HomeMy WebLinkAbout45379-Z a°yaS�F aE j o TOWN OF SOUTHOLD
ay BUILDING DEPARTMENT
z 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#: 45379 Date: 10/27/2020
Permission is hereby granted to:
New York State DEC
625 Broadway
Albany, NY 12233
To: Electric 100A temporary construction service
At premises located at:
750 Old Main Rd., Southold
SCTM #473889
Sec/Block/Lot# 56.-6-8.7
Pursuant to application dated 10/26/2020 and approved by the Building Inspector.
To expire on 4/28/2022.
Fees:
ELECTRIC $125.00
Total: $125.00
Building Inspector
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Town Hall Annex ® Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 a sean.devlinCcD-town.southold.ny.us
Southold,NY 11971-0959
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: New York State DEC
Address: 750 Old Main Rd city Southold st: NY zip: 11971
Building Permit#: 45379 Section. 56 Block: 6 Lot: 8.7
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: K Schrage & Sons Inc License No. 3507ME
SITE DETAILS
Office Use Only
Residential Indoor Basement Service X
Commerical X Outdoor X 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors
Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO
Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches 4'LED Exit Fixtures Pump
Other Equipment: 100A Temp Panel
Notes.
Inspector Signature: 7�7Date:
August 27, 2021
S Devlin-Cert Electrical Compliance Form
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��Ov ®Gym BUILDING DEPARTMENT-Electrical Inspector
® TOWN OF SOUTHOLD
*0 Town Hall Annex-54375 Main Road-PO Box 1179-Southold, NY 11971-0959
Telephone(631) 765-1802-FAX(631)765-9502
Temporary Certificate # Date OGAnlDPr a7 2020
Customer Name Electrician Name �V n SChy_aacl
Address 5 d � dl� Phone 511y 7x13 Oq. 5&
e-mail -o� Co- , nom} e-mail K OJA Y11
Fone (02) I —oZ�5(a 5(Qb License# J150_71E
Size (QC A Phase Overhead X Underground #of Meters �–
Remarks
#of Underground Laterals 1 2 NewX
"H" Frame or Pole H P Fire Reconnect
Was work done on Service? Y/N Flood Reconnect
Old Meter# Service Reconnected
Application for electrical service equipment is on file with the town of Southold.On the applicant's notification that this installation
is complete,the town will conduct a premises inspection of the service equipment.
This verification iZdt0 romthe d above.
Authorized by
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BUILDING DEPARTMENT Electrical Inspector
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TOWN OF SOUTHOLD
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54375 Main Road - PO Box 1179
, Q Hall Annex
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Southold, New York 11971-0959
%xTelephone (631) 765-1802 - FAX (631) 765-9502
seand@southoldtownny.gov
rogerrasoutholdtownny.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date:
Company Name: K. 6'c.H Par f sol-) /Al e-
Name: P"Ilrd CctfkftE
License No.: 3S7497- 1146' email: 6 r C H R.*a rX" )0,4'r&* 4 A
Address: /0 A 11,1VA1,0/F Ch "sr OA i c H r5 1v y </QYa
Phone No.: 5'/4- >7,f, g(frX
JOB SITE INFORMATION (All information Required)
Name: If 5.0C I /f rff
Address: -0 OU' Al 120 a M 491 10
Cross Street: 4/"o ?dA 7- or e-0 ye r INC
Phone
A/ePhone No.: a 1?j?- 6,f 00
Bldg.Permit#: q5?)-79 email: IAIFC) & C,4.,41*7-
Tax Map District: 1000 Section: QST Block: 6960006) LU
BRIEF DESCRIPTION OF WORK (Please Print Clearly)
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Circle All That Apply:
Is Job ready for inspection?: YES /'(0 Rough In Final
Do you need a Temp Certificate?: 40 NO Issued On eamoW 6h 1()-2-71-20
Temp Information: (All information required)
Service Size 1 Ph 3 Ph Size: �A # Meters Old Meter#
New Service - Fire Reconnect- Flood Reconnect- Service Reconnected - Underground - verhead
# Underground Laterals 1 2 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
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Request for Inspection FormAs
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