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Home My WebLink About49094-Z FOlxcOG Town of Southold 4/22/2023 P.O.Box 1179 co 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44050 Date: 4/22/2023 THIS CERTIFIES that the building ELECTRICAL Location of Property: 7800 Great Peconic Bay Blvd,Laurel SCTM#: 473889 Sec/Block/Lot: 126.41-15 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/5/2023 pursuant to which Building Permit No. 49094 dated 4/5/2023 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: electric car charger. The certificate is issued to Bloom, Steven&Susan of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 49094 4/10/2023 PLUMBERS CERTIFICATION DATED Autho ized Signature o�SUFFei�.co TOWN OF SOUTHOLD a� aye BUILDING DEPARTMENT y x 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#: 49094 Date: 4/5/2023 Permission is hereby granted to: Bloom, Steven 7800 Peconic Bay Blvd Laurel, NY 11948 To: Electric Car Charger At premises located at: 7800 Great Peconic Bay Blvd, Laurel SCTM #473889 Sec/Block/Lot# 126.-11-15 Pursuant to application dated 4/5/2023 and approved by the Building Inspector. To expire on 10/4/2024. Fees: ELECTRIC $85.00 Total: $85.00 Building Inspector so�ryol 0 Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 Q sean.devlinl'D-town.southold.ny.us Southold,NY 11971-0959 Q �yooum,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Steven Bloom Address: 7800 Great Peconic Bay Blvd city:Laurel st: NY zip: 11948 Building Permit#: 49094 Section: 126 Block: 11 Lot: 15 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: Modern Electric East License No: 4253ME SITE DETAILS Office Use Only Residential X Indoor X Basement X Service Commerical Outdoor X 1st Floor X Pool New X Renovation 2nd Floor Hot Tub Addition Survey X 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 1 Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transfer Switch UC Lights Dryer Recpt Emergency Strobe Heat Detectors Disconnect Switches 4'LED Exit Fixtures Sump Pump Other Equipment: JuiceBox Car Charger w/220 Outlet Notes: Car Charger Inspector Signature: — Date: April 10, 2023 S. Devlin-Cert Electrical Compliance Form �o�aUE SOUIyo� `t 9 v ! / "7 # # y , TOWN F SOUTH LD BUILDING DEPT. couo��' 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION AON [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ]' RENTAL REMARKS: DATE INSPECTOR I �ns� Lino FF04 BUILDING DEPARTMENT-Electrical Inspector Gy TOWN OF SOUTHOLD Town Hall Annex- 54375 Main Road - PO Box 1179 Ca • Southold, New York 11971-0959 Telephone (631) 765-1802- FAX (631) 765-9502 1 rogerr _southoldtownny.Aov - seand(aD-southoldtownny_gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 04/04/2023 Company Name: Modern Electric East, Inc. Electrician's Name: T. Rutkowski License No.: ME 4253 Elec. email:trut299@aol.com Elec. Phone No: 516-903-7151 01 request an email copy of Certificate of Compliance Elec. Address.: PO Box 321, Mattituck, NY 11952 JOB SITE INFORMATION (All Information Required) Name: Steven Bloom Address: 7800 Peconic Bay Blvd, Laurel, NY Cross Street: Bray Avenue Phone No.: 516-428-1473 BIdg.Permit#: email: 16 Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): ev--wiring car charger Square Footage: Circle All That Apply: Is job ready for inspection?: FvYES ❑ NO ❑Rough In ❑ Final Do you need a Temp Certificate?: ❑ YES R NO Issued On Temp Information: (All information required) Service Size❑1 Ph R3 Ph Size: A #Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead #Underground Laterals 1 F12 H Frame Pole Work done on Service? Y N Additional Information:EV-wiring of car charger PAYMENT DUE WITH APPLICATION �� '� � 4 t $<- W:)P 4 1 t o %; $Fp� � BUILDING DEPARTMENT- Electrical Inspector �r®`"® ®c%�`:t, TOWN OF SOUTHOLD Town Hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 �4 �N�-;} Telephone (631) 765-1802 FAX (631) 765-9502 s rogerr ansoutholdtownny.gov - seand(a_Dsoutholdtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 04/04/2023 Company Name: Modern Electric East, Inc. Electrician's Name: T. Rutkowski License No.: ME_4253 Elec. email:trut299@aol.com Elec. Phone No: 516-903-7151 01 request an email copy of Certificate of Compliance Elec. Address.: PO Box 321, Mattituck, NY 11952 JOE SITE INFORMATION (All Information Required) Name: Steven Bloom Address: 7800 Peconic Bay Blvd, Laurel, NY Cross Street: Bray Avenue Phone No.: 516-428-1473 Bldg.Permit#: email: Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): ev--wiring car charger Square Footage: Circle All That Apply: Is job ready for inspection?: YES ❑ NO F-]Rough In ❑ Final Do you need a Temp Certificate?: ❑ YES � NO Issued On Temp Information: (All information required) Service Size❑1 Ph❑3 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect[—]Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals D 1 n2 H Frame D Pole Work done on Service? Y N Additional Information:EV—wiring of car charger PAYMENT DUE WITH APPLICATION �1� '� C� $