HomeMy WebLinkAbout52269-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#: 52269 Date: 09/17/2025
Permission is hereby granted to
Mark D King
200 E Mill Rd
Mattituck, NY 11952
To:
Install roof mount solar on existing accessory structure as applied for,with flood permit,.
Disconnects must be located on the exterior, labeled, and readily accessible.
Premises Located at:
200 E Mill Rd, Mattituck, NY 11952
SCTM# 106.-4-5
Pursuant to application dated 08/04/2025 and approved by the Building Inspector,.
To expire on 09/17/2027.
Contractors:
Required Inspections:
Fees:
CO Accessory $100.00
SOLAR PANELS $100.00
Flood Permit $150.00
Total $350.00
Building Inspector
truer
TOWN OF SOUTHOLD —BUILDING DEPARTMENT
Town Hall Annex 54375 Main road P. ®. Box 1179 Southold NCI 11971-0959
Telephone (631) 765-I802 Fax (631) 765-9502 ➢::it w:w:
Date Received
APPLICATION I E I
For Office Use Only
PERMIT NO. Building Inspector: �
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an E
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: SCTM#1000- 0 .. Q 0 p.eos.O ,
Project Address: g o 0
Phone#:
(o '� - g g Q I Email: i��✓>m��- 2�,� .Cc F1
Mailing Address: 'c's
CONTACT PERSON:
Name:
Mailing Address: —7 47 o S ouA
Phone#: (DJ 1 392 Email: e rr"!�S
S � �1•✓►
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address: VO l r 9a " v )V;/- f r) q
Phone#: �� � . �^ g .-� D � . ' Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition FlAlteration ❑Repair ❑Demolition C1 Estimated Cost of Project:
ther l n5-1-�rL1 ar Pv 6 ` '.Z 3 KvLl ors $ a �Z 0 Q. --'
Will the lot be re-graded? ❑Yes;KNo Will excess fill be removed from premises? ❑Yes o
1
PROPERTY INFORMATION
Existing use of property„ Intended use of property'.
Zone or us district in which premises is situated: Are there any coven nts and restrictions with respect to
this property? ❑Yes o IF YES, PROVIDE A COPY.
Check IBox After l:teadli ng: The owner/contractor/design professional Is responslble 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):Lorraine DiPenta Authorized Agent ❑Owner
Signature of Applicant: .� /�`� Ammo Date:
STATE OF NEW YORK)
SS:
COUNTY OF Suffolk
Lorraine DI Penta 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
I�day of —J L ILA 20 2-5 �
�IjIV Public 0&1w N
PROPERTY
applicant IV "IJ hell lON �o� e
(Where the Isnot owner) CIO
h residing at 2-0 19 E7. H1 P fZA
�&- "I c ) doh reby authorize Lo w, pl to apply I' on
my behalf to the Town of Southold Building Department for approval as described herein„
-7 ` 3 z=-*
Owner's Signature Date
.Hp-rk IQ 1
Print Owner's Na e
2