HomeMy WebLinkAbout47245-Z sgijFFDI Town of Southold 5/4/2022
a P.O.Box 1179
0
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 43041 Date: 5/4/2022
THIS CERTIFIES that the building GENERATOR
Location of Property: 625 Corey Creek Ln., Southold
SCTM#: 473889 Sec/Block/Lot: 78.4-25
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
11/30/2021 pursuant to which Building Permit No. 47245 dated 12/21/2021
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:
accessory generator as applied for.
The certificate is issued to Chudzik,Roger&Darion,Ellen
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 47245 4/21/2022
PLUMBERS CERTIFICATION DATED /
d
Authorized Signature
-` TOWN OF SOUTHOLD
�O�suFFoiK�oG
� BUILDING DEPARTMENT
N a 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#: 47245 Date: 12/21/2021
Permission is hereby granted to:
Chudzik, Roger
625 Corey Creek Ln
Southold, NY 11971
To: install generator as applied for.
At premises located at:
625 Corey Creek Ln., Southold
SCTM #473889
Sec/Block/Lot# 78.4-25
Pursuant to application dated 11/30/2021 and approved by the Building Inspector.
To expire on 6/22/2023.
Fees:
ACCESSORY $100.00
ELECTRIC $85.00
CERTIFICATE OF OCCUPANCY $50.00
Total: $235.00
uilding Inspector
oF sovey®l
Town Hall Annex Telephone(631)765-1802
54375 Main Road
P.O.Box 1179 sean.deviin(aD-town.southold.ny.us
Southold,NY 11971-0959 QIyC®U�9�,��\
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Roger Chudzik
Address: 625 Corey Creek Ln city:Southold st: NY zip: 11971
Building Permit#: 47245 Section: 7$ Block: 4 Lot: 25
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: DAK Electric License No: 5120ME
SITE DETAILS
Office Use Only
Residential X Indoor X Basement Generator X
Commerical Outdoor X 1st Floor Pool
New X Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph 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 Pump
Other Equipment: 22kW Generac Generator w/200A Whole House Transfer Switch
Notes: Generator
Inspector Signature: Date:
April 21, 2022
S.Devlin-Cert Electrical Compliance Form
OF SO(/lholo
# # TOWN OF SOUTHOLD BUILDING DEPT.
' goyum,� 765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING
[ ] FRAMING /STRAPPING FINAL 66&C-014TH
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION-
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:
JR6--y otic. Feo. Cop(
DATE 6(—Tl =a-Z. INSPECTOR
OF SOUK,°!o � Q�
# TOWN OF SOUTHOLD BUILDING DE;
W.
��' 765.1802
INSPECTION -
[ ] FOUNDATION 1 ST [ ] ROUGH PL13G.
[ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION- [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
[ ] CODE VIOLATION [/ ] PRE C/O
REMARKS:
DATE ZI INSPECTOR
FIEM INSPECTION RERVAT'. DATE. . 0 CONIAIFNTS
FOUNDATION(1ST) j
I
FOUNDATION'(2ND.)'
Z
ROUGH FRAIKING:& H
PLUMBING
rr
INSULATION.PER N.•Y. .
