HomeMy WebLinkAbout46044-Z r�g11FF0lK�oG Town of Southold 11/5/2022
0
o� P.O.Box 1179
co
z 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 43576 Date: 11/5/2022
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 410 Blossom Bend,Mattituck
SCTM#: 473889 Sec/Block/Lot: 115.-6-27
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
3/17/2021 pursuant to which Building Permit No. 46044 dated 4/7/2021
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 in-around swimming pool fenced to code as applied for.
The certificate is issued to Faraone III,Valentino&Vanessa
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 46044 3/23/2022
PLUMBERS CERTIFICATION DATED
U
or e Signature
o�snFfnt,�� TOWN OF SOUTHOLD
BUILDING DEPARTMENT
z 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 #: 46044 Date: 4/7/2021
Permission is hereby granted to:
Faraone III, Valentino & Vanessa
410 Blossom Bnd
Mattituck, NY 11952
To: construct accessory in-ground swimming pool as applied for.
At premises located at:
410 Blossom Bend, Mattituck
SCTM # 473889
Sec/Block/Lot# 115.-6-27
Pursuant to application dated 3/17/2021 and approved by the Building Inspector.
To expire on 10/7/2022.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO- SWIMMING POOL $50.00
Total: $300.00
Bui g nspector
toF so�ryolo
Town Hall Annex Telephone(631)765-1802
54375 Main Road
P.O.Box 1179 sean.devlina-town.southold.ny.us
Southold,NY 11971-0959 'Q�yCOU
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Valentino Faraone III
Address: 410 Blossom Bend city:Mattituck st: NY zip: 11952
Building Permit#: 46044 Section: 115 Block: 6 Lot: 27
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Gerarti Electrical License No: 40564
SITE DETAILS
Office Use Only
Residential X Indoor Basement Service
Commerical Outdoor X 1st Floor Pool X
New 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 1 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 100W UC Lights Dryer Recpt Emergency Fixtures Time Clocks 1
Disconnect Switches 4'LED Exit Fixtures 11 Pump 1
Other Equipment: Intermatic Pool Panel 8 Circuit/ 5 Used, Pump 220GFI, Heater220, Salt Generator,
2 Lights Intermatic 100W w/ Color Switch
Notes: Pool
Inspector Signature: Date: March 23, 2022
S.Devlin-Cert Electrical Compliance Form
s � oq L I o '/ 1 o f u i!13ell d
ti o
# # TOWN OF IOUTHOLD BUILDING DEPT.
765-1802
INSPECTION - ..
[ ] FOUNDATION 1ST [ ] -ROUGH PL13G.
[ ] FOUNDATION 2ND [` ] -INSULATIOWCAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIREySAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] -FIRE RESISTANT PENETRATION '
[ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS: TOP
DATE INSPECTOR
OF SOUI�olo
TOWN OF SOUTHOLD BUILDING DEPT.
o
�� �y ourm��'�� 631-765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLEIG.
[ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING
[ ] FRAMING/STRAPPING [a(] FINAL (001—
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL
REMARKS:
LcL'K5 �EQvz,�lsb �,�. 63GG C3 ) 66gTc:5
kh-f-hS (&CZcll'7 4,EsrnxcTC&_S arc_ wXv9>0k,s r�
pcb(- ti MAL,
DATE INSPECTOR G�-
rjf so
TOWN OF SOUTHOLD BUILDING DEPT.
631-765-1802
INSPECTION,
FOUNDATION "IST ROUGH PL13G.
FOUNDATION 2ND INSULATIOWCAULKING
FRAMING /STRAPPING V�FINAL
FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION
FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION
ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
CODE VIOLATION PRE C/O RENTAL
REMARKS:-Aovtk gl7e
lul'AJ OLO
u ew-e— Pole-
j%ei
DATE INSPECTOR
OF SOOIyOIo
NI N1 * # TOWN OF SOUTHOLD BUILDING DEPT.
^ouff", 631-765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] SULATIOWCAULKING
[ ] FRAMING /STRAPPING [ ] FINALr�� li�
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL
REMARKS:
t
�1
DATE 0 INSPECTOR
OF SOGI'yo�
TOWN OF SOOT O H LD BUILDING DEPT.
`ycourm e�' 631-765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] I SUL IOWCAULKING
[ ] FRAMING/STRAPPING [ FINAL Z
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL
REMARKS:
bA�
W4 ,11
DATE 1 yv INSPECTOR
i
MELD INSPECTION REPORT DATE COMMENTS
• ro
FOUNDATION(IST)
N
l J
FOUNDATION(2ND)
O
C-)
ROUGH FRAMING&
PLUMBING
• f
• N
� r
r
INSULATION PER N.Y.
