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Town of Southold 7/11/2021
a P.O.Box 1179
0
ca 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 42150 Date: 7/11/2021
THIS CERTIFIES that the building ELECTRICAL
Location of Property: Pvt Rd Off E End Rd.,Fishers Island
SCTM#: 473889 Sec/Block/Lot: 3.-5-5.5
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
5/14/2021 pursuant to which Building Permit No. 46255 dated 5/14/2021
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:
200A underjaround electric service due to utilijy company re-location of transformer.
The certificate is issued to Norwell LLC
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 46255 6/17/2021
PLUMBERS CERTIFICATION DATED
uthorized Signature
o�suEFnl oTOWN OF SOUTHOLD
BUILDING DEPARTMENT
y TOWN CLERK'S OFFICE
oy • �� { 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#: 46255 Date: 5/14/2021
Permission is hereby granted to:
Norwell LLC
33 W Second St
Riverhead, NY,.11901
To: 200A underground electric service.
At premises located at:
Pvt Rd Off E End Rd., Fishers Island
SCTM #473889
Sec/Block/Lot# 3.-5-5.5
Pursuant to application dated 5/14/2021 and approved by the Building Inspector.
To expire on 11/13/2022.
Fees:
ELECTRIC $85.00
Total: $85.00
Building Inspector
® ®F SO(�r�®�
Town Hall Annex ® Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 roger.richert(C7own.souold. us
Southold,NY 11971-0959 y'
c®UNm
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Norwell LLC (Tim Madden)
Address: Private Road off East End Rd (975 Cedar Ridge Rd:City: Fishers Island St: New York Zip. 6390
Building Permit* 46255 Section: 3 Block 5 Lot: 51
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: BD Electric License No- 35821-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 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 Fixture Time Clocks
Disconnect 200a Switches Twist Lock Exit Fixtures TVSS
Other Equipment: Install new conduit, conductors, and meter pan, due to utility company re-location
of transformer.
Notes Service up grade, retaining original 200a main panel
Inspector Signature: Date: June 17 2021
81-Cert Electrical Compliance Form.xls
BUILDING DEPARTMENT- Electrical Inspector
4 2021 TOWN OF SOUTHOLD
® Tovpn Hall Annex- 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
1 rogerr(cD-southoldtownny.aov - seand D-southoldtownny.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: 3 /
Company Name: t'
Name:
License No.: - ��PM email:
Phone No: -- ^7Lt21-5- - I-request-ari email copy of Certificate of Compliance-
Address.: q26 o
JOB SITE INFORMATION (All Information Required)
Name: --rt
Address: Z
Cross Street:
Phone No.: ' 3 _Z
Bldg.Perrhit#: email: (42c
Tax Map District: 1000 Section: Block: Lot: �.
BRIEF DESCRIPTION OF WORK (Please Print Clearly)
ex.sf:- Woolf- w A d�..c. G�o fo 61 Lo 4
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Check All That Apply:
Is job ready for inspection?: 0 ES E]NO ❑Rough In Final
Do you need a Temp Certificate?: ❑YES EK(3 Issued On
Temp Informati : (Ah information required)
Service Size 1 Ph ❑3 Ph Size: Uo A #Meters _ Old Meter# '?-0 R3®
®New Service 'Service Reconnect Q Underground ❑Overhead
# Underground Laterals 21 ❑2 ❑H Frame[-]Pole Work done on Service? ❑Y ❑N
Additional Information:
PAYMENT DUE WITH APPLICATION
Electrical Inspection Form 2020.x1sx
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