HomeMy WebLinkAbout39006-Z „, r Town of Southold Annex 8/29/2014
1 P.O.Box 1179
54375 Main Road
¢ Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 37119 Date: 8/29/2014
THIS CERTIFIES that the building AS BUILT ALTERATION
Location of Property: 725 Harbor Rd, Southold,
SCTM#: 473889 Sec/Block/Lot: 75.4-3
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
6/16/2014 pursuant to which Building Permit No. 39006 dated 7/1/2014
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:
"AS BUILT”FINISHED BASEMENT INCLUDING BATHROOM TO A SINGLE FAMILY DWELLING AS
APPLIED FOR
The certificate is issued to Smith,Adam&Mohr,Nicole
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 39006 06-09-2014
PLUMBERS CERTIFICATION DATED 07-15-2014 Cutcho East P'uAibing&Heating
Aut Si ture
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#: 39006 Date: 7/1/2014
Permission is hereby granted to:
Smith, Adam & Mohr, Nicole
725 S Harbor Rd
Southold, NY 11971
To: as built" basement alterations as applied for
At premises located at:
725 Harbor Rd, Southold
SCTM # 473889
Sec/Block/Lot# 75.4-3
Pursuant to application dated 6/16/2014 and approved by the Building Inspector.
To expire on 12/31/2015.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $1,048.80
CO -ALTERATION TO DWELLING $50.00
Total: $1,098.80
Building Inspector
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new use:
1. Final survey of property with accurate location of all buildings,property lines,streets,and unusual natural or
topographic features.
2. Final Approval from Health Dept.of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1%lead.
5. Commercial building,industrial building,multiple residences and similar buildings and installations,a certificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings(prior to April 9,195')non-conforming uses,or buildings and"pre-existing"land uses:
1. Accurate survey of property showing all property lines,streets,..building and unusual natural or topographic
features.
2. A properly completed application and consent to inspect signed by the applicant.If a Certificate of Occupancy is
denied,the Building Inspector shall state the reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00,
Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00.
2. Certificate of Occupancy on Pre-existing Building- $100.00
3. Copy of Certificate of Occupancy-$.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00
Date.
New Construction: Old or Pre-existing Building: (check one)
Location of Property: 71---70 k6,9Wpe Ae 0 64 jM-[,)TD
House No. Street Hamlet
Owner or Owners of Property: .G}1,7, 3it.{ <5-It--ZITS
Suffolk County Tax Map No 1000,Section Block e::)!T= Lot
Subdivision Filed Map, Lot:
Permit No. Date of Permit. Applicant: �Y , k �fLCL[� J jar.?
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted:.$
r
Applicant Sign ture
�o'of SO!/ryol
0
Town Hall Annex Telephone(631)765-1802
54375 Main Road N Fax(631)765-9502
P.O.Box 1179 �Q roger.riche rt(Dtown.south old.ny.us
Southold,NY 11971-0959 Q
�yCUUNTY,�c�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Smith
Address: 725 S Harbor Rd City: Southold St: NY Zip: 11971
Building Permit#: Section: 75 Block: 4 Lot: 3
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: as built DBA: License No:
SITE DETAILS
Office Use Only
Residential X Indoor Basement X Service Only
Commerical Outdoor 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt 21 Ceiling Fixtures 1 HID Fixtures
Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures 1 Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures 17 CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture 1 Pumps
Transformer Appliances Dryer Recpt 1-30 Emergency Fixtures Time Clocks
Disconnect Switches 12 Twist Lock Exit Fixtures 11 TVSS
Other Equipment: as built-finished basement-------NO VISUAL DEFECTS-----
1-exhaust fan
Notes:
Inspector Signature: Date: June 9 2014
81-Cert Electrical Compliance Form.xls
SO�I�o
Town Hall Annex
Telephone(631).765-1802
54375 Main Road
P.O.Box 1179 Fax(63 l):76 -9502
G
Southold,New York 11971-0959 �Q
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATION
Date:
7[ f 5
)/ V
Building Permit No. $D-Y
Owner: _ Y t CQ " —_'alt Gil i Gtil�w fi
(Please print)
�fi
Plumber: cJ� �i C� � �SV�tdCi✓
(Please print)
I certify that the solder used in the water supply system contains less.than 2/10 of M.
lead.
