HomeMy WebLinkAbout36937-ZTown of Southoid Annex
54375 Main Road
Southold, New York 11971
1/27/2012
CERTIFICATE OF OCCUPANCY
No: 35414
Date: 1/27/2012
THlS CERTIFIES that the building
Location of Property:
SCTM #: 473889
Subdivision:
ADDITION/ALTERATION
10220 SOUND AVENUE, MATTITUCK,
Sec/Block/Lot: 122.-2-11.1
Filed Map No.
conforms substantially to the Application for Building Permit heretofore
11/17/2009 pursuant to which Building Permit No. 36937
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 an existing one family dwelling as applied for.
Lot No.
filed in this ofilced dated
dated 1/20/2012
The certificate is issued to
THOMAS & SUSAN BEST
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED 1/25/I2
35151
1/11/12
A~ut ~J_edhomas Best
S .~g~'t~¢
TOWN OF SOUTHOLD
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 #: 36937
Permission is hereby granted to:
THOMAS & SUSAN BEST
10220 SOUND AVENUE
MATTITUCK, NY 11952
Date: 1/20/2012
To:
ALTER AN EXISTING SINGLE FAMILY DWELLING & ADD A PARTIAL 2ND STORY AS
APPLIED FOR. THIS PERMIT REPLACES EXPIRED BP # 35151
At premises located at:
10220 SOUND AVENUE, MATTITUCK
SCTM # 473889
Sec/Block/Lot # 122.-2-11.1
Pursuant to application dated
To expire on 7/20/2013.
Fees:
11/17/2009 and approved by the Building Inspector.
PERMIT RENEWAL
Total:
$37.50
$37.50
Building Inspector
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
(THIS
BUILDING PERMIT
PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 35151 Z
Date NOVEMBER 17, 2009
Permission is hereby granted to:
THOMAS J & SUSAN F BEST
10220 SOUND AVENUE
MATTITUCK,NY 11952
for :
ALTER AN EXISTING SINGLE FAMILY DWELLING & ADD A PARTIAL 2ND STORY
AS APPLIED FOR. THIS PERMIT REPLACES EXPIRED BP # 33289
at premises located at 10220
County Tax Map No. 473889 Section 122
pursuant to application dated NOVEMBER
Building Inspector to expire on MAY
SOUND AVE MATTITUCK
Block 0002 Lot No. 011.001
17, 2009 and approved by the
17, 2011.
Fee $ 75.00
Authorized Signature
ORIGINAL
Rev. 5/8/02
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 33289 Z Date AUGUST 1, 2007
Permission is hereby granted to:
THOMAS J & SUSAN F BEST
10220 SOUND AVENUE
MATTITUCK,NY 11952
for :
ALTER AN EXISTING SINGLE FAMILY DWELLING AND ADD A PARTIAL SECOND
STORY AS APPLIED FOR. THIS PERMIT REPLACES BP # 23039
at premises located at
County Tax Map No. 473889 Section 122
pursuant to application dated AUGUST
Building Inspector to expire on FEBRUARY
Fee $ 75.00
10220 SOUND AVE MATTITUCK
Block 0002 Lot No. 011.001
1, 2007 and approved by the
1, 2009.
Aut~ori zed Signature
ORIGINAL
Rev. 5/8/02
TOWN OF $OUTItOLD
BUILDING DEPAETMENT
TOWN HALL
SOUTHOIn, N.Y.
N£ 23039 Z
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Permission is hereby granted to:
~r~..~i.+ ~,~ ~- ...........
Z~,~.,o,,.......:,,~,,~......,,-~- .............................
. ~..4.~:.~.~ ......... ~..:...../..~.~ ................ ,
,o . . . ~.,.:. . . ....... ~ ....... ~~.'. . . . . . . . ~ ~. . ,~ .......... ~. . . . . .,. ¥ ...............
. . . .~. . . .~. //. . .,.~ ~ . . . ,,>~~ ~ ........ ~ >. . ........ .~ . . . . . : . . ~.~. ?. . ....... ~. . . .~ . . . .~. . . ....
. f
~..:...:...,.~X.~. ....... ./..G./. .....................................................................................................
Coun~cTax Map No, ]000 Section ..... (.'~,...~. .......... Block ........~....'~.. ............ Lof No, ,.,,~,,(f.,,/.. .............
Building Inspector.
~ ~.. ?-~:.~ .......
