HomeMy WebLinkAbout39226-ZS�FFQI'fcpG Town of Southold 5/7/2015
P.O. Box 1179
53095 Main Rd
�ySouthold, New York 11971
CERTIFICATE OF OCCUPANCY
No: 37545 Date: 5/7/2015
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 1400 Grand Ave, Mattituck
SCTM #: 473889 Sec/Block/Lot: 107.-3-14
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
9/30/2014 pursuant to which Building Permit No. 39226 dated 9/30/2014
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:
150 Amp Overhead Electric Service
The certificate is issued to Kempski, Ronald & Kempski, Margie
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
39226
04-29-2015
Authorized Signature
SUFfe��� TOWN OF SOUTHOLD
BUILDING DEPARTMENT
y TOWN CLERK'S OFFICE
oy • �, 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 #: 39226 Date: 9/30/2014
Permission is hereby granted to:
Kempski, Ronald & Kempski, Margie
651 S 9th St
Lindenhurst, NY 11757
To: 150 Amp Overhead Electric Service
At premises located at:
1400 Grand Ave, Mattituck
SCTM # 473889
Sec/Block/Lot # 107.-3-14
Pursuant to application dated 9/30/2014
To expire on 3/31/2016.
Fees:
and approved by the Building Inspector.
ELECTRIC $85.00
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, NY 11971-0959
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Telephone (631) 765-1802
Fax(631)765-9502
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CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Ron Kempski
Address: 1400 Grand Avenue City: 'Mattituck St: New York Zip: 11952
Building Permit #: 39226 Section: 107 Block: 3 Lot: 14
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Goodale Electric License No: 783-E
SITE DETAILS
Office Use Only
Residential X Indoor X Basement X Service Only X
Commerical Outdoor X 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph 150A Heat Duplec Recpt Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel 150A 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 150A Switches Twist Lock Exit Fixtures TVSS
Other Equipment: 150A Over Head Service
Notes:
Inspector Signature: Date: April 29, 2015
Electrical 81 Compliance FormAs
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, NY 11971-0959
Telephone (631) 765-1802
roger.richert(aI own sou: 0 5.ny us
BUII.DING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: Dateq-;
Company Name:
4 � -
Name:
License No.:
Address: ,
Phone No.: G77 f
JOBSITE INFORMATION: (*Indicates required information)
*Name:
*Address:
*Cross Street:
*Phone Noi�';?j cl
Permit No.:
Tax -Map District:
1000 . Section: Block:
*BRIEF DESCRIPTION OF WORK (Please Print Clearly) O
(Please Circle All That Apply)
Is job ready for inspection:
*Do -you need a Temp Certificate:
YES / NO. Rough In
dtp/ NO
Lot:
Final
Temp Information (If n- ed)
*Service Size: 1 P 3Phase 100150 200 300 350 400 Other
*New Service: Re -connect Underground Number of Meters Change of Service Overhea
Additional Information:
PAYMENT DUE WITH APPLICATION
.82=Request for Inspection Form