HomeMy WebLinkAbout52462-Z of soUlyo Town of Southold
P.O. Box 1179
r cX 53095 Main Rd
urm. a Southold, New York 11971
CERTIFICATE OF OCCUPANCY
No: 46821 Date: 02/02/2026
THIS CERTIFIES that the building AS BUILT HVAC
Location of Property: 1025 Long Creek Dr Southold, NY 11971
Sec/Block/Lot: 55.-3-28
Conforms substantially to the Application for Building Permit heretofore,filed in this office dated: 10/07/2025
Pursuant to which Building Permit No. 52462 and dated: 11,/17/2025
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:
Legalize as built AC at existing single family dwelling as applied for.
The certificate is issued to: Jeffrey Worthington, Heather Worthington
Of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL:
ELECTRICAL CERTIFICATE: 52462 01/28/2026
PLUMBERS CERTIFICATION:
LAuorized Signa re
----------
\%OFS0Dry4(o TOWN OF SOUTHOLD
BUILDING DEPARTMENT
c 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#: 52462 Date: 11/17/2025
Permission is hereby granted to:
Jeffrey Worthington
1025 Long Creek Dr
Southold, NY 11971
To:
Legalize as built AC at existing single family dwelling as applied for.
Additional certification may be required.
Premises Located at:
1025 Long Creek Dr, Southold, NY 11971
SCTM#55.-3-28
Pursuant to application dated 10/07/2025 and approved by the Building Inspector.
To expire on 11/17/2027.
Contractors:
Required Inspections:
Fees:
As Built HVAC $500.00
CO-RESIDENTIAL $100.00
Total $600.00
Building Inspector
Ok'\pF SO(/lyol
� o
Town Hall Annex Telephone(631)765-1802
54375 Main Road N
P.O. Box 1179
Southold,New York 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Jeffrey Worthington
Address: 1025 Long Creek Dr City: Southold st: NY zip: 11971
Building Permit#: 52462 Section: 55 Block: 3 Lot: 2$
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Electrician: Current Electrical & Lighting License No: 65941ME
SITE DETAILS
Office Use Only
Commercial Indoor X Basement X Service Solar
Residential X Outdoor X 1st Floor X Pool Battery Storage
As-built Renovation 2nd Floor Hot Tub EV Charger
New X Addition Attic Spa Generator
Survey Mezzanine Garage Dock
INVENTORY
Service 1 ph In-wall Heater Recpt Ceiling Fixtures Smoke Detectors Pump
Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures CO Detectors Heater
Main Panel A/C Condenser Single Recpt RecessdFixtures Combo Smoke/CO Transformer
Sub Panel A/C Blower Range Recpt Ceiling Fan Heat Detectors Salt Gen
Transfer Switch Mini Split Dryer Recpt UC Lights Fridge AutoCover
ARC Blower Heads Switches 1 Pucks Lights Dishwasher Mini Fridge
GFI SepticDisconnect Emrgency Strobe 4'LED Microwave Garbage Disp.
ARC/GFI ERV Exit Lights Bath Exhaust Hood Dehumidifier
Other Equipment:
Notes: HVAC
Inspector Signature: Date: January 23, 2026
# . # TOWN OF SOUTHOLD BUILDING DEPT.
F°`y�oo►m��'''� 631-765-1802
INSPECTION
[ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [FINAL J�l�/9� IsLAUi11
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL
REMARKS: t I eGjga C ��-�S�i G am. i✓`J
DATE INSPECTOR
OF 50UTyolo X 7 <2- - /6 2�5 Lo l'--4
# # TVV F SOUTHOLD BUILDING DEPT.
o rm,�� 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: AS
DATE1,26 INSPECTOR
FIELD INSPECTION REPORT DATE COMMENTS
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FOUNDATION (1ST)
--------------------------------------
FOUNDATION (2ND) r
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ROUGH FRAMING& a
PLUMBING
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INSULATION PER N.Y.
STATE ENERGY CODE
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FINAL
ADDITIONAL COMMENTS
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TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
�y • °� Telephone (631) 765-1802 Fax(631) 765-9502 https://www.southoldtownn.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only \\k ,
PERMIT NO. LkC91 Building Inspector:I ---,-- �)a
Applications and forms must be filled out in their entirety.Incomplete ; .,
applications will not be accepted. Where the
Own Applicant er's Authorization form(Page 2)hall be completed not the owner,an
Date:
OWNER(S)OF PROPERTY:
Name: SCTM#1000-.
Te-fa
Project Address: �e
a
Phone#: _ ?53 7 -73 0 Email: La 40 n F
Mailing Address:o�� c ae� �
a
CONTACT PERSON:
Name
Mailing Address: C
Phone#:K31" 53 .,7 O Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Z -
Mailing Address:
Phone#:6,51 —PI v oW Email
CONTRACTOR INFORMATION:
Name: - L
Mailing Addres 06 — 7 g za-7/
Phone#:�� / `7 r 3� Email: .
