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*9W Town of Southold Annex 1/28/2014
P.O. Box 1179
54375 Main R
Southold, N woYork 11971
CERTIFICATE OF OCCUPANCY
No: 36740 Date: 1/28/2014
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 17235 Soundview Ave, Southold,
SCTM 473889 See/Block/Lot: 51.-1-1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this ofiiced dated
1/21/2014 pursuant to which Building Permit No. 38634 dated 1/21/2014
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 repair due to storm damage as applied for
The certificate is issued to Booth Edward C Revoc Trust
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 38634 1/27/14
PLUMBERS CERTIFICATION DATED
9 Authorized Signature
* TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
f
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 38634 Date: 1/21/2014
Permission is hereby granted to:
Booth Edward C Revoc Trust
17235 Soundview Ave
Southold, NY 11971
To: Replace Storm Damaged Electric Meter
At premises located at:
17235 Soundview Ave, Southold
SCTM # 473889
Sec/Block/Lot # 51.-1-1
Pursuant to application dated 1/21/2014 and approved by the Building Inspector.
To expire on 7/23/2015.
Fees:
ELECTRIC $85.00
Total: $85.00
Building Inspector
pF SOUT~OIo
Town Hall Annex Telephone (631) 765-1802
54375 Main Road Fax(631)765-9502
a~
P.O. Box 1179
Southold, NY 11971-0959 roger. richert(a)town.Southold. ny.us
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Edward Booth
Address: 37235 Soundview Ave City: Southold St: NY Zip: 11971
Building Permit* 38634 Section: 51 Block: 1 Lot: 1
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Paul Burns Electrical Cont License No: 3897-e
SITE DETAILS
Office Use Only
Residential X Indoor Basement Service Only X
Commerical Outdoor 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey X Attic Garage
INVENTORY
Service 1 ph 200a Heat Duplec Recpt Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel AIC 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 200a Switches Twist Lock Exit Fixtures TVSS
Other Equipment: storm damage repair, replace meter pan and riser
Notes:
Inspector Signature: Date: Jan 27 2014
81-Cert Electrical Compliance Form.xls
I
Tom HA Ann= # TaepWw (631) 765.1804
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8oudIAL MY 11971-0959 .
WELDING DFPARTSff r
TOWN OP SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: L3~6,2>u (/VC Date: y
Company Name: e<u I& r, ,1 f e
Name: 7~v 1Z. ) f Jr-
License No.: E
tAddress:
a 6 r Sr,"-tl.~ I~
Phone No.: 3G) - 3 l
JOBSITE INFORMATION: (*Indicates required information)
*Name: Cc~wL G~ l~cso 1"1~ !
*Address: / 723 5 S , A f
6L UIQ,.i Er f, ~ ~ol
*Cross Street:
*Phone No.: i
Permit No.: i.
TaxMap District: 1000 Sectlon: 51 Block: Lo
*BRIEF DESCRIPTION OF WORK (Please Print Clearly)
(Plea" Circia All That Apply)
Ms job ready for inspection. YE / NO Rough In Final
*Do you need a Temp Certificate: S NO
Tamp krformatlon (U needed)
*Service Sine 419e Whose 100 150 ~ 300 350 400
*New Service: m Underground Nwnber of Meters Change of Overhead
Additional lnfinpn PAYMENT DUE WITH APPLICATION
82 Requee[rarl Form