STATE ENERGY CODE
-S Z°Z Ow S C01 GaYGS �'E�X/-E�
(clZ Aa !L S2,�S P-6��
I.v t�ewS �',c� Pcw- GALaxem
9-27..2j.' ` vylofe. 3 CGS 4s
FINAL Akv s 7 J9419forah of (Z s
GI
ou✓t,�[. e- 4j�c wi in 2"- oW
OG GI�h ba�'h s 4V rA 5iC1e
8 Gi�
ADDITION C MMENTS
-� -off O
Z I ('qf AtA
® b
qS
��'If�tiv1 t V►sc�i 1 z-
y
d
' b
�a
o�osuFFock�.9 TOWN.OI+_SOUTHOLD.r-BUILDIlvG.DEPARTMENT
y` Town Hall Annex-54375-Main Road P. O. Box 1179-Southold NY 11971-0959
y': a'
Py s oma . Telephone(631) 765=1`802''Fax (631) 765-9502-https://www.southoldtownny_gov
Date Received
AP'PLI'CAI'ION,-FO.R P.Ul:LDING;-P:,;ER - .1,
For Office;Use Only }
PERMIT No. Building Inspector:" MAR 1 7 2021 `- l
i.',: ..a =4�^,ae.r �a•r!.�r .N.e. riz�-a:+�F`s'f,Ad'^�%:-'.; '"w`:::
lications'an."d forrris=must b'e:fillec[out�;i'nf:
11 fh�eir�ent re• :;'rn¢om.''lete'' S
pp .'M1,- R ? a°n�sp
applieatonsswill'nof':be a'ccepf�d�Wliehe"App�heat�tsnoth'''o (ner,:a � .
Ousrnet's'Au fiorIzAS' Pag MM t e;corripl
,,.�'� �'r �;'>�: ° `i' �, '4,',>• •2��,a"�„=.£;a:'r=`s.�ss.;':'���`�; '
Date:
,"a s- _ t;.,� 4,ja -!��y': i,,. .,a.a.� ::,�_ •',F•,. A:::-.�"s'Fj',^,;';°` ,ti...�:,:'..�c,,;:,�:°e: ;^.r�,•,t
ti` 6t��^k, ,•y =r,,. ,.���i�_, .rF,y".,.,.i�;,:.r,,N.r �,�.v.��•�', .'^,".'':`.a��. ,��°': �;r',t':r'x"�,,,�.�ty'T.,
Y,y':,,>r°: �1: - r' : I,FY,, Ytj'�: ~ :♦;..,,:.,.`''i',-,Y�. -� :t.,�w^, - ..µ,..'.ms,,Yr' �':6 �,r �,Y.-•,1���:
OWNER S PROP`ER1Y:� ,r: �<_ �"�;'�,::� ���•,- :�.,..�=,. ,.v,r;
�.;��;srw -�,�:a .&�� W.r;'. .s�. - .ry, ,a't•6:��.Yck'r.•,ir' -rk,% - is�'l{'Su<;1:
"'nf
_ .."..,,.._. _..�_A......... .a,:_-„._:.r ,../.:,,-_..... ..w..�p -
Name: z?YT// 6 !-, Lw _� n M#1000-
- _ - - - -
Project Address:
Phone#: -- _-Tv� Email:
Mailing Address:
- _..'<k:r ~�k F-5Sr
^-}rq.r r-I:s.".�'E.. `rLI i'r..�:C.'�L f°4'- - ';a.
`.l�_ w�Y�l�: ,Nas'•YTr}•., .:':•Y,'.. +„'f�i. Y
:d4.,',.r-a::,--,a-•�v' a�.wr�”-�:" 3,r....a.:-: 'M
Name: -
-
/'�_n��.'. p'r..�ni:lta'a�aF'vh."� �•'•��TM.�"Simi,�..w'C,...«�:LJN.TI_.r..P.12. '.`i.(�..iw.«T."''�:�:'.��f nom.i"-`�'_ if..�l:nr,
Name:
Mailing Address:
Phone#A ?J "��__ ��..___ Email. Pop - ---- -
_- -- - -r:ar, r:' „ - :i,wrt. :-•e� a;;.,.:
hC<'h'St.,: - - - - - ?;.fa.,,�:�"::5ajr'•,
'3: - .:M.':h f', ,•C.c^ aM'ii .`'�' .r,,.`5o,^i�r'�;::.-i r- riti,:-,'1aT;<6,. �,.r-. "�at,,: "i.M,.,„ .^s3,°W"r 1'"II: r�.ts;3;e' .,°j�i'?i:'.-" �,{� Ya;;."t...�'i.p;i; ��;t,'r" _
- - 7�. �,f:fe ,5+� ♦/R': ..1 ..icy.,,';...Y,.��:: x`'y'l,: A!SK: t,5�k+]�yi��,.�r4: ri��.,. J�.'uY,n�,��-�•'1!':'�t`..P.T._.