DESCRIPTION OFPROPOSED CONSTRUCTION
❑New Structure ❑Ad ition ❑Alteration ❑ epair ❑Demolition Estimated Cost of Project:
Other C O
Will the lot be re-graded? ❑Yes XNo Will excess fill be removed from premises? ❑Yes q No
AN
PROPERTY INFORMATION
Existing use of property: Intended use of property:
-es.) 1J,t;
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes ❑No IF YES, PROVIDE A COPY.
❑ Check Box After Reading: 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 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(s)for necessary inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By(print name) ��f-� �� � ❑Authorized Agent QOwner
Signature of Applicant: Date: foGJ/
STATE OF NEW YORK)
'SS:
COUNTY OF S�'.�oI K )
5e .C-J '6e v being duly sworn, deposes and says that(s)he is the applicant
(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
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
G day of Q�}obis` ,20Z' ,eae,nnHr
Notary Public ••o`•• C,�Z __,. ?•
PROPERTY OWNER AUTHORIZATION B Y a
Qae116edinsdblkcoutg V
(Where the applicant is not the owner) •• OIGL M157
I, residing at
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name
2
;.®S11FFpt,�C BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
4,o �a�� Telephone (631) 765-1802
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (Ali Information Rlequired)J Date:
Company Name: i I
Electrician's Name: !F1LJ6 j/ . ��/, /,�
License No.: Mp Elec. email: CU / ' o G
Elec. Phone No:(53 - 6 Uo L ❑I request an email copy of Certi,ricate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All.Information Required)
Name: /z. / eAJ
Address: /UZ c�k Cr,- :e v 2,
Cross Street: fe/ 4 vle,
Phone No.: 6'?l ?5-3— . 0Q
Bldg.Permit#: 5'2 q (p'� email:
Tax Map District: 1000 Section: S Block: 3 Lot: z
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
Square Footage:
Circle All That Apply:
Is job ready for inspection?: YES 0 NO ❑Rough In ❑ Final
Do you need a Temp Certificate?: ❑ YES ❑ 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 1 F12 R H Frame M Pole Work done on Service? Y DN
Additional Information:
PAYMENT DUE WITH APPLICATION
dr+ e� �Ftl� BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
- Town Hall Annex - '54375 Main Road - PO Box 1179
Southold, New York 11971-0959
(0- Telephone (631) 765-1802
r
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required)/19
Date:
Company Name: Cc)p,/� Clef JJ 1 j C� 1 C
Electrician's Name: i D, 1i1
License No.: Elec. email: CU . '�o j '/� p • G
Elec. Phone No:(53' 1 request an email copy of Certi Icate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All.Information Required)
Name: 0o r--a A -
Address: /vZ ojj
Cross Street:
Phone No.: 6 ) ?5-3— ,;50C
Bldg.Permit#: Cj (p' email:
Tax Map District: 1000 Section: S Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
Square Footage:
Circle All That Apply:
Is job ready for inspection?: � YES ❑ NO ❑Rough In ❑ Final
Do you need a Temp Certificate?: ❑ YES ❑ NO Issued On
Temp Information: (All information required)
1 Ph❑3 Ph Size: A # Meters Old Meter#
Service Size❑
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground -]overhead
# Underground Laterals 1 2 R H Frame F1 Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
dal t�.l�-s
PERMIT# Address:
Switches
Outlets
GFI's
Surface
Sconces
H H's
UC Lts Fridge HW POOL
Panel
Fans" Mini Fr. W/D Pump
Exhaust Oven Sump Heater
Trnsfmr
Smokes DW Generator Salt Gen.
Water Bond
Carbdn Micro G=rb.Dis Lights
Heat Pucks ERV
HOT TUB/SPA
Inst Hot DeHum Transfer Disc
Combo /Cooktop Minisplit
Blower
AC A t Hood Blower
Service Amps Have Used
Sub Amps Have Used
Comments
a
LONG SUR• Y (d CwR"
��fD N D Mwa 53, LOT 1`2PR 16 1998
�� MAP I O°w al HDA
\s YENNECO`( �
/ \S01' FILE No.5167 FILED OCTOBER 9, 1968
4 \�� SITUATED AT
SOUTHOLD
z \\ TOWN OF SOUTHOLD
p T\s SUFFOLK COUNTY, NEW YORK
m• ` / \�20, S.C. TAX No. 1000-55-03-28
oD / \\ SCALE 1"=20'
O `^ MARCH 22. 1997
APRIL 3, 1998 FINAL SURVEY
LOT 12 to AREA = 32.446.41 sq. ft.
