HomeMy WebLinkAbout42565-Z o.ASOFOL4,-aG. Town of Southold 4/19/2018
"yam P.O.Box 1179
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a' 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 39600 Date: 4/19/2018'
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 54100 Route 25, Southold
SCTM#: 473889 Sec/Block/Lot: 61.-4-20
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
4/12/2018 pursuant to which Building Permit No. 42565 dated 4/12/2018
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:
"as built"electrical survey and re-connection of existing 100a overhead service.
The certificate is issued to Rothman Ronald
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 42565 4/12/2018
PLUMBERS CERTIFICATION DATED
Authorized signatur
OF SOl�T�OI -
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Town Hall Annex Telephone(631)765-1802
54375 Main Road N Fax(631)765-9502
P.O.Box 1179 aQ roger.richert(aD-town.Southold.ny.us
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOXJTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To. Rothman R H Cred Shel Trust
Address: 54100 Route 25 city,Southold st: New York zip: 11971
Building Permit#: 42565 Section: 61 Block: 4 Lot: 20
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 Indoor Basement Service Only
Commerical X Outdoor 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey X 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 11 TVSS
Other Equipment: "AS BUILT" - "ELECTRICAL SURVEY' - "NO VISUAL DEFECTS"
Notes: Re-Connect Existing 100A Overhead Service
Inspector Signature: C Date: April 12, 2018
0-Cert Electrical Compliance FormAs
TOWN OF SOUTHOLD
ay BUILDING DEPARTMENT
A TOWN CLERK'S OFFICE
oy,• SOUTHOLD, NY
.fjol oh-
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#: 42565 Date: 4/12/2018
Permission is hereby granted to:
Rothman R H Cred Shel Trust
3995 Wells Ave
PO BOX 878
Southold, NY 11971
To: as built" electrical survey and re-connect existing 100a overhead service.
At premises located at:
54100 Route 25
SCTM # 473889
Sec/Block/Lot# 61.-4-20
Pursuant to application dated 4/12/2018 and approved by the Building Inspector.
To expire on 10/12/2019.
Fees:
ELECTRIC $85.00
Total: $85.00
f
Building Inspector
97
D IR
FFQ1 D ING DEPARTMENT- Electrical Inspector
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APR 13 2018 I TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
Southold New York 11971-0959
TOWN OF S&TJ hone (631) 765-1802 - FAX (631) 765-9502
1 roger.richert(aD-town.southold.ny.us
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED--BY: ;q ;,��; - -- Date: --I - - --
Company Name:
Name:
License No.: email:
Address: P -0& s0v7l' )
Phone No.:
JOB SITE INFORMATION: (All Information Required)
Name: (2 y '6 of-YVEIL s
Address: () S C
Cross Street:
Phone No.: s 3
Bldg.Permit#: L4Qk email:
Tax Map District: 1000 Section: 4Z) Block: Lot:
BRIEF DESCRIPTION OF WORK (Please Print Clearly)
Circle All That Apply:
Is job ready for inspection?: YES / NO Rough In Final
Do you need a Temp Certificate?: YES-/ NO Issued On
Temp Information: (All information required)
Service Size 1 Ph 3 Ph Size: A # Meters Old Meter#
New Service - Fire Reconnect- Flood Reconnect- Service Reconnected - Underground - Overhead
# Underground Laterals 1 2 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
d2� n 05
Request for Inspection FormAs I 9
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