HomeMy WebLinkAbout41593-Z �� g11FFt1t����� Town of Southold 8/28/2017
P.O.Box 1179
C* -
o + 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 39175 Date: 8/28/2017
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 1620 Grand Ave,Mattituck
SCTM#: 473889 Sec/Block/Lot: 107.-3-9.2
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
5/2/2017 pursuant to which Building Permit No. 41593 dated 5/2/2017
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:
200 AMP ELECTRICAL SERVICE
The certificate is issued to Rohrbach,George
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 41593 08-16-2017
PLUMBERS CERTIFICATION DATED
uthorized Signature
TOWN OF SOUTHOLD t
BUILDING DEPARTMENT
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#: 41593 Date: 5/2/2017
Permission is hereby granted to:
Rohrbach, George
PO BOX 1155
Mattituck, NY 11952
To: Electric Service
At premises located at:
1620 Grand Ave, Mattituck
SCTM # 473889
Sec/Block/Lot# 107.-3-9.2
Pursuant to application dated 5/2/2017 and approved by the Building Inspector.
To expire on 11/1/2018.
Fees:
ELECTRIC $85.00
Total: $85.00
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6
Building Ins ctor
*pE SOUr�®C
Town Hall Annex ® Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 c • roper.richert(d-)town.soLitho Id.ny.us
r Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Rohrbach
Address: 1620 Grand Avenue city:Mattituck st: New York zip: 11952
Building Permit#: 41593 Section: 107 Block: 3 Lot: 9.2
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
contractor: DBA: Hubbard Electric License No: 4709-ME
SITE DETAILS
Office Use Only
Residential X Indoor X Basement Service Only
Commerical Outdoor X 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph 200A Heat Duplec Recpt 3 Ceiling Fixtures 4 HID Fixtures
Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures 2 Smoke Detectors
Main Panel 200A A/C Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks
Disconnect 200A Switches 3 Twist Lock Exit Fixtures TVSS
Other Equipment: Electrical Service
Notes:
Inspector Signature: Date: August 16, 2017
0-Cert Electrical Compliance Form.xls
oF souryo�
\ ourm,
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLEIG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
REMARKS:
cy
DATE l INSPECTOR
-
Town HanAnnex n 80
54375 Main Road
P.O.Bou 1179 r�D errl
Southold,NY 11971-0959 far + DD
' JAY e 2 2097
BUR DING DEPARTAHM BUMDING DEPT.
TOWN OF SOUT$OLD TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL 1_NSPECTiON
REQUESTED BY Dade: ` a
CPay Name:
Company
Name: �.
License No.:
ddress: V7 1� Ubbarci AV1E' I\Yl 2e 0(0
Phone No.: (o3 S'
JOBSITE WFORMATION: (*Indicates required Information)
*Name: v>ZG� 436�-c
*Address: /,��� � 4_-�1� AVE !/-6
*Cross Street J s r OIl;r.J ( 1 0f
*Phone No.: 63
Permit No.: —_
Tax-Map District 1000 Section: Blocic Lot .
*BRIEF DESCRIPTION OF WORK(Please Print Clearly)
(Please Circle All That Apply),
*Is job ready for inspection: YENO Rough In Final
*Do-you meed a Temp Certificate: YE NO -
_Temp Information(If needed)
*Ser%dce Size: 1 Phass 313hase 900 150200 300 350 400 Other
*New Service: Re-r�onnect Underground Nurrrber of Meters CI range of Service Overhead /-, �3
.onal Information: PAYMENT DUE WITH APPUCAT1ON G�"
824ReWest for Inspection Form