HomeMy WebLinkAbout43195-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
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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#: 43195 Date: 11/5/2018
Permission is hereby granted to:
Latham, Henry
PO BOX 595
Southold, NY 11971
To: 200 Amp Electric Service
At premises located at:
845 Rogers Rd, Southold
SCTM # 473889
Sec/Block/Lot# 66.-2-40
Pursuant to application dated 11/2/2018 and approved by the Building Inspector.
To expire on 5/6/2020.
Fees:
ELECTRIC $85.00
Total: $85.00
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[hAIJQ Inspector
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Town of Southold 11/8/2018
P.O. Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 40027 Date: 11/8/2018
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 845 Rogers Rd, Southold
SCTM#: 473889 Sec/Block/Lot: 66.-2-40
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
11/2/2018 pursuant to which Building Permit No. 43195 dated 11/5/2018
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:
200 AMP OVERHEAD ELECTRIC SERVICE UPGRADE
The certificate is issued to Latham, Henry&Bette
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 43195 11-05-2018
PLUMBERS CERTIFICATION DATED
Authorized Signature
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Town Hall Annex Telephone(631)765-1802
54375 Main Road N Fax(631)765-9.502
P.O.Box 1 179 G Q
Southold,NY 11971-0959 O • �o roger.richert(c-Dtown.southold.nv.us
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To- Latham
Address. 845 Rogers Rd City- Southold St: New York Zip. 11971
Building Permit#- 43195 Section: 66 Block: 2 Lot: 40
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA. GJS Electric License No- 4839-ME
SITE DETAILS
Office Use Only
Residential X Indoor X Basement Service Only X
Commerical Outdoor X 1 st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph 200a Heat 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 A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks
Disconnect 200a Switches Twist Lock Exit Fixtures TVSS
Other Equipment: Service up grade, 200a overhead
Notes:
Inspector Signature: Date: November 5 2018
81-Cert Electrical Compliance Form.xls
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BUILDING DEPARTMENT- Electrical Inspector
Nov - 2 201 TOWN OF SOUTHOLD
twn Hall Annex - 54375 Main Road - PO Box 1179
DQ1G1J OZ,U Southold, New York 11971-0959
'1 'OV SO Telephone (631) 765-1802 - FAX(631) 765-9502
'Tos roger.richertO-town.southold.ny.us
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: (,�X-c� s�(,,'� Date: 1
Company Name: 7�S ec. Z L L C
Name: r
License No.: email: Qi3-F&V.cvnN
Address:
Phone No.: VDQAI�-�N(,,V A4 �--
JOB SITE INFORMATION: (All Information Required)
Name: eo h a-
Address: Tq4 RoaeA-s6G
Cross Street:
Phone No.:
Bldg.Permit#: email:
Tax Map District: 100 Section: (o(P Block: Lot:
BRIEF DESCRIPTION OF WORK(Please Print Clearly) - c;"2c
Circle All That Apply:
Is job ready for inspection?: YE NO Rough In C-Fal
Do you need a Temp Certificate?: YE NO I Issue
Temp Information: (All informa uired)
Service Size 1 Ph 3 Ph Size: _A #Meters Old Meter#
New Service- F Reconnect- Flood Reconnect-Service Reconnected - Underground verhea
round Laterals 1 2 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
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82-Request for Inspection Form.)ds
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