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HomeMy WebLinkAbout38757-Z Town of Southold Annex 5/20/2014 P.O.Box 1179 54375 Main Road Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 36932 Date: 5/20/2014 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 265 Orchard Ln, Southold, SCTM#: 473889 Sec/Block/Lot: 89.-2-5.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 4/2/2014 pursuant to which Building Permit No. 38757 dated 4/2/2014 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: garage addition to an existing one family dwelling The certificate is issued to Akscin, Raymond (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 38757 8/3/14 PLUMBERS CERTIFICATION DATED AuthorM Signat . TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE I$ 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#: 38757 Date: 4/2/2014 Permission is hereby granted to: Akscin, Raymond 1800 Cedar Beach Dr Southold, NY 11971 To: add garage to one family dwelling. Replaces BP 10864. At premises located at: 265 Orchard Ln, Southold SCTM # 473889 Sec/Block/Lot# 89.-2-5.1 Pursuant to application dated 4/2/2014 and approved by the Building Inspector. To expire on 10/2/2015. Fees: PERMIT RENEWAL $15.00 ELECTRIC $50.00 $125.00 4 otal: $190.00 uildi g In ector FORK NO. 2 TOVWN OF SOUTHOLD BUILDING DEPARTMENT TOWN .HALL SOUTH'OLD, N; Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N° 10864 Z Date ..........Sep sowblr..1.9.................. 19.. Permission is hereby granted to: RA7cMOND b c tALDIxs AIMOIN ................................................................................ 305 OR©BARD LAU ................................................................................ SOMHOLD, ]X1 YORK 11971 to ...........ADD GARAGE_PW V .A VAX=_ ZxEi....................................................... .... . .... . .... .. . ................................................................................................................................................................ at premises located at30,5 ORCHARD LANZ ............................................................................................................................ SODTHOLD, N.Y. ................................................................................................................................................................. CXDAR 1IXA= PARK, FILM SLAP #90, LOT 28 ................................................................................................................................................................. l County Tax Map No. 1000 Section ........................ Block ...... ............. Lot No. �' 0 .................... ... pursuant to application dated .......... opt' ��...2...................1 19..!4, and approved by the Building Inspector. ti 15 Fee $.......QQ............ . ................................................................................ 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 installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of I%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 1. 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. Updated Certificate of Occupancy - $50.00 Temporary Certificate of Occupancy - Residenti $15.0, , Commercial $15.00 ` '_5 �j—r /, GLS--! Date New Construction: r Old or Pre-existin Building: (check one) Location of PropeTty-�J , A/Z L,d,�, .5-py �-60/c/ House No. treet Hamlet Owner or Owners of Pry ,4 -5 Gam' Suffolk County Tax Map No 1000, Section Block Lot c Subdivision C¢ 14 Q lea C -4 �( Filed Map. / Lot: Permit No. 5 Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate411icia'n-Si,_ (check one) Fee Submitted: $ c tpre pF SO!/jyolo Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax (631)765-9502 P.O. Box 1179 G • �Q roger.riche rt(cb-town.Southold.ny.us Southold,NY 11971-0959 'rout I,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Raymond Akscin Address: 365 Orchard Ln City: Southold St: NY Zip: 11971 Building Permit#: 38757 Section: $9 Block: 2 Lot: 3 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 X Indoor X Basement Service Only Commerical Outdoor X 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey X Attic Garage X INVENTORY Service 1 ph Heat Duplec Recpt 3 Ceiling Fixtures 8 HID Fixtures Service 3 ph Hot Water GFCI Recpt 2 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks Disconnect Switches 2 Twist Lock Exit Fixtures TVSS Other Equipment: "AS BUILT" attached garage, ----no visual defects--- Notes: Inspector Signature: Date: April 3 2014 81-Cert Electrical Compliance Form.xls 7 �o��OP SOpl�o6 TOWN OF SOU OLD BUILDI G DEPT. "5-1802 c- 1 NS TION [ ] FOUNDATION 1ST [ ] UGH PLEIG. [ ] FOUNDATION 2ND [ ] NSULATION [ ] FRAMING /STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: /Gl r-7- DAT E DATE INSPECTOR pF 30(/ly�� An OUNI`1, TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE INSPECTOR f r4f so TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION I FOUNDATION I ST ] ROUGH PLUMBING FOUNDATION 2ND �] 31�ILATA*14\ FRAMING / STRAPPING FINAI FIREPLACE & CHIMNEY FIRE Sm My)INSPECTION FIRE RESISTMT CONSTRUCTION FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) ELECTRICAL (FINAL) CODE VIOLATION CAULKING REMARKS: DATE - J INSPECTOR 'J V ! L 1D I N1., !