HomeMy WebLinkAbout41301-Z ��Q�g11tFat/(, Town of Southold 2/6/2017
P.O.Box 1179
53095 Main Rd
�?+,� Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 38817 Date: 2/6/2017
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 4845 S Harbor Rd, Southold
SCTM#: 473889 Sec/Block/Lot: 87.4-11
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
1/20/2017 pursuant to which Building Permit No. 41301 dated 1/20/2017
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:
100a overhead electric service.
The certificate is issued to Clark, Susan&Hansen,Janice
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 41301 2/2/2017
PLUMBERS CERTIFICATION DATED
Authorized Signature
TOWN OF SOUTHOLD
o Via ; BUILDING 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#: 41301 Date: 1/20/2017
Permission is hereby granted to:
Clark, Susan
421 Swallowtail Ct
Rock Hill, SC 29732
To: Electric Service Change
At premises located at:
4845 S Harbor Rd, Southold
SCTM #473889
Sec/Block/Lot# 87.-1-11
Pursuant to application dated 1/20/2017 and approved by the Building Inspector.
To expire on 7/22/2018.
Fees:
ELECTRIC $85.00
Total: $85.00
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Building Inspector
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Town Hall Annex Telephone(631)765-1802
54375 Main Road G Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 �
coup a® roger.richertl'a�town. southold.ny.us
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Clark(Hansen)
Address: 4845 South Harbor Road City: Southold St: New York Zip: 11971
Building Permit#: 41301 Section: 87 Block. 1 Lot: 11
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 X Attic Garage
INVENTORY
Service 1 ph 100A Heat Duplec Recpt Ceding Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel 100A 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 100A Switches Twist Lock Exit Fixtures TVSS
Other Equipment: "AS BUILT" - "ELECTRICAL SURVEY" - "NO VISUAL DEFECTS"
Notes: 100A OVERHEAD SERVICE
Inspector Signature: Date: February 2, 2017
0-Cert Electrical Compliance Form.xls
pf SOUlyolo
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:
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DATE / INSPECTOR
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Town Hall Annex J [ Telephone(631)765-1802
54375 Main Road N �Fax(631)765..-g512
P.O.Box 1179 G • YQ roger.richert(cyiown.souod.ny.us
Southold,NY 11971-0959 '0
cOUff<i`I,�s�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY. 1-&M e a w n-e Ir Date: 11,1011-7
Company Name:
Name:
License No.:
Address:
Phone No.:
JOBSITE INFORMATION: (*Indicates required information) �v
`Name: a f) r L2 cios-e n Swam fi
*Address: 3ov4h 4a rbor
*Cross Street:
*Phone No.:
Permit No.:
Tax Map District: 1000 Section: Block: I Lot:
*BRIEF DESCRIPTION OF WORK(Please Print Clearly)
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too D
(Please Circle All That Apply)
*Is job ready for inspection: YES / NO Rough In Final
*Do you need a Temp Certificate: YES / NO
Temp Information (If needed)
*Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other
*New Se ' ect Underground Number of Meters Change of Service Overhead
AdditionaPAYMENT DUE WITH APPLICATION
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ID
82-Request fi�lBcQ ®LD