HomeMy WebLinkAbout47974-Z IZ-0-
O�Og�FFOLK Town of Southold 7/1/2022
y P.O.Box 1179
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53095 Main Rd
�o� ¢ Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 43213 Date: 7/1/2022
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 43385 Route 25,Peconic
SCTM#: 473889 -Sec/Block/Lot: 75.4-16
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
6/17/2022 pursuant to which Building Permit No. 47974 dated 6/17/2022
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 service at Unit A and owners panel.
The certificate is issued to Baltic Place Inc
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 47974 6/28/2022
PLUMBERS CERTIFICATION DATED
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Authorized Signature
r` g�Ffo ` TOWN OF SOUTHOLD
�oK BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
• 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#: 47974 Date: 6/17/2022
Permission is hereby granted to:
Baltic Place Inc
c/o John Bernhard III
12121 SE Heckler Dr
Hobe Sound, FL 33455
To: Electrical survey of Barn.
At premises located at:
43385 Route 25, Peconic
SCTM # 473889
Sec/Block/Lot# 75.-1-16
Pursuant to application dated 6/17/2022 and approved by the Building Inspector.
To expire on 12/17/2023.
Fees:
ELECTRIC $125.00
Total: $125.00
Building Inspector
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Town Hall Annex Telephone(631)765-1802
54375 Main Road
P.O.Box 1179 sean.devlin(-)town.southold.ny.us
Southold,NY 11971-0959 Q�yCOUn��
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Baltic Place Inc
Address: 43385 Route 25 city:Peconic st: NY zip: 11958
Building Permit* 47974 Section: 75 Block: 1 Lot: 16
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 Indoor X Basement Service X
Commerical X Outdoor X 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey X Attic Garage
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 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 Fixtures Time Clocks
Disconnect Switches 4'LED Exit Fixtures Pump
Other Equipment:
Notes: AS BUILT NO VISUAL DEFECTS " Surveyed Service for Unit A and Owners Panel
Inspector Signature: S��� Date: June 28, 2022
S.Devlin-Cert Electrical Compliance Form
OF so(/l 'L I ! / V A Lf/1/
# # TOWN OF SOUTHOLD BUILDING--DEPT-.---
631-765-1802
UILDING--DEPT
RUIN DjIIWG DEPARTMENT Electrical Inspector
1 % 3) TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
`o '-- Southold New York 11971-0959
,gyp o Telephone (631) 765-1802 - FAX (631) 765-9502
rogerr@southoldtownny.gov - seandgsoutholdtownny.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (Ali information Required) Date:
Y — �—
Compan Name: ��
Electrician's Name:
License No.: Elec. email:
Elec. Phone No: ❑I request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Re uired)
Name: Jn kt t er�
Address: �� 5 /��o �Zr ez�s✓� o 'ms's
Cross Street:
Phone No.: to
Bldg.Permit#: 1+7 q-71 email: J bepo�ko 'db I e,100 ct
Tax Map District: 1000 Section: Block: f Lot:
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BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
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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 1-11 Ph❑3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals F1 1 2 D H Frame D Pole Work done on Service? D Y MN
Additional Information:
PAYMENT DUE WITH APPLICATION ^2
PERMIT# Address:
Switches
Outlets
G FI's
Surface
Sconces
H H's
UC Lts
Fans Fridge HW
Exhaust Oven Dryer
Smokes DW Service
Carbon . Micro Generator.
Combo - - Cooktop Transfer-
AC AH Mini
Special:
Comments: ��