HomeMy WebLinkAbout42194-Z fait
Town Town of Southold 1/2/2018
P.O.Box 1179
o ` 53095 Main Rd
4A ao� Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 39430 Date: 1/2/2018
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 1125 Back Ln, Orient
SCTM#: 473889 Sec/Block/Lot: 17.-2-16
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. 42194 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:
100 AMP OVERHEAD ELECTRIC SERVICE UPGRADE
The certificate is issued to Ducrot,Beatrice
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 42194 12-27-2017
PLUMBERS CERTIFICATION DATED
Authorized Signature
gv=tK TOWN OF SOUTHOLD
BUILDING DEPARTMENT
y 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#: 42194 Date: 11/30/2017
Permission is hereby granted to:
Ducrot, Beatrice
Back Ln
PO BOX 332
Orient, NY 11957
To: Electric Service
At premises located at:
1125 Back Ln, Orient
SCTM # 473889
Sec/Block/Lot# 17.-2-16
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
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Bui ' pector
pF SO(/Ty®lo
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 iQ roger.richert(D-town.southold.ny.us
Southold,NY 11971-0959
®lyc®UNTY,�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Ducrot
Address: 1125 Back Lane city:Orient st: New York zip: 11957
Building Permit#: 42194 Section: 17 Block: 2 Lot: 16
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: BJ Electric License No: 2670-ME
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 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: 100A Overhead Service Upgrade.
Notes:
Inspector Signature: Date: December 27, 2017
0-Cert Electrical Compliance Form.xis
OF SO(/Tyolo
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) (&I ELECTRICAL (FINAL)
REMARKS:
DATE 1� /7 ( INSPECTOR
O��OF SOUryDI
Town Hall Annex ;J lephone(631)765-1802 E
54375 Main Road
P.O.Box 1179 G
Q ro er.ric t ,MOO
Southold,NY 11971-0959
NOV 3 0 2017
' f
BUILDING DEPARTMENT
TOWPI OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTIONJOWN OF SOUTHOL.D
REQUESTED BY: 61v Date: E
Company Name: lC�/l!L
Name: -
License No.: D
Address:
Phone No.: 04
JOBSITE INFORMATION: (*Indicates requir d information) f
f
*Name:
*Address:
div L � i
*Cross Street:
��
No.: V11 0,
*Phone: l
Permit No.:
led 6AI
Tax-Map District: 1000 Section:__J —- Bloc�kJ: Wit:
*BRIE
F DESCRIPTION OF WORK(Please Print Clearly�l 0 - ,,e � �f�►�� f
-(Please Circle All That Apply)
*Iis job ready for inspection: YES O Rough in Final
*Do you need a Temp Certificate: YES NO -
- - I
Temp Information(If ed)
*Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other
*New Service: Re-connect Underground Number of Meter Chang�Serv" Over ead
Additio I Information: PAYMENT DUE WITH APPLICATION-
- �,"� 01, _11_�
8 RAus, Inspection Form L
110611-2