(Pl ers Signature)
Sworn to before me this
day o 20
Notary Public,bi t-�_Aj ounty CONNIE D. BUNCH
Notary Public,State of New York.
No.01 BU6185050
Qualified in Suffolk County
Commission Expires Aprii 14.2�
Of SO(/l��l
h O
t f
TOWN OF SOUTHOLD BUILDING DlklPT.
b�
765-1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLUMBING
FOUNDATION 2ND INSULATION
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
DATE q INSPECTOR
a �pf SOUly
cou ,
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] R UGH PLUMBING
[ ] FOUNDATION 2ND [ ] SOLATION
[ ] FRAMING / STRAPPING [ FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION ] CAULKING
REMARKS: L=<=j \
4 L
DAT INSPECTOR
Frank Wolfgang Uellendahl Architect
123 Central Ave POB 316 Greenport, NY 11944 t: 631.477.8624 e: frank@frankuellendahl.com
August 25, 2014
Submitted to: Building Inspector's Office
Town of Southold
Owners: Nicole Mohr and Adam Smith
725 South Harbor Road
Southold, NY 11971
Project: As-Built Permit for a finished basement at 725 South Harbor
Road
LETTER OF •
Permit # -�900(0
FINAL INSPECTION
As per attached plan the owners enlarged the openings from the recreation room to the
home office and the fitness area in order for the entire finished basement to be counted as
ONE ROOM.
In addition a new window was installed in the home office area which presents the second
means of egress. The exterior window well
I herewith certify to the best of my knowledge that all work - including plumbing work - was
performed as per NYS code and as per the As-Built Building Permit plan.
Si I
Fra #ellendahRA
AUG 2 5 2014
6.ii �.
•' 1 1 0 • • I I
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Y
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: �PLUMING
IMULATIONPEAN.Y.
STATE ENERGY . r
WAAWWIA
I eWMIll�� i,
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TOWN OF SOAidus+`p BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
SoutholdTown.NorthFork.net PERMIT NO. L00 Check
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Examined ,20—A— Storm-Water Assessment Form
Contact:
Approved ,201L Mail to:��k l effl t(gy4a
Disapproved a/c J
Phone: 06-3( '4-n •�Cp `�L�
Expiration ,20_�
y .
Building Inspector
APPLICATION FOR BUILDING PERMIT
JUN 1 2(114
Date �(/ �/ , 20_Lf:
INSTRUCTIONS
a. This�pliratie» a completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
s pans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or
areas, and waterways.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit
shall be kept on the premises available for inspection throughout the work.
e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector
issues a Certificate of Occupancy.
f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the
property have been enacted in the interim,the Building Inspector may authorize, in writing,the extension of the permit for an
addition six months. Thereafter, a new permit shall be required.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County,New York,and other applicable Laws,Ordinances or
Regulations, for the construction of buildings, additions,or alterations or for removal or demolition as herein described. The
applicant agrees to comply with all applicable laws,ordinances,building code,housing code,and regulations,and to admit
authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant or name,if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises /41r yA?� -f � {-f ;� kll eoz� "OUIK—
(As on the tax rbll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
X20je� L�
House Number Street Hamlet 2
County Tax Map No. 1000 Section Block Lot
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy t7
3. Nature of work(check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost Fee 206' 622Q Q0/ J
(To be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
+ l
7. Dimensions of existing structures, if any: Front ' Rear 4;�;I- Depth Zq-cj,
�
Height f Number of Stories
Dimensions of same structure with alterations or additions: Front C4�' Rear
Depth � :�' Height — /,�; ' Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
r f
9. Size of lot: Front /Cc Rear /Cj!'-7> Depth
10. Date of Purchase !r - "ZL703 Name of Former Owner
11. Zone or use district in which premises are situated .L - -tiK-G�
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO
13. Will lot be re-graded? YES NO Will excess fill be removed from remises? YES NO
V'.�rn/�
14. Names of Owner of remises/9da,�< �64d ft Address 72 5. i&U hone No.e'31'S,4-�'"'L�lr gLl
Name of Architect L111 Address e (Ltk Phone No G 3! X77-1 W-4
Name of Contractor Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO L,-
*
,%* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES NO y"
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
18. Are there any covenants and restrictions with respect to this property? * YES NO
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF6t>
being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the
(Contractor,Agent, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;
that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn to before me this
day of Lde, 20
Notary Publ gnature o Applicant
CAROL HYDELL
NOTARY PUBLIC-STATE OF NEW YORK
NO.01 HY6189695
QUALIFIED IN SUFFOLK COUNTY
COMMISSION EXPIRES 06/30126-1 O
Scott A. Russell a°Su 'r ST(0)]CZI��1 WA F E K
SUPERVISOR NT ( r E NT
z ��1[A\�A\ G]EI��IU 1�
SOUTHOLD TOWN HALL-P.O.Box 1179
53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold
CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT )
_..__.._..----...........-....---_.---
DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWING:
Yes No (CHECK ALL THAT APPLY)
E]24 A. Clearing, grubbing, grading or stripping of land which affects more
I
than 5,000 square feet of ground surface.
