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Town of Southold 11/9/2017
y P.O.Box 1179
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°� 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 39332 Date: 11/9/2017
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 28355 Route 25, Cutchogue
SCTM#: 473889 Sec/Block/Lot: 102.-5-7
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
8/24/2017 pursuant to which Building Permit No. 41905 dated 8/24/2017
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:
RECONNECT 200 AMP ELECTRIC SERVICE
The certificate is issued to Marschean,Nancy
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 41905 10-19-2017
PLUMBERS CERTIFICATION DATED
Authorized Signature
�guFFoc,r�oTOWN OF SOUTHOLD
BUILDING DEPARTMENT
c 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#: 41905 Date: 8/24/2017
Permission is hereby granted to:
Marschean, Nancy
PO BOX 246
Cutchogue, NY 11935
To: Electric Service
At premises located at:
28355 Route 25, Cutchogue
SCTM # 473889
Sec/Block/Lot# 102.-5-7
Pursuant to application dated 8/24/2017 and approved by the Building Inspector.
To expire on 2/23/2019.
Fees:
ELECTRIC $85.00
Total: $85.00
pector
sovr�®
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Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 roger.richert(aD-town.Southold.ny.us
Southold,NY 11971-0959 ®l�COU1�,���
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Marschean
Address: 28355 Route 25 city,Cutchogue st: New York zip: 11935
Building Permit#: 41905 Section: 102 Block- 5 Lot: 7
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Goodale Electric License No: 783-E
SITE DETAILS
Office Use Only
Residential X Indoor Basement Service Only
Commerical Outdoor X 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph 100A Heat Duplec Recpt Ceiling 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 Fixture Time Clocks
Disconnect 100A Switches Twist Lock Exit Fixtures TVSS
Other Equipment: Re-Connect 100A Service.
Notes:
Inspector Signature: �" Date: October 19, 2017
0-Cert Electrical Compliance Form As
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Town Hall Annex Telephone(631)765-1802
54375 Main Road
P.O_Box 1179 -ro er.ri f
Southold,NY 11971-0959
0 AUG 2 4 2017
BLIMING DEPARTMENT BUILDINGDEFL
TOWN OF SOUTHOLD TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQ1,IESTED BY:
Com any Name:
Licen e No.: 6
Add r s
Phon No.: C31
JOB ITE INFORMATION: (*Indicates required information)
*Na
*Add s: c�,Q' / i/ ,*�-i v� ��' -
*Cros Street: Alcroe
*Pho No.: 76S-
Perm No.: �Q S
Tax p District: 1000 Section:. Block: Lof
*BRIE DESCRIPTION OF WORK(Please Print Clearly) ��ys 16e k'y-::,
(Plea a Circle All That Apply)
*Is job ready for inspection: YE IdW Rough In Final
*Do y need a Temp Certificate: E / NO
Temp nformation{If needed)
*S�ervk a Size: 1 P as 3Phade 10 150 200 300 350 400 Other
*New ervice: e-connect Underground Number of Meters Change of Service Overhead
Additidnal Information: PAYMENT DUE WITH APPLICATION
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82-R quest for Inspection Form qJ
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