HomeMy WebLinkAbout36624-ZTown of Southold Annex
54375 Main Road
Southold, New York 11971
8/19/2011
CERTIFICATE OF OCCUPANCY
No: 35157
Date: 8/19/2011
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 2200 Westphalia Rd, Mattituck,
SCTM #: 473889 Sec/Block/Lot: 114.-7-10.4
Subdivision: Filed Map No.
conforms substantially to the Application for Building Permit heretofore
8/15/2011 pursuant to which Building Permit No. 36624
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:
Lot No.
filed in this officed dated
dated 8/15/2011
underground electric service.
The certificate is issued to
Ciupryk, Andrew & Ciupryk, Mary
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
36624
8/17/11
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 #: 36624 Date: 8/15/2011
Permission is hereby granted to:
Larry Blessinger
Toz
underground electric service.
At premises located at:
2200 Westphalia Rd, Mattituck
SCTM # 473889
Sec/Block/Lot # 114.-7-10.4
Pursuant to application dated
To expire on 2113/2013.
Fees:
8/15/2011 and approved by the Building Inspector.
ELECTRIC
Total:
$85.00
$85.00
Building Inspector
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold~ New York 11971-0959
Telephone (631 ) 765- 1802
Fax (631 ) 765-9502
ro.qer, richort~town southo d.n¥.us
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Larry Blessingen
Address: 2200 Westphalia Rd City: Mattituck St: NY Zip: 11952
Building Permit#: '~(~.~, ,~1..~ Section: Block: Lot:
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: B.J. Electric License No: 2670-me
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
Service 1 ph
Service 3 ph
Main Panel
Sub Panel
Transformer
Disconnect
Other Equipment:
INVENTORY
Hot Water GFCl Recpt
NC Condenser Single Recpt
NC Blower Range Recpt
Appliances Dryer Recpt
Switches Twist Lock
200a underground service
Ceiling Fixtures ~
Wall Fixtures ~.~
Recessed Fixtures ~.~
Fluorescent Fixture ~
Emergency Fixtu res~
Exit Fixtures L
HID Fixtures
Smoke Detectors
CO Detectors
Pumps
Time Clocks
TVSS
Notes:
Inspector Signature:
Date: Aug 17 2011
81-Cert Electrical Compliance Form
Town Hall Annex
54,87,5 Main Eo;td
Southold. NY 1 L97 t -0959
Telephone (§St) 7654802
r~er,nGnert t~,,,,
BUILDING l) EPARTM1L~£
ToWN OF $OUTHOLD
~R ELECTRICAL INSP CTION
R EQUESTEDBY: -- ~ '~ ,~--~~ ~ Date:~
Company Name: ~ ~e~~~'~ --
Address: ~
3hone No.: ~/~ ~ ~
JOBSITE INFORMATION: (*lndi~tes required information)
*Name:
*Address:
*Cross Street:
*Phone No,:
Permit No.:
Tax Mal~ District: __
*BRIEF DESCRIPTION OF WORK (Please Print Clearly)
(Please Circle All That Apply) ~ Rough In. Final
*Is job ready for inspection:
*Do you need a Temp Certificate:
e 100 150 300 350 400
.T, emp Information] 3Phas, ~ . Other
Service Size: ~ ~;~ Number of Metem Change of SerV,ce Overhead
*New Service: Re-connect
Additional nformatlon: .__~PAYM~UE WITH A.p__PLICAT_.LON
f ? ~v 8~.r~quostfor inspection For --