- ,.1. �`-�K',�''71.Ln44n l�M.:.--+•7.r `irk%^.:f .:�3�..rrf-Y�.: -
N :rye':.,;.._ : . .
DESIGN=P'RO,FESSIONAL'I -', - ,. - ;r ., - ,-
.s".- '.0M'._
t..�.9�...5 :;�:, .,'mss`
Name:
Mailing Address:
Phone#: Email:
':;,:tit�•k v. dr", �c"FK.'
4 :°`YYy. r.�.:t�, ,p.: E,:,' w ,:^�,•
'']..
•c'h�-rt4. - ,F. Y�• ;.1. .,r.'. ...';_
ONTRACTOftINFORMAl`ION :r .;,.:. •:° :... m,•
„ '< -• c
...:.:........_....�•_—,_.��..,._.__..._.,.._:.�...�,�s.a.,a._'_: ��t :• �..w:�.,�-y�,t-.�.�S.,rar,M,�i`a'a°;.SF����a.:Wh:� :�'I,'��u�`rks°'>.m._,.. �:i:'�,.�,w :,4:'a,._ -
Name: pL —
Mailing Address: -
Phone#:
-,.,,.,.ate. .,�., -.-r..�..:..,.P^..v'::_aYF.-'.^,.r .,1-nq;^+s:4��ore .:Y,•,.;e:l-^.,,n�CRx:MF•,-. e:am.::F^.,:vy�r.-� - :.:,4aP.F,nz��,? •:x—nf� rn....r�, - 'Y•.,x-.;x.,,1:.'i+•''��
i..'i`, ".'�k.e`ui`. �a.•. ,..Y�dG..•1,...,�w v::t.n..�.w-�»,a.• x.., crr,�'•y'^�!�'aJl..s��?y.>u.r.Y'•'m�:a,=' x.54 „„�.' .,-„+d}3...,«�;i�.:'•. '";G;�;UW'i} ",.'�:M.i;���'-"k...u':� �:ri;�:w, =*s`�fr;
::�.' � ,vyY f; i K f 6. F - �a'+: : �C^ar !'� -'�r�=�4fr 7��ir��{yl s+" :�e,�4,=e,�,�--'l",..f-'''t"•ijr�A'ai`!��Yv.:•ri t •r.,'.�_�_•,:
`:DESCitIP,TI NOF PROPOSED CONSTRIlCTi1QN� �x ..,, = :;., z,
J _4�f� -.ti?l..:.1�__ _.''u•" ` �` *;�,�,'x4 ,.�� � �br4„v.^+�.,r ”».�"- rn tiYyf�,�;�,� '� _ .1^:y"',,;%vii' 3: •i:�l,�.'r{"J;,,i �gl.`^L•'i
❑New Structure ❑Addition ❑Alteration . Repair ❑Demolition = -Estimated"Cost of P'r'oject.
Other�Stf11d,- $
Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? ❑Yes N leo
1
_ -
s !„iY;'1,...,:.:s,.:..,;;�i,.�t.: :::,.,,ry•;- :�'�'` _ Mer
- "i=-.-�:ji,', _.,•�;;.- - �.:+t,::ct-;:t^.,�,:.•`>{a:".-„s h•g,.st.s�::,.�a,.,f�.,�,.,5�"'..,r�t^,y.^,....q`:�.,;:,;;:k i :y." ZIP,
' qPROPEtf iNFORI �TfO:.s.1.N.•�� =.ya:y,.�•�„'ZS3=2G;Ysrry','�:.��-,."^,w'-.'��',.Tc.,y.•s...i.rr.,Tr,S.�r_ --,..;-._.,,-_i'.r'.x''�'•'- _._.
