HomeMy WebLinkAbout39348-ZTown of Southold Annex
P.O. Box 1179
54375 Main Road
Southold, New York 11971
CERTIFICATE OF OCCUPANCY
1/9/2015
No: 37370 Date: 1/9/2015
THIS CERTIFIES that the building ELECTRICAL
Location of Property: Off Fox Ave, Fishers Island,
SCTM #: 473889 Sec/Block/Lot: 9.4-18
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
11/6/2014 pursuant to which Building Permit No. 39348 dated 11/6/2014
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:
200 AMP ELECTRIC OVERHEAD SERVICE
The certificate is issued to Johnson, Thomas & Johnson, Laura
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
39348
11-18-2014
Authorized Signature
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
* SOUTHOLD, NY
- FV
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 #: 39348
Permission is hereby granted to:
Johnson, Thomas & Johnson, Laura
326 S Wind Rd
Baltimore, MD 21204
To: 200 Amp Electric Service Up -Grade
At premises located at:
Off Fox Ave, Fishers Island
SCTM # 473889
Sec/Block/Lot # 9.-1-18
Pursuant to application dated
To expire on 5/7/2016.
Fees:
Date: 11/6/2014
11/6/2014 and approved by the Building Inspector.
ELECTRIC $85.00
Total: $85.00
Building Inspector
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, NY 11971-0959
Telephone (631) 765-1802
Fax (631) 765-9502
roger. richert(cD-town.southold . ny. us
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF FLFCTRIMAll r_nUPI ietirl=
SITE LOCATION
Issued To: Thomas Johnson
Address: 538 Upper Shingle Hill Rd off Fox Ave City: Fishers Island St: NY Zip: 6390
Building Permit* 39348 Section: 9 Block: 1 Lot: 18
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: BD Electric License No: 35821 -me
01 1 C UC 1 /•UL0
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 Duplex 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 Fixtures Time Clocks
Disconnect 200a Switches F1 Twist Lock Exit Fixtures TVSS
Other Equipment: 200a Overhead service
Notes:
Inspector Signature: Date: Date: Nov 18 2014
81 -Cert Electrical Compliance Form.xls
Tome IIall Aiuicx
59375 Main Road
P.O. Box 1179
Southold, NY 11971-0959
REQUESTED BY:
Company Name:
Name:
License No.:
Address:
Phone No.:
Telephonc (631) 765-1802
,or5lo�roper.rich er atwsd ny us
BUILDING DEPARnIENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
CArt'6
3/--�8S 9i9
Date:
anc�—c387
JOBSITE INFORMATION. (*Indicates required information)
*Name:
*Address:
*Cross Street:
*Phone No.:
Permit No.:
Tax Map District: 1000 Section: ____q_ Block: /
*BRIEF DESCRIPTION OF WORK (Please Print Clearly)
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Lot:
y
(Please Gircle All That Apply)
*Is job ready for inspection: ONO
NO Rough In Final
*Do you need a Temp Certificate:
Temp Information (If eded)
*Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other
a eta Sarvide � R�-t ec Underground Numbof Meters hange of Service Overhead
7�'Idltional in�ormatlon: 11'? PAYMENT DUE WITH APPLICATION
NOV - 3
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