HomeMy WebLinkAbout37642-ZTown of Southold Annex
P.O. Box 1179
54375 Main Road
Southold, New York 11971
CERTIFICATE OF OCCUPANCY
11/26/2012
No: 36053 Date:
11/26/2012
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 975 Anderson Rd, Southold,
SCTM #: 473889 Sec/Block/Lot: 50.-1-15
Subdivision: 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. 37642 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:
electric service
The certificate is issued to
Forestieri, John
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
37642 11/21/12
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 Cf: 37642
Permission is hereby granted to:
Forestieri, John
845 Mill Creek Dr
Southold, NY 11971
To:
electric service
Date: 11/26/2012
At premises located at:
975 Anderson Rd, Southold
SCTM Cf 473889
Sec/Block/Lot # 50.-1-15
Pursuant to application dated
To expire on 5/28/2014.
Fees:
11/26/2012
and approved by the Building Inspector.
ELECTRIC $85.00
Total: $85.00
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, NY 1197141959
Telephone (631 ) 765-1802
Fax (63 l) 765-9502
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
ssued To: John Forestieri
~,ddress: 975 Anderson Dr City: Southold St: NY Zip: 11971
~uilding Permit ¢~: Section: Block: Lot:
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
3ontractor: DBA: John Ludemann LicenseNo: 4643-me
SITE DETAILS
Office Use Only
Residential l~ Ind°°r I~ 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 A/C Blower Range Recpt
Transformer Appliances Dr~er Recpt
Disconnect Switches Twist Lock
Other Equipment:
Ceiling Fixtures [~ HID Fixtures
Wall Fixtures I I Smoke Detectors
Recessed Fixtures[~ CO Detectors
Fluorescent Fixture~.~ Pumps
Emergency Fixturel~ Time Clocks
Exit Fixtures [~ TVSS
400a overhead service, 2-200a service disconnects, 2-meters
Inspector Signature:
Date: Nov21 2012
81-Cer~ Electrical Compliance Form.xls
Town ~ Annex
54~75 ~ Road
P.O. Box 1179
Souli~o[d, NY 11971-09,59
REQUESTED BY:
Company Name:
Telephone (6,BI) 765-1802
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BUll ~I~NG DI~
TOWN OF SOUTtIOLD
APPLICATION FOR ELECTRICAL INSPECTION
Name:
License No.:
Address:
Phone No.:
JOBSITE INFORMATION: (*indicates required information)
*Name: '~A~ ~ ~%tesTis_ri
*Address:
*Cross Street:
*Phone No.:
Permit No.:
75' A ~cle~rs~/ ~r.
Tax.Map District: 1000 .. Section: _,~(~ Block: / Lot:
*BRIEF DESCRIPTION OF WORK (Please Print Cleady)
(Please Circle All That Apply)
*Is job ready for inspection:
*Do you need a Temp Certificate:
Temp Information (If. needed)
*Servlce Size: 1~ 3Phase
;'New Service: Re-connect
Additienal Information:
Rough In Final
100 150....200 300 350 (~) Other
Underground Number(~l~eters c~nge of Se~-"~ Overhead
PAYMENT DUE W~TH APPLICATION