Rev. 6~30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF occUPANcy
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or
topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form).
3. Approval of electrical instalIation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate
of Code Compliance'from architect or engineer responsible for the building~
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic
features.
2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is
denied, the Building Inspector shall state the reasons therefor in writing to the applicant.
C. Fees I. Certificate of Occupancy - New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00,
Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, Businesses $50.00~
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy- $.25
4. UpdatedCertificateofOccupancy- $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date.
New Construction:
Location of Property:
House No. Street
Owner or Owners of Property: ~ D ~ ~ S
Suffolk County Tax Map No 1000, Section [ ~ ~
Subdivision
Old or Pre-existing Building:
i c 2Zo ,. orw_d
Permit No. ~ Date of Permit.
Health Dept. Approval:
Block ~
Filed Map.
Applicant:
Underwriters Approval:
(check one)
Hamlet
eot I1.1
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $
Final Certificate:
(check one)
Applicant Signature
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, NY I 1971-0959
Telephone (631 ) 765-1802
Fax (631) 765-9502
ro,qer, richert~,town southold.ny.us
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Thomas Best
Address: 10220 Sound Ave City: Mattituck St: NY Zip: 11952
Building Permit Ct: 35151 Section: 122 Block: 2 Lot: 11.1
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: as built DBA: License No:
SITE DETAILS
Office Use Only
Residential ~ Ind°°r ~ Basement ~ Service Only3
Commerical Outdoor 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Servicelph ~ Heat ~ DuplecRecpt ~ Ceiling Fixtures I~ HID Fixtures ~r~l~r~l~
Service 3 ph Hot Water GFCI Recpt Wall Fixtures I I Smoke Detectors
Main Panel NC Condenser Single Recpt Recessed Fixtures I 11 CO Detectors
Sub Panel ,oJC Blower Range Recpt Fluorescent Fixturel I Pumps
Transformer Appliances Dryer Recpt Emergency Fixturest I Time Clocks
Disconnect Switches Twist Lock Exit Fixtures ~ TVSS
Other Equipment: 1 exhaust fan, 2 paddle fans
Notes:
Inspector Signature:
Date: Jan 11 2012
81-Cert Electrical Compliance Form
Town Hall Annex
54375 Main Road
P.O. Box 1179
Sonthold, New York 11971-0959
Telephone (631 ) 765,1802
Fax (63 I) 765-9502
BUILDING DEPARTMENT
TOWN OF SOUTHOI,D
CERTIFICATION
Date:
Building Permit No. ~ ~q ~',
(Please print)
Plumber:
(Please print)
I certify that the solder used in the water supply system contains less than 2/10 of 1%
lead.
Sworn to before me tbJs/3.5~
dayof , 20
Notary Public, ~IAWF~¢~-. County
(Plu~nbers Signature)
CONNIE D. BUNCH
Notary Public, Stale of New York
No. 01BU6185050
Qual/fled in Suffolk County O
Commission Expires April 14, 2 [
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FIREPLACE & CHIMNEY
DATE
INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ]/~0UGH PLBG.
[ ~/] INSULATION
[ ] FRAMING
[ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE
INSPECTOR
765-1~02
BUILDING DEPT.
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
REMARKS:
INSPECTION
[ ~ROUGH PLBG.
[ ] INSULATION
[ ] FINAL
50~OWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
] FOUNDATION 1ST
] FOUNDATION 2ND
] FRAMING / STRAPPING
] FIREPLACE & CHIMNEY
[ ] ROUGH PLBG.
[ ] INSULATION
[ ] FINAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) ~ ELECTRICAL (FINAL)
REMARKS:
DATE
iNSPEC.rOR"'~~
TOWN OF ~G DEPT.
I NSPEC TION
FOUNDATION 1ST
FOUNDATION 2ND
FRAMING/STRAPPING
FIREPLACE & CHIMNEY
[ ] ROUGH PLBG.
[ ] INSULATION
[~'~JL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
:OUlll)fi'[ itOH (2HI))
:OIl(;If FRAFIF. & ~
fI$1JLATIOH FlY, It fl.
CODE
F l rial,
II
II
~ o~
AI)I)tTIONAI, (;OHHEN'r5: ~
BLDG. DEPT,
'TOWN OF SOUTHOLr'
FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT..
