HomeMy WebLinkAbout53016-Z �o��Qf��uryo` TOWN OF SOUTHOLD
° BUILDING DEPARTMENT
i 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#: 53016 Date: 05/22/2026
Permission is hereby granted to:
Matthew Viederman
243 Clermont Ave
Brooklyn, NY 11205
To:
install roof-mounted solar panels on an existing accessory garage as applied for.
Premises Located at:
155 Shepard Dr, Southold, NY 11971
SCTM# 78.4-16
Pursuant to application dated 05/14/2026 and approved by the Building Inspector.
To expire on 05/21/2028.
Contractors:
Required Inspections:
Fees:
SOLAR PANELS $100.00
CO Accessory Structure $100.00
Total S200.00
Building Inspector
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TOWN OF SO[JTHOLD--BUILDING DEPARTMENT
TT Town Hall Annex 54.E 75 Main Load P. 0. Boy. 1179 Southold, Y 11971-0959
tV Telephone (631) 765-1802 Fax (631) 765-9502 h .11 N ,,,,,, o ry h , t
Date Received
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, N F I B I 1 111 PEI MIT
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Office
For
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PERMIT Nth. ,�,� � Building I rt s p e ct o r� MAY 1 4 2026
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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 ;q
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Owner's Authorization foam(Page 2)shall be completed.
Date: -f f
OWNER(S)OF PROPERTY:
Name: SCTM # 1000- 1
Project Address: 6.dc'62 0 4... !�d� 120(
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Phone#: 7 _ J Email: . w. .....i
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Mailing Address: /11,55
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CONTACT PERSON:
Name:
Mailing Address: b 4vL,(,iK �L
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Phone#: Email. �
DESIGN PROFESSIONAL INFORMATION:
Name
Mailing Address:
_X
Phone#: Email.
CONTRACTOR INFORMATION:
Names
b') .a
Mailing Address 14
i
Phone#: j Email: j)e.�'
DESCRIPTION OF PROPOSED CONSTRUCTION
F�New Structure ❑Addition ❑Alteration F Repair ❑Dem...olition Estimated Cost of Project:
ether:: `+" r / c'1
.
..........
..............
..............
Will the lot be re-graded? ❑Yes Will excess fill be removed from premises? RYes kAo
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PROPERTY INFORMATION
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Existing use of property. intended use of property. 1�2
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this ❑Ye o IF YES
property? ������� r PROVIDE A COPY.
" Check 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 210.45 of the New York State Penal Law.
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Application Submitted B t�name):
uthor�'l e t Downer
� ti
natur l n : E Sig a arf App scar t � ,� Date Al
..........
STATE OF NEW YORK)
COUNTY E �«.,..
being
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duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the
",-.-..... _ojLr,.�A,
(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 mariner set forth in the application file therewith.
Sworn br efo re t�hifs
/2day of 2D�
Public
PROPERTYWNER AUTHORIZATION
(Where the applicant is not the owner)
I, residing ato
vm
7
gyp, do hereby,authorize o apply on
/..........
my b,eh H, own of Southold Building Department for approval as described herein.
01
ner's Signature Date
L00UIS
Notary Public,State, �of New.
Print Owner's Name Pualified in Suffolk County
Commission Expires Novem er 7,20
2