HomeMy WebLinkAbout37059-Z OLt Town of Southold Annex 3/12/2012
3p �y P.O.Box 1179
54375 Main Road
o It Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 35486 Date: 3/12/2012
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 1115 Main Bayview Rd, Southold,
SCTM#: 473889 Sec/Block/Lot: 70.-8-2
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
3/12/2012 pursuant to which Building Permit No. 37059 dated 3/12/2012
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:
Electrical Upgrade
The certificate is issued to Custer Institute
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 37059 03/07/2012
PLUMBERS CERTIFICATION DATED
Authorized Signature
o�SUFFU�,yCp TOWN OF SOUTHOLD
BUILDING DEPARTMENT
' TOWN CLERK'S OFFICE
oy • 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#: 37059 Date: 3/12/2012
Permission is hereby granted to:
Custer Institute
PO BOX 1204
Southold, NY 11971
To: Electrical Upgrade
At premises located at:
1115 Main Bayview Rd, Southold
SCTM # 473889
Sec/Block/Lot# 70.-8-2
Pursuant to application dated 3/12/2012 and approved by the Building Inspector.
To expire on 9/11/2013.
Fees:
ELECTRIC $90.00
Total: $90.00
Building Inspector
o��OF SO�Tyol
Town Hall Annex ~ Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
roger.richerta-town.southold.nv.us
Southold,NY 11971-0959 0
UN%
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Custer Institute Inc
Address: 1115 Main Bayview Road City: Southold St: NY Zip: 11971
Building Permit#: Section: 70 Block: 8 Lot: 2
WAS EXAMINED AND FOUND TO.BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: License No:
SITE DETAILS
Office Use Only
Residential Indoor X Basement X Service Only
Commerical X Outdoor X 1st Floor X Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt 4 Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel A/C Condenser 3 Single Recpt Recessed Fixtures CO Detectors
Sub Panel 1-60 A/C Blower 3 Range.Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches Twist Lock Exit Fixtures - TVSS
Other Equipment: electrical alterations to existing building, 1 sub panel and 4 recpticles in telescope
room
Notes:
Inspector Signature: Date: March 7 2012
81-Cert Electrical Compliance Form.xls
03-02-12; 14;39 2734773 # 1/ 1
0so0f SO!/Tyo
Town Hall Anncx Telcphonc(631)765.1802
54375 Main Roady . l0(6d1)765
P.O.Boa 1179 �roihttwn.souola
.nv.us
S011Uxold,NY 11971-0959
BUILDING DEPARTI TN'1
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: Date: s ��
Company Name:
Name:
License No.:
Address: -3 4;�z,
Phone No.: 3 y
JOBSITE INFORMATION: (*Indicates required information)
*Name: �Gt S s' A 7 e
"Address': ��/lam �ii.-� r,:,/ -ez� ,���, �G� i/�/l� /J .97/`Cross Street:
*Phone No.: ( :j/ - �' 6 7,7
Permit No.:
Tax Map District: 1000 Section: Block: Lot: _
*BRIEF DESCRIPTION OF WORK (Please Print Clearly)
3 - e2 oefe/ Z6r r�C A-
e
(Please Circle All That Apply) /�' AV - /C_
*Is joly read for inspection: ry
• Y p � NO Rough In j � Final
*Do you need a Temp Certificate: / '
Y p YES NO �/`/,e
Temp Information-(If needed)
*Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other
*New Service: Re-connect Underground Number of Meters Change of Service Overhead G'
Additional Information: PAYMENT DUE WITH APPLICATION 4
82-Request for Inspection Form