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36930-Z
Town of Southold Annex 54375 Main Road Southold, New York 11971 1/30/2012 CERTIFICATE OF OCCUPANCY No: 35417 Date: 1/30/20 l 2 THIS CERTIFIES that the building Location of Property: SCTM #: 473889 Subdivision: ELECTRICAL Central Ave, Fishers Island, Sec/Block/Lot: 10.-1-9 Filed Map No. conforms substantially to the Application for Building Permit heretofore 1/19/2012 pursuant to which Building Permit No. 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 36930 dated 1 / 19/2012 new electric service. The certificate is issued to Fishers Island Dev Corp (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 36930 01/18/2012 Authorized Signature Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631 ) 765-1802 Fax (63 I) 765-9502 ro.qer, richert~town southold.n¥.us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRIClAL COMPLIANCE SITE LOCATION ssued To: FI Yacht Club &ddress: 1317 Central Ave City: Fishers Island St: NY Zip: 639£ Suilding Permit #: Section: Block: Lot: WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE 3ontractor: DBA: License No: 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 NC Condenser Single Recpt Sub Panel NC Blower Range Recpt Transformer Appliances Dryer Recpt Disconnect Switches Twist Lock Other Equipment: fed with 2x350 Ceiling Fixtures J~ HID Fixtures Wall Fixtures ] ] Smoke Detectors Recessed Fixtures~ CO Detectors Fluorescent Fixture ~,~ Pumps Emergency Fixtures[~ Time Clocks Exit Fixtures [~J TVSS 4 meter bank, underground, 1-60a disconnect, 3-200a disconnects Notes: Inspector Signature: Date: Jan 18 2012 81-Cert Electrical Compliance Form.xls 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 #: 36930 Permission is hereby granted to: Fishers Island Dev Corp Attn: F I Utility Co Drawer E Fishers Island, NY 06390 To: new electric service. Date: 1/19/2012 At premises located at: Central Ave, Fishers Island SCTM # 473889 Sec/Block/Lot # 10.-1-9 Pursuant to application dated To expire on 7/2012013. Fees: 1/19/2012 and approved by the Building Inspector. ELECTRIC Total: $85.00 $85.00 Building Inspector TOWN OF SOLllHgt~ ~ BUILDING DEPAItTMENT TOWN OF 80,UTH©LD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Company Name: qame: Date: 18- ~- !1 JOBSITE INFORMATION: (*Indicates required information) *Address: 131') ~,'~ *Cross Street: *Phone No.: Permit No.: Tax Map District: 1000 Section: Block: *BRIEF DESCRIPTION OF WORK (Please Print Clearly) (Please Circle All That Apply) *Is job ready for inspection: *Do you need a Temp Certificate: Temp Information (If neededj *Service Size: 1 Phase *New Service: Re-connect Additional Information: 82-Request for Inspection Form Rough In Final 3Phase 100 150 200 300 350 400 Other Un--nd Number of Meters Chan~rvice Overhead PAYMENT~UE WITH APPLICATION