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HomeMy WebLinkAbout49593-Z SUFFOII(c Town of Southold 9/19/2024 P.O.Box 1179 o • 53095 Main Rd A-- ot'.+J Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45566 Date: 9/19/2024 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 3415 Wells Ave Southold SCTM#: 473889 Sec/Block/Lot: 70.4-7 Subdivision: Filed Map No. Lot No. conforms substantially to the-Application for Building Permit heretofore filed in this office dated 12/7/1978 pursuant to which Building Permit No. 49593 dated 8/17/2023 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: additions and alterations to existing single family dwelling as applied for. The certificate is issued to Rich JH Jr Rev Trt of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 49593 4/18/2024 PLUMBERS CERTIFICATION DATED Aut riz ignature �o�S�FFa TOWN OF SOUTHOLD BUILDING DEPARTMENT In TOWN CLERK'S OFFICE o • SOUTHOLD, NY i 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#: 49593 Date: 8/17/2023 Permission is hereby granted to: Rich Family Trust#1 3415 Wells Ave PO BOX 208 Southold, NY 11971 To:, ADDITION TO DWELLING (Replaces #10066) 1 At premises located at: 3415 Wells Ave SCTM #473889 Sec/Block/Lot# 70.-4-7 Pursuant.to application dated 12/7/1978 and approved by the Building Inspector. To expire on 2116/2026. Fees: PERMIT RENEWAL $57.50 Total: $57.50 Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N.. V. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N° 10066 Z Date .. ... ,__ m.�,Z,;... ........ 197 Permission is hereby granted to: . -' . La14 .. .. ................ ....... .. .�.... �" .'......... to .. G:"G. ..�..I'Ird.. ... ............................... .... .. ...��-. . . ...................... ... ... . . .. ... .. .. ... -... .................... ofpre ises located at ....✓..�........................... ..................................`.`............................ ................................................................................ ......... ........................... ... ..../..� t............ ..pursuantto.. ..application dated •..... ... .v.(i4�.......7........................ pp roved by the Building Inspector. Fee $ ......�� ..... . . .. ............. ..... .. ..... ...... ............... Building Inspector oF so�ryol � o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 G Q �. • �o sean.devlin(&-town.southold.ny.us Southold,NY 11971-0959 O C4UM`1,0ct1� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Rich Family Trust#1 Address: 3415 Wells Ave city:Southold st: NY zip 11971 Building Permit#: 49593 Section: 70 Block: 4 Lot: 7 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: AS BUILT License No: SITE DETAILS Office Use Only Residential X Indoor X Basement X Service -X Commerical Outdoor X 1 st Floor X Pool New Renovation 2nd Floor X Hot Tub Addition Survey X Atticr— Garage INVENTORY Service 1 ph Heat Duplec Recpt 15 Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt 7 Wall Fixtures Smoke Detectors 4 Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO 4 Transfer Switch UC Lights Dryer Recpt Emergency Strobe Heat Detectors Disconnect Switches 27 4'LED Exit Fixtures Sump Pump Other Equipment: Notes: " AS BUILT NO VISUAL DEFECTS " House Wiring & Smokes Inspector Signature: Date: April 18, 2024 S. Devlin-Cert Electrical Compliance Form oF soary�6 3 * * TOWN OFSOUTHOLD BUILDING DEP . `ycou 631-765-1802 INSPECTION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [: ] FIRE"-SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [, ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) `[�j' ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: Vn ki-ArAoli _ �L' DATE 2 INSPECTOR OF SOOTyO� f # TOWN OF SOUTHOLD BUILDING DEPT. couffm 631-765-1802 qqc INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ]' RENTAL REMARKS: c-,, irugg, 4v a"-i 6, ey u U Io n.4v a& I n Su olti . LI emu Cpte -i pica. r �✓' • D� pry- �.�. DATE ANSPECTOR OE SOUTy�6 as- Ave # * TOWN OF SOUTHOLD BUILDING DEPT. `^0u m 631-765-1802 INSPECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] FINAL [ ] FIREPLACE &.CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [. ] CODE VIOLATION rl PRE C/O [ ] RENTAL REMARKS: I L!