HomeMy WebLinkAbout36949-Z �z TOWN OF SOUTHOLD
moo Gy BUILDING DEPARTMENT
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TOWN CLERK'S OFFICE
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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#: 36949 Date: 1/26/2012
Permission is hereby granted to:
Sledjeski, Monica
2130 Dakar PI
Dulles, VA 201892130
To: electric service upgrade
AtP remises located at:
31545 Old Main Rd, Orient
SCTM # 473889
Sec/Block/Lot# 14.-2-3.4
Pursuant to application dated 1/26/2012 and approved by the Building Inspector.
To expire on 7/27/2013.
Fees:
ELECTRIC $85.00
Total: $85.00
Building Inspector
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O��pF SD[/�yol
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Town Hall Annex 1 1 Telephone(631)765-1802
54375 Main Road y �ax(631)765 g5Q2
P.O.Box 1179 G Q roger.richertECUtown.sou 95618 nv us
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: UJ Date:
Company Name: S6'j -
Name: 1, S�A�
License No.:
Address: i ci,j2 TA) 1�� Gtie lI I Y
Phone No.: (9 I _
JOBSITE INFORMATION: (*Indicates required information)
*Name: h4 On/i GA
*Address: 31 SYS` C r 12 v1
*Cross Street: fib Z A
*Phone No.:
Permit No.:
Tax Map District: 1000 Section: 1 Block: �. _ Lot: 3,
*BRIEF DESCRIPTION OF WORK(Please Print Clearly)
S V civ o d e ,
(Please Circle All That Apply)
*Is job ready for inspection: Y NO Rough In Cina
*Do-you need a Temp Certificate: YES/ NO
Temp Informatioae-wn!nect
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*Service Size: 3Phase 100 150 200 300 0 400 Other
*New Service: Underground Number of Meters Change of Service erhead
Additional Information: PAYMENT DUE WITH APPLICATION
82-Request forinspection Form