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Town of Southold 8/5/2015
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P.O. Box 1179
53095 Main Rd
Southold, New York 11971
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CERTIFICATE OF OCCUPANCY
No: 37696 Date: 8/5/2015
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 9945 Route 25, Mattituck
SCTM #: 473889
Sec/Block/Lot: 142.4 -27
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
7/21/2015 pursuant to which Building Permit No. 39962 dated 7/21/2015
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:
The certificate is issued to GAMA Properties -Deer Inc
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
39962
07-28-2015
Authorized Signature
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit #: 39962 Date: 7/21/2015
Permission is hereby granted to:
GAMA Properties -Deer Inc
320 Front Pond Rd
Old Brookville, NY 11545
To: 8 LED Fixtures on Overhang
At premises located at:
9945 Route 25. Mattituck
SCTM # 473889
Sec/Block/Lot # 142.-1-27
Pursuant to application dated 7/21/2015
To expire on 1/19/2017.
Fees:
and approved by the Building Inspector.
ELECTRIC $125.00
Total: $125.00
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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TOWN CLERKS 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 #: 39962 Date: 7/21/2015
Permission is hereby granted to:
GAMA Properties -Deer Inc
320 Front Pond Rd
Old Brookville, NY 11545
To: 8 LED Fixtures on Overhang
At premises located at:
9945 Route 25. Mattituck
SCTM # 473889
Sec/Block/Lot # 142.-1-27
Pursuant to application dated 7/21/2015
To expire on 1/19/2017.
Fees:
and approved by the Building Inspector.
ELECTRIC $125.00
Total: $125.00
Building Inspector
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Telephone (631) 765-1802
Fax (631) 765-9502
roger.riche rta-town.southoId. ny.us
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: 7- Eleven Store #34216 (GAMA Properties)
Address: 9945 Route 25 City: Mattituck St: New York Zip: 11952
Building Permit #- 39962 Section: 142 Block: 1 Lot: 27
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Northstar Electrical Service License No: 5191 -ME
SITE DETAILS
Office Use Only
Residential Indoor Basement Service Only
Commerical X Outdoor X 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVFNTf)RV
Service 1 ph
Heat
Duplec Recpt
Ceiling Fixtures
8
HID Fixtures
Service 3 ph
Hot Water
GFCI Recpt
Wall Fixtures
Smoke Detectors
Main Panel
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
Switches El
Twist Lock
Exit Fixtures
TVSS
Other Equipment:
Install 8, 8 FT LED Fixtures In Over Hang At Front of Building
Notes:
Inspector Signature: Date: July 28, 2015
Electrical 81 Compliance Form.xls
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, NY 11971-0959
Telephone (631) 765-1802
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: Date:
Company Name: N - ui �
Name: Lo_Ro_co
License No.: _ HE
Address: - (0 A C0_r [
Phone No.:
JUt951 I t INF=ORMATION: (*Indicates reauired infnrmatinn)
*Name:
*Address:
*Cross Street:
*Phone No.:
Permit No.:
Tax -Map District:
1000 - - Section:
*BRIEF DESCRIPTION OF WORK (Please Print Clearly)
Block: d Lot:
(Please Circle Ail That Apply)
*Is job ready for inspection:E / NO Rough In anal
*Do you need a Temp Certificate: YES I NO
Temp Infarmation (If. needed)
*Service Size: 1 Phase 313hase 100 150 200 300 350 400 Other
*New Service: Re -connect Underground Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
X82 -Request for Inspection Farm