HomeMy WebLinkAbout51976-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 PLAINS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 51976 Date: 06/06/2025
Permission is hereby granted to:
Mark D King
200 E Mill Rd
Mattituck, NY 11952
To:
install roof-mounted solar panels to existing single-family dwelling as applied for with flood permit.
Premises Located at:
200 E Mill Rd, Mattituck, NY 11952
SCTM# 106.-4-5
Pursuant to application dated 04/30/2025 and approved by the Building Inspector.
To expire on 06/06/2027.
Contractors:
Required Inspections:
Fees:
SOLAR PANELS $100.00
ELECTRIC -Residential $125.00
CO-RESIDENTIAL $100.00
Flood Permit $150.00
Total $475.00
Building inspector� �
TOWN OF SO TFIOLD —BUILDING DEPARTMENT
T
Town Hall Annex 54375 Main Load F. 0. Box 1179 Southold, NY 11971-0959
Telephone (631) 765-1802 Fax(631) 765-950
0
Cate Received
PERMITAPPLICATION FOR BUILDING
For Office Use Only
1 �f q� I 1,
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o i PERMIT NO. Building lnspeCtor_ m�
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Applications and forms must be gilled out in their entirety.Incomplete i t, APR 3 0 2025 �
applications will not be accepted. @M>Ofioere the Applicant is not the owner,an
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Owner's Authorization forma(Page 2)shall be completed, J
Date
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OVame: 'RiDPEI3'�Yo O+4 NE
Protect Address: a d o e. 1 ,1 k , l aZ
Phone#:
3 3 - Email: CC r
Mailing Address: C� NJ
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CONTACT PEA No J
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Name: ?
Bailing Address: -7 4� ® 'OLA
Phone#: (P3 1 3 9 2 d7 0'4 1 Email: P rf4 f, if, -S
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DESIGN PROFESSIONAL INFORMATION.-
Name:
Bailing Address:
Phone#: Email;
el
CONTRACTOR INFORMATION:
Bailing Address:
Phone#: 6 b i D 4 11 Email: 'fir .. . corn
DESCRIPTION OF PROPOSED CONSTRUCTION
then l n3°�- ,,l � a )&Ly- P� p - $ )� f Project:
❑New Structure ❑Addition ❑Alteration ❑Re air ❑Demol"tion Estimated Cost o
Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? ❑Yes 10
1
PROPERTY INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
fQ" this property? ❑YesI;& IF YES, PROVIDE A COPY.
eCk Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
C apter 2S6 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 210A5 of the New York State Penal Law.
Application Submitted By(print name): I'—lZl.l� .�� le�- ®,Qy,lthorized Agent El owner
Signature of Applicant: Date: Lf l�q fay
STATE OF NEW YORK)
SS:
COUNTY OF;St, (4,5 l� , )
Lo a& N t IJ t 1''�]CJ k being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the n4 � -(—
(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 �� l 200?-5- w : .�.. .---1—.
Nl Public
LOUTS J ROMEO
PROPERTY OWNER AUTHORIZATION Notary Public,State of New York
No.01 R06314813
(Where the applicant is not the owner) Qualified in Suffolk County
Commission Expires November 17,20__&
I, Derl)`5c, K l' residing at C:� 00 . Mill k,
�W+) 4UC ado hereby authorize�Lb�l �� to apply on
C
my be If to the Town of Southold Buildi Department for approval as des ribedd herein.
• 1
Owner's Signature Date
Kiba
Print Owner's NarQej
2
BUILDING DEPARTMENT- Electrical Inspector
TOWN of SOUTHOLD
Town Flail Annex - 54375 Main Road - PO Sox 1179
Southold; New York 1 1 971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION II Information Required) Date:
CO mpany dame. E1 -e nta1' " � n L L-,C-
�Electrician's Name:
)- T
N License No.: ` �.. � ( '' Elec. email: ����m
r Elec. Rhone No:
`�� w�� ®I request an email copy of Certificate of Compliance
Elec. Address.: - �� � q V� ��� � , ' _
JOB SITE JNFORMATION (All Information Required)
Name: ,i
n fA
Address: 00 "
Cross Street: ll'o"" 1, C-t
Rhone No. 1, . -1 (o -730
Bld Permit#.
9 email: a C-1 itf.�QS S , un
Tax Map District: 1000 Section: Q J Block: o� Lcrt: I
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BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
P V' -
Square Footage:
Circle All That Apply:
Is job ready for inspection?: L__I YES N NO Ej Rough In Final
Do you need a Temp Certificate?: E] YES O Issued On
rE]Te,mTp Infolrn ation: (AII information required)
Service Size 1 Ph3 Ph Size: A #Meters Old Meter#
ewServiceQFire Reconnect OFlood Reconnect®Service Reconnect®underground❑Overhead
Underground Laterals 1 M2 Fi Frame Pole Work done on Service? Y N
Additional Information,
PAYMENT,OLI WIT i APPLICATION