HomeMy WebLinkAbout36719-Z r
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�ff0�,t�o, Town of Southold Annex
9/28/2011
�� 54375 Main Road
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Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 35242 Date: 9/28/2011
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 825 Kimberly Ln, Southold,
SCTM#: 473889 Sec/Block/Lot: 70.-13-20.5
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. 36719 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:
underground electric service.
The certificate is issued to Mandelbaum,Jay&Gordon,Lauren
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 36719 9/27/11
PLUMBERS CERTIFICATION DATED
Authorized Signature
*pF SO,�TyOlo
Town Hall Annex Telephone(631)765-1802
54375 Main Road '1 � Fax(631)765-9502
P.O.Box 1179 G Q roger.richertCC�town.southold.ny.us
Southold,NY 1 1 97 1-0959
'rout II,�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Jay Mandelbaum
Address: 825 Kimberly La City: Southold St: NY Zip: 11971
Building Permit#: 3t 11 9 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 X Indoor (Basement Service Only X
Commerical Outdoor X 1st 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 DHryer Recpt Emergency Fixtures Time Clocks
Disconnect 50a Switches Twist Lock Exit Fixtures TVSSL]
Other Equipment: 200a underground service with 50a disconnect
Notes:
Inspector Signature: Date:
N � � Sept 27 2011
81-Cert Electrical Compliance Form
TOWN OF SOUTHOLD
�z{os�fFotx�µ. BUILDING DEPARTMENT
TOWN CLERKS OFFICE
SOUTHOILD, 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 #: 36719 Date: 9/27/2011
Permission is hereby granted to:
Mandelbaum, Jay & Gordon, Lauren
1107 Fifth Ave
New York, NY 10128
To: underground electric service
At premises located at:
825 Kimberly Ln, Southold
SCTM # 473889
Sec/Block/Lot# 70.-13-20.5
Pursuant to application dated 9/27/2011 and a1pproved by the Building Inspector.
To expire on 3/28/2013.
Fees:
ELECTRIC $85.00
Total: $85.00
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Building Inspector
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Town Hall Annex Telephone()631)79655--11802
54375 Main Road roger.richert �tovm isouthoid.n
P.o..Box 1179 '� y.us
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN O:F SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY. Date:
Dater
Company Name:
Name: . �" p
License.No,: •77cp
------------
address: o Rol o ���.
' Phone No.: —�
JOBSITE INFORMATION: (*Indicates required information)
*Name:. t ti/ R�fDc"Z:SAcLo�t°I
*Address:
*Cross Street: ��,�,E AA- ,
*Phone No.: �!—
Permit No.:
Tax Map District: 1000 Section: .70 Block: Lot: D,
*BRIEF DESCRIPTION OF WORK(Please Print Clearly)
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1/4- 19 &� `
(Please 6irc a All That Apply)
*Is.job ready for inspection: 1Y / NO Rough In- Final.
*Do.you need a Temp Certificate: 1►'E NO
Temp Information (if needed}
*Service Size: ' <�Iftase. 313hase 100 150 200, 300 350 400 Other .
*New Service: Re-connect Undergroun (Number of Meters Change of Service Overhead
Additional Infonnation: PAYMENT DUE WITH APPLICATION
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