B. Excavation or f illing involving more than 200 cubic yards of material
within any parcel or any contiguous area.
❑[ ' C. Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance. '
EIP D. Site preparation within 100 feet of wetlands, beach, bluff or coastal I
erosion hazard area. i
❑(;E. Site preparation within the .one-hundred-year floodplain as depicted
on FIRM Map of any watercourse.
❑ F. Installation of new -or resurfaced impervious surfaces of 1,000 square .
feet or more, unless prior approval of a Stormwater Management
Control Plan was received by the Town and the proposal includes
in-kind replacement of impervious surfaces.
If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name,
Signature, Contact Information, Date & County Tag Map Number! Chapter 236 does not apply to your project.
If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan
and a completed Cbeck List Form to the Building Department wit$your Building Permit Application.
APPLICANT: (Property Owner,Design Professional,Agent,C tra or,Other) S.C.T.M. #: 1000 Date
District
NAME: -�
C, o 92K Block Lot
d ^7 FOR BUILDING DEPART'41LNT USE v,NLY
Contact Information: [ 7< �_ elf �I O
Reviewed By
Date: 6 !b t
Property Address/ Location of Construction Work: — — — — — — — — — — — — — — —
�c �//ee__ 4166(r Approved for processing Building Permit.
!�-�' �y?, Stormwater Management Control Plan Not Required.
N l! ❑ Stormwater Management Control Plan is Required.
(Forward to Engineering Department for Review.)
FORM SMCP-TOS MAY 2014
w
pF SOIJlyol
Town halt Annex 4
54375 Main Road Telephone(631) 765-1$02
P.O.Box 1179 G. (631)765-gg50
Southold,NY 11971-0959 YQ ro er.richert Aown southol�d n us
- I��DUNIY,N�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY:
Company Name: Date:
Name:
License No.:
Address:
Phone No.:
JOBSITE INFORMATION: (*Indicates required information
*Name:
*Address: `
*Cross Street: r D 1 4�7
*Phone No.:
Permit No.:
Tax Map District: 10__ Section:
Block: Lot:
*BRIEF DESCRIPTION OF WORK (Please Print Clearly
(Please Circle All That Apply)
*Is job ready for inspection:
*Do you need a Temp Certificate: YES / NO Rough In
YES / NO Final
Temp Information (If needed)
*Service Size: 1 Phase 3Phase 100 150 200 300
350'New Service: Re-connect Underground Number of Meters Change of Service Other
9
NdditionalInformation: Overhead
PAYMENT DUE WITH APPLICATION
O
82-Request for Inspection Form
TOWN OF SOUTHOLD PROPERTY RECORD CARD
2,1
OWNER STREET VILLAGE DIST. SUB. LOT If
kr'10
JJit � . } i�oh r` v " ' "w " :" t ;, �.. r�• s r .f "
f
-FORMER OWNER1_u,,iv I 1Trus1 rS N E ACR.
-�(j`
f t`S I X-0 r) U Ts S W TYPE OF BUILDING
RES. SEAS. L. FARM COMM. CB. MICS. Mkt. Value
LAND IMP.. __ _ TOTAL ._ -DATE REMARKS
fie .Zs � S f�i
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/ r r�a c3T5
. . d Z�L /ZZd q z/2 -bi aly,*I X0 �U Z_u d vl gs00 Txtz5t NIL-,
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AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE
FARM Acre Value Per Value
Acre
Tillable ! FRONTAGE ON WATER
Woodland FRONTAGE ON ROAD r , '
Meadowland DEPTH /
House Piot BULKHEAD
TottrFDOCK
T
:VARANTEES WO/CA TED HERE ON SHALL RUN
1WLY TO THE PERSON FOR WHOM THE SURVEY
S PREPARED,AND ON HIS BEHALF TO THE
77LE COMPANY, GOVERNAIENTAL AGENCY, YS 25
EAVWO" R#GASSI tES OF7WL7EDENaNG INsn7Unay. ROAD N
WARANTEES ARE NOT TRANSFERABLE TO MAIN
100177ONAL INSRTURONS OR 5U8SE0UEHT ONNERS.
