HomeMy WebLinkAbout37643-ZTown of Southold Annex
P.O. Box 1179
54375 Main Road
Southold, New York 11971
CERTIFICATE OF OCCUPANCY
12/17/2012
No: 36087
Date:
12/17/2012
THIS CERTIFIES that the building
Location of Property:
SCTM #: 473889
Subdivision:
ELECTRICAL
290 Oak St, Mattituck,
Sec/Block/Lot: 141.-1-16.1
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
11/26/2012 pursuant to which Building Permit No. 37643 dated 11/26/2012
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:
overhead electric service.
The certificate is issued to
Zawasky, John & Zawasky, Dorothy
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
37643 12/13/12
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 #: 37643
Permission is hereby granted to:
Zawasky, John & Zawasky, Dorothy
4790 Aston Gardens Way
Naples, FL 34109
Date: 11/26/2012
To:
Electric Service Change
At premises located at:
290 Oak St, Mattituck
SCTM # 473889
Sec/Block/Lot # 141 .-1-16.1
Pursuant to application dated 11/26/2012
To expireon 5/28/2014.
Fees:
and approved by the Building Inspector.
ELECTRIC $85.00
Total: $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.southo d ny us
BUILDING DEPARTMENT
TOWN OF SOUTI-IOI,D
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: John Zawasky
Address: 290 Oak St City: Mattituck St: NY Zip: 11952
Building Permit#: 37643 Section: 141 Block: 1 Lot: 16.1
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: ELCO Electric Corp License No: 2816-me
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 Wall Fixtures ~l Smoke Detectors
Main Panel NC Condenser Single Recpt Recessed Fixtures I~ CO Detectors
Sub Panel NC Blower Range Recpt Fluorescent Fixture ~ Pumps
Transformer Appliances Dryer Recpt Emergency Fixtures~l Time Clocks
Disconnect Switches Twist Lock Exit Fixtures L.~ TVSS
Other Equipment: 100a overhead service
Notes:
Inspector Signature:
Date: Dec 13 2012
81-Cert Electrical Compliance Form.xls
P.O. Bo~ 1179
Somhold, NY 11971..0989
Telephooe (~1) 765-180~
m er '-- · ~ax (cai) 765~95Q°~
~ .ncnert0mtown.soumom.ny.,~m
BUff~I~G DEPARTM~.~iT
TOWN OF $OUTHOT.~
APPLICATION FOR ELECTRICAL INSPECTIOH
REQUESTED BY:
Gompany Name:
Name:
License No.:
Address:
'Phone No.:
*Name:
*Address:
*Cross Street:
*Phone No.:
Permit No.:
TaxMap District:
Date:
JOB$1TE INFORMATION: (*Indicates required information)
Block: Lot:
*BRIEF DESCRIPTION OF WORK (Please Print Clearly)
(Please Circle AH That Apply)
*Is job ready for inspection:
*Do-you need a Temp Certificate:
~ Rough In Final
NO
T~Itp Information (I.,~.p~cled] ,
*SorvlceSiz~: (1P~.~ 3Phase (~ 150 200 300~400
Additional Information: PAYMERTDUE WITH AP~L-I'C~OI~I
for Inspection Form