-r- DATE I'P INSPECTOR N. J. MAZZAFERRO, P.E. v PO Box 57, Greenport,N.Y. 11944 ; ((�� (��/J( Phone - 516-457-5596 f ❑ 15��U V L5 ConsultingE` ' eer DD September 10, 2024 Design, Construction, ns idn2 2024 Page 1 of 1 BUIiI DNG DEPT. Town of Southold-Building Department TOWN r)F SOUTH017; 53095 Main Road Southold NY 11971 Re: Rich Family Trust 3415 Wells Ave Southold,N.Y. 11971 District-1000, Section-70. Block-7 Lot-7 Building Permit Number—49593 On September 10, 2024, I verified the insulation installed at the noted location. The inspection covered the basement, exterior and interior walls and the ceiling/roof for the existing addition. The inspection results are: 1 —Exterior Walls—Insulation provided and installed to meet Code at the time of construction(fill cavity 100%). 2—Roof—Insulation provided and installed to meet Code at the time of construction(fill cavity 100%). All insulation provided was done in compliance with the NYS and Southold Town Building Codes at the time of construction. Result—Based upon inspection of this project and to the best of my knowledge, belief and professional judgment, construction as installed complies with the applicable codes of NYS and Southold Town Building Codes. Nicholas J. Mazzaferro,P.E. �* of N y 7� z � O w O �O 57�y AR�F�SSION*� , { SCENE t - , D A 1 ij S E P 1 2 2024 N. J. MAZZAFERRO, P.E. PO Box 57, Greenport,N.Y. 11944 � � ��E ' Phone- 516-457-5596 TOWN,-)r SOUTHO' Consulting Engineer September 10, 2024 Design, Construction, Inspection Page 1 of 1 Town of Southold-Building Department 53095 Main Road Southold NY 11971 Re: Rich Family Trust 3415 Wells Ave Southold,N.Y. 11971 District-1000, Section-70. Block-7 Lot-7 Building Permit Number—49593 On September 10, 2024, I verified the plumbing installed at the noted location. The inspection covered the basement, first and second floors for the existing addition. The inspection covered the interior plumbing roughing for the Drainage Waste and Vent System(DWV) and the Water Supply System(WS). The inspection results are: 1 —DWV—System was fully exposed and readily viewed. I observed the drainage and vent lines.System constructed as required.New installation was connected to the existing system. 2—WS— System was fully exposed and readily viewed. I observed the hot and cold water supply lines. System constructed as required.New installation was connected to the existing system. Result—Based upon inspection of this project and to the best of my knowledge, belief and professional judgment, construction as installed complies with the applicable codes of NYS and Southold Town Building Codes. OF N � ro Nicholas I Mazzaferro, P.E. � 0 r �Fp All o57�9y AROFESSION���• ?IELD INSPECTION REPORT I DATE COMMENTS •.0 •o t� FOUNDATION (IST) ,9 a VIA � ------------------------------------ C FOUNDATION (2ND) M LA z V\ H ROUGH FRAMING& �.. PLUMBING t' N a � � r INSULATION PER N.Y. y STATE ENERGY CODE r b $-11•a3 onj ine to- Ge4li /0 [)IAAV anA i/lsul or...a FINAL ADDITIONAL COMMENTS S. �'l c 4 l S 2 q- IE�(ec AgI- 5 u rYaq l©�,/ & r) C Z -ay y �o � z x � d r� b H FORM NO. Y TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .. 19 77 Application No. " Approved. ..... .......... .1 197J Permit No. ®. ..5?. .. ..... Disapproveda/c ............................................................................................ .......................................................................... .... ... ........... ..... .................. . ....................... ..... ............................... (Bui,ding Inspector) APPLICATION FOR BUILDING PERMIT Date ..R e ........ ................. .. 19.. .. INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot-plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION 'IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal' or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for nece ary inspections. . . ......!J? ?. ... ... ..�... . ........................................... (Signature of applicon name, if a corporation) .. .�. ..... .. �...I� .................. Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. C��v+#i :!z......................................... ............. ......................................................................................................... .... ...... Name of owner of premises ....... ................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. "V."?,sm.an... !�.�✓............. Plumber's License No. ....................:...:...... ..:........... Electrician's License No. ..........................?.............. OtherTrade's License No. ............................................. //''``'' _ 1. Location of land on which proposed work will be done. Map Nolte' tt:. r .!-�... ..... .... Lot No. . ................... �" Ar Street and Number .................................W. l;,i,.S.... . 4....................r:..���.4:R.1�'k�Q�°�..�..I.V'.�...................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....61.0.Kr.....".....I.......FAmi�-.�....�)JN<I—1,ii�� .............. b. Intended use and occupancy .... .........u!/....... .. .X.& A.rd.....N......................... � ~� 3. Nature of work (check which applicable):ob|e)� New Bui|di�� Addition —��'un .......... /\berotknn Repair .................. Removal ------ Demolition-- —' y Other or N ork ----------.-----.. ,— (Description) 02l 4. Estimated Cost —.---.—' O4u� 00..:----^—� .��ed — ' ��--.-----------------------_. . ` � (to be paid on filing this application) � U 5. If dwelling, number of dwelling units --- —.----..Nun�berofdweUing units on each floor --,.u................... If garage, number of cars -----.--_-----'-------_—'-'-----------------------' 6. If business' commercial or nixed occupancy, ��' re,ond ' of each type of use ............................�L 7. Dimensions of existing structumu, ifany: Front —..��................ Rear - Sa..................... Depth ..a... .........U �� «Height --- ---' Number of Stories ---.w���-----------.. -----.---,-.-----------. Dimensions�of� na structure with alterations or additions:�on-x� F"ront 4. e...........................� ' Re or '* -.A.................. »—--' �.q , .Depth --. -----' Height /-- ----..Number of Stories ...... 8. [ inonnim`s of entire new construction: Front -----5.0----- Rear ....5 .a............... Depth ..� .1(.............. Height —.1.9--- Number of Stories ........��--._---_—.—'------------.------------- � ~' ' ' v 9 Size of lot: Front --.. ��K�x�------------. Rear --. ---.. '�L����__---- ` " --' > ' =�^ — � � . |. �x8' l0� Dote of Purchase —`.��k���-L-----------. of Fonner Owner K������,-opw~.��,�'�.-.'��J�»�����. ll. Zone or use district in'Which premises are situated —. hbE: . . ./.AI~.................................—......... 12. Does,. ,ruction vi�o|ote 8nyzoninQ low, ordinance or regulation: ..N.0--------_------. . . . / 13. Will lot ba regraded ........ excess fill be removed from premises: ( ) Yen (��) No '14. Name of Owner nf premises J�]M�A' � &4 A. �rpk.--- AddrmosSQJ10.9.UQ.............. Phone No. Mm Z_-"_'-".. Nome of Architect ----'N° � -------'-.--. /\ddreso .-.---'---,---- .PhoneNo ...................... ��� � . � � � ,` Non�e of [ontroctor ..�:����������—��x^°~°----.—.. �x�dreaa —.--..---�-_. Phone ho� -'_--...—' PLOT D|/\GR/\&4 clearlyLocate all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior orcorner |o*. .J/ A 51-ATE OF NE ....... . ....�.-...being dylisworn, deposes a 'd says Th],at he is the applicant ve named. of said owner or owners,'an'd' 'i is dtu-,�y'Iauf'hori�e�',tio' ,r')erform' or have' performed )tk�e said work. and to make and file this application; that*all statements contained in this application are,.true,to the best of his knowledge and belief; and thaT the work wilf��be perform d in the manner set forth in the a plication I filbd therewith. Sworn efore me this (Signature of applicant) Q­lificd in Suffolk COunl�,� Ccmmijsjnn Expires March 30, 100 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .. ....... ............ 197C .� •, ''77 Application No ........ ................... Approved .JQi�:<:.... ........... .. 191.. Permit No. � •C� C�............. f 4 3a.- 7 Disapproved a/c ....:.:...........A(Bu .. ............ 