�c '?- N•t 1 1 .y w L { L U 1`A i\.A i 51 4 �7T t'GGv A-,i14 a b aO v G H F 2P,P. i-/Atq ! (� N I ! 3 1 t`cSvL�T10 ti:t � f I 0 Qom - ���%►-- L4 q R - d 1 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 c7 �1 TEL.: 765-1802 Examined . . . . . . . �X!. . . ., 19 Q !' 3 Application No. . . Approved . . . . . ?1ZI. . . . . .. 19 n Permit No. .1� . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .✓��/` ' ' ' . . . . . . . . ., 19�G INSTRUCTIONS 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 appli- cation. 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 necessary inspections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Signature of applicant, or name, if a corporation) )),letV X-FT> . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . . . . . . . . . . . . . . . . . . . . . . (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 License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .�6.�:e . . . . . . 1`f�,ec:��;e d ..�r�N.��. �.�2�/./3,e . . B�.g-.�.(►. .�l!'. . . �v ���.!� . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section . . . g.7. . . . . . Block . . . . .�A . . . . . . . . . Lot . . . . Subdivision . . .�P9't '��'� f}!e !.\ . . . . . . . Filed Map No. . . . .l. . . . . . . . . Lot . . . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . .C1 /t G . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy �.�' . . . C�iG 9/� !3-rf e �c � C c'w lv cc/ i s? . �c 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . Alteration . .!!'-% . . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . . (Description) 4. Estimated Cost .0.'0 G Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling,number of dwelling units . . .l . . . . . . . . . . Number of dwelling units on each floor . ./. . . . . . . . . . . . . Ifgarage,number of cars . . . A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . . . . . . �. . . . . . . . 7. Dimensions of existing structures,if any: Front . . . . . . . . . . Rear . . . . . . . . . Depth . .3-0. . . . . . . . . . . . Height 09?. s;Tk:eV . . . . Number of Stories /. . . . Dimensions of sante structure with alterations or additions: Front ... . . . . . . Rear . . 2ck. . . . . . . . . . . . Depth . . . . .,3.Q. . . . . . . . . . . . . . Height . . . . / . . . . . . . . Number of Stories / 8. Dimensions of entire new construction: Front . . .. . . . . . . . Rear . . . . .aaA. .� . . . . Depth —60. . . . . . . . . . . Height . . . . /. 57;1�fy . Number of Stories 9. Size of lot: Front . . . . . v.7. . . . . . . . . . . . Rear . . . .!�4 Depth 3�Ca J .A . . . . . . . . . . . . . . . . 10. Date of Purchase . . . 1.75-:1. . . . . . . . . . . . . . . . . . . Name of Former Ow er .Ar-'Ae"ov!x! 11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded .M4. . . . . . . . . Will excess fillp e re�pi�noved from premises: Yes No 14. Name of Owner of premise�yma+ ��'�•�iy(�f�r'¢'�Asc�cfr ss . .C:eq!�l�t9c/r.,400"Phone No. ;;7 6.5--�4d'��� Name of Architect . . / . . . . Address Phone No. Name of ContractorD-S OSli'!. . . . . . Address . . . )c4 . . . Phone No. v? PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. l6° X.4 fe i c wV v � ' I STATE OF NEW Y 'RK, S.S COUNTY OF Ja ;, 1 being duly sworn, deposes and says that he is the applicant (Nat'Ke df individual signi contract) above named. Heis 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 knowledge and belief;and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this f day of "_''� 19 Notary Public, . . . . . . . .r,.. . . . . County . . . . e� tifZA8�1ff aNN NEVILIE G . . . OTARY PUBLIC fair of (Signature of applicant) ,3 New York ( � pp ) No.52.8125850,SufffIIJc�ounty Term Expires MarcWn_ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 (� TEL.: 765-1802 Examined . . . . . . . . . . / ., 19 '." Application No/�. .>. . . . . . . Approved . . . . . . . . . . ./. .� ., 19 ermit No. . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . J`... . . . (Building Inspector APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS 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 appli- cation. 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 necessary inspections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Signature/off applicant, or name, if a corporation) (e)iPc °}} (Mailing addre?s of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 614, . �E '. