HomeMy WebLinkAbout43743-Z Town of Southold 6/6/2019
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P.O.Box 1179
53095 Main Rd
�a%-fjh Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 40436 Date: 6/6/2019
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 10905 Route 25, East Marion
SCTM#: 473889 Sec/Block/Lot: 31.4-19
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
5/14/2019 pursuant to which Building Permit No. 43743 dated 5/14/2019
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 FOR RE-CONNECT TO PSEG
The certificate is issued to Brophy,Michael&Pisacano,Ethel
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 43743 05-15-2019
PLUMBERS CERTIFICATION DATED
Authorized Signature
��o�guFFot,rcoG TOWN OF SOUTHOLD
BUILDING DEPARTMENT
z TOWN CLERK'S-OFFICE
oy • �� 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#: 43743 Date: 5/14/2019
Permission is hereby granted to:
Brophy, Michael & Pisacano, Ethel
Route 25
PO BOX 28
East Marion, NY 11939
To: electric inspection for a re-connection of power from PSEG.
At premises located at:
10905 Route 25, East Marion
SCTM # 473889
Sec/Block/Lot# 31.-4-19
Pursuant to application dated 5/14/2019 and approved by the Building Inspector.
To expire on 11/12/2020.
Fees:
ELECTRIC $85.00
Total: $85.00
BuilAi r
S0�/Ty®�
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 Q
Southold,NY 11971-0959 .® • ao roger.richert(D-town.southold.ny.us
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Michael Brophy
Address: 10905 Route 25 City: East Marion St: New York Zip• 11939
Budding Permit#: 43743 Section- 31 Block. 4 Lot 19
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 X Service Only
Commerical Outdoor X 1st-Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey X Attic Garage
INVENTORY
Service 1 ph 150a Heat Duplec Recpt Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel 150a 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 150a Switches Twist Lock Exit Fixtures 11 TVSS
Other Equipment. "AS BUILT' "ELECTRICAL SURVEY" "NO VISUAL DEFECTS"
Notes: OK to re-connect existing 150a overhead service
Inspector Signature: oellw Date: May 15 2019
81-Cert Electrical Compliance Form As
��1fF�Kc BUILDING DEPARTMENT- Electrical Inspector
�o TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
roger.richertPtown.southold.ny.us
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: Date:
Company Name:
Name:
email:
License No.:
Address:
Phone No.:
JOB SITE INFORMATION: (All Information Required)
Name: !
Address:
Cross Street:
Phone No.: 3 7- �V
Bidg.Permit#: �L/ email:
Tax Map District: 1000 Section:
Block: Lot:
BRIEF DESCRIPTION OF WORK(Please Print Clearly) )¢ IIVI
Circle all That Apply= Final
Is job ready for inspection?: YES I NO Rough In
Do you need a Temp Certificate?: YES / NO Issued On
Temp Information: (All information required)
Service Size 1 Ph 3 Ph
Size: = # Meters Old Meter#
New Service- Fire Reconnect- Flood Reconnect- Service Reconnected - Underground-Overhead
# Underground Laterals 1 2 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
82-Request for Inspection Form.xls �� ��