HomeMy WebLinkAbout37475-ZTown of Southold Annex
P.O. Box 1179
54375 Main Road
Southold, New York 11971
9/25/2012
CERTIFICATE OF OCCUPANCY
No: 35972
Date: 9/25/2012
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 25 Azalea Rd, Mattituck,
SCTM #: 473889 Sec/Block/Lot: 115.-6-13
Subdivision: Filed Map No.
conforms substantially to the Application for Building Permit heretofore
8/27/2012 pursuant to which Building Permit No.
Lot No.
filed in this officed dated
37475 dated 8/28/2012
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:
Electric Service Upgrade.
The certificate is issued to
Molchan, Robert
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
37475 9/24/12
~uth~orized 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 #: 37475
Permission is hereby granted to:
Molchan, Robert
Date: 8/28/2012
2600 Ruth Rd
PO BOX 205
Mattituck, NY 11952
To:
Electric Service Upgrade
At premises located at:
25 Azalea Rd, Mattituck
SCTM # 473889
Sec/Block/Lot # 115.-6-13
Pursuant to application dated
To expire on 2/27/2014.
Fees:
8/27/2012 and approved bythe Building Inspector.
ELECTRIC
Total:
$85.00
$85.00
/ Building I"~spector
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, NY 11971-0959
Telephone (631 ) 765-1802
Fax (631) 765-9502
ro.qer, dchert~,town.southold, nv. us
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: robert Molchan
Address: 25 Azalea dr City: Mattituck St: NY Zip: 11952
Building Permit #: Section: 115 Block: 6 Lot: 13
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Laurel Lighting Inc LicenseNo: 4718-me
SITE DETAILS
Office Use Only
Residential R Ind°°r ~ Basement ~ Service Only~
Commerical Outdoor 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Servicelph ~ Heat ~ DuplecRecpt ~
Service 3 ph Hot Water GFCl Recpt
Main Panel NC Condenser Single Recpt
Sub Panel NC Blower Range Recpt
Transformer Appliances Dryer Recpt
Disconnect Switches Twist Lock
Other Equipment: 200a overhead service change
Ceiling Fixtures [~ H~D Fixtures
Wall Fixtures ~ Smoke Detectors
Recessed Fixtures ~ CO Detectors
Fluorescent Fixtur~ Pumps
Emergency Fixture Time Clocks
Exit Fixtures [~J TVSS
Notes:
Inspector Signature:
Date: Sept 24 2012
81-Ced Electrical Compliance Form.xls
Town H~ Annex
~375 Ma~ Road
P.O. Box 1179
Southold, NY 11971-0~$9
Telephone (631) 765-1809
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BUn.n~C DF~gr~ENT
TOWN OF 8OUTHO~.n
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: F~,'~FT~'"~ F~?O-/' Date:
Name:
Llcen~ No.: ~ ~ ~ ~
-/2_
JOBSITE INFORMATION: (*Indicates required information)
*Address: ~-~'
*Cross Street:
*Phone No.:
Permit No.:
Tax.Map District: 1000 Section: I J_.,~ Block: ~
*BRIEp DESCRIPTION OF WORK (Please Pdnt Clearly) ' ~' ~ t/~-[_ ~
Lot:
(Please Circle All That Apply)
*Is job ready for inspect on:
*Doyou need a Temp Certificate:
Temp Information (If needed}
*Service Size: 1 Phase 3Phase
NO
100 150 200
Rough In Final
300 350 400 Other
~New Service:
Additional Information:
Re-connect
82-Request l'or Inspection Form
Underground Number of Meters C~n~eof~e~"~ Overhead
.PAYMENT DUE WITH ^P,~N