�-.;.c.."..:✓*,~'-
.._ -
�,�.. �..: .. v-:_._r.'v tL:":.Xro:i''::.�5`i .�. ��r. .7.:., �:ri:.,�:Td•3.'.'h'. .1!t _ -
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
___..._.__..____._.-_. _.t_____.__.__.. __ __-__,_,_____ _._-.-_• this property? Dyes IF YES, PROVIDE A COPY.
�.�:��_ :c- .�-,�� - - - mow• �xar:•' --�,�r<<,=^,;,,.�•.�:•. „x - ___,...__..._ _ _ -:?----T L: __..____ _ _ -- -------_
�a-i,,•^�` u.. ,E fie: ;.�,, rr.
i��= tt
- ;�' -,.r *M. z.;r-•iP°"+1¢¢ t-. ..i-�'�1.4':e,k.lk'Ye^ �rt.�Y� x,� .�:•„
IT 112Ck'`8fl('/fter Real[ing: :7tThe`'oi nerLcdntractor%design"proge onaM reser RSible�fot .dransa e and'storm;water issues as."rounded b'y.
Ytir '.,-f',.:h..;.tr,?. _..5.:?,:..n,• •.,at pro i`rr ,y
Chapter-236 of;the Towii'Code';AP.P,1 ICATIONt15 iiEREBX-MADEstoitFie'Buitdin 6 'i#ment+or he'�ssuance of.a:Buildn F rm�
tpur$uant to theuBuililirigrzone
prdinance,of=the.Town:of SoutholiJ Suffolk County;New York and ottieiappllcab}erGaws,07tlinarices orRe'lation`s;for'tFie'.constiu_ition.ofauitdin s"
additiohs;alteratiohi�oHor.ee—opal•'oF demo)tion as.herein desc�i6ad:Thea Iicant:a es to:com with atLa liable laws'ordi"ances:b ild--�
.< a cresp , mgC
P,P.,_... .:. PR.,..:_ n .r u o
housirig,&deift'egufations aril to,admitauthiirized;,inspecfors'on. femises and in.buildifi"1s.for necessa`.ins ections:.,False sfatements.made'herei'a-
�:•;f a..K' �-Sine, - ,gip" c,-.:..iF v,fi'��' ••,c. 1p _,r,p,.- ,.g1.:�, ry,- n f8 _
`umshatile as a,Class A inisdemeador ursuantto'Sectioii 2I0:45:of: rY. :
�P, _ P. t e; ew .ott�StateM41"21 r, ;�,'it:3;�'y.•� „�„ - ,
...w _:-:,.,.t..,.. ,.._ ':.��'...,,�..-. -••n:9:m;wh^s::,ac*, r.¢irr�.,ro e3rcA,.
...- ,.. «-'..a�e•^ .,,:. a wa�:..x, . d
Application Submitted By(pri t me): � �� Lqu,thorized Agent ❑Owner
Signature of Applicant: Date: 13
STATE OF NEW YORK)
SS-
COUNTY OF ) =
being duly sworn, deposes and says that(s)he is the applicant
(Name of individGl signing contract)above named,
(S)he is the �pC�Pl�e- --7:E
(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
day of 20
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant isnot the owner).
Y✓G /L/��/y�n
g at L/�6 1GSSonn �l
7 /`�J
,4J-7- 7Tu 4 .IV-V do hereby authorize / diO7-f /0901&W, lAfe. 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
Z Z -
.:��. :�`;PROP�Ii'f�16.it<iF�Rftil)a`hON, _ - _
,.J- .P` '•Nf.'_ - _ y+!',-� �Ma vr.'.':'. .'3'.Ly`in.`i".�l.tt r,' e:Jv..; ^:'.A+ , , P l,r•• _ _
Existing use of property: --r _ Intended use of property:obi t
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
_ - this property? []Yeslo IF YES, PROVIDE A COPY.
, yAf. ^.,, ."f,:.: �%: 5"�.`.yt.,,,.h`._;1..:;'".., n• �:'e� �.4 va_i+.^-4.i...A_..
.'s'w:. .q:a�'�t.;. 'ri,�.;!•' .:: ...d.
— vde-dkydteirfd8n`poe :'anwit';:Chek$o;l` 'aa
-
.', '::. •:.:.i.'.':.`r..: "' ,. ...
