HomeMy WebLinkAbout37333-Z o�g�Fpal,fcoG Town of Southold Annex 7/9/2012
P.O.Box 1179
C x 54375 Main Road
ph
a Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 35809 Date: 7/9/2012
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 25350 Route 25, Orient,
SCTM#: 473889 See/Block/Lot: 18.-6-14.5
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
6/28/2012 pursuant to which Building Permit No. 37333 dated 6/28/2012
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:
change electric panel and reconnect electric
The certificate is issued to Ezair,Khedouri
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 37333 07/02/2012
PLUMBERS CERTIFICATION DATED
on
Authorized Signature
�=2Z TOWN OF SOUTHOLD
�� ay BUILDING DEPARTMENT
y TOWN CLERK'S OFFICE
o 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#: 37333 Date: 6/28/2012
Permission is hereby granted to:
Ezair, Khedouri
931 Madison Ave
New York, NY 10021
To: change electric panel and reconnect electric
At premises located at:
25350 Route 25, Orient
SCTM # 473889
Sec/Block/Lot# 18.-6-14.5
Pursuant to application dated 6/28/2012 and approved by the Building Inspector.
To expire on 12/2812013.
Fees:
ELECTRIC $85.00
Total: $85.00
Building Inspector
o�\N'pF SO(/j�ol
Town Hall Annex ~ Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 G iQ roger.richert@town.southold.ny.us
Southold,NY 11971-0959
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Ezari Khedouri
Address: 25300 Main Rd City: Orient St: NY zip: 11957
Building Permit#: Section: Block: Lot: j q,
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Arthur Ruroede License No: 2334-e
SITE DETAILS
Office Use Only
Residential X Indoor X 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 Dryer Recpt Emergency Fixtures Time Clocks
Disconnect 200a Switches Twist Lock Exit Fixtures 11 TVSS
Other Equipment: replace panel, re-connect existing 200a underground.service
Notes:
Inspector Signature: '� , Date: July 2012
81-Cert Electrical Compliance Form.xls
Wo
Tdwa hall Annex Telephone(631)765-1802
54375 Main Road. roger.riclierl(N�t (�1)7��..����QQ
P.O..Box 1179 G . O,(6")1 11110 6y.us
Sou old,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION" a.
REQUESTED BY: Date:
Company Dame: Ty
Name:
f.icense.No,: 3 - F
Address., SMe iti Roc; J 0
` Phone No.: -31 0/0 S 3 9-% R
JOBSITE INFORMATION: (*I"ndicates required information) .
*Name:: � � 2- G � r I i h e A o k-4- r i
*Address. . �5 O " �) 5 3 Q 0 Pi f r- n h i g-ti
*Cross Street:
*Phone No.: .
Permit No..
Tax Map District: 1000 Section: tMock: Lot: 77, 77
*BRIEF DESCRIPTION OF WORK(Please Print Cleariy
R t n Oh ►1 -a C �
(please Circle Alf That Apply).
*Is•�ob ready for Inspection: ES / NO Rough In: Final..
*Da`you need'a Temp Certificate: E / NO
Ternp-Information(If.needed) -
*Service Size: 1 Phas 3 200 Phase 100 -150 . 3001 � 350 400 Other
*New Service: Re-connec Undergroun Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
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