TNAU7IIORlZED AL7ERA RON OR AOD/AQy TO THIS + N/F&MEL FMRLY LUKOSVICUS
HE NEW YORK S ATE MICA RON LAW.7701V OF SECTION 7209 O'' FORMERLY LYfT.E 200.00'
N 78'56'10E _ FD
cm
.OPI£S OF THIS SURVEY MAP NOT BEARING 2-RAIL FENCE ON LINE
HE[ANO SURVEYORS 04BOSSED SEAL SHALL r n M f
IOT BE CONSIDERED TO BE A VALID TRUE C+1 v
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(A STOOP RESIDENCE nl oz
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N/F KRMu(Ow5N1 SURVEYED: 30 OCTOBER 2003
SCALE 1'= 30'
TM# 1000-075-04-003 SURVEY of AREA = 19,993.32 S.F.
DESCRIBED PROPERTY OR
SITUATE 0.459 ACRES
SOUTHOLD, TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y. SURVEYED BY
STANLEY J. ISAKSEN, JR.
SURVEYED FOR: ADAM G. SMITH P.O. BOX 294NEW SUFFOLK. N.Y. 119 6
NICOLE MOHR 631 34—?ND
GUARANTEED TO:
ADAM G. SMITH -NICOLE MOHR
COMMONWEALTH LAND TITLE INS. CO. ---- —" ---
CmMORTGAGE, SNC. ENSE SUR OR
NYS Lic. No. 4927 03R1272
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SURFACE MOUNTED CEIUNG FIXTURE CO CO DETECTOR s
BASEMENT SURFACE MOUNTED WALL FIXTURE
BATE 08/30/2014
SCAIE 3/16'=I'
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FIN m GARAGE FINISHED UNHEATED FLOOR AREA = 811 SFBASEMENT PIAN
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ELECTRICAL RM. RESIDENCE
SOUTHOLD, NY
HOME OFFICE
CLG. HGT: 7'-0" I-V BAT RM. — — — — — — - MO WM RD-
BASEMENT
CARPET STAIR:
18 R.0 8"x9mi
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ARCHITECT
" LINEN CLO+ STORAGE APPROVED AS NOTED o
FRANK UELLENDAHL
T
L P.O.BOX 316
9fiRR r DATE B.P. # GREENPORT, NY 11944
00 5268 OPENING 16 TEL: 631-477 8624
STORAGE I
C14 v MECH. RM. FEE:It C14 OWNERS
NOTIFY BUff3l LDEPAR ENT AT
765-1802 8 ANI TO 4 PM FOR THE ADAM SMITH
El FOLLOWING INSPECTIONS: & NICOLE MOHR
725 SOUTH HARBOR RD
B 1. FO' IN')ATION-TWO REQUIRED SOUTHOLD, NY 11971
1 1 CURED R,
Fr_;� T FID CONCRETE TEL 631-848-0640
RECREATIONAL ROOM FITNESS ROOM N
CLG. HGT: 7'-0" STAIR: 12 R. 2. F H- 14,G. PLJ%13i��O. I
CARPET S7FR'PP!V- ELECTRICAL&CAU'L-'^, �k '14
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11, `4
ULWiGN
3. INS''"
U 4. FINAL-�CNST'UCTION ELECTR�',_
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S-00 L
EGRESS #1 1 - P MUST BE CCM�'LETE FOR&C.O.
ALL CON r
CID CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NE,,%,
� OIL TANKF
YORK-STATE. IqtT RfSP0NnLE-fOR--
L UESI(31NI OR GUN6 I RUG I ION ERRORS.
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SURFACE MOUNTED CEILING FIXTUREFC 07 CO DETECTOR
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PLUMBINq DATE: 06/16/2014
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