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Town of Southold 12/19/2022
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P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 43026 Date: 4/30/2022
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 130 W Lake Dr., Southold
SCTM#: 473889 Sec/Block/Lot: 90.-1-19
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
3/4/2022 pursuant to which Building Permit No. 47521 dated 3/4/2022
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:
200 amp electric service, panel and sub panel.
Corrected 12/19/2022 for Certificate of Occupancy number only.
The certificate is issued to Alsobrook,Victor&Gloria
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 47521 3/24/2022
PLUMBERS CERTIFICATION DATED
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AutholKed Signature
�o�OS�FMit . Town of Southold 4/30/2022
3 y� P.O.Box 1179
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Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 47521 Date: 4/30/2022
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 130 W Lake Dr., Southold
SCTM#: 473889 Sec/Block/Lot: 90.-1-19
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
3/4/2022 pursuant to which Building Permit No. 47521 dated 3/4/2022
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:
200 amp electric service,panel and sub panel.
The certificate is issued to Alsobrook,Victor&Gloria
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 47521 3/24/2022
PLUMBERS CERTIFICATION DATED
uthorized Si ature
g�FFQ TOWN OF SOUTHOLD
BUILDING DEPARTMENT
y z TOWN CLERKS 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#: 47521 Date: 3/4/2022
Permission is hereby granted to:
Alsobrook, Victor
130 W Lake Dr
PO BOX 355
Southold, NY 11971
To: New electric panel and new sub panel.
At premises located at:
130 W Lake Dr., Southold
SCTM #473889
Sec/Block/Lot# 90.-1-19
Pursuant to application dated 3/4/2022 and approved by the Building Inspector.
To expire on 9/3/2023.
Fees:
ELECTRIC $180.00
Total: $180.00
Building Inspector
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New e,�chr�c
BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
® Town Hall Annex - 54375 Main Road - PO Box 1179
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® Southold, New York 11971-0959
®� Telephone (631) 765-1802 - FAX (631) 765-9502
rogerr(aD-southoldtownny.gov — seand(cD-southoldtownny.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date:
Company Name:
Electrician's Name:
License No.: Elec. email:
Elec. Phone No: ElI request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name:
Address:
Cross Street:
Phone No..
Bldg.Permit#: Z..,f =a l email:
Tax Map District: 1000 Section: Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
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Square Footage:
Circle All That Apply:
Is job ready for inspection?: .YES ❑`NO ❑Rough In ❑ Final
Do you need a Temp Certificate?: ❑ YES EJNO 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 R2 F1 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
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