HomeMy WebLinkAbout36137-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-34820
Date: 01/25/11
THIS CERTIFIES that the building ELECTRIC SERVICE
Location of Property: 1850 SMITH RD
(HOUSE NO.) (STREET)
County Tax Map NO. 473889 Section 98 Block 3
Subdivision
Filed Map NO. __ Lot No. __
PECONIC
Lot 19
(HAMLET)
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 13, 2011 pursuant to which
Building Permit No. 36137-Z dated JANUARY 13, 2011
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 is issued to AIqN E FAY
of the aforesaid building.
( OWNER )
SUFFOLK COU~FI"fDEPARTME~TOFHEALTHAPPROVAL
ELECTRICAL c~KTIFICATE NO.
PLUMBERS C~'rIFICATION DA'r~u
N/A
36137 01/24/11
N/A
Authorized Signature
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. 36137 Z
Date J~2qVJARY 13, 2011
Permission is hereby granted to:
ANN E FAY
300 HAWORTH AVENUE
HAWORTH,NJ 07641
for :
ELECTRIC SERVICE AS APPLIED FOR.
at premises located at
County Tax Map No. 473889 Section 098
pursuant to application dated JANUARY
Building Inspector to expire on JULY
1850 SMITH RD PECONIC
Block 0003 Lot No. 019
13, 2011 and approved by the
13, 2012.
Fee $ 85.00
AuthOriZed Signature
ORIGINAL
Rev. 5/8/02
5/37.5 Main Road
ILO. Box 1179
Soulhold. Nh' 11971-09,59
Telephone (631) 763-18t)2
l:ax (631) 7ti,5-9302
ro,qer, richert~town.so uthold, ny. us
I~UII,DIN(; 1)I,]I'ARTM I']NT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
ssued To: Ann Fay
Address: 1850 Smith Road City: Peconic St: NY Zip: 11958
Building Permit #: ~ J '~ ,'~ Section: ~'~ Block: '.~ Lot: J~
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Doroski Elec Inc License No: 2941-e
SITE DETAILS
Office Use Only
Residential ~ Indoor ~ Basement ~ Service Only [~
Commerical Outdoor 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Servicelph ~ Heat ~ DuplecRecpt ~
Service 3 ph Hot Water GFCl Recpt
Main Panel NC Condenser Single Recpt
Sub Panel NC Blower Range Recpt
Transformer Appliances Dryer Recpt
Disconnect Switches Twist Lock
Other Equipment:
Ceiling Fixtures [~ HID Fixtures
Wall Fixtures ~.~ Smoke Detectors
Recessed Fixtures ~,~ CO Detectors
Fluorescent Fixture ~.~ Pumps
Emergency Fixtures~ Time Clocks
Exit Fixtures ~ TVSS
100a overhead service-replace meter pan and mast only, did not replace main par
Notes:
Inspector Signature:
Date: Jan 24 2011
81-Cedr Electrical Compliance Form
Town ~ ~um~
P.O, Box 1179
Tc{ephon~ {~3i)
f~qsr,ncn erti~town ,seumo{o,nv, us
REQUESTED BY:
~,ompany Name:
Name:
License No.:
~one No.:
BUILDING DF.2ARTIV[F-Y,'T
TOWN O~ $OUT~O'{J)
APPL CATION FOR ELECTRICAL INSPECTION
Date:
JOBSITE INFORMATION: (*Indicates required information)
· me: _ , .....
· c~s~ st~t: I~ ~ ~, ~-' ......
· P~ne No.: ....... ~ ~ '7.~ .....
Pe~lt No.:
T~ Map Diem: 1,0~ S~on:, ~ _
'BRIEF DESCRIPTION bi:: WORK (Please Pdnt Clearly)
//NO Rough In
NO
~" 150 21J0 300 350 400 Other
Underground Number of M !*tern Change of Service Overhead
PAYMENT D_L[E W TH APPLICATION
3Phase
(l~leaaa Clml$ Ail That Al;ply)
*is j~ ready for inspection
'Do you need · Tamp Cart flcate:
Tamp Information (If needed]
*Service Size: 1 Pham~
*N~W Service' Rs-con~'~3t
Additional Information:
82-Reque~t for In~e~tion Form