HomeMy WebLinkAbout42448-Z TOWN OF SOUTHOLD
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BUILDING DEPARTMENT
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#: 42448 Date: 3/12/2018
Permission is hereby granted to:
Myers, Ruth
1500 Wickham Ave
Mattituck, NY 119521612
To: 100 Amp electric service
At premises located at: ( _
1580 Wickham Ave d`�'
SCTM # 473889
Sec/Block/Lot# 139.-3-45
Pursuant to application dated 3/12/2018 and approved by the Building Inspector.
To expire on 9/11/2019.
Fees:
ELECTRIC $85.00
Total: $85.00
Building Inspector
ySFF�tA'c BUILDING DEPARTMENT- Electric
TOWN OF SOUTHOLD
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Town Hall Annex 54375 Main Road B%A 1 T92 2018
Southold, New York 11971-0959
° Telephone (631) 765-1802 - FAX (631) 765-9502 . :, ;:;, ;n•
roger.richert(c-town.southold.ny.us�---,OF50UTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: jt,;a v►B Date:
Company Name:
Name: r
License No.: E-
Address:
Phone No..
JOB SITE INFORMATION: (All Information Required)
Name:
r
Address: --15F0
Cross Street:
Phone No.: _ g_
Bldg.Permit#: ypVy email:
Tax Map District: 1000 Section: t'-69 Block: Lot:
BRIEF DESCRIPTION OF WORK (Please Print Clearly)
lop Amp &Wmcz or-
Circle All That Apply:
Is job ready for inspection?: E" . NO Rough In Final
Do you need a Temp Certificate?: ®/ NO Issued On
Temp Information: (All information required)
Service Size 3 Ph Size:�A # Meters Old Me r# ag3f l 7
New Service - Fire Reconnect- Flood Reconne - Service Reconnecte Underground verhea
# Underground Laterals 1 2 H Frame Pole Work done on Service? Y
Additional Information:
1 CSL
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PAYMENT DUE WITH APPLICATION ��
82-Request for Inspection Form.xlsMD