HomeMy WebLinkAbout43631-Z %ZIOSU` OL, Town of Southold 4/18/2019
y P.O.Box 1179
V 53095 Main Rd
o4,y �a� Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 40338 Date: 4/18/2019
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 19475 Route 25, Mattituck
SCTM#: 473889 Sec/Block/Lot: 108.4-8
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
4/9/2019 pursuant to which Building Permit No. 43631 dated 4/9/2019
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"ELECTRICAL SURVEY
r
The certificate is issued to Ubaldo Gonzalez Irr Trt
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 43631 04-12-2019
PLUMBERS CERTIFICATION DATED
uthorized Signature
TOWN OF SOUTHOLD
�suFFn��co BUILDING DEPARTMENT
N TOWN CLERK'S OFFICE
o . SOUTHOLD, NY
yfjo1 � ,�ao�
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#: 43631 Date: 4/9/2019
Permission is hereby granted to:
Ubaldo Gonzalez Irr Trt
PO BOX 248
New Suffolk, NY 11956
To: meter pan and service panel
At premises located at:
19475 Route 25, Mattituck
SCTM # 473889
Sec/Block/Lot# 108.-4-8
Pursuant to application dated 4/9/2019 and approved by the Building Inspector.
To expire on 10/8/2020.
Fees:
ELECTRIC $85.00
Total: $85.00
Buil ' g Inspector
OF SO�jy®l®
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 G Q
Southold,NY 11971-0959 ® ® �o roger.riche rt(a-town.soLitho Id.ny.us
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Gonzales
Address: 19437 Route 25 City: Mattituck St: New York Zip: 11952
Building Permit#• 43631 Section: 10$ Block. 4 Lot: 8
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 X Indoor X Basement X Service Only X
Commerical Outdoor X 1 st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey X 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 Fixtures Time Clocks
Disconnect 200a Switches Twist Lock Exit Fixtures 11 TVSS
Other Equipment "AS BUILT" "ELECTRICAL SURVEY' "NO VISUAL DEFECTS"
Notes: 200a overhead service
Inspector Signature: Date: April 12 2019
81-Cert Electrical Compliance Form.xls
OE 50UTyO�
# TOWN OF SOUTHOLD BUILDING DEPT.
courm 765-1802 f
� I
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)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
DATE �/Z"" J INSPECTOROT
��1FfO1,�cQ/ BUILDING DEPARTMENT- Electrical Inspecflor
TOWN OF SOUTHOLD'
Town Hall Annex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
roger.richertfttown.southold,ny.us
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: (A gca�v q+� Date:
Company Name:
Name:
License No.: email:
Address:
Phone No.:
JOB SITE INFORMATION: (All Information Required)
Name: ibld((�lAddress: 7 r
Cross Street:
Phone No.:
BIdg.Permit#: ,�-bj email:
Tax Map District: '1000 Section: b Bl )ck: Lot.
BRIEF DESCRIPTION OF WORK(Please Print Clearly)
Circle All That Apply: -
YES / NO Rough In Final
Is job ready for inspection.:
Do you need a Temp Certificate?: YES I 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 Reconnected -Underground -Overhead
# Underground Laterals 1 2 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION �y
82-Request for Inspection FormAs �/