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Home My WebLink About46623-Z 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) Permit#: 46623 Date: 7/27/2021 Permission is hereby granted to: Kubtm Jacob _... ...... .. ---11—..----------...-.--1 255 Knollwood Ln ........ _wwww............. _______. _.wwww____....... ._ _...., _.................... _.. _...._. Mattituck, NY 11952 To: install roof-mounted solar panels with energy storage system to existing single-family dwelling as applied for. At premises located at: 5 Knollwood Ln., Mattituck SCTM # 473889 Sec/Block/Lot# 107.-6-11 Pursuant to application dated 7/16/2021 and approved by the Building Inspector. To expire on 1/26/2023. Fees: SOLAR PANELS $50.00 ELECTRIC $100.00 CO-ALTERATION TO DWELLING $50.00 Total: $........................� 200.00 ilding Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall.Annex 54375 Main Road P. 0. Sox 1.179 Southold,NY 1.1971-0959 Telephone (631) 765-1802 hax (631) 765-9502 �g �://v , a�� haiaNaaaut ss�a Date Received I C. .� u LI I F BUII DI PES D ��a�-.:� � For Office Use Only a� PERMIT NO. .... � _ Building lnspe(tor. .. 2021 . ...,__ _..._.. Applications and forms must be filled out in their entirety.Incomplete 111'i[L1)VgG Hl. .1 applications will not be accepted. Where the Applicant is not the owner,an PP P PP Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name: Jacob T. Kubetz SCTM#1000- Project Address: 255 Knollwood Lane Mattituck, NY 11952 i(0. 2 05 Phone#: 631-766-6397 Email: jacobkubetz@gmail.com Mailing Address: 255 Knollwood Lane Mattituck, NY 11952 CONTACT PERSON: Name:Tesla Energy Operations,lnc./Anais Fernandez Mailing Address: 15 Grumman Rd West Suite 400 Bethpage, NY 11714 Phone#: 631-406-9567 email: anafernandez@tesla.com DESIGN PROFESSIONAL INFORMATION: Name: Equilux Engineers LLC Mailing Address: 4129 Brittany Drive Ellicott City MD 21043 Phone#: 443-416-7800 Email: hkariuki@equiluxengineers.com CONTRACTOR INFORMATION: Name:Tesla Energy Operations,lnc./Anais Fernandez Mailing Address: 15 Grumman Rd West Suite 400 Bethpage, NY 11714 Phone#: 631-406-9567 J Email: anafernandez@tesla.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure E--]Addition 2Alteration ❑Repair ❑Demolition Estimated Cost of Project: 29,055 Will the lot be re-graded? ❑Yes E2No Will excess fill be removed from premises? ❑Yes V1No 1 PROPERTY INFORMATION Existing use of property: Residential Intended use of property: Residential Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? []Yes ONO IF YES, PROVIDE A COPY. 12 Check Box After NReadin : The owner/contractor/design rofessional is res responsible for all drainage and storm water issues as li� P p g provided by Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings, additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code, housing code and regulations and to admit authorized inspectors on premises and in building(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted B runt name): Anais Fernandez DAuthor'zed gent F—JOwner° Signature of Applicant: Date: STATE OF NEW YORK) SS: COUNTY OF Nassau Anais Fernandez being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)he is the_mmm__..m_..... .._.._ _ contractor/agent _.. ... ...... ................_. ._ __ _......_m. (Contractor,Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/her knowledge and belief;and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this t day of r .n._...___ww...�420 Notary Public ZP�RQPIII��M-- _.......,... JTI�IIIII �� IIII 1 "ALEXuAND—SRW,, KOMAPOLWANY Ork (Where the applicant is not the owner) No.01KAM1991 , residing at hereby a u t h o r i ze.___.._..... M.....n. �......_. _._........_......_. ____,to apply on my behalf to the Town of Southold Building Department for approval as described herein. ................_mw_ Owner's Signature _._..__�... g Date Print Owner's Name 2 i muumwwam mouuo . G- 'i uil in a art ent A Ii ti�an AUTHORIZATION (Where the Applicant is not the Owner) I, � a�' residing at (print property owner's name) (Mailing Address) ma��nf�z do hereby authorize Tesla Energy Operations,Inc. (Agent) Anais Fernandez to apply on my behalf to the Southold Building Department. (Owner's Signature) (Date) (PrintOwner's e) M491m)G;McCoy"i,Em poria o:ac�a�sss, "UNA,t i Suffolk County Dept.of Labor,Licensing&Consumer Affairs HOME IMPROVEMENT LICENSE Name CHARLES J PICARD it Business Name This bearer is uly!'c 9w TESLA ENERGY OPERATIONS INC d by Lhe County of su'folt License Number:HI-62558 Frrr+k,Na4vW i, Issued: 9112/2019 Comn*sane• Expires: 9/1/2021 e y.. RECEIPT SUFFOLK COUNTY GOVERNMENT DEPARTMENT OF LABOR, LICENSING,AND CONSUMER AFFAIRS COMMISSIONER ROSALIE DRAGO P.O. BOX 6100, HAUPPAUGE, NY 11788 (631)853-4600 Today Date: 03/22/2021 Application: ME-37295 Application Type: Master Electrical License Receipt No. 421664 Payment Method Ref. Number Amount Paid Payment Date Cashier ID Comments Check 149 $400.00 03/22/2021 CHRIST11 Renewal Contact Info: JASON KANE INC JASON KANE 127 WEST BLVD EAST ROCKAWAY, NY 11518 Work Description: / Suffolk County Dept.of Labor,Licensing&Consumer Affairs e, MASTER ELECTRICAL LICENSE Name JASON KANE e Business Name This cerlIfles that the bearer is duly licensed JASON KANE INC by the County of suffolk License Number:ME-37295 Rosalie Drago Issued: 04/20/2005 Commissioner Expires: 04/01/2023