HomeMy WebLinkAbout37642-Z fSUFp tl Town of Southold Annex 11/26/2012
P.O.Box 1179
3 ` ' 54375 Main Road
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CERTIFICATE OF OCCUPANCY
No: 36053 Date: 11/26/2012
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 975 Anderson Rd, Southold,
SCTM#: 473889 Sec/Block/Lot: 50.4-15
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
11/26/2012 pursuant to which Building Permit No. 37642 dated 11/26/2012
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
The certificate is issued to Forestieri,John
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 37642 11/21/12
PLUMBERS CERTIFICATION DATED
Authorized Signature
SUF t/( TOWN OF SOUTHOLD
BUILDING DEPARTMENT
y z 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#: 37642 Date: 11/26/2012
Permission is hereby granted to:
Forestieri, John
845 Mill Creek Dr
Southold, NY 11971
To: electric service
At premises located at:
975 Anderson Rd, Southold
SCTM # 473889
Sec/Block/Lot# 50.-1-15
Pursuant to application dated 11/26/2012 and approved by the Building Inspector.
To expire on 5/28/2014.
Fees:
ELECTRIC $85.00
Total: $85.00
Building Inspector
o��pF SO(/r�Ol
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 Q roger.richert(d-)town.southo Id.ny.us
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: John Forestieri
Address: 975 Anderson Dr City: Southold St: NY Zip: 11971
Building Permit#: Section: Block: Lot:
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: John Ludemann License No: 4643-me
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 400a Heat Duplec Recpt Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel 2-20 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 2-20 Switches Twist Lock Exit Fixtures TVSS
Other Equipment: 400a overhead service, 2-200a service disconnects, 2-meters
Notes:
Inspector Signature: , (� Date: Nov 21 2012
81-Cert Electrical Compliance Form.xls.
SjlyO
Town Hall Annex 4 Telephone(631)765-1802
54375 Main Road (631)765 5
P.O.Box 1179 G Q roger.richert(c own.soutf9ioQd.ny.us
Southold,NY 1197I-0959Qr�
BUILDING DEPARTMENT
TOMW OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: (�� �/'n2!?yL Date:
Company Name:
Name: e
License No.:
Address: T aa,/ I�'fcjl L C A X 12 95 2
Phone No.: 31 aq/8
JOBSITE INFORMATION: (*Indicates required information)
*
Name:
*Address: V- 7 5 1 ce-rsyA/ m r.
*Cross Street: re
*Phone No.: 631 A 5- 99 79
Permit No.:
Tax-Map District: 1000 Section: Block:�` Lot:—/ �
*BRIEF DESCRIPTION OF WORK(Please Print Clearly)
E yaah 2 A411n. ze rna.;gr P vyice.� zio dl2Me7ar &:tao
(Please Circle All That Apply)
*Is job ready for inspection: �1 NO. Rough In Final
*Do-you need a Temp Certificate: ES NO
Temp Information(if needed)
*Service Size: 1 Phase 3Phase 100 `l50 200 300 350 400 Other
*New Service: Re-connect Underground Number Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
82=Request for Inspection Form y