HomeMy WebLinkAbout41240-Z Town of Southold 1/23/2017
P.O.Box 1179
'; 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 38787 Date: 1/23/2017
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 1280 Bayberry Rd, Cutchogue
SCTM#: 473889 Sec/Block/Lot: 118.-2-10
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
12/27/2016 pursuant to which Building Permit No: 41240 dated 12/27/2016
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 UNDERGROUND ELECTRIC UPGRADE
The certificate is issued to Rosenblum, Jane
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 41240 01-05-2017
PLUMBERS CERTIFICATION DATED
Authorized Sign ture
a,AsV=r--- TOWN OF SOUTHOLD
.�
6.1k DEPARTMENT
TOWN CLERK'S 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#: 41240 Date: 12/27/2016
Permission is hereby granted to:
Rosenblum, Jane
33 W 10th St
New York, NY 10011
To: Electric Service
At premises located at:
1280 Bayberry Rd, Cutchogue
SCTM # 473889
Sec/Block/Lot# 118.-2-10
Pursuant to application dated 12/27/2016 and approved by the Building Inspector.
To expire on 6/28/2018.
Fees:
ELECTRIC $85.00
Total: $85.00
B ng I ctor
pF SOVj�®�®
Town Hall Annex Telephone(631)765-1802
54375 Main Road c� Fax(631)765-9502
P.O.Box 1179 ® a� _roger.richert(a town.southold.ny.us
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Rosenblum
Address: 1280 Bayberry Road City: Cutchogue St: New York Zip: 11935
Building Permit#: 41240 Section: 118 Block: 2 Lot: 10
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Pauls Burns License No: 3897-ME
SITE DETAILS
Office Use Only
Residential X Indoor 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 Ceding 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 UPGRADE
Notes:
Inspector Signature: Date: January 5, 2017
0-Cert Electrical Compliance Form.xls
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Town Hall Annex 4 Tel "o a
54375 Main Road
P.O.Box 1179 G roenrichert ow 3 oil Southold,NX 11971-0959 Q .
UUNt'I,� DEC 2 7 2016
BUILDING DEPARTMENT BITXDJNG.DEPT.
Town OF SOUTHOLD To"OF SOUTIjOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY.
.tom.�n Date: e z 2-7
/1
Company Name: It urn>
Name:
5 v r^,1 J
License No.: 3 R9 7-,-.Lc
Address:
Phone No.:
JOBSITE INFORMATION: (*Indicates required information)
*Name: Jens
*Address: /2- non iq G �Ao
*Cross Street:
*Phone No.:
I
Permit No.:
Tax-Map District: 1000 Section: Block: Lot: (�
*BRIEF DESCRIPTION OF WORK(Please Print Clearly)
(Please Circle All That Apply)
Is job ready for inspection: &Q/ NO Rough In Fi
*Do you need a Temp Certificate: YE t NO
Temp Information(if needed) i
*Service Size: 1 ha 3Phase 100 150 200 300 350 400 Other
4'New Service: Re-connect ndergroun Number of Meters Change of Service Overhead
Additional of ation: PAYMENT DUE WITH APPLICATION
ti
824Request for Inspection Form o
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