HomeMy WebLinkAbout36717-Z ` Town of Southold Annex 9/28/2011
1%sU AoG�� 54375 Main Road
T
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 35250 Date: 9/28/2011
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 11500 Route 25, Mattituck,
SCTM#: 473889 Sec/Block/Lot:' 122.-3-6
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
9/27/2011 pursuant to which Building Permit No. 36717 dated 9/27/2011
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 repair
The certificate is issued to Six Kings LLC
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 36717 9/27/11
PLUMBERS CERTIFICATION DATED
Authorized Signature
OF SO(/jyol
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 roger.richert(a_town.southold.ny.us
Southold,NY 11971-0959 • a0
OWN,
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Steve King (East End Sporting Goods)
Address: 11500 Main Rd City: Mattituck St: NY Zip: 11952
Building Permit#: y Section: Block: Lot:
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Glens Electric License No: 4770-me
SITE DETAILS
Office Use Only
Residential Indoor Basement Service Only X
Commerical X Outdoor X 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixtures
Service 3 ph 200a Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches Twist Lock Exit Fixtures TVSS EJ
Other Equipment: replace meter pan only, on existing 200a, 3 phase service
Notes:
Inspector Signature: Date: Sept 27 2011
81-Cert Electrical Compliance Form
TOWN OF SOUTHOLD
o�suFFo� o�
BUILDING DEPARTMENT
CO TOWN CLERK'S OFFICE
o� . SOUTHOLD, NY
F 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 #: 36717 Date: 9/27/2011
Permission is hereby granted to:
Six Kings LLC
PO BOX 863
Mattituck, NY 11952
To: electric service repair
At premises located at:
11500 Route 25, Mattituck
SCTM # 473889
Sec/Block/Lot# 122.-3-6
Pursuant to application dated 9/27/2011 and approved by the Building Inspector.
To expire on 3/28/2013.
Fees:
ELECTRIC $85.00
Total: $85.00
Building Inspector
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Tows Hall Annex Telephone(631)765-1802
54375 Main Road' vu P.O.Box1179 rooer. certdomoho .nvus
Southold,NY 11971-0959 '
BUILDING DEPARTMENT -
TOWN OF SOUTHOLD
APPLICATION FOR. ELECTRICAL INSPECTION,
• REQUESTED BY.: Date:
Company dame: l
Name:
License:No,: c
Address:
r
Phone No.: _ _
JOBSITE INFORMATION: (*Indicates— required information)
«Name:. c` i A/9.- /E��� �ic�� �fi�✓� 'a��a
*Address:
*Cross Street: xa j s v FOP,(10 s ye-o
*Phone No.: �' i� �'i�- Y s�
Permit No.:
Tax Map District: 1000 Section: Block: Lot:
*BRIEF'DESCRIPTION OF WORK(Please Print Clearly) ���
.(Please Circle All That Apply).
*Is•job ready for inspection: ES / NO Rough In- ena
*Do you need a Temp Certificate: E NO
Temp Information (if needed) -
*Service Size: ' 1 Phase. 3Phas 100 '150 . 200 3001 350 400 Other
*New Service: Re-connect Underground Number of Meters Change of Service ve ad
Additional Information: PAYMENT DICE WITH-APPLICATION