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FOt�`C© Town of Southold 2/11/2020 P.O.Box 1179 53095 Main Rd `�'•4�j�� �p`r = Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41055 Date: 2/11/2020 THIS CERTIFIES that the building ELECTRICAL Location of Property: Pvt Rd Inner Bay, Fishers Island SCTM#: 473889 See/Block/Lot: 10.-944 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/5/2012 pursuant to which Building Permit No. 37036 dated 3/5/2012 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: 200a overhead electric service. The certificate is issued to DeBroff,Brian&DeBroff,Karen of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 37036 10/292019 PLUMBERS CERTIFICATION DATED Authorized Signature "= 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 #: 37036 Date: 3/5/2012 Permission is hereby granted to: DeBroff, Brian & DeBroff, Karen 2220 Huntington Tpke Trumbull, CT 06611 To: Replace Electrical Service At premises located at: � Pvt Rd Inner Bay, Fishers Island SCTM # 473889 Sec/Block/Lot# 10.-9-14 Pursuant to application dated 3/5/2012 and approved by the Building Inspector. To expire on 9/4/2013. Fees: ELECTRIC $85.00 Total: $85.00 Building Inspector ®� ®v s®Uri®� Town Hall Annex ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 roger.riche rta-town.south old.ny.us Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To DeBroff Address- Prvt Rd Inner Bay (271 Gloaming Extension) City. Fishers Island St: New York Zip 6390 Building Permit#• 37036 Section, 10 Block 9 Lot 14 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: AS BUILT DBA: BD Electric License No: 35821-ME SITE DETAILS Office Use Only Residential X Indoor X Basement X Service Only X Commerical Outdoor X 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey X 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 200a Switches Twist Lock Exit Fixtures TVSS El Other Equipment: "AS BUILT" "ELECTRICAL SURVEY" "NO VISUAL DEFECTS" Notes, 200a overhead service Inspector Signature: \iJ'�- Date: October 29 2019 81-Cert Electrical Compliance Form.xls so Toms Hall Annex �b Telephone(SSI) 765-1802 51375 h1ain Road n y _g f ;! Faa(631) 765, 5 2 P.O.Bos 1179 �� roger.richer(5fown,sout[i0fd.nu,us Southold,NI'11971-0959 BUTLDE\TG DEPAMIMNT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: ��,�-f S i-- c� ( CG�-� Date: Company Name: �� 'c_ �° �-L c_ Name: License No.: Z--- Address: _L iIIQ 02 Phone No.: JOBSITE INFORMATION: (*Indicates required information) *Name: f�"c:;z(� ego�� *Address: *Cross Street: :j!2e-- 6/ocL m t A e *Phone No.: & l _ Permit No.: 3-2Q3(� Tax Map District: 1000 Section: Block: Lot: *BRIEF,DESCRIPTION OF WORK (Please Print Clearly) M e4 - (Please Circle All That Apply) *Is job ready for inspection: YES NO Rough In OFInal *Do you need a Temp Certificate: ES NO Temp Information (If needed) *Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other *New Service: e-connect Underground Number of Meters Change Additional Information: PAYMENT DUE WITH APP MAP 2QJ2 BLDG DEPT 82-Request for Inspection Form TOWN OF SOUTHOLD