Ciiapter`236ofthetown.[ode:>,AP.PLICATfOPi7S't1EREBY,MADEto;the.BiBfdNrigDepartmextfor4feissuanofa8uitdtngPerm�t-pursuant to the Sul iding2ane "
Drdipairce of the Town O Soathofd,Svffotk,'County,New Yoi k and otherappiteahteYaws,ord hi,
arReguiatioris,forthe constructrdn of 6uiidings, „
addRions;alterations or•for removaior,demoGtion asherein described The appiicdtrt,agrees io camptyirr3th aii.appiicable law3,ordinances,6uildipg code;
-housing code ari'd r`egritations,.and to admitauthoft2 inspeitors;ort premises an73n'tiyiidirig(s}Sfor,.;iaecessary insQeitions:.Faise st®ieaients made hetein are
t ,'1i
pririishatite as a'Cfa'ssA rriis8emeeeor."putsirant to Section 2iQ 45 of the New=Yaric 6tate Penai Larli:� °"' x
Application Submitted By(print name): • D % authorized Agent ❑Owner
Signature of Applicant: Date: Z-b 2_, ,
CONNIE D.BUNCH .
STATE OF NEW YORK) Notary,Publlc,State of New York
SS. No.01 BU6185050
COUNTY OF ) oualifled In Suffolk County
Commission Expires April 14,2q
being duly sworn,deposes and says that(s)he is the applicant
(Name of indiviial signing contract)above named,
(S)he is the OOT p0
(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
Notary Public
PROPERTY QWNER AUTHORIZATION
(Where the applicant is not the owner)
�141ff/VT/Nb�1, -F 11 V6G_ ing at 1-116 lam. l o 5 Sari-) /e,�
�TGtIV.Vdo hereby authorize /Vd� f 4 IL-11 ��C, to apply on
my beha�tqTown of So Id Building Department for approval as described herein.
Owner' gnature Date
Print Owner's Name
2
I ' � F,
Tom MU Amex
Telephone(681)765 I=F E B 2 4 2022
54375 Maifa,16d �c(G9t)76�.r}=95o22
P:O.Soic 1175 G , - resaar richert.. iO10TS'0lJiIlO1tl:I1V t!S
Southold,NY 119714959
O �;
�:.�•..�:; Y,SZ;r�(;,M-PT.
1BUIMINC DEPAR'I2VdEIVT
APPLICATION.FOR ELECTRICAL I SPE ION
REQUESTED BY: Date:
Company Name: 2�9 (L-T) ELE� e�leinL.
Blame: ep' : p-I UP
cleanse No.: c f ,
Address: ? �tS -s �( -
Phone-No::
JOSSITE INFORMATION' (*Indicates regtaired information)
*Name: lab
Address: 10
*cross Street:
*Phoria•No.: _631-6:,71!3
Perrrlifi�lo:: V�vC9 q y
Tax•Map'Dlstrict 9000- Section:_f/� Block: _ Lot:
''BRIEF DESCRIPTION OF"rWORK(Please Print Cieady) o
QPoeassrCir�le�/�19•�'�at��PflY)
*Is job readjr for'iiispection / NO Rough On Final
*Do you deed-a Temp'C�rtificate: YES/4
Tent nformatooW(iVnedded)
*86AAceSte" 1 Phase Whose 900 150 200 300 350 400- Other
*146W-SeM"— Reconnect. Underground Number of Meters Change of Service Overhead
Additionaiinforrhation: PAYMENT DUE WlTH-AcPPLICA'TION
-----------------
82-Request for'Insp6Won'Form rl�
Town H',O Annex4
Telephonc tsau,!�-ism'F E B 2 2022
,. ros�e�'riche s
,;� rt` o�iun-sa�o��'riy us
SQuffidd,4-Y 119X-0959 , y .
TOWN OF SO'U'UOL,-0
APP 1C ON JOTME EtEeTRICA L.. NSi TION
REQ.0--T SY:
Date:
Company'Name: !
�cLE�. ICi�1:L tis C, {
!Names
;license No:
Address:
11.709:
Phone No _
= t3
4098"lTE.IN'FORM�AT(ON fnci Cates q re :uired
infoa�matiton)
*Ad`
- 477i7'uG1�
"C[+OSS'`St11L@� ��� �Lc.FAD Ce K �lI'�`� • . .