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL,: 765-1803
Examined .... .~.~.~..~ ...... ,19 (~.5'''~
A pp,oved ...... ./5.¢-.-~.. ..... 19~.STPe r mit No. 4~.
l)isapproved a/c '
BOARD OF IlEAl. Itl
/3 sETS OF PLANS
CIIECK
SEPTIC R .....
tlOTl FY ~ ·
CALL
l'l^ I L TO:
· z~ .':z..~.~ ..~. ~..
( B~n,, Inspector) ........
APPLICATION FOR BUILDING PERMIT
Date ~/. -~. ......... 19 .?~"..
INSTRUCTIONS
a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plau showing location of lot and of buildings on premises, relationship to adjoining premises or public sti'eets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
c. The work covered by tiffs application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued 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 oi
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 building for necessary in,,:.~pe¢~,:2 .~
-- (Signature of applicant, or name, if a corporation)
.. p.~..~.~,,,~.g. ?.% ~A :Lkg.~, ~.q,t.L%: .~....
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.... o. oo.o. ¢..~. .................................................................................
Name of owner of premises ... ~ .~kS...~..q/...-~...05..~.~...C:. ~.~-T ......................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No ..........................
Plumber s L cerise No .........................
Electrician's License No .......................
Other Trade's License No ......................
Location of land on which proposed work will be done ..................................................
.>. ........................................
llouse Num bet Street tlamlet
County Tax Map No. 1000 Section .... ....~..Z:...."~/ .....Block . .9.....-. ' Lot..O.l.l ..............
Subdivision ............................ · ......... Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
b. Intended use and occupa,,cy..
Repair .............. Removal .............. Demolition . ..~.: ......... '6t'h'e ............
4. Estimated Cost ~,~ .'" (Deser. il~n)
- ' ........ · ...... Fee ~
(to be paid on filing this application)
5. If dwelimg, number of dwelling units ...... } ........ Number of dwelling units on each floor... 1.
If garage, number of cars ...............................................................
6. If busiuess, commercial or mixed occupancy, specify nature and extent of.each e
7. Dnnens~onsolexistingstructures if any' Front ! q~,.O~ ~ ,a~Yp, of use ........... ~..., .....
.................. ear '~ ": Depth ...q'~. -,art
Height ............... Number of Stories .... ./ ............ ,' . i,' .................... , ............
Dimensions of shine structure with alterations or additions' Front .3Z -o Rear 2..W2.. pa
Depth i~'-Ol~ . t ·
,-. '.' ................... Height . ..~.O-.o. 9, · .......
8. o:mens~ons of entire.new cpnstruction. Front /~ ~..~' i ...... .~.. pmm~ef_,o,{ Stones ... ~ ...............
l-teght ~OLt~'-- Numh*~,,r'c~ '' ';a~..~.'~ ....... ~ear . ./.7:?. ........ Depth .'~.~.gct
10. I~i2~e°:fl;turcFhra°s;t "'{~:/;~/~'[ .......... Rear..:: .... 2'.' ........... Depth .~.~/.;.~.q~ :
.... t" T .......... ......... ~ame otPormer Owner .............................
11. Zone or use district in which premises are situated... ~..¢~. *> ~T'I g.{ ..........................
12. Does proposed construction vipers, any zoning law, ordinance or regulation' X3~
13. Will lot be regraded . ~.W' .,. ~ · .....................
· ' ....... ~ ................... Will excess lln De removed from premises' Yes
14. Name orOwneroCpremises . .~.~ .~.~.-:-~'....~_.~..4-. Addr~- zo'>_~.--'~ a~. - ' --.- (~
Name of Architect ~,.e,.:o.~..e'~4k~.- ' ' ' ,,. ~ ' ~k:¢~a"~'~, · · · enone No..~.3 .~:~: .~.?
Name of Contractor ...................... ~auress .............. {. ·.. Phone No ................
.......................... Address ................... Phone No ................
15. I.s this property with±n 300 feet of a tidal wetland? ~Yes ........ No.j,~ ......
· If yes, Southold Town Trustees Permit may be required.
· . PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
property imes. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
!TATE OF NEW'°'~'R '
........ '' 'M~'~O~I~" '~':' '~' ~"~' ........... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
bore named.
