HomeMy WebLinkAbout43046-Z Town of Southold 10/25/2018
P.O.Box 1179
F 53095 Main Rd
s, ��u Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 39998 Date: 10/25/2018
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 7625 Skunk Ln, Cutchogue
SCTM#: 473889 Sec/Block/Lot: 104.4-27.2
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
9/17/2018 pursuant to which Building Permit No. 43046 dated 9/17/2018
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:
UNDERGROUND 200 AMP ELECTRIC SERVICE
The certificate is issued to Tietjen Elsie L Rev Trt
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 43046 10-22-2018
PLUMBERS CERTIFICATION DATED
Authorized Signature
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
o • SOUTHOLD,'NY
low
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#: 43046 Date: 9/17/2018
Permission is hereby granted to:
Tietjen Elsie L Rev Trt
144 Argent Way
Bluffton, SC 29909
To: Underground electric service
At premises located at:
7625 Skunk Ln, Cutchogue
SCTM # 473889
Sec/Block/Lot# 104.4-27.2
Pursuant to application dated 9/17/2018 and approved by the Building Inspector.
To expire on 3/18/2020.
Fees:
ELECTRIC $85.00
Total: $85.00
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Town Hall Annex Telephone(631)765-1802
54375 Main Road y Fax(631)765-9502
P.O.Box 1179 G Q
�. • ao roger.richerta-town.southold.ny.us
Southold,NY 11971-0959 QIyeoUNTY,��
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To Elsie Tietjen
Address: 7625 Skunk Ln City: Cutchogue St New York Zip- 11935
Building Permit#: 43046 Section 104 Block 4 Lot 27.2
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor, DBA: BJ Electric License No. 2670-ME
SITE DETAILS
Office Use Only
Residential X Indoor Basement Service Only X
Commerical Outdoor X 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph 200a Heat Duplec Recpt Ceding Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel 200a A/C Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks
Disconnect 200. Switches Twist Lock ri Exit Fixtures 11 TVSS EJ
Other Equipment convert existing 200a overhead service to underground
Notes,
Inspector Signature: Date: October 22 2018
81-Cert Electrical Compliance Form As
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# # TOWN OF SOUTHOLD BUILDING DEPT.
cou765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND ' [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[` ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
DATE �� �� C� INSPECTOR ��
$uFFQLK BUILDING DEPARTMENT - Electrical Inspector
C TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
oSouthold, New York 11971-0959
�- Telephone (631) 765-1802 - FAX (631) 765-9502
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roger.richert(cDtown.South old.ny.us
APPLICATION FOR ELECTRICAL INSPECTION
-411
--- - --- J ------- -- - -- - --� ----- - --- - -- - - - Date: W112 Itle
- - -- -- - -
REQUESTED-BY` t��Y�f ✓
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Company Name:
Name:
License No.: /Z,!� 70 A email:
Address:
Phone No.: 5-1 <y5-
JOB SITE INFORMATION: (All Information Required)
Name:
Address:
Cross Street: ® j /� � � !✓ ®�
Phone No.: Z,
B[dg.Permit#: email:
Tax Map District: 1000 Section: (� Block: Lot:-XII),
BRIEF DESCRIPTION OF WORK (Please Print Clearly)
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Circle All That Apply:
Is job ready for inspection?: YE NO Rough [n Final'
Do you need a Temp Certificate?: ES / NO Issued On
Temp Information' (All information required).
Service Size 1 Ph Ph Size: A # Meters Old Meter#
New Service -Fire Reconnect- Flood Reconnect- Service Reconnecte - Underground Overhead
# Underground Laterals 1 2 H Frame Pole Work done on Service? Y N
Additional Information.
1ve/"�kEeA,-
PAYMENT DUE WITH APPLICATION
SEP 1 7 2018
1
Request fo ln�sre'"fiF�DEPT. ��I