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Town of Southold Annex 4/3/2014
P.O. Box 1179
~r 54375 Main Road
}lr Southold, New York 11971
CERTIFICATE OF OCCUPANCY
No: 36846 Date: 4/3/2014
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 1030 Bay Shore Rd, Greenport,
SCTM 473889 See/Block/Lot: 53.-4-35.3
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
10/30/2013 pursuant to which Building Permit No. 38467 dated 10/30/2013
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:
200a underground electric service.
The certificate is issued to Veber, Jeffrey
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 38467 4/1/14
PLUMBERS CERTIFICATION DATED
Authorized Signature
TOWN OF SOUTHOLD
~ ! BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
'e 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 38467 Date: 10/30/2013
Permission is hereby granted to:
Weber, Jeffrey
1030 Bayshore Rd
Greenport, NY 11944
To: 200a underground electric service.
At premises located at:
1030 Bay Shore Rd, Greenport
SCTM # 473889
Sec/Block/Lot # 53.-4-35.3
Pursuant to application dated 10/30/2013 and approved by the Building Inspector.
To expire on 5/1/2015.
Fees:
ELECTRIC $85.00
Total: $85.00
Building Insp
pF SO!/lyolo
Town Hall Annex yy Telephone (631) 765-1802
54375 Main Road T Fax (631) 765-9502
P.O. Box 1179 c o roger. riche rt(cDtown.southoId.nY.us
Southold, NY 11971-0959
OOU
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Jeff Weber
Address: 1030 Bayshore Rd City: Greenport St: NY Zip: 11944
Building Permit#: 38467 Section: 53 Block: 4 Lot: 35.3
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
contractor: DEN Lademann Electric Inc License No: 4141-e
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 200a Heat Duplec Recpt Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel 200a 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 200a Switches Twist Lock Exit Fixtures TVSS
Other Equipment: 200a underground service
Notes:
Inspector Signature: Date: April 1 2014
81-Cert Electrical Compliance Form.xls
ho~~OF SO~ryo
Town Hall Anne:
54375 Main Road Telephone (63661)55..765-1802
7y0Q1g Box 1179
Southoldold, , NY 11971-0959 roger.richert9*0060 906051tlnv us
'jury 11,
BUMDING DEPARTMENT
TOWN OF SOiTTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: Date: Company Name:
L~~7 N E car: C .tJ
Name:
N~
License No.: t
Address: 6 2 57-
11ohone No.: -
JOBSITE INFORMATION: (*Indicates required information)
*Name:
*Address:
*Cross Street:
*Phone No..
Permit No.: l{
Tax Map District: 1000 Section: Block: Lot:
*BRIEF DESCRIPTION OF WORK (Please Print Clearly)
I
(Please Circle All That Apply)
Is job ready for inspection: C~ NO Rough In Final
*Do you need a Temp Certificate: YE NO
Temp Information (If needed)
*Service Size: 1 Phase 3Phase 100 150 300 350 400 Other
*New Service: Re-connect ndergroun Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
l0.3o j3
824RNuest for Inspection Form