HomeMy WebLinkAbout37417-ZTown of Southold Annex
P.O. Box 1179
54375 Main Road
Southold, New York 11971
CERTIFICATE OF OCCUPANCY
9/21/2012
No: 35964 Date: 9/21/2012
Location of Property:
SCTM #: 473889
Subdivision:
THIS CERTIFIES that the building ELECTRICAL
1900 Pine Tree Rd, Cutchogue,
Sec/Block/Lot: 98M-17.1
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
8/2/2012 pursuant to which Building Permit No. 37417 dated 8/2/2012
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:
200 AMP Electrical Service
The certificate is issued to
Kosmynka, Martin & Kosmynka, Christine
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
37417 9/18/12
thorized 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 #: 37417
Permission is hereby granted to:
Kosmynka, Martin & Kosmynka, Christine
1985 Pine Tree Rd
Cutchogue, NY 11935
To:
200 AMP Electrical Service
Date: 8/2/2012
At premises located at:
1900 Pine Tree Rd, Cutchogue
SCTM # 473889
Sec/Block/Lot # 98.-1-17.1
Pursuant to application dated
To expire on 2/1/2014.
Fees:
8~2~2012
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
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
ssued To: North Fork Self Storage
Address: 1900 Pine Tree Rd City: Cutchogue St: NY Zip: 11935
3uilding Permit#: Section: 98 Block: 1 Lot: 17~1
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
3ontractor: DBA: G&S Electric LicenseNo: 578-e
SITE DETAILS
Office Use Only
Residential ~] Indoor ~ Basement
Commedcal Outdoor 1st Floor
New Renovation 2nd Floor
Addition Survey Attic
Service 1 ph ~ Heat
Service 3 ph ~i Hot Water
Main Panel NC Condenser
Sub Panel NC Blower
Transformer Appliances
Disconnect Switches
Other Equipment:
INVENTORY
GFCI Recpt
Single Recpt
Range Recpt
Dryer Recpt
Twist Lock
200a underground service (h frame)
Service Only ~
Pool
Hot Tub
Garage
Ceiling Fixtures ~[~t__lr--I~] HID Fixtures
Wall Fixtures II Smoke Detectors
Recessed Fixturesl I CO Detectors
Fluorescent Fixture Pumps
Emergency Fixture Time Clocks
Exit Fixtures I I TVSS
Inspector Signature:
Date: Sept 18 2012
81-Cert Electrical Compliance Form.xls
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, ~.~ 11971-0959
Telephone (63l) 765-1802
, Fax (631) 76,~-,950~,
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BUILDING DEPARTMENVT
TOWN OF $OUTHOI.f)
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY:
Company Name:
Name:
License No.:
Address:
Phone No.:
JOBSITE INFORMATION:
*Name:
*Address:
*Cross Street:
*Phone No.:
Permit No.:
Tax Map District:
Date:
(*Indicates required information)
1000 Section: ~)~ Block: I Lot: ~-/' I
*BRIEF DESCRIPTION OF WORK (Please Print Clearly)
o __oo
(Please Circle All That Apply)
*Is job ready for inspection:
*Do you need a Temp Certificate:
NO
NO
Rough In Final
Temp Information (If needed)
*Service Size: 1 Phase 3Phase 100 150 (~ 300 350 400 Other
*~-'~ Re-connect~ro~d Number of Meters / Change of Service Overhead
Additional Information: ~ PAYMENT DUE WITH APPLICATION
82-Request for Inspection Form