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Home My WebLink About50561-Z �1g11FFOt �p_ Town of Southold 8/22/2024 ao Gyp P.O.Box 1179 o - o _ 53095 Main Rd y�01 ' r Southold,New York 11971 4 ' CERTIFICATE OF OCCUPANCY No: 45478 Date: 8/22/2024 THIS CERTIFIES that the building ELECTRICAL Location of Property: 6565 Route 25,Laurel SCTM#: 473889 Sec/Block/Lot: 125.-1-19.5 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/15/2024 pursuant to which Building Permit No. 5661 dated 4/17/2024 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: "as built"400 amn electric service&repairs The certificate is issued to Watroba,Tisha of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 50787 8/2/2024 PLUMBERS CERTIFICATION DATED Authorize ignature ofF III,t�o TOWN OF SOUTHOLD BUILDING DEPARTMENT x TOWN CLERK'S OFFICE Wo • g' 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#: 50561 Date: 4/17/2024 Permission is hereby granted to: Watroba, Tisha 2555 Marys Rd Mattituck, NY 11962 To: legalization of"as built" electrical repairs At premises located at: 6565 Route 26, Laurel -2 h�P �� SCTM #473889 AA-a- Sec/Block/Lot# 125.-1-19.5 Pursuant to application dated 4/15/2024 and approved by the Building Inspector. To expire on 10/17/2025. Fees: ELECTRIC $150.00 Total: $150.00 Building Inspector OF SOUr��l � o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 G Q � sean.devlinr�town.southold.ny.us Southold,NY 1 1 97 1-0959 ��yCOU�'�� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Tisha Watroba Address: 6565 Route 25 city,Laurel st: NY zip: 11948 Building Permit#: 50787 Section: 125 Block: 1 Lot: 19.6 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: REP Electric License No: 46528ME SITE DETAILS Office Use Only Residential Indoor X Basement Service X Commerical X Outdoor X 1st Floor X Pool New Renovation 2nd Floor Hot Tub Addition Survey X Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt 2 Ceiling Fixtures Bath Exhaust Fan Service 3 ph X Hot Water GFCI Recpt 3 Wall Fixtures 4 Smoke Detectors Main Panel 200X2 A/C Condenser Single Recpt Recessed Fixtures CO 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 4'LED Exit Fixtures 11 Sump Pump Other Equipment: 3 Phase 200A Panel 40 Circuits / 5 Used, 3 Phase 200A Panel 40 Circuit/ & Used Notes: " AS BUILT NO VISUAL DEFECTS " Service & Some Lighting / Outlets Inspector Signature: Date: August 2, 2024 S.Devlin-Cert Electrical Compliance Form SOGtyo� a07 IU # # TOWN OF SOUTHOLD BUILDING DEPT. `y�o ►� 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 [ ] PRE C/O [ ] RENTAL REMARKS: �� &�Z40/ DATE INSPECTOR .. " �O,�,OFSOUTyOIo 0S /Q ,5 _ TOWN OF. SOUTHOLD BUILDING DEPT. cou 631-765-1802 INSPECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] 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 [ ] RENTAL REMARKS: ►- DATE INSPECTOR _ f ,� BUILDING DEPARTMENT-Electrical ect -AP-R 5 2024 t `� ss TOWN OF SOUTHOLD , . ` Town Hall Annex- 54375 Main Road - POD Southold, New York 11971-0959t« i ' o Telephone (631) 765-1802 - FAX (631) 765-9502 iameshCDsoutholdtownny.gov - seand(@-southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION.(Aii Information Required) Date: March27, 2024 Company Name: 14 P f b4C rf,-r& 4 C Electrician's Name:. 966e-r- Pa.I ad no. License No.:, (D Z g tV1 G Elec. email: re p a-1<edri G 1/Yl4i 1, &a/M Elec. Phone No:. to '� '76-1 6 0 ?a y Ell request an email copy of Certificate of Compliance Elec. Address.:: �0 �✓,i ��,�'` III{ �1C7 i'��ti�i� l�-�,�� h,; r�'uL� �' d �Iv✓�� ( �%✓��' JOB SITE INFORMATION (All Information Required) Name: Tisha Watroba Address: 6565 Route 25, Mattituck; New York 11952 Cross Street: Bray Avenue Phone No.:. 631.298.4418 Bld,g.Permit#: email: goggins aw gmai :com Tax Map-District: 1000 .Section: Block: 1 Lot: 19,5 BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): as per Building-Department inspection,report dated 3/14/24 Square Footage: Circle All That Apply: Is-job ready for inspection?: YES'r NO 7 Rough In FV Final. Do you need a Temp Certificate?: ❑ YES 0 NO Issued'On Temp Information` (All information required) Service Size�1 Ph FV Ph Size: A #Meters. Old Meter# ❑New Service0 Fire Reconnect[]Flood Reconnect[]Service Reconnect[Underground✓]Overhead # Underground Laterals 1 R2- H Frame Pole Work.done on Service? Y ✓ N Additional Information: PAYMENT DUE WITH APPLICATION 141 , ��I1.,i I9*4 k -Ittitt 'i ., pit �., A P A 1 5 2024 ff � BUILDING DEPARTMENT- Electrical'n t e'6 TOWN OF SOUTHOLD f tA Town Hall Annex- 54375 Main Road - PO ° : Southold, New York 11971=0959 l • ; .E C.7k,` 2:f ..;Y �� Telephone (631) 765-1802 - FAX (631) 765-9502 Lamesh �southoldtownny gov seand(cr�southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (Ali information Required) Date: March 27, 2024 Company Name: 14 P f t,LT-_mac LL C Electrician's Name: 966er- Pa,I id no License No.: (� '�2� ftl a Elec. email: re 44 crtr i' j Q q