-- (Contractor, agent, cor'porate officer, etc.)
f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
~plication; that all statements contained in this application are true to the best of his knowledge and belief and that the
'ork will be performed in the manner set forth in the application filed therewith.
worn to before me this
~ct~a-~u%%~St%~ ~ ~E~a~ork ' ' ($ign;itire o f applicant)
No. 52-8125850, Suffolk Coup, fy/
Term ExDires October 3~, 19 ¥~
June 16, 2004
Southold Town Building Department
P.O. Box 1179
53095 Main Road
Southold, NY 11971
To Whom it May Concern
I need your help here, as am not quite sure how to proceed. As part of my divorce
settlement, I must now sell my house. In 1996, I filed the plans for a second story
addition. The plans were approved by your department, the framing inspection was
done, the insulation inspection done, the rough plumbing inspection done, and the
rough eleclrJcal inspection done. In other words, all inspections were done, wilh the
exception of the final inspection. Several attempts were made to have this done, but
we could never coordinate a day or time, and il just sort of got forgotten about. Now I
need to get the Certificate of Occupancy for the addition as well as pre-existing CO for
the 1st floor, as lhe house was originally built in 19567. Please tell me what I have to do
to finalize this. Your help would be greatly appreciated.
Sincerely,
Tom Best
10220 Sound Avenue
Mattituck, NY 11952
298-8185
Town HaIL 53095 Main Road
P.O. Box 1179
Southold, New York 11971-0959
Fax (631) 765-9502
Telephone (631 ) 765-1802
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
July26th, 2007
Thomas J. Best
10220 Sound Avenue
Mattituck, N.Y, 11952
RE: 10220 Sound Ave. (alterations/addition 2"a story)
SCTM# 1222 11 1
Dear Mr. Best,
Please be advised that your Building Permit # 23039 issued October 3rd, 1995 has
expired. According to the Code of the Town of Southold, a Certificate of Occupancy
must be issued prior to use of the structure.
To renew your Building Permit, please submit a fee of $75.00; at that time we can
schedule an inspection by one of our Building Inspector's.
If you have any questions, please call us at 631-765-1802.
Respectfully,
SOUTHOLD TOWN BUILDING DEPT.
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, New York 11971-0959
Telephone (63 I) 765- 1802
Fax (631) 765-9502
BUILDING DEPARTMENT
TOWN OF SOUTI-IOLD
October 14th, 2009
FIRST NOT ¢E
Thomas & Susan Best
10220 Sound Avenue
N~attituck, N.Y. 11952
10220 Sound Ave. (Alteration/Addition)
SCTM: ge 1000-122.-2-11.1
To Whom It gay Concern:
Please be advised that your Building Permit # 33289 issued August 1st, 2007 has
expired. According to the Code of the Town of 5outhold, a Certificate of Occupancy
must be issued before the use of the structure.
To renew your Building Permit please submit a fee of $75.00; at that time we can
Schedule an inspection by one of our Building Inspector's.
If you have any questions, please call us at 765-1802.
I~espectfully,
50UTHOLD TOWN BUILDING DEPT.
January 19, 2012
Thomas Best
10220 Sound Avenue
Mattimck, NY 11952
P: 631-926-7992
Town of Southold
Building Departmem
Town Hall Annex Building
54375 Route 25
Southold, NY 11971
Enclosed, please find my check in the amount of $37.50 for permit number 35151.
All inspections have been done, electrical, rough plumbing, framing, insulation, so I need
a final to get the C.O. for the second story (the first story already has a C.O.) I am going
to contract on or about February 3fa. I am off on Wednesday's, so that would be great if
we could schedule the appointment for that day. What ever time is convenient for the
inspector.
Sincerely, Tom Best
OWNER ("
-TOWN OF SOUTHOLD PROPERTY RECORD CARD'---
FORMER OWNER
LAND IMP.
~oo
VL
STREET /(~Z' ~) VILLAGE D)ST. SUB.
E ACR. J
COMM. CB. MlCS. Mkt Value
TOTAL
FARM
DATE
LOT
REMARKS
,L ~ 27
AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE
FARM ; Acre Value Per Value
Acre
Tillable FRONTAGE ON WATER
Woodland FRONTAGE ON ROAD
MeadOwland
DEPTH
BULKHEAD
DOCK
House Plot
Total ~
COLOR /1/~ T', ...... TRIM
M. Bldg.
Exten,sion
Extension
Parch
Porch
Breezeway
Garage
'Patio
Total
Foundation
Basement
Ext. Walls
Fire Place
~, .2. O Type Roof
Recreation Room
Dormer
Beth / Dinette
Floors ~ ~x,,- K~
q//~. ~:~' LR.
