HomeMy WebLinkAbout43308-Z o�SUFFo�,��oTOWN OF SOUTHOLD
BUILDING DEPARTMENT
a TOWN CLERK'S OFFICE
�y • o� SOUTHOLD, NY
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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#: 43308 Date: 12/12/2018
Permission is hereby granted to:
Jayne, Jeannine
PO BOX 657
Orient, NY 11957
To: Change of electric sery ce
At premises located at:
16109 Route 25, East Marion
SCTM # 473889
Sec/Block/Lot# 23.-1-10.1
Pursuant to application dated 12/12/2018 and approved by the Building Inspector.
To expire on 6/12/2020.
Fees:
ELECTRIC $85.00
Total: $85.00
it nspector
D ECEDIVRI G DEPARTMENT- Electrical Inspector
` TOWN OF SOUTHOLD
DEC 1 2 Tgvf Flnnex - 54375 Main Road - PO Box 1179
$ Southold, New York 11971-0959
telephone (631) 765-1802 - FAX(631) 765-9502
"LTi ,D�i�G 11'""T�' ro"er,richert@town.southold.ny."us
TOWN OF SO CLD _
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: ��o Date: a
Company Name: 1
Name:
License No.: email:
Address: 1 e1C My1
Phone No.":
JOB SITE INFORR TION: (Ail Information Required)
Name:f
Address:: / I(OC ton
Cross Street:
Phone No.: !-(-� 1 C51
Bldg.Perm4t#: email: C. ma, l C c�
Tax Map District: 1000 Section: Block: Lot:
BRIEF DESCRIPTION OF WORK(Please Print Clearly) �, ,e e L9
Circle All That Apply:
Is job ready for inspection?: N Rough In Final
Do you need a Temp Certificate?: YE NO Issued On
Temp Information: (All information required)
Service Size 1 Ph 3 Ph Size: _A #Meters�� Old Meter# 1'�)I000 159
New Service- Fire Reconnect- Flood Reconnect- Service Reconnected nderground - Overhead
#Underground Laterals 1 2 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
f3,
82-Request for Inspection Form As 1�C