HomeMy WebLinkAbout37813-Z TOWN OF SOUTHOLD
o�gUfFot,��oay BUILDING DEPARTMENT
y 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#: 37813 Date: 2/15/2013
Permission is hereby granted to:
Surrey Lane LLC
30 Surrey Ln
Tenafly, NJ 07670
.To: electric service
At premises located at: 01D
Route 25, Southold
i
SCTM # 473889
i
Sec/Block/Lot# 69.-5-18.6 j
Pursuant to application dated 2/15/2013 and approved by the Building Inspector.
To expire on 8/17/2014.
Fees:
ELECTRIC $85.00
Total: $85.00
Building. Inspector
S0I/pj
Town Hall Annex J Telephone(631)765-1802
54375 Main Road cn ,r
- o (631}765- o9 �P.O.Box 1179 ra enrichertwn.sou
.n .us
Southold,NY 1197I-0959 Q �o
w . BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: P-tA VC 6 Lt4 Date: 02 /
!tgmpany Name: -1C`C
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License No.:
..z
Address: S it_VV3 49--D w q f)
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Phone No.: �p�j -(22 - aZ
. ,0BSITE INFORMATION: ,(*Indicates required information)
*!`tame: UX-
*Acldress: S00 THGL,G N C f I
*Cross Street:
*Phone No.: �
F'�Fmit No.:
� PMap District: 1000 Section: Block: Lot: Ia.
EF DESCRIPTION OF WORK(Please Print Clearly)
;Pease Circle All That Apply)
kl *:fob ready for inspection: YES / NO. Rough In Final
Vp.--you need a Temp Certificate: ES NO
rip Information(if needed)
.eervlce Size: 1 Phase 3Phase 100 150 200 300 350 400 Other
`N"pw Service: Re-connect` Underground Number of Meters " hange of Service Overhead
4:d
,-1-d onal Information:. t - PAYMENT DUE WITH APPLICATION
.82=Request for Inspection Form
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