HomeMy WebLinkAbout52875-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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..b` SOUTHOLD., NY
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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#: 52875 Date: 04/17/2026
Permission is hereby granted to:
Timothy J Rice
398 W Neck Rd
Huntington, NY 11743
To:
install accessory ground-mounted solar panels as applied for.
Premises Located at:
4390 Mill Ln, Mattituck, NY 11952
SCTM# 107.-5-1.3
Pursuant to application dated 04/06/2026 and approved by the Building Inspector.
To expire on 04/16/2028.
Contractors:
Required Inspections:
Fees:
SOLAR PANELS $100.00
CO Accessory $100.00
Total S200.00
�i~ Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
ryy �l Town Hall An-1ex 54375 Main Road.P. 0. Box 1179 'Southold.NY 11971-0959
�r Telephone (631) 765-1802 Fax (631) 765-9502 /'" ,,.s ho o 07
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APPLICATION FOR BUILDING PERMIT
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For Office Use Only
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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
Owner's Authorization form(Page 2)shall be completed.
Date.411
OWNER(S)OF PROPERTY:
Name:TimothySCTM# 1000- -.
107 5 ��
Project Address:4390 Mill Lanes MattituCk, NY 11952
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Phone#:
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831_405_���� Email:t,mer'lce8@gma'll.com
Mailing Address.'
CONTACT PERSON:
Name:Barbara - GreenLogic LLC
Mailing Address:97 Forth ,lea Road, Southampton, NY 11968
Phone#:631-771-5152 x117 Email:Barbara@
DESIGN PROFESSIONAL INFORMATION:
Nam e-o JaffWS J. StoUt ArChiterat,& Assoc''rt
Mailing Address:2GregLane, E. Northport, NY 11731
........
Phone#:631-858-9388 Email:stouthub@jamesstoutarch.com
CONTRACTOR INFORMATION:
Name: reenoi i'C LLB
Mailing Address,97 North Sea Road, Southampton, NY 11968
Phone#:8,31-771-5152 Email:AM@Greenlogic.com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑Nevw Structure ❑Addition `Alteration n Repair ❑Demolition Estimated Cast of Project:
i
r-�Other Ground mounted solar panels $� 150,000
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Will the lot be re-graded? 17 Yes *No W-111 excess fill he removed frorn premises'? OYes *No
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PROPERTY INFORMATION
Existing use of property: Agriculture Intended use of property: residence
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
AC this property? E]Yes No IF YES, PROVIDE A COPY.
*�Wwwww OMMMMMMM "I' , I'll I
91 Checl(Box After Read"1119101 'The owner/contractor/desip professional is responsible for all drainage and storm water Issues as provided by
Chapter 236 of the Town Code.APPUCATION 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): �reenLogic LLC @Authorized Agent 0Owner
Signature of Applicant: 10001���� Date:
STATE OF NEW YORK)
SS:
COUNTY OF Suffolk
Nesim Albukrek
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
day of 20
Notary Public
WoMAACASCKMA.
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jk"yPub "We of NW ftt
PROPERT,Y OWNER AUTHORIZATION Ift 01,CA4W9% "
(Where the applicant is not the owner) Qu~(, ,In$Oolk Coo*
Ow,m"w Eow May I I
IV Tim Rice residing at 398 West Neck Road, Huntington, NY 11743
11743 do hereby authorize �reenLog�c LLC to apply on
my behalf to the Town of Southold Building Department for approval as described herein.,
9/12/2025
Date
Owners Signature
Tim Rice
Print owner's Name
2
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