02 .............................................................. .. .. .. ....a............ .... , . .................................................. ... ... ding Inspector) APPLICATION FOR BUILDING PERMIT i. .. h. Date ........ :. :.......�................. .. 19...1.. . INSTRUCTIONS • I _, a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector,,with 3 sets of plans, accurate plot plan to scale. Fee according to'schedule:, b. Plot plan showing location of lot and of buildings on,premises, relationship to.adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept'on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until .a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New.%York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or"demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to , admit authorized inspectors on premises and in buildings for nece cry inspections. ....�.1..?... .. .....�r .. . ...... ..... . . ....................................... (Signature of..applicant name, if d/ccoorporation) y.... .. ..... pP... . ........ (Address of a licant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .....0.1{'�.N.C.0............................................. . ............. ... ........`...:..................................................................................... ` �!. �:S...... I..... '. :.................................................................................. Name of owner of premises ... If applicant is a corporate, signature of duly authorized officer. ........................................................................................ (Name and title of corporate office) Builder's License No: ! a5�?'1.�7'� ��. Plumber's License No. ................................. Electrician's License No. ............................................ ' Other Trade's License No. ...............:................................ 1. Location of land on which proposed work will a done. ap No.c"�.0.:. t �5 .-. Lot No., ... . ................ Street and Number .................................. ............. Municipality 2. State existing use and occupancy of premisesand intended use and occupancy of proposed construction: a. Exisiting use and occupancy .....C..!. ...:....1...... . �- ..... W�J t.� ...... ............................. b. Intended use and occupancy ..... .!1. ....,(�,! ...l..J �.. Q �.�.,e.,1��✓'s ......... \ . ` \ »m� 3. N�`vo ^ work (check which applicable): New Building. ------ Addition ... r�..--.. Alteration .X--..' Repair .................. Removal ----.'-',Dan��itioh.----'-- Other Work —,.---.----------. '— (Description) � 4. Estimated Cost ---_--.��r� .�—_--_—.Feo --'���.��--------------_-------_--. ' (to be paid on filing this application) � K 5. If dwelling, nun`berx� dwelling units --..�------Nun�bor'uf dwelling units on each floor�.—,.u------. ' � � � ` Ifgarage, number of com --�_—'--^------'----_'------'--'—'—'-_~----.--------. ' 6. H buyinexs commercial or mixed occuponcy, specify nature and extent of each typ& of use' ............................. u�. 7. [}inn*nsiona'ofexsting structures, /f any: Front .. Reor' ..°����.------- Depth ..=���^" ........ � � Height .---'x..8��--- Number of Stories ---'�r*--..----_---. ..�.---� —.—_-----_------- ' . � Dimensions structure w�h,..o�eroti or additions: Front w��*�--------.- Rear ��.��-----' D�� � Height K � ' Mumbe�� S�h� ......' . �—.. �°+. .—.---' � ,—.—'_—..,--� — �������� _-,-� �~�� � �� , » « �^. .^ � �� 8. Oinn 'ehtine new construction: Front ----����—.---- Rear .-"��^�*-_.--_ Oepth ..�*���---- �^�| ' HoiQht'.'..�.,�--- Nun�be, of Stories. --.��—��-----''''�--------------_----------.-- p ^ � 9. Size of lot: Front -- -----------. Rear --.� .�.��---- ao-o................... I��� Oo�e of Purc^-�� -- .�_—_________� �_ 11, Zone or use district in which'premises are situated --��.�..`. �K*—.-----------.--- l2. Does construction violate on zoning |o� ordinance or regulation:y regulation: ..8����.-----.---------- -' ost 13. Will lot be ragnodad.— U be removed from, premises: ( ) Yes No l4. Monnaof'Ownerofpnenn�oes `b� . .��. �---. ass .