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��O�QSUFf01�G� Town of Southold 2/4/2020
P.O.Box 1179
53095 Main Rd
'✓.,y01 ��o� s Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 41035 Date: 2/4/2020
THIS CERTIFIES that the building ELECTRICAL
Location of Property: Off East End Rd,Fishers Island
SCTM#: 473889 Sec/Block/Lot: 4.4-7
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
1/13/2020 pursuant to which Building Permit No. 44588 dated 1/13/2020
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:
UNDERGROUND ELECTRIC SERVICE(100 AMP-COTTAGE AND 200 AMP-HOUSE)
The certificate is issued to HSTR LLC
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 44588 01-30-2020
PLUMBERS CERTIFICATION DATED
Authorized Signature
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
wo
o • 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#: 44588 Date: 1/13/2020
Permission is hereby granted to:
HSTR LLC
1010 River Rd
Manakin-Sabat, VA 23103
To: electric service (200a for house; 100a for cottage)
At premises located at:
Off East End Rd, Fishers Island
SCTM # 473889
Sec/Block/Lot# 4.-4-7
Pursuant to application dated 1/13/2020 and approved by the Building Inspector.
To expire on 7/14/2021.
Fees:
ELECTRIC $85.00
Total: $85.00
Building Insp r
®�IxOF SOU��®l
Town Hall Annex ® Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 • �O� roger.riche rtd-)town.south old.ny.us
COWN
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To HSTR LLC (Scott)
Address: 'off East End Rd (265 Hungry Point) City: Fishers Island St: New York Zip: 6390
Budding Permit# 44588 Section 4 Block 4 Lot: 7
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA' NI Electric License No: 34408-ME
SITE DETAILS
Office Use Only
Residential X Indoor Basement Service Only X
Commerical Outdoor X 1 st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph 300a Heat Duplec Recpt Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency FixturesTime Clocks
Disconnect Switches Twist Lock Exit Fixtures TVSS
Other Equipment: Re-locate service to outdoor "H" frame, 300a underground, 1-200a disconnect
for main house, 1-100a disconnect for cottage
Notes
Inspector Signature: y±jDate: January 30 2020
81-Cert Electrical Compliance Form As
sorry
Town Hall "qex JAN - 3 2020 ' Telephone(631)765-1802
54375 Main Road �pax g QQ�
P.O.Box 1179 G • roger.rlChertl sown soU1950% W Us
Southold,NY 11971-059��
BLM DLNG DEPARTNEW
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: V l L OLA S G i I\)0 CL)a K O Date: /a 30 - )
Company Name: -T
Name: < it
License No.:
Address: l E L bL I/V)E
Phone No.:
JOBSITE INFORMATION: (*Indicates required information)
'Name: -EU- . 1-+ L Z Ll,-rJ (;CDT-T- tl-esT �
'Address: CD LA H i AS or 1z IVB
`Cross Street:
'Phone No.: , f '?9'9 7 y6-!o
'ermit No.:
fax Map District: 1000 Section: Block: Lot:
'BRIEF DESCRIPTION OF WORK(Please Print Clearly)
M va--tz soFF CAI l T74- CIS 7 o0612 1061-9m E20 LQ
�usc-
Please Circle All That Apply)
Is job ready for inspection: GEPNO Rough In Final
Do you need a Temp Certificate: YES/ NO
.emp Information(If needed)
� Service Size: 1 Phase 3Phase 100 150 200 0" 350 400 Other
\' ew Service: Re-connect tln�rg=9
Number of Mete I Chan of Service.0 �` ) x Overhead
g ►dditional Information: PAYMENT DUE WITH APPLICATION
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