HomeMy WebLinkAbout36886-ZTown of Southold Annex
54375 Main Road
Southold, New York 11971
CERTIFICATE OF OCCUPANCY
12/28/2011
No: 35370 Date: 12/28/2011
THIS CERTIFIES that the building ELECTRICAL
Location of Property:
SCTM #: 473889
695 Theresa Dr, Mattituck,
Sec/Block/Lot: 115.-15-6
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
12/22/2011 pursuant to which Building Permit No. 36886 dated
12/22/2011
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.
The certificate is issued to
Rutkowski, Richard & Rutkowski, Margaret
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
36886
12/28/11
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, NY 11971-0959
Telephone (631 ) 765-1802
Fax (631 ) 765-9502
ro.qer, dchertC, town.southold.n¥.us
BUILDING DEPARTMENT
TOWN OF 8OUTItOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Richard Rutkowski
Address: 695 Theresa Dr City: Mattituck St: NY Zip: 1195~
Building Permit #: ¢~ ~,¢ ~- ~ Section: 1 1 5 B~ock: 15 Lot:
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Custom Lighting of Suffolk License No: 38893-me
SITE DETAILS
Office Use Only
Residential ~ Indoor ~ Basement ~ Ser~iceOnly [~
Commedcal Outdoor 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Servicelph ~ Heat ~ DupleoRecpt ~
Service 3 ph Hot Water GFCI Recpt
Main Panel A/C Condenser Single Recpt
Sub Panel A/C Blower Range Recpt
Transformer Appliances Dryer Recpt
Disconnect Switches Twist Lock
Other Equipment: 200a overhead service
Ceiling FixtureseR~~ HiD Fixtures
Wall Fixtures I I Smoke Detectors
Recessed Fixtures CO Detectors
Fluorescent Fixtur Pumps
Emergency Fixture~ Time Clocks
Exit Fixtures I I TVSS
Notes:
Inspector Signature:
Date: Dec 28 2011
81-Gert 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 #: 36886
Date: 12/22/2011
Permission is hereby granted to:
To:
Rutkowski, Richard & Rutkowski, Margaret
695 Theresa Dr
Mattituck, NY 11952
electric upgrade
At premises located at:
695 Theresa Dr, Mattituck
SCTM # 473889
Sec/Block/Lot # 115.-15-6
Pursuant to application dated
To expire on 6/22/2013.
Fees:
12122/2011 and approved by the Building Inspector.
ELECTRIC
Total:
$85.00
$85.0O
Building Inspector
Town Hall Annex
54375 M~fin Road
P.O. Box 1179
Southold, NY 11971-0959
Telephone (631) 765-1802
BUtl~F~ING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR F:LFCTRICAL INSPECTION
-"D BY:
Company Name:
Name:
License No.:
Address:
Phone No.:
Date:
JOBSITE INFORMATION: (*Indicates required information)
*Name:
*Address:
*Cross Street: ~}~
*PhoneNo.: 27 % 5Z~ -~
Permit No.:
TaxMap District: 1000 Section: i/5' Block:
Lot:
*BRIEF DESCRIPTION OF WORK (Please Print Clearly)
(Please Circle All That Apply)
*Is job ready for inspection:
*Do you need a Ternp Certificate:
Temp Information ~d}
*Service Size: 3Phase 100
*New Service: Re-connect Underground
Additional Information:
~/NO Rough In ~
150 20(..~0J 300 350 400 Other
PAYMENT DUE WITH APPLICATION
82~equ~.st k)r Inspection Form