HomeMy WebLinkAbout35976-ZFORM NO. 4
TOW~g OF SOUTHOLD
BUILDING DEP~RTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: z-34808
Date: 01/19/11
T~IS C~TIFIES that the building ELECTRIC
Location of property: 500 DEEP HOLE DR MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
Co%k~ty Tax Map NO. 473889 Section 115 Block 12 I~t 6
Subdivision FiledMap No. __ Lot No. __
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 27, 2010 purs,,~t to which
~ilding ~er~t No. 35976-Z dated OCTOBER 27, 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 ELECTRIC SERVICE UPGRADE AS APPLIED FOR.
The certificate is issued to LAWRENCE P & SHERRI KELLY
( OWNER )
of the aforesaid building.
SUFVOL~ COUNT~DEPARTMENTOF ~E~J~TNAPPRO~-AL
ELEt-r~ICAL CERTIFICATE NO.
PLU~ERS CERTIFICATION DA'r~3
N/A
34976 12/30/10
N/A
Rev. 1/81
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 35976 Z
Date OCTOBER 27, 2010
Permission is hereby granted to:
LAWRENCE P & SHERRI KELLY
PO BOX 743
CUTCHOGUE,NY 11935
for :
ELECTRIC SERVICE UPGRADE AS APPLIED FOR.
at premises located at
County Tax F, ap No. 473889 Section 115 Block
pursuant to application dated OCTOBER 27, 2010
Building Inspector to expire on APRIL 27,
500 DEEP HOLE DR
MATTITUCK
0012 Lot No. 006
and approved by the
2012.
Fee $ 85.00
//~h~f/~i~nature
ORIGINAL
Rev. 5/8/02
Form No. 6
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be flied in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new use: 1. Final survey of property with accurate location of all buildings property lines, streets, and unusual natural or
topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal (S_9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate
of Code Compliance from architect or engineer responsible for the building.
6. ·Submit PI..atoning Board Approval of completed site plan requirements.
B. F~ existing b(~dings (pri~r t~ Apri~ 9~ ~957) n~n-~nf~rming nses~ ~r bui~d~ngs and "pre-existing~ ~and uses:
1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic
features·
2. A properly completed application and consent to inspect signed by the applicafit. Ifa Certificate of Occupancy is
denied, the Building Inspector shall state the reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy ~ New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00,
· Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy 0f Certificate of Occupancy - $.25
· 4.Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
New Construction:
Location of ProPerty:
Date.
Old or Pre-existing Building:
House No. Street
OwnerorOwnersofProperty: ~ FJ.,x.~D~F~C~L. ~ 7~-
· Suffolk County TaxMav No I000, Section I ] ~
SubdixSsion '
'e tNo. Dateofpennit.
· (check one)
Hamlet
Health Dept. Approval:
Planning Board Approval:
Block
Filed Map.
Applicant:.
Underwriters Approval:
Lot:
Request for: Temporary Certificate
Fee Submitted: $ [,q ?~
Final Certificate:
(check one)
Applicant Signature
Town Hall Annex
,54375 Mail~ I/oad
I'.t). B{~x 117!t
Southold. 5/5' 11971-0959
Tclcpho~lt, (631 ) 76,5-1802
Fax (631) 76,'5-9,;02
toiler r chert~town.southold.ny, us
1½1 III,DIN(; I)EPAI/TMIqNT
TOWN OF $OUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
ssued To: Sheed Kelly
~,ddress: 500 Deep Hole Dr City: Mattituck St: NY Zip: 11952
Building Permit #: 35976 Section: 1 1 5 Block: 12 Lot:
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Sirs Electrical Contracting License No: 47125-me
SITE DETAILS
Office Use Only
Residential /~ Indoor ~ Basement [~ Service Only
Commericel Outdoor 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Servicelph ~ Heat ~ DuplecRecpt ~ CeilingFixtures [~ HIDFixtures
Service 3 ph Hot Water GFCl Recpt Wall Fixtures ~-I Smoke Detectors
Main Panel NC Condenser Single Recpt Recessed Fixtures I'~ CO Detectors
Sub Panel NC Blower Range Recpt Fluorescent Fixture ~ Pumps
Transformer Appliances Dryer Recpt Emergency Fixtures~I Time Clocks
Disconnect Switches Twist Lock Exit Fixtures ~ TVSS
Other Equipment: 200a underground service with main panel
Inspector Signature:
Date: Dec 30 2010
81-Ced Electrical Compliance Form
T~m Hall Aunex
P.O.~ 117~
· So~bold, NY 1
REQUESTED BY:
~,empany Name:
Name:
I~ense No.:
Address..'
Phone No.:
*Address:
· *Cross Street:
*Phone No.:
Permit No.: .
Tax Map District:
TOWN OF SO[J'THOLD
,APP.LICATION FOR ELECTRICAL INSPECTION,
JOBSITE INFORMATION: (*Indicates. required information).
1000 Section: .
*BRIEF DEscRIPTION OF WORK (Please Print. clearly)
'YES/NO
.(Please Cimle AI~ That,a~ly)
*Is jOb ready for inspe~tion:
*Do you need a Temp Certificate:
Rough In"'
Final.
Temp'information (If needed).
*Service Size: ~ 3Phase 100 150.~ 300 350 400 Other
*New Service: 'Re-conneot ~ Nu~m c.efl,a-h~6f $e~..3 Overhead
Additional Information: PAYI~=NT-Dt~ WITH APPLICATION