HomeMy WebLinkAbout37262-ZTown of Southold Annex
P.O. Box 1179
54375 Main Road
Southold, New York 11971
7/6/2012
CERTIFICATE OF OCCUPANCY
No: 35802
Date: 7/6/2012
THIS CERTIFIES that the building
Location of Property:
SCTM #: 473889
Subdivision:
ELECTRICAL
140 Founders Path, Southold,
Sec/Block/Lot: 64.-2-27.1
Filed Map No.
conforms substantially to the Application for Building Permit heretofore
5/30/2012 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
37262 dated 5/30/2012
electric service upgrade.
The certificate is issued to
Widirstky, Betsy
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
37262 6/11/12
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 #: 37262
Permission is hereby granted to:
Widirstky, Betsy
PO BOX 523
Southold, NY 11971
Date: 5/30/2012
To:
electric service
At premises located at:
140 Founders Path, Southold
SCTM # 473889
Sec/Block/Lot # 64.-2-27.1
Pursuant to application dated
To expire on 11/29/2013.
Fees:
5/30/2012
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. NY 11971-0959
Telephone (631 ) 765-1802
Fax (631) 765-9502
ro.qer, richert~,town.southold.ny, us
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
ssued To: Widertsky
~,ddress: 140 Founders Path City: Southold St: NY Zip: 11971
]uilding Permit It: Section: 64 Block: 2 Lot: 27.1
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
3ontractor: DBA: Brian Brooks Elec Inc License No: 3613-e
SITE DETAILS
Office Use Only
Residential R Ind°°r ~ Basement ~ Service Only [~
Corn medcal Outdoor 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Servicelph ~ Heat ~ DuplecRecpt ~
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: new 200a overhead service
Ceiling Fixtures [~ HID Fixtures
Wall Fixtures I I Smoke Detectors
Recessed Fixtures[~ CO Detectors
Fluorescent Fixture ~,~ Pumps
Emergency Fixtures[~ Time Clocks
Exit Fixtures [~ TVSS
Notes:
Inspector Signature:
Date: June 11 2012
81-Cert Electrical Compliance Form.xls
~ D1EI'/LRTMEN~
~ SOIJ-THOLD
)N
) BY: 't2;712,~r~ '1J2-~'~'3~--~' -
' Name: ' ' r ' '
License No.: ;Z/~ I. ~ ~ ~
JOBSITE INFORMATION: (*Indicates required information)
Date:
*Name:
*Address:
*Cross Street:
*Phone No.:
Permit No.:
Tax Map District:
1000 Section: ~ ~ Block:
Lot:
*BRIEF DESCRIPTION OF WORK (Please Print Clearly)
' {Please Circle Alt That Apply)
*Is job ready for inspection:
*Do you need a Temp CerUficat.e:
.O
O
Rough In Final
Temp Information (If needed)
*Service Size: ~ 3Phase 100 150 ~ .300 350 400
*New Service: Re-connect Underground Number of Meters Change of Servia/
Additienal Information: PAYMENT DUE WITH APPLICATION
k
.82~Req~est fo~nspecUon Form