HomeMy WebLinkAbout53286-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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#: 53286 Date: 09/17/2026
Permission is hereby granted to:
Wang MH Irry Edu Trt
338 E 67th St Apt 3
New York, NY 10971
To:
Install roof mounted solar panels to an existing single-family dwelling as applied for per
manufacturers specifications.Additional certification may be required.
Premises Located at:
1085 Gin Ln, Southold, NY 11971
SCTM#88.-4-9
Pursuant to application dated 09/01/2026 and approved by the Building Inspector.
To expire on 09/16/2028.
Contractors:
Required Inspections:
Fees:
SOLAR PANELS $100.00
CO-RESIDENTIAL $100.00
Total $200.00
wilding inspector
�rtwa ., TOWN OF SOUTHOLD—BUILDING DEPARTMENT
p Town Hall Annex 54375 Main Road P. O. Box 1 179 Southold, NY 11971-0959
Telephone (631) 765-1802 Fax(631) 765-9502 httf)s://'w,ww.sotitholdtowntiy.gov
Date Received
APPLICATIONIL IPERMIT
For Office Use Only I
E G � 1:!
9`''''PERMIT No. 5 3� Building Inspector: A, --_ G
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an Building Department
Owner's Authorization form(Page 2)shall be completed. Town of Southold
Date:
OWNER(S)OF PROPERTY:
Name: �i'mo-)1� l�v t SCTM#1000- U� Ua ` p00 _ Q 000
Project Address: h j l�-a" V 7 1
Phone#: 1 - ' U 22 -v (p e1 g Email: ►'?
Mailing Address:
CONTACT PERSON:
g
Mailing Address: 7 41 o . 1 ?i
LknLi
Phone#: I( 2 , L
t.LJ cJ 1'a� � � 0 `-I � Email: crnl 1" 's, C..C'""+'r
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: ole-)
MailingAddress^l 4-1 C) go',Lt, �c H&44)�+LtC K- �) A .
Phone#: 3 j --7-7 9 -2 09 Email: ) le—, d.6 C dyn
a
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition] ❑Alteratian ❑Repai ❑17emalition Estimated Cost of Project:
ether .. p' ° , $ a
Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? OYesVNo
1
PROPERTY INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which is situated:: Are there any covens is and restrictions with respect to
this property? Dyes o IF YES,PROVIDE A COPY.
heck Born After Reading: The owner/contra ;or/ professional'Is r sponsiblefor all drainageand storm water issues as provided by
r 236 of the Town Code. APPUCATit1N IS HFRFaY 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 anther applicable Laws,Ordinances or Regulations,for the construction of buildings,
additions,alterations orfor 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 230.4S of the New York State Penal taw.
Application Submitted By(print name): L rrrtk , w ' n�- [authorized Agent ❑Owner
Signature of Applicant: {�(�'h-' Date:
STATE OF NEW YORK)
SS:
COUNTY OF Is L'l )
6► i9e n+u- being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the �0 n T�C-�-Oy--
(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
,
day of _ 20 Zb
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
1 i ►�17 o-�h � U-� residing at 'S
11"'! do hereby authorize G-O i' Pt V1 4' to apply on
my behalf t he Town of Southold Building Department for approval as described herein.
Owner's Signature ate
LOUIS J ROMEO
Lk)dL yt 4 Notary Public,State of New York
No.01 R06314813
Print O s Name Qualified in Suffolk County
Commission Expires November 17,20 iL6
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