-'-...Address No. �� .. .. w� .. | �� Nome of Architect ...............Kvj.(�....... ........................... /\dd,ess ................................ .Phone No. .................. "d r° � . Norne of Contractor .. spf iY1 —.��i"~~------ �Address --.*—.---._-.-. Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposedi o. 1ndi oto all set-back dimensions from property knes Give street and block number or description according to deed' and shbw street names and indicate whether interior orcorner lot. ` Aq SP STATE Pf NEW COUN ,OF .......... .....i... .. ....... . . ............... ..........being.duli", sworh dep'ose' s and �ays that he is the applicant ,Contractor, agent, corporate officbr,,'etcJ. of said owner or,owners, al"Id -is- ddly�au 0 w6'k and file this application;-that all statements contained in this application ore,tru& to'th6* best of.1-'fls knowledge and belief; and thOT the work will be per rmed in the manner set forth iFt e applicialtio'n-filed therewith. Sworn p of - � |Notory Public, '.'':'«'—«' '—'--'—`—. tSignoure of o \ � ' ica � Cornmislon~~���~ /��u DEC -EOVE fIPt,, BU NG DEPARTMENT- Electrical Inspector 4v F E8 1 2 2024 ,. TOWN OF SOUTHOLD Town Hall Annex- 54375 Main Road - PO Box 1179 sr,7 on rim ent Southold, New York 11971-0959 soL1,ff1rWiephone (631) 765-1802 - FAX (631) 765-9502 jamesh()_southoldtownny.gov- seand(aD_southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company 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 Required) Name: R i c� ►1 < < s'P -#- Address: 11 K- A-P-e- Cross Street: 0 rh-t���►� Phone No.: Bldg.Permit#: email: y es *��� 3 �� -4aNl•�c. Tax Map District: 1000 Section: t4-132�9 9 Block: ' 1 o, Lot: - -� BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): hCAd+o L LC -j t<tC rt-c_ SCA � �� rGP U � Q -I—v /�­ � .d d`/`i' n S Mts. sec Circle All That AP CC(n00►1 n+- e Oftl Cl 1191 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 Ph❑3 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals E11 2 H Frame D Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION 4 `ia-b 6LA_rVe_� Un1,,,, D ECE9VE �g�fFO(,��, BUI NG DEPARTMENT- Electrical Inspector o F E B 1 2 2024 TOWN OF SOUTHOLD Town Hall Annex- 54375 Main Road - PO.Box 1179 B%11Ws'—T r3,mm,,-! v_,,nt Southold, New York 11971-0959 "''{ d ephone (631) 765-1802 - FAX (631) 765-9502 O���l �ao�� ` southoldtownn lamesh southoldtownny.4ov- s eand v gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company 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 Required) Name: R A-FAk( -Vt2�s-IT -#- Address: CJe-L�__s A-4-0- Cross Street: 0 ood Phone No.: Z_U-ll BIdg.Permit#: email, 6-•,Aes —Tax Map District: 1000 Section: t *7150A 5 Block: '-10, Lot: --J- BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): �G�L j Sc.L cC1'Do a 5.r &-k L t,i 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 Ph❑3 Ph Size:Zq�LA #Meters�_ Old Meter# ❑New Service❑Fir Reconnect❑Flood Reconnect❑Service Reconnect❑Underground verhead # Underground Laterals 1 2 H Frame Pole Work done on.Service? Y Additional Information: ' I PAYMENT DUE WITH APPLICATION ��-(D 6Lo, ^ L' —L a-.;k ► ®4(0(� PERMIT ti Address: Switches Outlets I ' G FJ's Surface Sconces H H's UC Lts Fans Fridge HW Exhaust Oven W/D Smokes '� DW Mini -arbon Micro Generator -ombo Cooktop Transfer aC AH Hood Service Amps Have Usec -pedal: :omments ®� ��av-47.17 ;I-/— /V1in r , r+ , # g l , P` v L 4 } a. 1 r` p -.8-k , Moo. , 2 ..,. •c.,_ .� ., ..f, ,: ,,.� �. .. a �.. -..�. ., ,. a-: k � s r F s-. aw- , APPROVED AS NOTED SATE: A`b. �7 FEE: By: — NOTIFY BUILMNG DEPARTMENT AT 765-2,560 9P:.M to 4RM FOR REQUIR, ED MSPr;C-Fc I,,4S: 1. BEFORE QAC FILLING, FOUNDA- TK','N O!, START 3. BEFORE COVERING P�P,;S OF ANY KIND 4. FINAL WHEN JOB COMPLETED 3 NOT RESR'OINS@3LE FOR DESIGN OR CO;14STRUCTION ERRORS 5. ALL CONSTRUCTION MUST MEET � REQUIREMENTS OF N.Y. STATE CODE AND TOWN HOUSING CODE, & ZONING r w . .. o �3 P E I M" 14 LJ r r � � } Y y , 711Loy i CA t i t.war �-w.un.....rr.. .nYa�-...... v r r � : L _ dr - _ A T ___ 1 Jy r i �x � X S i fs � a f , ip + 1 � I w, x.�5 t � r , t . i + i i 76 1 111 L. ^ a E f _