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Home My WebLink About51565-Z TOWN OF SOUTHOLD-BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax(631) 765-9502 btt ://www.southoldtownny. e� Date Received APPLICATION FOR BUILDING PERMIT . r For Office Use Only PERMIT NO. Is 1 y s Building Inspector. AK Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,anp Owner's Authorization form(Page 2)shall be completed. " Date: OWNER(S)OF PROPERTY: Name: SCTM#1000- Project Address: -I F5b L.-. a Phone#: ?�1� $ - 4-0 S Email: el °L Mailing Address. -) , CONTACT PERSON: Name: ' k` Mailing Address: 2941 Sunrise Hwy, Islip Terrace, NY 11752 Phone#: (631) 647-3402 Email: hppermitting@harvestpower..net DESIGN PROFESSIONAL INFORMATION: Name: Michael Dunn, R.A. Mailing Address: 256 Orinoco Dr, Brihtwaters, NY 11718 Phone#: (631) 665-9619 --TEmail: Bayblueprint@aol. com CONTRACTOR INFORMATION: Name: Harvest Power LLC -7 Mailing Address: 2941 Sunrise Hwy, Islip Terrace, NY 11752 Phone#: (631) 647-3402 Email: hppermitting@harvestpower.net DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ®Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other 1 - � Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes jKNo 1 PROPERTY INFORMATION Existing use of property: Residence Intended use of property: (no change) Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes ®No IF YES, PROVIDE A COPY. ® Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as 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 By(pri t name): �( }e.1�n'Z�c'ce� 'Authorized Agent ❑Owner Signature of Applica Date: 1 A 4 STATE OF NEW YORK) SS: COUNTYOF a�A� KaAe--,�Lin �. being duly sworn,deposes and says that(s)he is the applicant (Name of individual Wing contract)above named, (S)he is the ontractor,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 day of 20�2q NOTARY PUBLIC,Ca NA NSA BLIC,STATE OF NEW YORK Rerlislration N(-, 01 LA6034714 Oualfflod in Suffolk County PROPERTY OWNER AUTHORIZATIC N Commission Ex ire May 30„20 �wro�rim.� 1, l \ residing at . b 1 I do hereby authorize LLC to apply on me do my behalf To touthold Building Department for approval as described herein. Owner's figniature Date Print Owner's Name 2 ,d �y , Ty BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 - Telephone (631) 765-1802 - FAX (631) 765 9502 a nr 'amesh southoldtownn .1 ov Z seand southoldtownn . ov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 11/12/2024 Company Name: Harvest Power LLC Electrician's Name: Carlo Lanza License No.: ME-68518 Elec. email: hppermifting@harvestpower.net Elec. Phone No: 631 647-3402 01 request an email copy of Certificate of Compliance Elec. Address.: 2941 Sunrise Highway, Islip Terrace, NY 11752 JOB SITE INFORMATION (All Information Required) Name: Gabriel Kochmer Address: 780 Legion Avenue, Mattituck, NY 11952 Cross Street: Pacific Street Phone No.: (312) 218-5599 Bldg.Permit#: rj j 5 email:gkochmer@gmail.com Tax Map District: 1000 Section: 142 Block: 2 Lot: 13.1 BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Installation of a 4.60 kW solar PV system with (10) REC460AA roof-mounted panels. Square Foota e: Circle All That Apply: Is job ready for inspection?: El YES R NO []Rough In ✓ Final Do you need a Temp Certificate?: Fv YES F] NO Issued On Temp Information: (All information required) Service Size1:11 Ph E3 Ph Size: 200 A #Meters 1 Old Meter# ❑New Service❑Fire Reconnect[:]Flood Reconnect❑Service Reconnect❑Underground❑✓Overhead #Underground Laterals 1 2 H Frame Pole Work done on Service? Y nN Additional Information: PAYMENT DUE WITH APPLICATION r Ruildil1g,Department Agplication AUTHORIZATION (Where the Applicant is not the Owner) residing at " � (Print property owner's name) (Mailing Addret do hereby authorize necc� (Agent) Harvest Power LLC to apply on my behalf to the Southold Building Departrne (dwraer's Signattt ()ate) (Print Owner's.Name) n CONSENT TO INSPECTION L-Q�rc( ,the undersigned,do(es)hereby state: Owner(s)Name(s) wner(s)of premises in the Town of Southold, located at ( )( re the o I That the undersign is which is sho rid designated on the SuffolkCounty Tax �elap as [district 1000, Section , Block Q , Lot )S, I— That the undersigned(has)(have)filed,or cause to be filed,an application in the Southold Town Building Inspector's Office for the following, \ That the undersigned do(es)hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and all buildings located thereon,to conduct such inspections as they may deem necessary with respect to the aforesaid application, including inspections to determine that said premises comply with all of the laws,ordinances,rules and regulations of the Town of Southold. The undersigned, in consenting to such inspections;do(es)so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used in subsequent prosecutions for violations of the laws,ordinances,rules or regulations of the Town of Southold. Dated: gnatu�) Print Nam � t�nature) (Print Name)