InferiOr Fihish
Heat ~? $ DR.
Roo~s 1st FIooK' : '~ /BR:
Room~ 2~d Flor . ) FI N. B
Driveway
OWNER
FORMER OWNER
REs. ,~ ~,,,y SEAS.
LAND IMP.
NEW NORMAL
FARM Acre
Tillable
Woodland
Meadowlond
House Plot
Total
STREET
N
,.9ou ~D Awr~
VL. O~L FARM
T DATE
VILLAGE
W
T. SUB.
ACR.
o, 4o
TYPE OF BUILDING
COMM. CB. MICS. Mkt. Value
REMARKS
LOT
FRONTAGE ON ROAD
DEPTH
BULKHEAD
DOCK
BUILDING CONDITION
BELOW ABOVE
Value Per Value
Acre
FRONTAGE ON WATER
~_ .~xrc~_~
COLOR TRIM
'M. Bldg~
Extension
I~xtension
Extension
Porch
Porch
Breezeway
Foundation
Basement
Ext. Walls
Fire Place
Both
Floors
Interior Finish
Heat
Garage Yype Roof Rooms 1st Floor BR.
Pati6 Recreation Room RooMs 2nd Floor FIN. B
O, B. Dormer Drivewey
Total
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, NY 11971-0959
Telephone (631) 765-1802
ro,cler, richert~,t~w(~n.ts) o7 ur~5o(~ .ny.us
BUILDING DEPARTMENT
TOWN OF $OUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
UESTED BY:
Company Name:
Date:
Name:
License No.:
Address:
Phone No.:
JOBSITE INFORMATION: (*Indicates required information)
*Name:
*Address'.'
*Cross Street:
*Phone No.:
Permit No.:
Tax Map District:
Block: ~ Lot:
*BRIEF DESCRIPTION OF WORK (Please Print Cleady)
(Please Circle All That Apply)
*Is job ready for inspection:
*Do you need a Temp Certificate:
Temp Information (If needed]
*Service Size: 1 Phase
*New Service: Re-connect
Additional Information:
3Phase 100
Underground
YES / NO Rough In Final
YES / NO
150 200 300 350 400 Other
Number of Meters Change of Service Overhead
PAYMENT DUE WITH APPLICATION
82-Request for Inspection Form
KULHANEK and PLAN
LANO SURVEYORS, P.C.
Aogust 12, 1991
,5'o
0,%,
E~IF, I~,GY CODI~ IIEVIl'34
l'
Envelo[~ ~c~ponen~
Exl:el: loc Hall R-Ill
Iloo[/cell il,ti 11-19
Floc 1~-19
Folmda[ {oil ~all R-lO
slab ~g~ l.~ulaElo.
fllazin9 II-!
En~ranc~ ~r~ R-2.5
All IIV/~ Igqull~tnL I:o m~_e~, roqu|re.~nl:a o[ 71114.11
c~qol~l~lll:fl O[ 7014.21
All Electric Syeke.t~ ~o u~e~ requlremen~ of 7B14.31
To ~he b~ o£ .~t kno~ledge~
~uckJ~ml~, ~l~e~ plann
'i
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
PLUMBER CERTIFICATION
tuung b u~d ON LEAD CONTENT BEFORE:
CERTIFIC4TE OF OCCUPANCY
distributing
P~ ~fl ~ SO~ER'USE~ IN WATER,
~K~kon~ SUPPLY SYSTEM CANNOT
~D~ ~ EXCEED 2/10 of 1% ~AD.
PRO1/IDE OPENINGS FOR
EMERGENCY ESCAPE AS
REQUIRED BY PAET. 714 OF
N.Y. STATE BUILDING CODE.
APPROVED AS NOTED
NOTIFY RUIt. OING DEPARTMENT AT
76B-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION ' TWO REQUIRED
FOR POURED CONCRETE
ROUGH ' FRAMING & PLUMBING
3, INSULATION
4. FINAL - CONSTRUCTION MUST
RE COMPLETE FOR C.O:
ALL CONSTRUCTION SHALL' MEET
THE REQUIREMENTS OF THE N.Y-
STATE CONSTRUCTION & ENERGY
,\
CODES, NOT RESPONSIBLE FOR
EFx S
,/
~2, I0
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