HomeMy WebLinkAbout41387-Z O�guFFO( G Town of Southold 4/4/2017
P.O.Box 1179
o -
d' n 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 38885 Date: 4/4/2017
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 18875 Route 25, Mattituck
SCTM#: 473889 Sec/Block/Lot: 108.4-2.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
2/27/2017 pursuant to which Building Permit No. 41387 dated 2/27/2017
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:
200A UNDERGROUND ELECTRIC SERVICE
The certificate is issued to Jacobs,Jon
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 41387 03-28-2017
PLUMBERS CERTIFICATION DATED
Authorized Signature
o�SUFFnc�coTOWN OF SOUTHOLD
BUILDING DEPARTMENT
y a 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#: 41387 Date: 2/27/2017
Permission is hereby granted to:
Jacobs, Jon
PO BOX 475
Mattituck, NY 11952
To: Electric Service
At premises located at:
18875 Route 25, Mattituck
SCTM # 473889
Sec/Block/Lot# 108.-4-2.1
Pursuant to application dated 2/27/2017 and approved by the Building Inspector.
To expire on 8/29/2018.
Fees:
ELECTRIC $85.00
Total: $85.00
BljIding I ector
pf SO(/T�olo
Town Hall Annex Telephone(631)765-1802
54375 Main Road CP Fax(631)765-9502
P.O.Box 1179 aQ roger.richert(aD-town.southoId.ny.us
Southold,NY 11971-0959 Q
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Jacobs
Address: 18875 Route 25 City: Mattituck St: New York Zip: 11952
Building Permit#: 41387 Section 108 Block 4 Lot: 2.1
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Ice Electric License No: 4586-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 FixtureTime Clocks
Disconnect 6Switches F-1 Twist Lock Exit Fixtures TVSS
Other Equipment: Existing 200A Service Changed from Overhead to Underground.
Notes:
Inspector Signature: Date: March 28, 2017
0-Cert Electrical Compliance Form As
��pfSOUrHp�` BUILDING FDEPA►RTMENT ,
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-TOWN _Of SOUTHOLD
Town Half Annex•54375 Main,R6eia--P-.O'.,Box 1179•Southold,NY 11971-0959
Teleph8ne(631)765-1802•Fax(631)765-9502'
Date 1 I ,
1720
;:Numb&bf`,Meters Temporary Certificate
Phase
Overiiead`'0 Underground
New°Service.-,4,` Change'of`Service t"❑ •Reconnect`Existing Service
`� ❑
' .`Location'°- � _
"`.Installed{by Lrv "°�`'' Lic.#
-
-'Application for electrica[service egdl0m6nt:is on file with the Town_ of Southold.On applicant's notification
that this installatibn,is complete,the town.will conduct a premises inspection of the service equipment.
This v n is va' �rrt tb bove date.
Authorized by
SO�Iy°lo
Town Hall Annex Telephone(631)765-1802
54375 Main Road N ( 2
P.O.Box 1179 • r0 er.nc
Southold,NY 11971-0959
CaU�+�� D
FEB 2 7 2017
BUILDING DEPARTMENT
TOWN OF SOUTHOLD BUILDING DEPT.
APPLICATION FOR ELECTRICAL INSPECTIOM'"OFSOU'1ROLD
REQUESTED BY: Date: 2,27- 17
Company Name:
Name: 146e.112
License No.:
Address:
Phone No.: 631 9
JOBSITE INFORMATION: (*Indicates required information)
*Name:
*Address:
*Cross Street:
*Phone No.:
Permit No.:
Tax'Map District: 1000 Section: Block:.(��— Block: LP Lot: 0711
*BRIEF DESCRIPTION OF WORK (Please Print Clearly) /V� G �o
(Please Circle All That Apply)
*Is job ready for inspection: <YE NO Rough In Final
*Do you need a Temp Certificate: �NO
Temp Information (If n d)
*Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other
*New Service: Re-connect<Pnderground Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION d�
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82-Request for Inspection Form