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . .4-,r>��./1!4'!V. . � . . . . . PR/3 le�.!! t S c �. Al (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 License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �°� 'e . . . . . .(�Rc/9,c�. � !e . Cie . . ,d�•��1. . .. ' �c� o.�`!. . . . .. House Number Street Hamlet p County Tax Map No. 1000 Section . . . . . . . .� . . . . . . . Block . . . . . . . . . . . . . . . . . . Lot . . . . :';Q . .�. . . . . . . . J . . Lot . . 'A61 . . . . Subdivision . .�.?.�!¢R. . . . :P.�9-�. .,�j9R�. . . . . . . . Filed Map No. . . . �. . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . . b. Intended use and occupancy . . . . .7' v y. , , Cn?, , w 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . . Alteration . . . . . . . . . . Repair . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . . (Descriptip) _ 4. Estimated Cost . . . til �.� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :�0. Fee (to be paid on filing this application) 5. If dwelling,number of dwelling unfits . . . . . .I . . . . . . . . Number of dwelling units on each floor . . . /. . . . . . . . . . . . Ifgarage,number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing ptructures,if any: Front . . . . ..5'�? . . . . . . Rear X0 . Depth . . 3. Q . Height 0NP. S vK l . . . Number of Stories . . . . . ./. . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . . .7A ... . . . . . . . Rear . �ok. '. Depth . . . . ..3 b./ . . . . . . . . . . . . Height . . 1. . .S�`u�2.�/ . . . . . . . . Number of Stories . /. . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . . .,9A. . . . . . . . Rear . . .d? .. . . . . . . . Depth . 3.v. . . . . . . . . . . Height . . . . /.$77.pa:gY Number of Stories . . . . .I . . . . / . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . .ani 4.1. . . . . . . . . . . Rear . . . . . l.�.D, , , , , , , , , , , , , Depth . . . . O . . 10. Date of Purchase . . . . . . . . . . !9,�r./. . . . . . . . . . . . . . Name of Former Owner „&-ck..e•es Pt. 11. Zone or use district in which premises are situated . . . . . . .Ife 5.j.cdPN T,'- */ . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . ,/.V6. . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded . . . . . . ./Vo Will excess fill be removed f om premises: Yes o 14. Name of Owner of premises .B N�d=��Y . �t/Address 6ee(ft.#eofF4 .'�' . Phone No. 7laS',3�d��� Name of Architect . . . . . . . . . . . . Address . . . . . . . . . Phone No. . Name of Contractor .QsTee,5.e. i'. . . . . Address . . .5Q,t-WPPhone No. 5-.”.a yy;7 PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. 1 so �a 30 7�vcc5� � ��3ov l lPs� j STATE OF NEW RK S.S COUNTY OF . . • • • • • • • • • . • .Tf- being duly sworn, deposes and says that he is the applicant N 'Jividual* sign' con ract) above named. Heis 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 knowledge and belief;and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this . . . . . . . . . . . . .day of Notary Public, . . . . . . . . . . County NOTARY USLIC Sta a of New York , (Signature of applicant) No. 52. 125850,Suffolk Cougio, Term Expires March 30, 19, i SO�lyol � o Town Hall Annex 41 l [ Telephone(631)765-1802 54375 Main Road �.�+,ax ggyy 0p22 ; P.O.Box 1179 G Q roger.richertdrUln.soui 50,75 nV us Southold,NY 11971-4959 BUaDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Date: _ — Company Name: Name: License No.: Address: Phone No.: JOBSITE (NFORMATION: (*Indicates required information) *Name: (I/ J7 *Address: A,-9 . *Cross Street: �e��� �.°e �. � �� *Phone No.: _ �_'� Pennit No.: Tax-Map District. 1000 Section: Block: Loi *BRIEF DESCRIPTION OF WORK(Please Print Clearly) (Please Circle All That Apply) Is job ready for inspection: YES/ NO. Rough In Final *Do-you need a Temp Certificate: YES! NO Temp Information(If.needed) *Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other *New Service: Re-connect' Underground Number of Meters Change of Service Overhead Additional Information: PAYMENT DUE WITH APPLICATION W .82=Request for Inspection Form (� . � 'vet 1/s x G COAAC,pe� ,�era�e APPROV D AS NOTED p 2'c'Z DATE: a M P. Z--- �, FEE: i BY : NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE 4l�ivcioheA + FOLLOWING INSPECTIONS: co1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION eKss�-� 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C. O. ALL CONSTRUCTION SHALL MEED' THE REQIARFMENTS OF THF N. Y. STATE CONSTRUCTION & ENERGY yin A CODES. NOT RESPONSIBLE F012 I(fes• DESIGN OR CONSTRUCTION ERRORL (LA ju tv x OCUPANCTOR 4 ' •.3 USE IS UNLAWFUL "'WITHOUT UU CERTIFICATE CF v`CCUPANCY I 2 3 4 5 G 7 8 9 10 I ! 12 13 14 15 16 17 I j I _ LLjLj[lLlljlDl NORTH ELEVATION �i F i E FAIRWEATHER-BROWN DESIGN ASSOCIATES,INC. 205 BAY AVE.,GREENPORT,NEW YORK 11844 631-477.9752 OCT;,a WEST ELEVATION ;DENCE ELN-ON5 P i !""'� ,q6 £ Rr.uvcieo R * K05IN50MA51N ROAD PARAOISE POINT A6 5oumo I