HomeMy WebLinkAbout36719-Z9/28/2011
Town of Southold Annex
54375 Main Road
Southold, New York 11971
CERTIFICATE OF OCCUPANCY
No: 35242
Date:
9/28/2011
THIS CERTIFIES that the building
Location of Property:
SCTM #: 473889
Subdivision:
ELECTRICAL
825 Kimberly Ln, Southold,
Sec/Block/Lot: 70.-13-20.5
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
9/27/2011 pursuant to which Building Permit No. 36719 dated 9/27/2011
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:
under~round electric service.
The certificate is issued to
Mandelbaum, Jay & Gordon, Lauren
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
36719 9/27/11
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, NY 11971-0959
Telephone (631 ) 765-1802
Fax (631) 765-9502
ro.qer, richert~,town, so uthold, ny. us
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
ssued To: Jay Mandelbaum
Address: 825 Kimberly La City: Southold St: NY Zip: 11971
3uilding Permit #: "~,"~ I ~ Section: Block: Lot:
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Glens Electric LicenseNo: 4770-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
INVENTORY
Service 3 ph Hot Water GFCI Recpt
Main Panel A/C Condenser Single Recpt
Sub Panel NC Blower Range Recpt
Transformer Appliances Dryer Recpt
Disconnect Switches Twist Lock
Other Equipment: 200a underground service with 50a disconnect
Ceiling Fixtures [~ HID Fixtures
Wall Fixtures ~.~ Smoke Detectors
Recessed Fixtures ~.~ CO Detectors
Fluorescent Fixture ~.~ Pumps
Emergency Fixtures~ Time Clocks
Exit Fixtures [~ TVSS
Notes:
Inspector Signature:
Date: Sept 27 2011
81-Cert Electrical Compliance Form
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 #: 36719
Permission is hereby granted to:
Mandelbaum, Jay & Gordon, Lauren
1107 Fifth Ave
New York, NY 10128
Date: 9/27/2011
mo~
underground electric service
At premises located at:
825 Kimberly Ln, Southold
SCTM # 473889
Sec/Block/Lot # 70.-13-20.5
Pursuant to application dated
To expire on 3/2812013.
Fees:
9/27/2011
and approved by the Building Inspector.
ELECTRIC
Total:
$85.00
$85.00
Building Inspector
TOWN OF $OIPI'HOLr~
.A. PPMCATiON FOR ELECTRICAL INSPECTION,
REQUESTED BY:
CompanY Name:
Name:
Ucense No.:
Address-:
Phone No.:
*Address:
· *Cross Street:
*Phone No.:
Permit NO.:
Tax Map District:
JOBSITE INFORMATION: (*Indicates required information)
.1000 Section: -'70 Block: ]._~
*BRIEF 'DESCRIPTION OF WORK (Please Pdnt Clea'?~/) ~./.~//~_~ O/,/z;i~d.,O~OM~2
,(Flease,o'~o~'e Al} That AppI~) '
*lsJOb ready for inspection:
*DO you need a Temp C~l:ificate:
Temp-lnformation (If needed}.
*8el~ce size: *~ 3Phase
*New Service:
100 150.~
Re-connect ~"~ Number of Metem
Rough In'"
300 350 400
Change of Service
Other
Overhead
Additional Information: PAYMENT DUE WITH APPLICATION