HomeMy WebLinkAbout46401-Z '%rskl L Town of Southold
roti oGy 6/15/2021
C
o P.O.Box 1179
o ` 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 42090 Date: 6/15/2021
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 16505 Route 25,Mattituck
SCTM#: 473889 Sec/Block/Lot: 115.-2-2.3
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
6/10/2021 pursuant to which Building Permit No. 46401 dated 6/10/2021
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 wiring in existingshed hed(chicken coop).
The certificate is issued to Ruland W Revoc Trt
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 46401 6/10/2021
PLUMBERS CERTIFICATION DATED
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Authorized Signature
o�S�EF Qin. TOWN OF SOUTHOLD
aye BUILDING DEPARTMENT
CO. 2 TOWN CLERK'S OFFICE
oy • 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#: 46401 Date: 6/10/2021
Permission is hereby granted to:
Ruland W Revoc Trt
50 Mill Ln
PO BOX 164
Mattituck, NY 11952
To: electric for chicken coop
At premises located at:
16505 Route 25, Mattituck
SCTM # 473889
Sec/Block/Lot# 115.-2-2.3
Pursuant to application dated 6/10/2021 and approved by the Building Inspector.
To expire on 12/10/2022.
Fees:
ELECTRIC $90.00
Total: $90.00
Building Inspector
oe sov��®�
Town Hall Annex ® Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 ® sean.devlin ai7town.southold.ny.us
Southold,NY 11971-0959
®lac®UNT�,�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Ruland W Revoc Trust
Address: 16505 Rt 25 City:Mattituck st: NY zip: 11952
Building Permit#: 46401 Section: 115 Block 2 Lot: 2.3
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: AS BUILT License No:
SITE DETAILS
Office Use Only
Residential X Indoor X Basement Service
Commerical Outdoor X 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey X Attic Shed X
INVENTORY
Service 1 ph Heat Duplec Recpt 1 Ceiling Fixtures 1 Bath Exhaust Fan
Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures 1 Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors
Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO
Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches 2 4'LED Exit Fixtures Pump
Other Equipment:
Notes. " AS BUILT NO VISUAL DEFECTS " New Wiring in Shed
Inspector Signature: Date: June 10, 2021
S.Devlin-Cert Electrical Compliance Form.xls
fat/('® BUILDING DEPARTMENT-Electrical Inspector
��O Gym TOWN OF SOUTHOLD
® =` Town Hall Annex- 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
y O� Telephone (631) 765-1802 - FAX (631) 765-9502
ro err@southoldtownny.aov — seand(cD-southoldtownny.aov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: 6/9/2021
Company Name: NA
Name:
License No.: email:
Phone No: ❑I request an email copy of Certificate of Compliance
Address.:
JOB SITE INFORMATION (All Information Required)
Name: The William Ruland Revocable Trust
Address: 16505 Main Road Mattituck, NY 11952
Cross Street: Mill Lane
Phone No.: 631-806-6773
Bldg.Permit#: na Ll bLI p' email: rulandfarm@yahoo.com
Tax Map District: 1000 Section: 115 Block: 2 Lot: 2.3
BRIEF DESCRIPTION OF WORK (Please Print Clearly)
electric underwriters for chick coop
Check All That Apply:
Is job ready for inspection?: OYES ❑NO ❑Rough In O✓ Final
Do you need a Temp Certificate?: ❑YES ONO Issued On
Temp Information: (All information required)
Service Size ❑1 Ph ❑3 Ph Size: A #Meters Old Meter#
❑New Service ❑ Service Reconnect ❑ Underground [—]Overhead
# Underground Laterals ❑1 ❑2 ❑H Frame❑Pole Work done on Service? ❑Y ❑N
Add
itional Irtformation: Electric underwriters fol; a re-CO.
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PAYMENT DUE WITH APPLICATION
Electrical Inspection Form 2020.xlsx
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