HomeMy WebLinkAbout36004-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
NO: Z-34713
Date: 11/29/10
THIS tma(TIFIES ~h~t ~h, building ELECTRIC SERVICE
Locatio~of Property: 705 HU~4EL AVE
{HOUSE NO.) (STREET)
County Tax Map No. 473889 Bectio~ 63 Block 2
Su~4/visi~
Filed Map No. __ Lot No. __
SOUTHOLD
Lot 21
(HAMLET)
conforms substantially to the Application for Building Permit heretofore
filed in kh~s office ~ated NOVEMBER 3, 2010 [~/r~,m-t to w~tich
Buil~-g Perm/t No. 36004-Z dated NOVEMBER 8, 2010
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 OVERHEAD ELECTRIC SERVICE AS APPLIED FOR.
The certificate ia issued to MARY JARUSIEWIC
(OWNER)
of the aforesaid building.
~UF~OLKCOIH~TY~EPA~T~TOFHEALTHAPPP~)FAL N/A
~.~.-rM_ICAL C~K'£IFICATH NO. 36004 11/08/10
~ CE~TIFICATI(~ DA~'~U N/A
Rev. 1/81
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUII/)ING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 36004 Z
Date NOVEMBER 8, 2010
Permission is hereby granted to:
MARY JARUSIEWIC
PO BOX 472
SOUTHOLD,NY 11971
for :
ELECTRIC SERVICE AS APPLIED FOR.
at premises located at
County Tax Map No. 473889 Section 063
purs,,~nt to application dated NOVEMBER
Building Inspector to expire on MAY
705 HUMMEL AVE SOUTHOLD
Block 0002 Lot No. 021
3, 2010 and approved by the
8, 2012.
Fee $ 85.00
Authorized Signature
ORIGINAL
Rev. 5/8/02
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, NY 11971-0959
Telephone (631) 765-1802
Fax (631) 765-9502
ro.qer.dchert~town.southold.ny.us
Issued To: MapJ Jarusiewic
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Address: 705 Hummel Ave
City: Southold St: NY Zip: 11971
SuildingPermit#: ~('O~"~q Section: 63 Block: 2 Lot:
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
21
;ontractor; DBA: Brian Brooks Electric Inc License No: 3613-e
SITE DETAILS
Office Use Only
Residential ~ Indoor ~ Basement ~ Service Only ~
Commerical Outdoor 1 st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Servicelph ~ Heat U DuplscRecpt ~
Service 3 ph Hot Water GFCl Recpt
Main Panel NC Condenser Single Recpt
Sub Panel NC Blower Range Recpt
Transformer Appliances Dp/er Recpt
Disconnect Switches Twist Lock
Other Equipment: 150a overhead service
Ceiling Fixtures [~ HID Fixtures
Wall Fixtures ~ Smoke Detectom
Recessed Fixtures ~ CO Detecfom
Fluorescent Fixture ~ Pumps
Emergency Fixtures[~ Time Clocks
Exit Fixtures [~[ TVSS
Notes:
Inspector Signature:'
Date: Nov 8 2010
81-Cert Electrical Compliance Form
APP.LICATION FOR I~LI~CTRICAL INSPECTION
JOBSI~'rE INFORMATION: (*{ndi~ates. required information)
~.'"'J'-O-~U .~ I ~ ~ ~-~ . -
~m.~
· *Cross Street:
*Phone No.:
Permit No.:
· 1000 Secflen: .C~"~'.Block:
~RIEF DE,.~_,R~ON OF WORK (Please PdmClea'dy)
you r.r..-~! a T.emp Cm~ea{.e:
~)1 NO R.~h In"" Rna[
Underground Number of Metem Change of Sen~e~/~ead_.~
P^~ DuE W,TH~PUC. T,o. ~ ~ ~5~ ~'