STATE ENERGY CODE
�-'l.�-2Z � ���i'�. Y7�✓ �1-'Tl�.1C��.iC a--tuA��
tQ
FINAL
ADDITIONAL COMMENTS
rtZ
m
C
H
�BUILDING DEPARTMENT- Electrical Inspector
'A% U TOWN OF SOUTHOLD
, '.-' Trow Hall Annex - 54375 Main Road - PO Box 1179
R.T1 J ,1 - Southold, New York 11971-0959
"Telephone (631) 765-1802 - FAX (631) 765-9502
r rogerrp_ outholdtownny.gov - seand&southoldtownny.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date:
Company Name. �) t�-'K 1�_Z C\4ZNL
Electrician's Name: ,ur&-
License No.: 1- -512 0 Elec. email: 6?i oi, e �Sf-e&\Ss. CCtm
Elec. Phone No: El request an email copy of Certificate of Compliance
Elec. Address.: NC -0 1 v S k AQ�_K i` 114;2—
JOB
4;2JOB SITE INFORMATION (All Information Required)
Name: 1,0
Address: 2-,I �tvzJ `'
Cross Street:
Phone No.:
Bldg.Permit#: email:
Tax Map District: 1000 Section: -7 Block: 0 11 Lot: `
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
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 2 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
PERMIT# Address:
Switches
Outlets
G FI's
Surface
Sconces
H H's
UC Lts
Fans Fridge HW
Exhaust Oven WAD
Smokes DW Mini
Carbon Micro Generator
Combo Cooktop Transfer
AC AH Hood Service
Amps Have Used
Special:
Comments:
16-7
--�
rd
*PROPERTY INFORMATION
Existing use of property.Sln le familydwellingIntended use of property Sin le familydwellln
..._.._ 9 �..__.v ..._.a �.., ..,....m .9 _..9_�a_.
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes ®No IF YES, PROVIDE A COPY.
8 Check BOX After Reading The owner/contractor/design professional is'respo6" le'for alledramage and storm water issues as provided by
Chapter 236 of the Town Cade ,APPLICATION IS HEREBY MADE tothe}Building Department for the issuance of a Building permit pursuant to fhe Building Zone
Ordinance of the Towwbf Southold,Suffolk,County,New York and other applicable Laws,ordinances,or Regulatwns for the construction of tiuddtngs,
additions,alterations o'r for removal or demohtion(as herein:described The'apphcant agrees to comply uvith all applicable laws;ordinances,building code
husing code antl regulations,and to adm
mit authorized inspectors on preises and inbuildings)fo
or necessary inspections False statements made herein are
punishable as a Class A misdemeanor pursuant"to 5ect�on•210 45 of_the New.Yor 'State Penal Law
Application Submitted By(print name): ��'�'f°� C� � l AZ ❑Authorized Agent .&wner
ry _ llI_ _
Signature of Applicant Date.
G G 30 21
,._.,yw�m... .�._.� ,._..�.�.�_Hn.,�u.=_.t �• .. ..�_ _ �....r_�. .�. �ar.m..W.� .�._.r�.�M�.��..�_.Y�,.��..m..�.�:.M._��..�,�. .�....,w_.�_� K. r ,_�... ,._......
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STATE OF NEW YORK)
SS:
COUNTY OF Surrd LIQ )
being duly sworn, deposes and says that(s)he is the applicant
(Name cf individual signing contract)above named,
(S)he is the
(Contractor,Agent,Corporate Officer,etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application;that all statements contained in this application are true to the best of his/her knowledge and belief, and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
—30 day of NIIYU' f3 f3 YL ,20
Notary Public
CAROLINE M MACARTHUR
PROPERTY OWNER AUTHOR17-ATION NOTARY pU®LIM6 NEW YORK
No.011 MAA E A6384635.
(Where the applicant IS not the owner) oualified in Suffolk County
My Commission Expires 12-17-2022
I, residing at
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name
2
1
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CER TIF/ED TO:
,CHICAGO TITLE ° LOT 21
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INSURANCE COMPANY
SOUTHOLD SAVINGS BANK COREY CREEK ESTATES i X. � R
FRANK NICOLICCHIA. gin. F/CEDAUG.15,1967 AS MAP NO.4923 Prepared in accordant mu
with the limum LA p R
PHILOMENA NICOLICCHIA AT BAYV/EW thestaLids for tide serve as esfablado by
N..YS L .49618
.,� � the L I.A L 5. and approved and adopted
`j J�2 �y� ��2 TOWN OF SOUTHOLD for nth use by The Hew YorkState Land (5/61 727-7//8
SUFFOLK COU/VTY, N.Y. We^"°"°''°"• /396 ROANOKE AVE_
rAX MApNO- /00i-7894-25
� R/VERHEAD,N.Y,//90/
C• U�hv� 7L�GOLD SCALE/ =30
MAY 9, /985; SEPT. 17,1985; DEC.26,1985
85-1T6