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HomeMy WebLinkAbout39677-ZPermit #: 39677 TOWN OF SOUTHOLD BUILDING DEPARTMENT 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) Permission is hereby granted to: Brenner Ellen 2007 Trt Part C 27 Club House Ct Jericho, NY 11753 To: new switches and outlets�or 3 6drod" and 2 bathrooms S Lb At premises located at: 40 South Ln, East Marion SCTM # 473889 Sec/Block/Lot # 37.-6-4 Date: 4/14/2015 Pursuant to application dated 4/14/2015 and approved by the Building Inspector. To expire on 10/13/2016. Fees: ELECTRIC $90.00 Total: $90.00 REQUESTED BY. Company Name: Name: Date: �/G, /J License No.: 7,Y Address: Phone No.:. / JOBSlTE INFORMATION: (*indicates required information) OM14 '7 � �����Gzr-�� *Name: ,�•T� it1� - *Address: L q2JAS'i Ca *Gross Street: OLP ©a 4/LD C t *Phone No.: 76 Z %L -` _ Pen -nit No.: Tax -Map District: 1000 Section: - --- Block: ---(, Lot: 4 *BRIEF DESCRIPTION OF WORK (Please Print Clearly) SLLJ (Please Circle All That Apply) _ *Is job ready for inspection: E NO. Rough in Final *Do -you -need a Temp Certificate: YES O Temp Information (if needed) *Service Size: 1 Phase 3Phase 100 150 200 300 350 .400 Other *New Service: Re -connect Underground Number of Meters Change of Service Overhead Additional Information: PAYMENT DUE WITH APPLICATION .82=Request for Inspection Form