HomeMy WebLinkAbout47178-Z r' Suf�K TOWN OF SOUTHOLD
BUILDING DEPARTMENT
x TOWN CLERK'S OFFICE
"o • 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#: 47178 Date: 12/6/2021
Permission is hereby granted to:
Orlofsky, Sam
440 W 21 st St Mil
Nek York, NY 100
To: Electricals rvey
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At premises located at:
18575 Soundvie Ave, Southold
SCTM # 473889
Sec/Block/Lot# 51.-1-12
Pursuant to application dated 1/1/1900 and approved by the Building Inspector.
To expire on 6/7/2023.
Fees:
ELECTRIC $120.00
Total: $120.00
Building Inspector
oS%IFFp4c � tVon
ILDING DEPARTMENT- Electrical Inspector
�Gy TOWN OF SOUTHOLD
b all Annex- 54375 Main Road - PO Box 1179
o • '* ®�C, �F�. Southold, New York 11971-0959
elephone (631) 765-1802 - FAX (631) 765-9502
reerr _seutheldtewnny.gev - seand(�seutheldtownny.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (Ali information Required) Date:
Company Name: �P�vnc
Electrician's Name: o
License No.: Elec. email:
Elec. Phone No: g z S t L ❑I request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFOR TIO (AII nformati n Requir d)
Name: s� a 0V ��{S�
Address: I U
Cross Street:
Phone No.:
Bldg.Permit#: LAI 3 26 mail:
Tax Map District: 1000 Sec 'on: lock: f Lot! -
BRIEF DESCRIPTION OF WORK, INCLUD RE FOOTAGE (Please ri ar y .
T(
Square Foot ge: o
Circle All That Apply:
Is job ready for inspection?: 0' YES ❑ NO ❑Rough In -Final
Is �S
Do you need a Temp Certificate?: ❑ YES ❑ NO Issued On U �+
Temp Information: (All information required)
Service Size❑1 PhF-13 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect[—]Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 1 R2 H Frame D Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLI ATION
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