HomeMy WebLinkAbout37475-Z �c,UFfOt��oGy
Town of Southold Annex 9/25/2012
3�0 P.O.Box 1179
N 54375 Main Road -
oy Southold,New York 11971
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CERTIFICATE OF OCCUPANCY
No: 35972 Date: 9/25/2012
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 25 Azalea.Rd, Mattituck,
SCTM#: 473889 See/Block/Lot: 115.-6-13
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
8/27/2012 pursuant to which Building Permit No. 37475 dated 8/28/2012
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:
Electric Service Upgrade.
The certificate is issued to Molchan, Robert
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 37475 9/24/12
PLUMBERS CERTIFICATION DATED
Authorized Signature
TOWN OF SOUTHOLD
��o�° BUILDING DEPARTMENT
ze TOWN CLERK'S OFFICE
oy . 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#: 37475 Date: 8/28/2012
Permission is hereby granted to:
Molchan, Robert
2600 Ruth Rd
PO BOX 205
Mattituck, NY 11952
To: Electric Service Upgrade
At premises located at:
25 Azalea Rd, Mattituck
SCTM # 473889
Sec/Block/Lot# 115.-6-13
Pursuant to application dated 8/27/2012 and approved by the Building Inspector.
To expire on 2/27/2014.
Fees:
ELECTRIC $85.00
Total: $85.00
Building Inspector
OF SO�lyol
Town Hall Annex ~ Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 G • �Q roger.riche rt(a7town.southo Id.ny.us
Southold,NY 11971-0959
COUN N
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: robert Molchan
Address: 25 Azalea dr City: Mattituck St: NY Zip: 11952
Building Permit#: Section: 115 Block: 6 Lot: 13
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Laurel Lighting Inc License No: 4718-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 A/C Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer ARppliances DF1ryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches Twist Lock Fl. Exit Fixtures TVSS
11
Other Equipment: 200a overhead service change
Notes:
Inspector Signature: Date: Sept 24 2012
81-Cert Electrical Compliance Form.xls
soly
� 'l4
Town Hall Annex ] J�( Telephone(631)765.1802
54375 Main Road N ,,aax(631)7659g50Q22
P.O.Box 1179 G roger rlchertdown.southold ny Us
Southold,NY 11971-0959
ca11M.1
BUILDING DEFARThtW
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: , tyo► Date:
Company Name:
Name:
License No.: Z� f m
Address:
Phone No.: 53 6
JOBSITE INFORMATION: (*Indicates required information)
*Name: /GA 6LVI
*Address: 157 A- ZA De i ve, -� L Z T
*Cross Street:
*Phone No-:
Pen-nit No.:
Tax-Map District: 1000 Section: Block: Lot:
*BRIEF DESCRIPTION OF WORK (Please Print Clearly) _5e v r�� �Y
-(Please Circle All What Apply)
*Is job ready for inspection: YE / NO Rough In Final
*Do-you need a Temp Certificate: YES/ NO
Teranp 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
Additional Information: PAYMENT DUE WITH APP N
.82=Request for Inspection Form t