HomeMy WebLinkAbout40868-Z ��osrOFFQtKoGTown of Southold 9/12/2016
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3 . P.O.Box 1179
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53095 Main Rd
Qy. o�� Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 38509 Date: 9/12/2016
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 515 Private Rd#12, Southold
SCTM#: 473889 Sec/Block/Lot: 78.-6-10.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
7/29/2016 pursuant to which Building Permit No. 40868 dated 8/1/2016
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:
150a overhead electric service.
The certificate is issued to Stegner,Daniel&Patricia
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 40868 8/17/2016
PLUMBERS CERTIFICATION DATED
Authorized Signature
�SVFEo6�c TOWN OF SOUTHOLD
BUILDING DEPARTMENT
y TOWN CLERK'S OFFICE
o 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#: 40868 Date: 8/1/2016
Permission is hereby granted to:
Stegner, Daniel
470-12 Windy Point Ln
Southold, NY 11971
To: Electric Service Change
At premises located at:
515 Private Rd #12, Southold
SCTM #473889
Sec/Block/Lot# 78.-6-10.1
Pursuant to application dated 7/29/2016 and approved by the Building Inspector.
To expire on 1/31/2018.
Fees:
ELECTRIC $85.00
Total: $85.00
1
tilding Ins ctor
pF SOVT�,®l
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 roger.riche rt(ED-town.so utho Id.ny.us
Southold,NY 11971-0959
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Stegner
Address: 515 Private Road#12 City: Southold St: New York Zip: 11971
Building Permit#- 40868 Section: 78 Block: 6 Lot: 10.1
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor. DBA: Jim Sage Electric License No: 3635-E
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 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 15 AA Switches Twist Lock Exit Fixtures TVSS
Other Equipment: 150A OVER HEAD SERVICE
Notes:
Inspector Signature: Date: August 17, 2016
00Electncal 81 Compliance Form.xls
SOUlyolo
COUW,�c�
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PL13G.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
DATE INSPECTOR
----------
'4f so
f/ BUILDING DEPARTMENT
H TOWN OF SOUTHOLD
Town Hall Annex•54375 Main Road•P.O.Box 1179•Southold,NY 11971-0959
7"`�r7UNf1 Telephone(631)765-1802•Fax(631)765-9502
Number of Meters Date & Z' 20�
Temporary Certificate
Size s Phaseven&
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Overhead ❑ Underground ❑
I
! New Service ❑ Change of Service Reconnect Existing Service ❑
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Location �l5
Issued to
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Installed Lic.#
Reference__6 f" � L�
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Application for electrical service equipment is on file with the Town of Southold.On applicant's notification �
that this installation is complete,the town will conduct a premises inspection of the service equipment.
Thi rific ti is valid f r 90_d7vYs the above date.
Authorized by
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pf SO{/l�,o
Town Hall Annex JR J�[ Telephone(631)765-1802
54375 Main Road N m�ax(631)765-g95Qi
P.O.Box 1179 G, Q roger.richert(CU1own.so 15 nV us
Southold,NK 11971-0959 I
P
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BUILDING DEPARTMENT (� �
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: Date:
Company Name:
Name:
License No.: I(
Address: d Q c C I
Phone No.:
JOBSITE INFORMATION: (*Indicates re 'red information) !
*Name:
*Address:
*Cross Street:
*Phone No.:
Permit No.:
Tax-Map District: 1000 . Section: Block: Lot:
*BRIEF DESCRIPTION OF WORK(Please Print Clearly) f
Jeya
(Please Circle All That Apply)
*'Is job ready for inspection: �
(—YE NO Rough In Final
*Do you need a Temp Certificate: YES NO -
Temp Information(if needed)
*Service Size: 1 Pha a 3Phase 100150 200 300 350 . 400 Other
*New Service: Re-connect Underground Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
82-Request for h Lspecflon Form ^�
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