HomeMy WebLinkAbout39726-Z SUFFocTOWN OF SOUTHOLD
BUILDING DEPARTMENT
C4 a . TOWN CLERK'S OFFICE
'oy 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#: 39726 Date: 5/4/2015
Permission is hereby granted to:
Tom's North Fork Prop LLC
2371 E 71st St
Brooklyn, NY 11238
To: Electric Service
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At premises located at:
44780 CR 48, Southold
SCTM # 473889
Sec/Block/Lot# 63.-1-24
Pursuant to application dated 5/4/2015 and approved by the Building Inspector.
To expire on 11/2/2016.
Fees:
ELECTRIC $85.00
Total: $85.00
Building In
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I`ocvn Hall Annex J Telephone(631)765-1802
54375-Main Road
c� ,aaxx(631)765_"5 2
P.O.Box 1179 •: 0 fOQer.rlCher( IOWn.S076-8-52
11t�0�d ny us
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION '
REQUESTED BY: Date:
4/
Company Name:
Name:
License No.:
Address: .
'Phone No.:
JOBSlTE INFORMATION: (*Indicates required information) -
*Name: MY
W
u
*Address: 1Y9
*Cross Street: X�.
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*Phone No.: �3� - �t -cD//
Permit No.:
Tax-Map District: 1000 Section: Block: Lot: �
*BRIEF DESCRIPTION OF WORK(Please Print Clearly)
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(Please Circle All That Apply)
Is job ready for inspection: YES/ NO. Rough In Final
*Do-you need a Temp Certificate:
YES NO
Temp Information(If needed)
*Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other I .
*New Service: Re-connect Underground Number of Meters change of erviceverhead
Additional Information: PAYMENT DUE WITH APPLICATION
,82--Request for Inspection Form
I.