HomeMy WebLinkAbout37993-Z OFF RA, Town of Southold Annex 5/2/2013
P.O.Box 1179
54375 Main Road
c> r, Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 36221 Date: 5/2/2013
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 1850 Main Bayview Rd, Southold,
SCTM#: 473889 Sec/Block/Lot: - 75.-4-28
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
5/2/2013 pursuant to which Building Permit No. 37993 dated 5/2/2013
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 for commercial range.
The certificate is issued to LI Head Start Child Dev
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 37993 5/2/13
PLUMBERS CERTIFICATION DATED
vK Authorized Signature
sz�eLK TOWN OF SOUTHOLD
caG� BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
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 #: 37993 Date: 5/2/2013
Permission is hereby granted to:
LI Head Start Child Dev
98 Austin St
Patchogue, NY 11772
To: electric for commercial range.
At premises located at:
1850 Main Bayview Rd, Southold
SCTM # 473889
Sec/Block/Lot# 75.-4-28
Pursuant to application dated 5/2/2013 and approved by the Building Inspector.
To expire on 11/1/2014.
Fees:
ELECTRIC $85.00
Total: $85.00
Building Inspe for
OF SO(/ryo
Town Hall Annex �O l� Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 • roger.riche rt(D-town.southold.ny.us
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: North Fork Head Start
Address: 1850 Main Bayview Rd 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: as built DBA: License No:
SITE DETAILS
Office Use Only
Residential Indoor X Basement X Service Only
Commerical X Outdoor 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph 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 Appliances Dryer Recpt Emergency Fixtures Time Clocks
Disconnect F1 Switches Twist Lock 11 Exit Fixtures TVSS
Other Equipment: installation of commercial range with 2-200a disconnects
Notes:
Inspector Signature: Date: May 1 2013
81-Cert Electrical Compliance Form.xls
�4
Town Hall Annex 7f Jf Telephone(631)7611802
54375 Main Road.: .
P.O.Box 1179. �. roger dchett W 1.S llt &h.ny us:
Sou fiold,NY 119h*4959
�ByU�II�.�DTING D�i(EPAR�T1 M EN
T'TD
OF
v APPLICATION FOR ELECTRICAL 1NSPECTtON
REQUESTED BY: `
�. ���`� � Date:
Company Name: . �1
Name: .
License No.:
Address: 5}11) a__ rilY 1 l'7 7 Z
Phone No.:
JOBSITE INFORMATION: ( `Indicates required information)
*Name:
*Address: P)CI;n R4 vs d Rd As+- xu to o
*Cross Street:
*Phone No.: &5 i-
Permit No.:
Tax-Map District: 1000 Section: �7t:�— Block: Lot:
*BRIEF DESCRIPTION OF WORK(Please Print Clearly)
(Please Circle All That Apply)
*ls job ready for inspectibn: YES I NO. Rough In Final
*Do you need a Temp Certificate: YES I NO
Temp Information Of 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 APPLICATION
82-Request for Inspection Form