HomeMy WebLinkAbout45304-Z Qrp �IF�lC� Town of Southold
10/24/2020
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P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 41562 Date: 10/24/2020
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 2360 Village Ln.,Orient
SCTM#: 473889 Sec/Block/Lot: 26.4-15.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
10/8/2020 pursuant to which Building Permit No. 45304 dated 10/8/2020
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:
electric connection to hydro-action wastewater treatment system.
The certificate is issued to Henry John B Revoc Trust
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 45304 10/20/2020
PLUMBERS CERTIFICATION DATED
Authorized Signature
o�os�FFac,�°oTOWN OF SOUTHOLD
a G�� BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
V. f¢{ SOUTHOLD, NY
O
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#: 45304 Date: 10/8/2020
Permission is hereby granted to:
Henry John B Revoc Trust
54 Riverside Dr 16B
New York, NY 10024
To: Electric connection to a hydro-action wastewater treatment system.
At premises located at:
2360 Village Ln.,Orient
SCTM #473889
Sec/Block/Lot# 26.-1-15.1
Pursuant to application dated 10/8/2020 and approved by the Building Inspector.
To expire on 4/9/2022.
Fees:
ELECTRIC $85.00
Total: $85.00
o
Building Inspector
of So
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 roger.riche rta-town.south old.ny.us
Southold,NY 11971-0959 a
COU
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To* John Henry
Address: 2360 Village Ln City: Orient St- New York Zip- 11957
Budding Permit#: 45304 Section. 26 Block 1 Lot: 151
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA- Hubbard Electric LLC License No: 4709-ME
SITE DETAILS
Office Use Only
Residential X Indoor Basement Service Only
Commerical Outdoor X 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph 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 Fixtures Time Clocks
Disconnect Switches Twist Lock Exit Fixtures TVSS
Other Equipment. Electric connection to hydro-action waste water treatment system with disconnect,
20a circuit.
Notes.
Inspector Signature: Date: October 20 2020
81-Cert Electrical Compliance Form As
OF SOUTyO�
TOWN OF'SOUTHOLD BUILDING DEPT.
courm, 765-1802 Q
47
INSPECTION 4
[ ] -FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE"SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ]" FIRE RESISTANT PENETRATION
[
] ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:
�3
DATE la INSPECTORYf
N
BUILDING DEPARTMENT-Electrical inspector
TOWN OF SOUTHOLD
Town Hall Annex- 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
lephone (631) 765-1802 - FAX (631) 765-9502
e southoldtownny.gov— seandg?southoldtowngy.gov
C,�
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (Aii information Required) Date:
Company Name:, Atkbard fLer_+r10C_ LLC
Name: C -H ck b h aL o)
License No.: M E- q-40 q email:
Address: Ay + C-1 _ 9
I Phone No.: to 3)- 2 52 o(o
JOB SITE INFORMATION (All Information Required)
Name:
Address:, 91.20 A11-11160f Lal(,)r- r r n r\J V J 9
Cross Street:
Phone No.:
3 I 3 23 595
Bldg.Permit email:
I Tax Map District: 1000 Section: Block: Lot:
L 57a 1
BRIEF DESCRIPTION OF WORK(Please Print Clearly)
16(imemi-sty-) An2.1 _C_ooCy-,e+e_
Vn, i onro-chan ag_ T-Al
Circle All Thaq 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)
Service Size I Ph 3 Ph Size: A #Meters Old Meter#
New Service- Fire Reconnect- Flood Reconnect-Service Reconnected-Underground-Overhead
1#Underground Laterals 1 2 H Frame Pole Work done on Service? 'Y N
Additional lnformatioh,�
-PAYMENT-DUE WITH APPLICATION
CP
Request for Inspection FormAs