HomeMy WebLinkAbout51795-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#: 51795 Date: 04/01/2025
Permission is hereby granted to:
Casarona J Revoc Trt
PO BOX 1149
Cutchogue, NY 11935
To:
Install roof mounted solar panels to an existing single-family dwelling as applied for.Additional
certification may be required.
Premises Located at:
705 Birch Ln, Cutchogue, NY 11935
SCTM#83.-1-26
Pursuant to application dated 02/24/2025 and approved by the Building Inspector.
To expire on 04/01/2027.
Contractors:
Required Inspections:
Fees:
SOLAR PANELS $100.00
CO-RESIDENTIAL $100.00
ELECTRIC -Residential $125.00
Total $325.00
Building Inspector
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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 'rtps://Nvww.soti!t!�l�oldtowni y
4
APPLICATION FOR BUILDING PERMIT
n�
Date Received
For Office Use Only
PERMIT N0. (5 Building Inspector,
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Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an rti
Owner's Authorization form(Page 2)shall be completed.
Date. -?/QD ) --?5'
OWNER(S)OF PROPERTY:
Name:Joseph Casarona SCTM#1000-83-1-26
Project Address: 705 Birch.., Cutchogue, NY 11935
Phone#:347-888-7844 r_VX: I Email: jasarona@mac.com
Mailing Address:P.O. Box 1149, Cutchogue, NY 11935
CONTACT PERSON:
Name: Evelyn Polvere/Sunation Solar Systems
Mailing Address: 171 Remington Blvd., Ronkonkoma, NY 11779
Phone#: 631-750-9454 ext 346 Email:permitting@sunation.com
DESIGN PROFESSIONAL INFORMATION:
Name:Michael Dunn
Mailing Address:256A Orinoco Drive, Brightwaters, NY 11718
Phone#: 631-665-9120 Email:glenn@grahamassociatesny.com
CONTRACTOR INFORMATION:
Name:Scott Maskin/Sunation Solar Systems
Mailing Address:171 Remington Blvd., Ronkonkoma, NY 11779
Phone#: 631-750-9454 Email:permitting@sunation.com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition RAlteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $ I I
Will the lot be re-graded? ❑Yes *No Will excess fill be removed from premises? Dyes BNo
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 BNo IF YES, PROVIDE A COPY.
4Check 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 210AS of the New York State Penal Law.
Application Submitted By(print name): Sco askln BAuthorized Agent ❑Owner
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
COUNTY OF Suffolk
Scott Maski n being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the Contractor
(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
w �
day of ✓ IM^" ,20 5
Notary Public LY N VITA
i4otary Public, Stale of New York
Registration -#01'�15068369
O�ii li61r d in 3walleN County
PROPERTY OWNER AUTHORIZATION my Commission 'I x�.Ires Oct. ,20 P
(Where the applicant is not the owner)
Joseph Casarona residing at 705 Birch
Cutchogue do hereby authorize Scott Maskin
_ ....... ---_to apply on
my alf to thaTown of Southold Building Department for approval as des gibed herein.
� 3
` Owner's Signature Date
J �s',eph Casarona
Print Owner's Name
2
BUILDING DEPARTMENT-Electrical Inspector
TOWN OF SOUTHOLD
iq Town Hall Annex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
4 w
°w Telephone (631) 765-1802 - FAX (631) 765-9502
ro err southoldtownn , ov— seand@souitholdtownnygov
APPLICATION FOR ELECTRICAL. INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date:
Company Name: SUNation Solar Systems, Inc
Name: Scott Maskin
License No.: 33412-ME email: permitting@sunation.com
Address: 171 Remington (Blvd. Ronkonkoma NY 11779
Phone No.: 631-750-9454
JOB SITE INFORMATION (All Information Required)
Name: Joseph Casarona
Address: 705 Birch ad Cutchoclue, NY 11935
Cross Street:
Phone No.: 347-888-7844
g.Bld Permit#: email: 'casaronamac.com
Tax Map District: 1000 Section: 83 Block: 1 Lot: 26
BRIEF DESCRIPTION OF WORK (Please Print Clearly)
Circle All That Apply:
Is job ready for inspection?: YES / NO Rough In Final
Do you need a Temp Certificate?: YES / NO Issued On
Temp Information: (All information required)
Service Size 1 Ph 3 Ph Size: A #Meters Old Meter#
New Service - Fire Reconnect- Flood Reconnect- Service Reconnected - Underground - Overhead
Underground Laterals 1 2 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
Request for Inspection FormAs
NY F PO Box 66699,Albany,NY 12206
New York State Insurance Fund I nysif.com
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
A A A A A A 753118816 ..
GCG RISK MANAGEMENT INC
AN NFP COMPANY
100 CHURCH STREET-SUITE 810
NEW YORK NY 10007
SCAN TO VALIDATE
AND SUBSCRIBE
POLICYHOLDER CERTIFICATE HOLDER
SUNATION SOLAR SYSTEMS INC TOWN OF SOUTHOLD
171 REMINGTON BOULEVARD 54375 ROUTE 25
RONKONKOMA NY 11779 SOUTHOLD NY 11971
POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE
Z 2160 670-2 500704 01/01/2025 TO 01/01/2026 12/02/2024
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 2160 670-2, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS'
COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE
STATE OF NEW YORK, EXCEPT AS INDICATED BELOW,AND,WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK,TO
THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY.
IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF
CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE, VISIT OUR WEBSITE AT HTTPS:/MIWW.NYSIF.COM/CERT/
CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH
NOTIFICATIONS.
THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY
COMPANY.
THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT
OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN
WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE
EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN
CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE
COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE
AFFORDED BY THE POLICY.
NEW YORK STATE INSURANCE FUND
DIRECTOR,I SURANCE FUND UNDERWRITING
VALIDATION NUMBER: 273292463
0lll 0H0�00001�0 0 0l 1 134 011 0 1111111
6 4 7 � 1
I loll 111111IIIl I���NII
Form WC-CERT-NOPRINT Version 3(08/29/2019)[WC Policy-21606702] U-26,3
62 [ODOODOOOOOD134908764][0001-000021606702][##Z][16526-41][Cer[_NoP-CERT 1][01-00001]
Suffolk County Dept. of
Labor, Licensing & Consumer Affairs
MASTER ELECTRICAL LICENSE
Name
SCOTT A MASKIN
y
Business Name
SUNATION SOLAR SYSTEMS INC
This certifies that the
bearer is duly licensed License Number ME-33412
by the County of suffolk Issued: 06/24/2003
Way we., T. Rogery Expires: 06/01/2025
Commissioner
Suffolk County Dept. of
Labor, Licensing & Consumer Affairs
HOME IMPROVEMENT LICENSE
Name
SCOTT MASKIN
Business Name
SUNation Solar Systems Inc
This certifies that the
bearer is duly licensed License Number H-44104
by the County of suffolk Issued: 03/06/2008
Wa,y",� T. Rog&ry Expires: 03/01/2026
Commissioner