HomeMy WebLinkAbout47771-Z �oSuffot��o. TOWN OF SOUTHOLD
�o aye BUILDING DEPARTMENT
a TOWN CLERK'S OFFICE
o �r 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#: 47771 Date: 5/2/2022
Permission is hereby granted to:
Clous, James
4 Woodstone Ct
Huntington Station, NY 11746
To: As built underground electric service for garage
At premises located at: \,
3805 Bay Shore Rd, Greenport V
SCTM #473889 ?PO C4Gin4e—Y rcul/J
Sec/Block/Lot# 53.-6-18 � G `J��Y ,
00"tA fie. C'0
Pursuant to application dated 5/2/2022 and approved by the Building Inspector.
To expire on 11/1/2023.
Fees:
ELECTRIC $170.00
Total: $170.00
Building Inspector
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\4DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
�Toy ' uHaR nnex- 54375 Main Road - PO Box 1179
bull z;,,F.,. Southold, New York 11971-0959
"t`l honone (631) 765-1802 - FAX (631) 765-9502
rogerrt�southoldtownny.gov - seand(@-southoldtownny.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: Z Z
Company Name: 1e (�i ceVASWk "
Electrician's Name:
aV,i e I Wk k 6✓1 S
License No.: Elec. email: UVI1cep►sk; _Jec-fri, aG�cro .
Elec. Phone No: 3 i' -76S a,?6`( ®I request an email copy of Certificate of Compliance
Elec. Address.: P O 66,< 31 cjukl fd N`r K9-7
JOB SITE INFORMATION (All Information Required)
Name: �! CIM-PS Ct o(AS
Address: -Zt- g0'�- dre
Cross Street: Vecw%;n \vd-
Phone No.: -5(6 ' �d
Bldg.Permit#: 4-7 email:
Tax Map District: 1000 Section: Block: Lot: f
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
_ _ s iuo� f-o--nem,v
Square Footage:
Circle All That Apply:
Is job ready for inspection?: ® YES ❑ NO ❑Rough In ❑ Final
Do you need a Temp Certificate?: ❑ YES ❑ NO Issued On
Temp Information: (All information required)
Service Size❑1 Ph❑3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect[—]Flood Reconnect❑Service Reconnect❑Underground[]Overhead
# Underground Laterals 1 2 M H Frame M Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION