HomeMy WebLinkAbout47414-Z ao��g1)FFp(k�oliy4 Town of Southold 5/14/2022
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P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 42771 Date: 5/14/2022
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 1005 Pequash Ave, Cutchogue
SCTM#: 473889 Sec/Block/Lot: 103.-7-21
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
2/3/2022 pursuant to which Building Permit No. 47414 dated 2/3/2022
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:
As built electrical work.
Corrected 5/14/2022 for application date only.
The certificate is issued to Doroski Wilma C Irry Trust
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 47414 2/4/2022
PLUMBERS CERTIFICATION DATED
Authorized Signature
�SUFFnt�c TOWN OF SOUTHOLD
moo ��s BUILDING DEPARTMENT
N x TOWN CLERK'S OFFICE
"oy • err SOUTHOLD, NY
0
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#: 47414 Date: 2/3/2022
Permission is hereby granted to:
Doroski Wilma C Irry Trust
3000 Pequash Ave
Cutchogue, NY 11935
To: As built electrical work
At premises located at:
1005 Pequash Ave, Cutchogue
SCTM #473889
Sec/Block/Lot# 103.-7-21
Pursuant to application dated 1/1/1900, and approved by the Building Inspector.
To expire on 8/5/2023.
Fees:
ELECTRIC $170.00
Total: $170.00
Buil g Inspector
SO!/T,�OI
0
Town Hall Annex Telephone(631)765-1802
54375 Main Road
P.O.Box 1179 �Q sean.deviinc@-town.southold.ny.us
Southold,NY 11971-0959 OIyCOUNN,��
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Doroski Wilma C Irry Trust
Address: 1005 Pequash Ave city:Cutchogue st: NY zip: 11935
Building Permit* 47414 Section: 103 Block: 7 Lot: 21
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 X Service X
Commerical Outdoor 1st Floor X Pool
New Renovation 2nd Floor X Hot Tub
Addition Survey X Attic Garage
INVENTORY
Service 1 ph X Heat Duplec Recpt 5 Ceiling Fixtures 4 Bath Exhaust Fan
Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors
Main Panel 100A 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 Fixture Time Clocks
Disconnect Switches 4'LED Exit Fixtures Pump
Other Equipment: 100A Panel 20 Circuit/ 18 Used
Notes: " AS BUILT NO VISUAL DEFECTS " Some Outlets and Lights Ran with Romex
in House
Inspector Signature: Date: February 4, 2022
S..Devlin-Cert Electrical Compliance Form
soUTyOIo L4 --7Lt L d -
* # TOWN OF SOUTHOLD BUILDI DEPT.
765-1802
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:
cm 2 S-
r
DATE . =INSPECTOR
10 Re
O�sVFFOj,�CO BUILDING DEPARTMENT- Electrical Inspector
�, � '7 F= TOWN OF SOUTHOLD
C* ` ' TownZAnnex - 54375 Main .Road - PO Box 1179
c thold, New York 11971-0959
FEB - 3 2026ee (631) 765-1802 - FAX (631) 765-9502
' BUILDir� err c(DDsoutholdtownny.gov - seandCaDsoutholdtownnygov
TOWN OF s 1UU n IOLa
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: Z --, 2z
Company Name:
Electrician's Name:
License No.: Elec. email:
Elec. Phone No: ❑1 request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name: U►���r!,l_ w I l WICK .r-1 -Cvu*t P4GtJI462 L 72--&C
Address: '
Cross Street:
Phone No.: r16 771- o551
B'Idg.Permit.#: email:,yY1Ql Wil,cave
p
Section: l0 Block:
Tax:Ma District: 1000
7 ,
Lot. 2l
BRIEF DESCRIPTION OF WORK,-INCLUDE SQUARE.FOOTAGE (Please Print Clearly):
C Al ayn".-ice: z4z� 6 q"A
Square Footage:
Circle All That 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❑1 PhF]3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect[]Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 1 M2 H Frame Pole Work done on Service? Y FIN
Additional Information:
PAYMENT DUE WITH APPLICATION
�l
PERMIT# Address:-
Switches
ddress:Switches
Outlets
G F I's
Surface
Sconces
H H's
UC Lts
Fans . Fridge HW
Exhaust Oven W/D
Smokes DW Mini.
Carbon. , IVlicro Generator
Combo Cooktop: _ TransferY.. .
AC' AH - Hood Service
m
` A ps Have °Used' "
Special:..
..
Comments: C� i `J