HomeMy WebLinkAbout40627-Z r -�
OgUzFFadp�c Town of Southold 5/25/2016
O ri
'� P.O.Box 1179
i- g 53095 Main Rd
o*I a.0 �#4 Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 38833 Date: 5/25/2016
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 423 Willow Terrace Ln, Orient
SCTM#: 473889 Sec/Block/Lot: 26.-2-39.17
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
4/18/2016 pursuant to which Building Permit No. 40627 dated 4/18/2016
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 OVERHEAD ELECTRIC SERVICE
The certificate is issued to Dermody,Nancy
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 40627 05-05-2016
PLUMBERS CERTIFICATION DATED
11: ,
Authorized Signature
,`gaFFn� TOWN OF SOUTHOLD
�cOG i BUILDING DEPARTMENT
t o TOWN CLERK'S OFFICE
ss,{sn x
oy $ 0 SOUTHOLD, NY
Ldol * �a ,
, r
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#: 40627 Date: 4/18/2016
Permission is hereby granted to: -
Dermody, Nancy
285 Alvahs Ln
Cutchogue, NY 11935
To: Electric Service
At premises located at:
423 Willow Terrace Ln, Orient
SCTM # 473889
Sec/Block/Lot# 26.-2-39.17
Pursuant to application dated 4/18/2016 and approved by the Building Inspector.
To expire on 10/18/2017.
Fees:
ELECTRIC $85.00
Total: $85.00
JP' ,
i ding l
Town Hall Annex iili jig Telephone(631)765-1802
54375 Main Road % y % Fax(631)765-9502
% ke
P.O.Box 1179 Q ,, roper.richertRtown.southold.ny.us
Southold,NY 11971-0959
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CoUN 1 19 " /1
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Dermody
Address: 423 Willow Terrace Lane City: Orient St: New York Zip: 11957
Building Permit#: 40627 Section: 26 Block: 2 Lot: 39.17
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: HOME OWNER DBA: License No:
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 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 NC 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 OVER HEAD SERVICE
Notes:
Inspector Signature: Y-l-r—C?&07 ) Date: May 5, 2016
z Electrical 81 Compliance Form(2).xls
, �ttsoulyo: t- ':BUIL'DI,NG''DEPARTMENT' ;;
�:
- _ - '_' - -;.TOWN>'OF-SOUTHOLD' . .. ,.
• °•' TownFiall Annex�54375'tJlain Road;•P.O.Box 1179 rSouthold;-NY.7°7971=0959'"' '-_• -
,ltcoi 'Telephone,(631),765-18020•Fax(631)/7765=9502 q"-
-` - ' ' ~ , , ''' .. ', _ .,'Date`Pleg(,L- 7.•:.:7.,::-,`g9::/G' _
` - ;•.. - Tem ora Certificate'
.Number of Meters - -_ - � � � - - -- p -ry� ' , : _.
f T Size- ,..• , ,
_ - ad's,Overhead's ',--`:-°Underground 0}. , ' ,'',
NewService.,0r''Change:of°Service7,.0' ,Reconnect Existing Service;; ''
Issued to' / )/i' = y
t,
Installed'by -// 64 6.61--`5' Lio.#`
Reference _ _ f 7` ;- ' - _ ;
-- _Applicationforelectricalseruiceequipmentis;on•fife•with,tlieTowniof>Souttiold,On;applicants:notification,,i„,,
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'th
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'that this installation,incomplete;�the''town Twill conduct arpremises inspection,of the:service equipment:
'.:This
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,•,/*OF SO#4,-,
Town Hall Annex
54375 Main Road - ;
• P.O.Box 1179 `G • @ Iroger.rich, r . ST n
Southold,NY 11971-0959 Vee
�! .a0,'�t ,
yCOU ,%*.o' APR 7
8 2016
BUILDING DEPARTMENT
TOWN OF SOUTHOLD BUILDING DEPT.
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
• REQUESTED BY: ("14.(.. Dr, /mss Date:
Company Name:
Name:
License No.:
Address: •
Phone No.:
JOBSITE INFORMATION: (*Indicates required information)
•*Name: i�aZa�t. "/.7l�s5
*Address: ala. t,- 12,ryrxcr9_- Lr -
*Cross Street: I` ii-,c;7Li/1'11(2k; t'e-ff-igt&._ 0-724 �� I
*Phone No.: r 3( L)c 'a 7/0 ire--
Permit No.: , F
Tax•Map District: 1000 Section: 1 . Block: Lot:
*BRIEF DESCRIPTION OF WORK(Please Print Clearly) • • •
2,•00 fl,pJV-r
(Please Circle All That Apply)
*Is job ready for inspection: OM NO Rough In Final
*Da you need a Temp Certificate: NO
Temp Information (If needed) �``
*Service Size: CI 3Phase 100 150 103 300 350 400 Other
*New Service: Re-connect Under round Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
`721-- 3/56F ®� — - -
82-Re st fo(�sp on Form