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4 Town of Southold Annex 12/2/2013
' P.O. Box 1179
54375 Main Road
Southold, New York 11971
CERTIFICATE OF OCCUPANCY
No: 36624 Date: 12/2/2013
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 1700 Village Ln, Orient,
SCTM 473889 Sec/Block/Lot: 24.-2-17
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore fled in this officed dated
3/15/2013 pursuant to which Building Permit No. 37867 dated 3/15/2013
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:
400 AMP UNDERGROUND ELECTRIC SERVICE
The certificate is issued to Hossenlopp G J Revoc Trt & Hossenlopp L L
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 37867 11-21-2013
PLUMBERS CERTIFICATION DATED
Authorized Signature
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
e® SOUTHOLD, NY
r~~t
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 37867 Date: 3/1512013
Permission is hereby granted to:
Hossenlopp G J Revoc Trt & Hossenlopp L L Revoc Trust
1101 Spinnakers Reach Dr
Ponte Vedra Beach, FL 32082
To: 400 amp Underground Service
At premises located at:
1700 Village Ln, Orient
SCTM # 473889
Sec/Block/Lot # 24.-2-17
Pursuant to application dated 3/15/2013 and approved by the Building Inspector.
To expire on 9/14/2014.
Fees:
ELECTRIC $85.00
Total: $85.00
ui116 Inspector
pF SO!/Tyolo
Town Hall Annex y Telephone (631) 765-1802
54375 Main Road T 4 Fax (631) 765-9502
P.O. Box 1179 roper.richert(a~town.southold.ny.us
Southold, NY 1 1 971-0959
OOUN1`I ,0
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To, Hassenloop
Address: 1700 Village La City: Orient St: NY Zip: 11957
Building Permit 37867 Section: 24 Block: 2 Lot: 17
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: BJ Electric License No: 2670-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 400a Heat Duplec Recpt Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel 2-20 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
Disconnect 2-20 Switches Twist Lock Exit Fixtures TVSS
Other Equipment: 400a underground service with 2-meters and 2-200a main panels
Notes:
Inspector Signature: Date: Nov 21 2013
81-Cert Electrical Compliance Form.xls
SOUIyo~ .
Town Hall Annex Or Telephone (631) 7651802
54375 Main Road N C (6311 rs.nq Qg
_ P.O. Box 1179 ~ Perficheft Yon $OllttlOlfl nV US-
SoufOld, NY 119714959
°vUfl1Y,
BUR DING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: Date:/
Company Name:
Name: 0r345-l N Av A-~j c "L
License No.:
/ 2d
Address: CD T ue-,
Phone No.: S F8 0106 LO
JOBSITE INFORMATION: (*Indicates required information)
*Name: CEO 2 'C ' A_SS 6..00 P Q~ZfCZT
*Address: 1700 V /.t 4 y h/~N~ ON ~r N A,! P_P_wo r
`Cross Street: C~/L 0 l4 F1 dt- t~ r T t}OcS eS PtE
*Phone No-: 6 S.S 0(c 6 d dFG~cE u~
Permit No-:
Tax-Map District: 1000 Section: Block: 2L Lot:,/ 171
*BRIEF DESCRIPTION OF WORK (Please Print Clearly)
¢60 ffowo
l/i+~h sa~wb S ~7drr~
IYICT~rLS
(Please Circle All That Apply)
*Is job mady for inspection: YES NO. Rough In Final
*Do you need a Temp Certificate: _ YES NO
Temp Informationtla -
*Service Size: 1 Phase 3Phase 100 150 200 7Chane 350 400 Other
*New Service: Re-connect Underground Number of Meters of Service verhead
Additional Information: PAYMENT DUE WITH APPLICATION
0182-Req for Inspection Form