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HomeMy WebLinkAbout35705-Z FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 35705 Z Date JULY 13 , 2010 Permission is hereby granted to: SUSAN C WARD 4400 OLD NORTH RD SOUTHOLD,NY 11971 for NEW ELECTRIC SERVICE AS APPLIED FOR. INS( l at premises located at 4400 OLD NORTH RD SOUTHOLD County Tax Map No. 473889 Section 055 Block 0002 Lot No. 00s49�. pursuant to application dated JUNE 23 , 2010 and approved by the 5 ' q Building Inspector to expire on JANUARY 13 , 2012 . Fee $ 85 . 00 Authorized Signature COPY Rev. 5/8/02 j ;TOWN OF SOUTHOLD BUILDING DEPARTMENT Roger Richert Electrical Inspector 765-1802 Temporary Certificate Date Z-3 f Number of Meters S/B/L Size d Phase # 007 f Overhead Underground New Service Change of Service Reconnect Existing Service Location Issued to U,;>utt rr1-- Installed by 00�6, Et Zafr�> — 671— 74�57- Reference �Ls6 '�eG�rls- pj�� Ui�� �4" Application for electrical service equipment is on file with the Town of Southold. On applicant's notification that this installation is complete, Southold Town will conduct a premises electrical inspection of the service equipment. This verification is valid for 90 days from the above date. Authorized by Division Electrical Inspections i i\QF S�(/r�O Town Hall Annex Telephone(631)765-1802 54375 Main Road H tg aaxxw(63 )765g5 P.O.Box 1179 roend hert0 n1souoQd.ny.us Southold,NY 11971-0959 COU BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: I�' oner)c� � � Date: Company Name: ^ Name: cx1Pr�� c e2 License No.: Adc�ess: Jj�CL1 SOrl Ve, j e q_ Phone No.: 1251 NO S-i x 651-'7 Lf y - 44C.R Ny tel) 651-'7q 3` >4 O JOBSITE INFORMATION: (*Indicates, required information) *Name *Address: sty D» o� '—Qorv� y O© - 0) *Cross Street: *Phone No.: _ L2 Zcf o Permit No.: Tax Map District: 1000 Section: r S Block: Lot: �, 5 *BRIEF DESCRIPTION OF WORK(Please Print Clearly) (Please Circle All That Apply) *Isjob ready for inspection: NO Rough In Final *Do you need a Temp Certificate: YES NO Temp Information (If needed} *Service Size: 1 Phase 3Phase 100 15 00 300 350 400 Other New Service: Re-connect Underground umber of Mete Change of Service Overhead _ o Additional Information: PAYMENT DUE WITH APPLICATION 3C�HM eUL)I LQ- A e5N A c 01 aJ , T � ry-Gfe- hkv_._1_- P111) - 5 i �� 82-Request for Inspection Form �`