HomeMy WebLinkAbout53111-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#: 53111 Date: 07/07/2026
Permission is hereby granted to:
JSK Park Ave LLC
159 W 24th St Apt 7B
New York, NY 10011
To:
install roof-mounted solar panels to an existing single-family dwelling as applied for.
Premises Located at:
2150 Park Ave, Mattituck, NY 11952
SCTM# 123:8-10.1
Pursuant to application dated 06/22/2026 and approved by the Building Inspector.
To expire on 07/06/2028.
Contractors:
Required Inspections:
Fees:
SOLAR PANELS $100.00
CO-RESIDENTIAL $100.00
Total 200.00
4uirding Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
'q Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold NY 11971-0959
Po
a1802 Fa631l765-9502tS Tele l -----------------------------------------
Date Received
APPLICATION FOR BUILDING PERMIT
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 yawner,an
Owner's,Authorization form(Fags 2)shall be completed. PP
of
Date-,
OWNER(S)O PROPERTY.
TY:
Name: SCTM#1000- ot \
Project Address:2150 Park Avenue, Mattituck, NY 11952
Phone#: Email:
Mailing Address: 10011
fJ N'11, f*3
CONTACT PERSON:
Name:Barbara - CreenLogic LLC
MailingAddress:g7 North Sea Road, Southampton, NY 11968
Phone#:531-771-5152 x117 Email:Barbara@Greenlogic.com
DESIGN PROFESSIONAL L INFORMATION:
Names 6=
I 6.101
Mailing Address,,
i v
e
Phone#: Email•SOW-&
CONTRACTOR INFORMATION.
Name:GreenLogic LLC
Mailing Address:97 North Sea Road, Southampton, NY 11968
Phone#:531-771-5152 Email:AM Greenly ic.com
DESCRIPTION OF PROPOSED CONSTRUCTION
� 9
❑New Structure ❑Addition WAlteration ❑Repair ❑Demolition Estimated Co of Project:
F Other Solar Panels
Will the lot be re-graded? ❑Yes WNo Will excess fill be removed from premises? ❑Yes R No
1
.......................................................................................
................................
PROPERTY INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any covenant and restrictions with respect to
his property? FlYes RN No IF YES,, PROVIDE A COPY.
'he c k B o x Aft e r R ea di n g" The owner/contractor/design professional Is responsible for all drainage I I 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 buildinigs,
additions.,alterations or for removal or demolition as herein described.The applicant agrees to'comply with all,applicable ,ordinances,building code,
housing code and regulations and to admit authorized Inspectors on premises and In building(s)for necessary Inspections.False statements made he are
PU nishable as a Class A misdemeanor pursuant to Section 210AS of the New York State Penal Law.
H% Ww"ORPRP10114 I" I
Application Submitted By(print name):GreenLogic LLC RAuthorized Agent El owner
Signature of Applicant: ✓ 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,
Nhe 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 aw
day of 20-:7—(o Coil
---------- e&4, a e-
Notary Public
BARBARA A CASCIOTTA
Notary Public-State of Now Yo*
Nm,,01CA09490
PROPERTY OWNERAUTHORIZATION
0� OwNWIn ftftk Cw*
(Where the applicant is not the owner) Camission Exptm,May'J If,,,2W
I XA M,t residing at
..........
,do hereby authorize GreenLogic LLB to apply on
my behalf to the Town of Southold Building Department for approval as described herein,
owner's Signature Date
-A
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