HomeMy WebLinkAbout37871-Z ��34FFQI,Ye��� Town of Southold 10/5/2015
P.O.Box 1179
cf, 53095 Main Rd
�,�, �p� Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 37812 Date: 10/5/2015
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 4415 Camp Mineola Rd,Mattituck
SCTM#: 473889 Sec/Block/Lot: 123.-5-22
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
3/15/2013 pursuant to which Building Permit No. 37871 dated 3/18/2013
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:
200 AMP UNDERGROUND ELECTRIC SERVICE
The certificate is issued to Willets,Adam
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 37871 09-16-2015
PLUMBERS CERTIFICATION DATED
Authorized Signature
SUfFO�� TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
' o SOUTHOLD, NY
* t
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#: 37871 Date: 3/18/2013
Permission is hereby granted to:
Willets, Adam
4415 Camp Mineola Rd
Mattituck, NY 11952
To: 200 Amp Underground Service
At premises located at:
4415 Camp Mineola Rd, Mattituck
SCTM # 473889
Sec/Block/Lot# 123.-5-22
Pursuant to application dated 3/15/2013 and approved by the Building Inspector.
To expire on 9/17/2014.
Fees:
ELECTRIC $85.00
Total: $85.00
• Building Inspector
its.:Iet
Town Hall Annex 1 ® : Telephone(631)765-1802
*54375 Main Road ; % Fax(631)765-9502
P.O.Box 1179 ; G Q��`� roger.richert(a�town.southold.ny.us
Southold,NY 11971-0959 •\ ye 0
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To. Adam Willets
Address: 4415 Camp Mineola Road City: Mattituck St: New York Zip: 11952
Building Permit#: 37871 Section: 123 Block: 5 Lot: 22
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 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 Fixtures Time Clocks
Disconnect 200A Switches Twist Lock Exit Fixtures TVSS
Other Equipment' 200A Underground Service
Notes:
Inspector Signature: ).A--- Date: September 16, 2015
Electrical 81 Compliance Form xls
�O�OF SOU 04
;* *
1-7
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) ,�J ELECTRICAL (FINAL)
REMARKS: 1
DATE g//41(‘------
INSPECTOR
Town Hall Annex , * • * 1 Telephone(631)765-1802 _
54375 Main Road (a , roger.richert lO`wn.sou�io1�d.nv.us •
P.O.Box 1179t. • 6 .
Southold,
Southold,NY 11971-0959 :'4' r'
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
-REQUESTED BY: "f14/.4 ,/ii/ R,,j, 5 Date: 3/4_543
Company Name: 4.4/ea,f-`k_ze,c74,--,?-
Name: /47,49,7� /--7/6, -.5 -
License No.:
Address: /P/ ///1,,1, e 5/. ,,A-57`krG; / //g563 . .
• Phone No.: ' 6'3(-1e)- 3555
JOBSITE INFORMATION: (`Indicates required information) .
* ilii`//G�S
Name: 4 ,I4'7
*Address: 4//5. �c� /1I I ev//' fps 47a 2e-` i,,v,
*Cross Street: ee,e_ f.'
*Phone No.: f 7--�5-l-7 ,2 -
Permit No.: 3 7 -7] •
Tax•Map District 1000 Section: le-,73 Block: 5 Lot:RR_
*BRIEF DESCRIPTION OF WORK(Please Print Clearly) -_,/_"---#7571-9144,p'. ,2 Q,i •
5e (//' -e__ -4eck,'' ,(1 -�/--e,-4.., -.2c.." . c./
(Please Circle All That Apply) .
*Is job ready for inspection: YES NO Rough In Final
*Doyou need a Temp Certificate: ! NO
Temp Information(If needed)
*Service Size: GPhaseD 3Phase 100 150 00 300 350 . 400 Other I
*New Service: Re-connect(dergroun) Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION •
- M..�YJ�.4 J .fes
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82-Request for Inspection Form p
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