� __ .d t ..x 6 1C'" ^+» o w EE COMPLETE FOR '. < 3 / 2 CTI � ALL CONSTRUCTION�C','�: ::i:",i.t_ MEET THE lo It — \ ►� REQUIRE"`ENTS OF THE CODES OF NEW ,3 -re) t -r'L7 X.If ^co -rr1..Y 5 - ...( "..---r5.14 2 t�Q l YORK Sl A, NOT RESPONSIBLE SIEI_E FOR \�\\�����'•,`�\\�� �j�l�lt`cra� ����� 1 DESIGP! 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