otcl`r(. C'aIr'► Elec. Phone No: 0 ; y [EI request an email copy of Certificate of Compliance Elec. Address.: PO _90Y 03— 11 q 00 W1411%, 14 XIti VI+ & i fiv L� ��Zliv ��1= r �I✓ Z JOB SITE INFORMATION (All Information Required) Name: Tisha Watroba Address: 6565 Route 25, Mattituck, New York 11952 Cross Street: Bray Avenue Phone No.: Bldg.Permit#: email: g°g9ins aw gmai .com Tax Map District: 1000 Section: 125 Block: 1 Lot: 19.5 BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): as per Building Department inspection report dated 3/14/24 Square Footage: Circle All That Apply: Is job ready for inspection?: 0 YES❑ NO ' Rough In ✓❑ Final Do you need a Temp Certificate?: [ YES FV� NO Issued On Temp Information: (Ail-information required) Service Size[1 Ph F&/�3 Ph Size: '(WA # Meters. Old Meter# ❑New Service[]Fire Reconnect OFlood Reconnect QService Reconnect oUnderground�Overhead # Underground Laterals R 1 FJ2 D H Frame 0 Pole Work done on Service? Y ✓ N Additional Information: PAYMENT DUE WITH APPLICATION 197 PERMIT# Address:- Switches Outlets GFI's Surface Sconces H H's UC Lts Fridge HW POOL Panel Fans Mini Fr. W/D Pump Exhaust Oven Sump Heater Trnsfmr Smokes DW Generator Salt Gen. Carbon Micro GrbDis Water Bond Lights Heat Pucks ERV HOT TUB/SPA Inst Hot DeHum Transfer Disc Combo Cooktop Minisplit Blower AC Ali Hood Blower Servic mps 2m--, Have --tC--) Used A m Have qD Used Comments WILLIAM C. GOGGINS Attorney at Law 13235 Main Road, P.O. Box 65 Mattituck, New York 11952 Phone: (631) 298-4818 Fax: (631) 298-4214 Email: gogginslaw@gmail.com April 11, 2024 Building Department of the Town of Southold 53095 Main Road, P.O. Box 1179 Southold, New York. 11971 Re: Watroba: Permit, 6565 Route 25, Mattituck, NY Dear Sir/Madam: In connection with the above referenced matter, enclosed please find the Application for a building permit, electrical inspection application together with a check in the amount of$150.00. If you have any questions, please do not hesitate to contact the undersigned. Very truly yours r WILLIAM C. G GINS WCG/dmp enclosures �SUFFQLt�OG� TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-0959 �o! Telephone (631) 765-1802 Fax(631) 765-9502 https://www.southoldtownny.gov Date Received APPLICATION FOR BUILDING PERMIT wu�-. E C L For Office Use Only At PERMIT NO. Building Inspector: 24 ' AP 20 =Applications•and•forrns must.be filled out in•tl eir entirety:,,fncoinplete applicationswillnot'be"accepted. 'Where the Applicant i's:not the'owner;an Owner's Authorization form(Page.2)shall,be completed'.'Date:March 19, 2024 "OWNER(RS)OF'PROPERTY; Name:Tisha Watroba SCTM#s000-125.00-01.00-019.005 Project Address:6565 Route 25, Mattituck, New York 11952 Phone#:631-298-1714 Email:gogginslaw@gmail.com Mailing Address:P.O. Box 1502, Mattituck, New York 11952 CONTACT PERSON:: ., _ Name:William C. Goggins Mailing Address:P.O. Box 65, Mattituck, New York 11952 Phone#:631.298.4818 TEmail:gogginslaw@gmail.com DESIGN°PROFESSIONAL!INFORMATION ' r Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION.'. Name: Robert Paladino d/b/a REP Electric Mailing Address: P.O. Box 635, 11200 Main Road Phone#:631.298.9602 Email: DESCRIPTION OF;PROPOSED'CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ®Repair ❑Demolition Estimated Cost of Project: 20ther Existing Electrical Repair $500.00 Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes ®No 1 ..'PROPERTY INFORMATION: Existing use of property: Car Wash Intended use of property: Car Wash Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to General Business Zone this property? ❑Yes iiNo IF YES, PROVIDE A COPY. ❑ Check Box After Reading:,The owner/contractor/design professionai'is responsible for ail drainage ani&storm water'Issues as provided by ' Chapter 236 of the Town Code.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,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 building(s)for necessary inspections.'FaIse statements made herein are punishable as a Class A misdemeanor pursuant to.Section 210.45 ofthe New York State Penal'Law: Willi m C. Goggins Application Submitted By(print name): ®Authorized Agent ❑Owner W4, Signature of Applicant: Date: March 19, 2024 STATE OF NEW YORK) COUNTY OF SUA&K ) William C. Goggins being duly sworn,deposes and says that (s)he is the applicant (Name of individual signing contract)above named, Attorney (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 19th March 24 a�i� �- day of ,20 DONNAM. PALMER Notary 11ublic NOTARY PUBLIC,STATE OF NEW YORK Registration No.01 PAS069978 Qualified in Suffolk Count OPERTY OWNER AUTHORIZATION Commission Expires December 9, (Where the applicant is not the owner) Tisha Watroba 2555 Mary's Road, Mattituck, New York I, residing at William C. Goggins do hereby authorize to apply on my behabt, h own of S uth Id Building Department for approval as described herein. March 19, 2024 Owner's Signature Date Tisha Watroba Print Owner's Name 2