HomeMy WebLinkAbout38163-Z �0�0 uFF04tO�y Town of Southold 10/26/2017
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P.O.Box 1179
53095 Main Rd
oyay0 �� y Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 39317 Date: 10/26/2017
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 555 Broadwaters Rd, Cutchogue
SCTM#: 473889 Sec/Block/Lot: 104.42-6.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
7/9/2013 pursuant to which Building Permit No. 38163 dated 7/9/2013
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:
150 AMP UNDERGROUND ELECTRIC SERVICE
The certificate is issued to Martz Jr,Theodore
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 38163 10-17-2017
PLUMBERS CERTIFICATION DATED
Aikborized Signature
SU FF o��c TOWN OF SOUTHOLD
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#: 38163 Date: 7/9/2013
Permission is hereby granted to:
Martz Jr, Theodore
145 Reyerson Ave
Manorville, NY 11949
To: Change Electrical Service
At premises located at:
555 Broadwaters Rd, Cutchogue
SCTM # 473889
Sec/Block/Lot# 104.-12-6.1
Pursuant to application dated 7/9/2013 and approved by the Building Inspector.
To expire on 1/8/2015.
Fees:
ELECTRIC $85.00
Total: $85.00
Building Inspector
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 �� roger.richert(D_town.southoId.ny.us
Southold,NY 11971-0959
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To. Theodore Martz
Address: 555 Broadwaters Road city,Cutchogue st: New York zip: 11935
Building Permit#: 38163 Section: 104 Block: 12 Lot. 6.1
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
Commerical Outdoor X 1st Floor X Pool
New Renovation 2nd Floor Hot Tub
Addition Survey X 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 Fixture Time Clocks
Disconnect 150A Switches Twist Lock Exit Fixtures TVSS
Other Equipment: Convert Overhead 150A Service to Underground
Notes: "AS BUILT" - "ELECTRICAL SURVEY" - "NO VISUAL DEFECTS"
Inspector Signature: Date: October 17, 2017
0-Cert Electrical Compliance Form.xls
I
OF SO�ryD
Town Hall Annex Telephone(631)765-1802
54375 Main Road
c� (631)763- 5
P.O.Box 1179 G @ roaer.richert __ex i01d.ny.us i
Southold,NX 11971-0959
i
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICAT40N FOR ELECTRICAL INSPECTION
REQUESTED BY: Date: ®9
I
Company Name: .
Name:
License No.:
Address:
Phone No.: - ®f ." a
JOBSITE INFORMATION: Indicates vire info ati )
*Name: /
*Address: ry+
*Cross Street: b j
*Phone No.: 0A .. Is
Permit No.:
Tax-Map District: 1000 Section: Block: Lot:
*BRIEF DESCRIPTIO F WOR (Please Print Clearly)
4 -NIcy ®- ,
(Please Circle All That Apply) i
*Is job ready for inspection: YES I NO Rough In Final
*Do-you need a Temp Certificate:
. ES NO
Temp Information (if ded)
*Service Size: Phas Whase 100 150 200 300 350 400 Other
*New Service: Re-connect Underground Number of Meters Change of Servic �l1
Additional Information: PAYMENT DUE WIT OD E E v
]F
JUL2013
82-Request for inspection Form BLDG DEPT.
TOWN OF SOUTHOLD