HomeMy WebLinkAbout38299-Z Town of Southold Annex 9/30/2013
P.O. Box 1179
54375 Main Road
~ ~ ~
Southold, New York 11971
CERTIFICATE OF OCCUPANCY
No: 36542 Date: 9/30/2013
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 250 Wendy Dr, Laurel,
SCTM 473889 Sec/Block/Lot 128.-5-2
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
9/3/2013 pursuant to which Building Permit No. 38299 dated 9/3/2013
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:
ELECTRICAL SERVICE UPGRADE TO 150 AMPS
The certificate is issued to Gorecki, Maria & Black, Michael Joseph
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 38299 09-09-2013
PLUMBERS CERTIFICATION DATED
t' Authorized Signature
TOWN OF SOUTHOLD
~ BUILDING DEPARTMENT
66 TOWN CLERK'S OFFICE
~~g SOUTHOLD, NY
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a
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 38299 Date: 9/3/2013
Permission is hereby granted to:
Gorecki, Maria 8~ Black, Michael Joseph
246 Withers St
Brooklyn, NY 11211
To: Electrical Service Upgrade to 150 Amps
At premises located at:
250 Wendy Dr, Laurel
SCTM # 473889
Sec/Block/Lot # 128.-5-2
Pursuant to application dated 9/3/2013 and approved by the Building Inspector.
To expire on 3/5/2015.
Fees:
ELECTRIC $85.00
Total: $85.00
Building Inspector
~0~~ SOUryolo
Town Hall Annex y Telephone (631) 765-1802
54375 Main Road ~ T Fax (631)765-9502
G •
P.o. Bnx I I79 roger. richert(a~town.southold.ny.us
Suuthuld,NY 11991-0959
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued 70: Michael Black
Address: 250 Wendy Drive City: Laurel St: NY Zip: 11948
Building Permit#: 38299 Section: 12$ Block: 5 Lot: 2
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
contractor: DBA: Direct Connection Const License No: 44943-me
SITE DETAILS
Office Use Only
Residential X Indoor X Basement Service Only X
Commerical Outdoor X 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph 150a Heat Duplec Recpt Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel 150a A/C Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpl Emergency Fixture Time Clocks
Disconnect 150a Switches Twist Lock Exit Fixtures TVSS
otner Equipment: service up grade to 150a overhead
Notes:
Inspector Signature: ~ t.._-~~~ Date: Sept 9 2013
81-Cert Electdcal Compliance Form.xls
i
Town Hall Agnex ~ # Tdep6one (68L) 765-1804
54375 Ma®Road ~u ~~y
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TOWN OP i301i1T1EI0)LD
APPLICATION FOR ELECTRICAL INSPECTION j
REQUESTED BY:
~A-J1 ~ ~ . VJI~Si OilJl"- Date: q -3' l3
Company Name: G.~
Name: i O Aiu~L
License No.:
dress: I ~ - _
Phone No.: (p 1 - 3 - 3S (03 i Z 55 0 8'f
JOBSITE INFORMATION: (*Indlcates required information)
'Name: n/1, Cda AcL Q( '
*Address: So N - 2.E t 4 S
*Cr+oss street: ~ L
*Phone No.: (0'3 ] (0 2 1 j
Permit No.:
Tax Map District: 1000 Section: Block: Lot:
`BRIEF DESCRIPTION OF WORK (Please Print Clearly) R Q ~ ~ ~
~YL~ i t~ 1 JY~ !LA A ~ ~ I ~ A-,.,i~ ~ ~ crvi l C') f*c~ s
(Please Circle AN That Apply)
*Is job ready for inspection. YE / NO 1
Rough in Final
*Do you need a Temp Certificate: YE NO ~
Temp Irrformatlon (If needed) .
`Service Sias: 1 Phase 3Phase 100 ~ 200 300 350 400 Otiler
`New Servk;e: Re-oonr>act Underground Mumbo f Me Change of Overhead
Additional Information: ~ ~ ~ ~ ~q DUE WITH APPLICATION
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