HomeMy WebLinkAbout47385-Z suFfn,
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y� P.O.Box 1179
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53095 Main Rd
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CERTIFICATE OF OCCUPANCY
No: 42761 Date: 2/4/2022
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 4105 Mill Rd., Mattituck
SCTM#: 473889 Sec/Block/Lot: 106.-9-4.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
1/6/2022 pursuant to which Building Permit No. 47385 dated 1/26/2022
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:
electrical survey for accessory
The certificate is issued to Ryan,Patrick
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 47385 1/6/2022
PLUMBERS CERTIFICATION DATED
Au ori ed g ature
�o�SUFFQt�co TOWN OF SOUTHOLD
Gym BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
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#: 47385 Date: 1/26/2022
Permission is hereby granted to:
Ryan, Patrick
PO BOX 1164
Mattituck, NY 11952
To: Electric survey for accessory barn.
At premises located at:
4105 Mill Rd., Mattituck
SCTM # 473889
Sec/Block/Lot# 106.-9-4.1
Pursuant to application dated 1/6/2022 and approved by the Building Inspector.
To expire on 7/28/2023.
Fees:
ELECTRIC $120.00
Total: $120.00
Building Inspector
pF SO(/r�,ol
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Town Hall Annex Telephone(631)765-1802
54375 Main Road
P.O.Box 1179 �Q sean.devlin(cD-town.southold.ny.us
Southold,NY 11971-0959 OIyCQUIV
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Patrick Ryan
Address: 4105 Mill Rd City:Mattituck st: NY zip: 11952
Building Permit#: 47385 Section: 106 Block: 9 Lot: 4.1
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: AS BUILT License No:
SITE DETAILS
Office Use Only
Residential X Indoor X Basement Service
Commerical Outdoor X 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey X Attic Barn X
INVENTORY
Service 1 ph X Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel A/C Condenser. Single Recpt Recessed Fixtures CO2 Detectors
Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO
Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches 4'LED Exit Fixtures 11 Pump
Other Equipment:
Notes: " AS BUILT NO VISUAL DEFECTS " Survey of Barn
Inspector Signature: Date: January 6, 2022
S.Devlin-Cert Electrical Compliance Form
UF SOUIyO� - -
TOWN O UTHOLD. BUILDING DEPT.765-1802 �� I v� IIl �J.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE &. CHIMNEY [ "] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT��CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH)` [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:. '
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DATE INSPECTORi`-
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gvfFOL �o BUILDING DEPARTMENT-Electrical Inspector
y� G$ TOWN OF SOUTHOLD
y, Town Hall Annex- 54375 Main Road PO Box 1179
o Southold, New York 11971-0959
y�0 a0� Telephone (631) 7654802 - FAX (631) 765-9502
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APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATIO re - q i d Date:
Company Name:
Electrician's N e:
Liceqde No.: Elec. email:
Elec. Ph No: an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name:
Address:
Cross Street:
Phone No.:
BIdg.Permit.#: email:
Tax Map District: 1000 Section: - -0 Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
-*e�-G- n G �r v-e. 4�O bRYN bn I
Square Footage:
Circle All That Apply;
Is job ready for inspection?: ❑ Y[=5❑ NO ❑Rough In Final
Do you need a Temp Certificate?: ❑ Y1:=5❑ NO Issued On
Temp Information: (All information required)
Service SizeF�1 Ph❑3 Ph Size: A #Meters Old Meter#
New Service Fire Reconnect Flood Reconnect Service Reconnect Unde round
❑ ❑ ❑ ❑ ❑ r9 ❑Overhead
# Underground Laterals 1 2 H Frame Pole Work done on Service? 7 Y MN
Additional Information:
PAYMENT DUE WITH APPLICATION