HomeMy WebLinkAbout40453-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
• SOUTHOLD'NY
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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.#: ' 40453 Date: 2/4/2016
Permission.is hereby granted to:
Antoniadis, Dimitrios
3300 North Sea Dr
Orient, NY 11957
To: Electric Service
At-premises located at:
1275 Greenway W, Orient
SCTM #473889
Sec/Block/Lot# 15.-1-25
Pursuant to application dated 2/4/2016 and approved by the Building Inspector.
To expire on '8/5/2017.
Fees:
ELECTRIC $85.00
Total: $85.00
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spector
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Town Hall Annex Telephone(631)765-1802
54375 Main Road N aaxx{631)765ggQ
OP.O.Box 1179 r0 er.rchertWr.SOO ,n .US
Southold,NY 11971-0959 �O
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: ��m � ' Date:
Company Name:
Name:
License No.: -
Address: V I
Phone No.:
JOBSITE INFORMATION: (*Indicates required information) 1� b Lf F.113 I'
*Name: _ 1/ I / Q
*Address: a`� f1�FAJ J 0 74Cz��Si
*Cross Street: vR 10 -
*Phone No.:
Permit No.:
Tax Map District: 1000 Section: _ Block: Lot:
*BRIEF DES RIPTION OF WORK(Please Print Clearly)
(Please Circle All That Apply)
*Is job ready for inspection: (2�Dl NO. Rough In Fina
*Do-you need a Temp Certificate: YE / NO
Temp Information_(if needed)
'Service Size: Cl Phase Whase 00 150 200 300 . 350 400 Other
ew Seni , Re-connect- Underground Number of Meters Change of Service verhea
Additional Information: PAYMENT DUE WITH APPLICATION
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.82=Request for Inspection Form U yL�'