Obirm
Tax=Map District 'i000` Section: //�' Block: Lot:
BMEF'DESbRIPTIOWOl='1NORK(Please Ptint Clearly)
l
�Pieaee'Ci'�cle�gl[Tfiat ee►pply)
FIs jot -readyfor"inspection ! NO Plough An Final
*Doo}iou n-biad a UnpCertifjcate 'S l�
Tem 0 Information"(Ifi'Ihwdded)
*Service'Sizer 1 Phase 3Phase 100 15.0 200 300 350 400" Other
*Newservlce: Re-connect. Underground Number of Meters Change of Service Overhead
Addii;ienal Informatlon: PAYMENTDUE WITH-APPLICATION
82-Request for Inspection Form r ��
i
�` '
�OvM 1/I 12�
i
TITLE NO.12800 2 }.
i
58.50'
V
8 f— Q,y. ..... / �.�' _ ' !r.rrt;s.xnT r..na!•TwH« q is
'� '• =;� atcnoH Tana Pr THt NTw roc alae °�✓S F
XOrLtt`l 1HI:sWr1Y aV.r NDI f1.1M
wnnors wpm s!u w m o'i� p
eo�. '\ p 7� � p t air«.,e rr..A,Haa'or•eownaaar! .j„b� �.
eppy ——- •�ti '�' ,e�' D C Tor ruin Tam con. a�'q n
w,r lP[ls N,olc.no N,UPH SHW awe cp"y.c+ a
TH!1,[SON TOa WHOM IN[SUaYB O • L�+O
"J _ et30� �� � (y e V O K,rPr`.4b OH NIs Y1YST TO 1W [)
dI' •_�^; Igy, 4o
Ull.
= --.lam 1J' \ Howe sH:l�lclloH Uirm HsasOH.uD wa •Z of�.,
2 — � Q TH!♦•.si4HtL'«MI,I,Gx.G tl6Tt i sNp Ze 0
,; V 3 ,S wwa.:m,s..,Na rauw+r.w ♦�'o�
^, "I O•r�HIOHs,I,NLTHNN"11 Oa"�"^�" ?7E •« •
Lr l SROWwx fi IN�{gE F
stvcnons
Q I AND°OY FBOA�DRER 7gE',Rg
N.6p%6 i0 AV O v F o
NONUNEMT
O ti Ir 61 p _ 5%&171Y/S/0NXAPF/L EDIN THE ArFiLE
r \ a)HE LL EMOF SUFFOLK COGWTYCW
SQPr.B,190ASFILE NO.4{33
�T Lor �B tj 11EVISSONS YOUNG JL YOUNG S,P�E DF Neal`
PAPRIL 28,1973 40D OSTRANDER AVENUE, RIVERHEAD, EW Q•1tD sv. Oq
O 10 MAR 25,(974 r
ALOEN W.YOUNG ,,p YOQ91
JULY 9:1974 µKoa>ruA[YO.~n.v~`E4,G MO.ail.3 Y a ,P
I R9'22 J SURVEY FOR: H '
JAMES M.CHRISTY 81 ELIZABETH A.CH $ Y o a
LOT N0.27,H MATTITUCK ESTATES,INC,' 4af 4589
MATTITUCK THEr LEGUARANTEECO.
SUFFC"0)UNTYNATIC*AL9ANK
TOWN OF SOUTHOLD
NEW Sl/FFpLK SUFFOLK CO.,-N.Y, e:,/�L10,6eG Fl.
4VENUE scALe: wrE: No.
I" = 40 APR.25,1973 73-372
r>rcttec. as vara
!V
1�
\ n
V
► - v V
APPROVED AS NO ED
DATE:ALL B.P.#
FEE: " BY:
NOTIFY BUILDING DEPARTMENT AT
765-1802 8 AM TO 4 PM FOR THE " RETAIN STORM WATER RUNOFF
FOLLOWING INSPECTIONS: PURSUANT TO CHAPTER 236
1. FOUNDATION - TWO REQUIRED OF THE TOWN CODE.
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONST?!"! ""^,N MUST
BE COMPLETE ; �- 0.ALL CONSTRUCT!C:N S-ALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS. ELECTRICAL
INSPECTION REQUIRED
COMPLY WITH ALL CODES OF
NEW YORK STATE & TOWN CODES
AS REQUIRED AND CONDITIONS OF
--tftWEDt9V t F�G BOARD
! i! STEES
nrn
ENCLOSE POOL TO CQDt.
w.;7 UPON COMPLETION
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFll--/ 1,�;
OF OCCUPANCY
�rS�Z
Aft)
POOL (,J.(gtls ox '-rems Aloll,
a h:v _hr- o f �Y," (F Ur )
q a W rah
3 regio r' iced ,�St cue
• . a;�d
ftp. P o o F
c ll. 14,1so Qerhmlly "ry Fa-jr
Rr p"L.
bl,4 7- rs ,,'spilk
Re
' I Af:FA't'tE-N -
ALL PnA,. 10
• FLt
MA NQ
09 Wl
• V •
,Gr
- �� ` • • •, [gyp/�,
• P