HomeMy WebLinkAbout42195-Z ��o�gUFFOt,f�aG Town of Southold 12/21/2017
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P.O.Box 1179
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53095 Main Rd
�yfj®1 �a0� Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 39417 Date: 12/21/2017
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 55200 Route 25, Southold
SCTM#: 473889 Sec/Block/Lot: 62.-2-5.2
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
11/30/2017 pursuant to which Building Permit No. 42195 dated 11/30/2017
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:
ELECTRIC SERVICE FOR THREE BUILDINGS AS APPLIED FOR
The certificate is issued to Southold Historical Soc
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 42195 11-21-2017
PLUMBERS CERTIFICATION DATED
uthorized Signature
!0L TOWN OF SOUTHOLD
cOG 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#: 42195 Date: 11/30/2017
Permission is hereby granted to:
Southold Historical Soc
54325 Route 25
PO BOX 1
Southold, NY 11971
To: Electric in Moore House
At premises located at:
55200 Route 25, Southold
SCTM #473889
Sec/Block/Lot# 62.-2-5.2
Pursuant to application dated 11/30/2017 and approved by the Building Inspector.
To expire on 6/1/2019.
Fees:
ELECTRIC $85.00
Total: $85.00
Building Inspector
pF SOUK,®l
0
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 ® �Q roger.richertRtown.southoId.ny.us
Southold,NY 11971-0959 Q
lycOUI�V,��
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Southold Historical Society
Address: 55200 Route 25 city,Southold st: New York zip: 11971
Building Permit t 42195 Section: 62 Block: 2 Lot: 5.2
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Brian Brooks Electric License No: 3613-E
SITE DETAILS
Office Use Only
Residential Indoor X Basement Service Only
Commerical X Outdoor 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph 200A Heat elec-5 Duplec Recpt Ceiling 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 60A A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency FixtureTime Clocks
Disconnect 200A Switches Twist Lock Exit Fixtures TVSS El
Other Equipment: 200A Service In "Ann Currie Bell" House.
60A Sub Panel in "Print Shop".
Notes:
Replace Electric Baseboard Heaters (5) in the "Thomas Moore" House.
Inspector Signature: Date: December 21, 2017
17
0-Cert Electrical Compliance Form.xls
ho��OF SOUjyolo
UNOV
TOWN OF SOUTHOLD BUILDING DEPT:
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING [ ] FINAL -
[ ] FIREPLACE & CHIMNEY_ [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ELECTRICAL (FINAL)
REMARKS:
141
DATE �� �� INSPECTOR F,
so�lyo
Town Hall Annex llt J�[ Telephone(631)765-1802
54375 Main Road N ,fx(63765
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P.O.Box 1179 roger.richert(a. nQ
ny us
Southold,NY 11971-0959
Il I►t� i
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION '
REQUESTED BY. Date:
i
Company Name: !.
Name-
License No.: _
i
Address: 1
Phone No.:
JOBSITE INFORMATION: (*Indicates required information)
*Name: .
*Address: .td. ll 5a0t) 5
*Cross Street: K"�g .
*Phone No.:
Permit No.:
21
Tax-Map District: 1000 Section: 40 P, Block: pj Lot: S , 2
*BRIEF DESCRIPTION OF WORK(Please Print Clearly)
no 4", �i�,ti'pi
iP) 'R -TU -
6 P aCUA
(Please Circle All That Apply)
*Is job ready for inspection: YES/�O Rough In Final
*Do you need�A�Certificate:
.
Temp Information (if needed)
*Service Size: <1Phas 31'hase 100 150 Q� 300 350 400 Other
*New Service: Re-connect Underground Number of M e s Change of Service
Additional Information: PAYMENT DUE WITH APPLICATION
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82-Request for Inspection Form 1 a I