/ p (10 TIE LINE) 0.745 cc.
m
9UIL1MM0 QIVMPE 0.5 PQx-1 —� I �J
5}DATEO 9/R6/BB 1N' afA I / C
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t2ff—I FRAME HOUSE
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VOTES:
1. S.C.D.H.S. REVERENCE No. TIO-97-0091
d�' IGtSSPwE 1 9g 2. SEPTIC LOCATIONS AS PER S.C.O.H.S.
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�E
p CERTIFIED TO,
• x " •'"� FIDELITY NATIONAL TITLE INSURANCE COMPANY
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• STG ASSOCIATES. Inc.
mBE 1' JEFFREY WORTHINGTON
S 83 4 •CC Tt HEATHER HILL WORTHINGTON
G CRWEEY D��V1J
LONG (PUBLIC 1 iEP nrou DN oR wx WN
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OB1wafWeRtfORd Westea°lerMYrN({t0[OI No/ EASEYENIS of MOORD.IF
ANY.NOT 6NOWN ARE NOT CDARAIREED.
�x K.W<aIWCE WRII R2 NMYw
A"M. —R M.° Joseph A. Ingegno
USE Bf.NEYOR W0
p�Fg D Land Surveyor
* * rNa sarvey,-w6errBlar�- ste Ra°e- em�1.Y°6°a Layoul
PHONE(516)727-2090 F..(516)722-5093
9 C•OaF F ,10 OFFICES LOGTED AT "ISO AODRM
N.Y.S.LI. Na.69666 One Ilnlon SRwra P.O.R.19JI
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LOT 11 .
DWELLING
(USES PUBLC WATER)
i I �
OCCUPANCY OR
APPROVED AS NOTED USE IS UNLAWFUL
DATE• #4ara # a WITHOUT CERTIFICATE
FEE w& BY:
NOTIFY BUILDING DEPARTMENT AT OF OCCUPANCY..,-.-.:..-,: ..
631-765-1802 8AM TO 4PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION-TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH-FRAMING&PLUMBING
3. INSULATION
4. FINAL-CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE COMPLY WITH ALL CODES OF
REQUIREMENTS OF THE CODES OF NEW NEW YORK STATE&TOWN CODES
YORK STATE NOT RESPONSIBLE FOR AS REQUIRE AND CONDITIONS OF
DESIGN OR CONSTRUCTON ERRORS $011TH0LD T0WN ZBA
SMOLD TOWN PLANNING BOARD
AU TRUSTEES
777 Vim we
o N.Y.S DEC
RETAIN STORM WATER RUNOFF
OUR HE TOWN COD
OF T
Additional
Certification
AA Be RC-gllircd.
4,4
WElf.
MODEL 1,401 MODL E h : RA 1 A
SERIAL 1401 �.4A1� " A MF0J A3. 212015
PJ DE SERIE, V-,1072513712 Zl O .
COMPRESOR CODE I CODES DE COrrj�RE, ! a ; Ex TrIE!JE`
VOL I S ��� � �S�CIr;. 1�3
COMPRESSOR! C0IPRES Q� PHAQ�. 1 HERTZ S�U,,. R.�..A. 9.,� C.R.A. 59
OUTDOOR FAIL MOTOR
ACTEUR VEI,JTIL. E„T : F,L.A. 116
H.
kill"l. SUPPLY CIRCUITAMPACITY/ 8 .
COURANT ADI!;ISSABLE D'ALIM. MII-1.. 13 A
MAX FUSE OR CKT. BI�~R. SIZE*/
CAL. MAX. DE FUSIBLE/DISJ*: 200 A
Mit'l. FUSE OR C�,T. BRA! SI7_E*/
CAL. lollI, DE FUSIBLE,D„
5/15
A% iLLOVvABLE DISCI-;ARGE PRESSURE/ '`
PRESSIM NIAYINIALE DE DECRARGE 111SE: r PSI
r
MAY ALLOWABLE SUCT N PRESSURE/ ��0 vt3102 kPa
PRESSJO1] MAVVIALE D'ASPIRATI0lq PERKS—OUt P�IG1l723T p UNITS FACTORY CHARGE/ u
k'a
CHARGE USIHE D-UIJITES EXTERIEUR: 11 � 131 i5, R4Z
TOTAL SY EI CNAI;GE/ -
CHARGE T OTALE DU SYSTEME: R 54b
SEE ICES Rom;ICES I fSlDE ACCESS PANELVOIR f
CHARGE ISTRUC,!C,i,;A C 11`JTI r�1EUP DU P�,��J�VEAt�g'�;
RHEEM SALES COMPANY CCES
FORT SMITH, AR ANSAS
* a TYPE BREAKER FOR U.S.A./ �ssea�zY
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