HomeMy WebLinkAbout41407-Z g�FFOtfcp Town of Southold 3/9/2018
P.O.Box 1179
_ 53095 Main Rd
2 o�' Southold, New York 11971
CERTIFICATE OF OCCUPANCY
No: 39386 Date: 3/9/2018
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 5670 Mill Rd, Mattituck
SCTM#: 473889 Sec/Block/Lot: 106.-64.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
3/8/2017 pursuant to which Building Permit No. 41407 dated 3/9/2017
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:
electrical survey of an existing non-habitable storage building
The certificate is issued to Glebe Associates LLC
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 41407 4/4/2017
PLUMBERS CERTIFICATION DATED
Authoriz ignature
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#: 41407 Date: 3/9/2017
Permission is hereby granted to:
Glebe Associates LLC
10 Great Circle Dr
PO BOX 1291
Shelter Island Hgts, NY 11965
To: Electrical Survey of existing tower.
At premises located at:
5670 Mill Rd
SCTM # 473889
Sec/Block/Lot# 106.-6-4.1
Pursuant to application dated 3/8/2017 and approved by the Building Inspector.
To expire on 9/8/2018.
Fees:
ELECTRIC $90.00
Total: $90.00
Buildi or
*pF SOUj�,ol
Town Hall Annex Telephone(631)765-1802
54375 Main Road CA Fax(631)765-9502
P.O.Box 1179 Q roper.richert(a)-town.southold.ny.us
Southold,NY 11971-0959 Q
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Glebe Associates LLC
Address: 5670 Mill Road City- Mattituck St: New York Zip 11952
Building Permit#• 41407 Section: 106 Block: 6 Lot: 4.1
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Goodale Electric License No: 783-E
SITE DETAILS
Office Use Only
Residential Indoor X Basement Service Only
Commerical X Outdoor X 1st Floor X Pool
New Renovation 2nd Floor X Hot Tub
Addition Survey X 3rd Floor X Garage
INVENTORY
Service 1 ph 100A Heat Duplec Recpt 9 Ceiling Fixtures 3 HID Fixtures
Service 3 ph Hot Water GFCI Recpt 2 Wall Fixtures 1 Smoke Detectors
Main Panel 100A A/C Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency FixtureTime Clocks
Disconnect 100A Switches 4 Twist Lock Exit Fixtures TVSS R P
Other Equipment: "AS BUILT" - "ELECTRICAL SURVEY" - "NO VISUAL DEFECTS"
Notes: Existing Three Story Tower, 1- Well Pump.
Inspector Signature: Date: April 4, 2017
0-Cert Electrical Compliance FormAs
SOUTyo�
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TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION-
FOUNDATION
1ST [ ] ROUGH PLEIG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) ,11 ELECTRICAL (FINAL)
REMARKS:
r
DATE 17 INSPECTOR
SO�jyo
Town Hall Annex 411
Telephone(631)765-1802
54375 Main Road- 6 pg
P.O.Box 1179 G Q roQer.richertCc� wn southOld.nv.us
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOL THOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQt JESTED BY: 4 d 91, u ' Date:
Comr any Name: 0 r, 1'� —lLf 6,
Nam -- --
Licen a No.: - -
Addr
r
Phon No.: 3
JOB ITE INFORMATION: (*Indicates required information)
*Na [� L Ul �G % �/�� ' 1 e.�e, LLC_
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*Addrss: S^ /"�/L Z r��-✓'►'T� ✓�
*Cros Street:
*Pho No.: �� U
Perm' No.:
Tax Map District: 4000 Section-, loll, Block: Lot: I
*BRIE DESCRIPTION OF WORK (Please Print Clearly)
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o Z. l L-L 1�✓�/ �� w�
(Pleas e Circle All That Apply)
Is job ready for inspection: YES / NO Rough In Final
*Do yc u need a Temp Certificate: YES / NO
-Temp: nformation (If needed)
*Servi a Size: 1 Phase 3Phase 100 150 200 300 350 400 Other
*New ervice: Re-connect Underground Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
82-Rquest for Inspection Form
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