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4 Town of Southold Annex 10/25/2013
P.O. Box 1179
54375 Main Road
"d i~4q Southold, New York 11971
H
CERTIFICATE OF OCCUPANCY
No: 36583 Date: 10/25/2013
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 1290 Oriole Dr, Southold,
SCTM 473889 Sec/Block/Lot: 55.-6-15.39
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
10/22/2013 pursuant to which Building Permit No. 38436 dated 10/22/2013
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:
Electric Service.
The certificate is issued to Summers, George & Summers, Lynn
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
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 38436 Date: 10/22/2013
Permission is hereby granted to:
Summers, George & Summers, Lynn
1100 Sayers Rd
Mattituck, NY 11952
To: Electric Service
At premises located at:
1290 Oriole Dr, Southold
SCTM # 473889
Sec/Block/Lot # 55.-6-15.39
Pursuant to application dated 10/22/2013 and approved by the Building Inspector.
To expire on 4/23/2015.
Fees:
ELECTRIC $125.00
Total: $125.00
Buil
ZInspe
hO~~pf SO!/j9pl~
Town Hall Annex y yy Telephone (631) 765-1802
54375 Main Road T T Fax (631) 765-9502
P .O. 1179
Southold, NY 11971-0959 roger. richert(a)town.southold.nv.us
OOutim Nc~
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: G & L Summers
Address: 1290 Oriole Dr City: Southold St: NY Zip: 11971
Building Permit 38436 Section: 55 Block: 6 Lot: 15.39
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
contractor: DBA: John Ludemann License No: 4643-me
SITE DETAILS
Office Use Only
Residential X Indoor X Basement Service Only
Commerical Outdoor X 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt 1 Ceiling Fixtures 1 HID Fixtures
Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks 1
Disconnect Switches 5 Twist Lock Exit Fixtures TVSS
Omer Equipment: 100a generator panel and 30a generator plug for portable enerator, also up-grad
to interior of house, and 1 entry way post light
Notes:
Inspector Signature:` , Date: Oct 22 2013
81-Cert Electrical Compliance Form.xls
Town Ha8 A®ex Tawbom (631) 765.1804
54875 Mam Road ~((68 7
P.O. Baer 1179 rODeT.rIf~lBrttl@ODrGI1~.mY.US
SoW wK NY 11971-09M
"vllltlis -
BUUDM DEPAtt l7rtM
TOWN OF SOUMOLD
APPLICATION FOR ELECTRICAL. INSPECTION
REQUESTED BY: _ Dnu44erx,zhIL Date:
Company Name: JaJekh~anw
Name:
use No.: 146q3 L
Address:
Phone No.:. 431 A99 ;aj,!Q
JOBSITE INFORMATION: (*Indicates required information)
*Name: (7l°1h Izi ~it/1!/l
*Address: 1.2267
~)r ie~,= >7riu 2
*Cross Street Ltsd Drluc
*Phone No.: G at D:2 S' J'319
Permit No.:
Tax-Map District: 1000 Section: Block: Lot:
"BRIEF DESCRIPTION O PW~ORK, (Please Print Clearly)
//2572111 o f0t1G&netoTor /'~r~~! T 'te7-.(~~L?r
sunruelk Gt+l/Aro duller
(Ples" Circle AN That Apply)
*Is job ready for kupecdon: ES NO. Rough in
*Do you need a Temp Certificate: YES / Vd
Temp Information (N-needed)
*Service Size: 1 Phase 3Phase 100 150 C20~0) 300 350 .400 Otfm
*New Service: Rwoonneat Underground Number of Meters Change of Service Overhegd
Additional Information: PAYMENT DUE WITH APPLICATION
82-Request for Irepedmn Form