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Home My WebLink About53127-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#: 53127 Date: 07/15/2026 Permission is hereby granted to: John Bloom 1240 Glenn Rd Southold, NY 11971 To: Install roof mounted solar panels to an existing single-family dwelling as applied for per manufacturers specifications.Additional certification may be required. Floodplain development permit is required. Premises Located at: 1240 Glenn Rd, Southold, NY 11971 SCTM#78.-2-30 Pursuant to application dated 06/24/2026 and approved by the Building Inspector. To expire on 07/14/2028. Contractors: Required Inspections: Fees: SOLAR PANELS $100.00 CO-RESIDENTIAL $100.00 Flood Permit $150.00 Total S350.00 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone(631) 765-1802 Fax(631) 765-9502 httt)s://www.soudiolcitowiiny.gov w"d fd dG Date Received gd 2 APPLICATION FOR BUILDING PERMIT � For Office Use Only � `` �; ,. PERMIT NO. Building Inspecton d9t�li�rfin. Oopam�n1" Applications and forms must be filled out in their entirety.Incomplete of S r��af applications will not be accepted. Where the Applicant Is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date:6/22/2026 OWNER(S)OF PROPERTY: d, 30 Name:Lorena Bloom scTM#1000- 0500078000200030000 Project Address: 1240 Glenn Road, SOUTHOLD, New York 11971 Phone#: 516 835-1533 1 Email: johnbloomcd62@gmail.com Mailing Address: 1240 Glenn Road, SOUTHOLD, New York 11971 CONTACT PERSON: Name:Alex Yackery Mailing Address:100 Charlotte Ave. Hicksville NY 11801 Phone#:516-234-9991 Email:Permittingny@venturehome.com DESIGN PROFESSIONAL INFORMATION: Name:Patrick Busset Mailing Address:100 Charlotte Ave. Hicksville NY 11801 Phone#:516-234-9991 Email:permittingny@venturehome.com CONTRACTOR INFORMATION: Name:Venture Home Solar LLC -Alex Yackery Mailing Address:100 Charlotte Ave. Hicksville NY 11801 Phone#:516-234-9991 Email:Permittingny@venturehome.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ®'Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $ $18 517.95 Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes ONo 1 PROPERTY INFORMATION Existing use of property:Residential Intended use of property:Residential Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes ONO IF YES,PROVIDE A COPY. 8 Check Box After er 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 demolltion 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 ofthe New York State Penal Law. Application Submitted By(print name):Alex Yackery BAuthorized Agent El Owner Signature of Applicant: Date: 6/22/2026 STATE OF NEW YORK) SS: COUNTY OF ) Alex Yackery being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)heisthe Contractor- Venture Home Solar LLC (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 22nd Jun 26 day of 20 STEPHEN JOHN LUISE JIL otar blic NOTARY PUBLIC,sTATE OF NEW YORK Registration No.02LU6407287 Qualified in'Sufi`olk 0,aUV P 11 11 OWNER AUTHORIZA°)°ION My commission Expires " e the applicant is not the owner) Lorena Bloom residing at 1240 Glenn Road, SOUTHOLD, New York 11971 I, . Alex Yackery-Venture Home solar do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. a 6/22/2026 Owner s S'ignature Date Lorena Bloom Print Owner's Name 2 V BUILDING DEPARTMENT- Electrical Inspector ' a TOWN OF SOUTHOLD ' own Hall Annex- 54375 Main Road - PO Box 1179 n Southold, New York 11971-0959 " Telephone (631) 765-1802 - FAX 631 765-9502 rogerr@sou�tholdtownny.gov seand southoldtownn . ow APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date:6/22/2026 Company Name: Venture Home Solar LLC Electrician's Name: Jason P. Sampogna License No.: ME-60556 Elec. email: permittingny@venturesolar.com Elec. Phone No: 516-234-9991 ❑I request an email copy of Certificate of Compliance Elec. Address.: 100 Charlotte Ave Hicksville, NY 11801 JOB SITE INFORMATION (All Information Required) Name: Lorena Bloom Address: 1240 Glenn Road, SOUTHOLD, New York 11971 Cross Street: Phone No.: (516) 835-1533 Bldg.Permit#: email:johnbloomcd62@gmail.com 11 Tax Map District: 1000 Section: 17L Block: Loi BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): PV ROOF-MOUNTED SOLAR INSTALLATION 11.00 PANELS, 11 MICROINVERTERS, 4.785 kW Square Footage- Circle All That Apply: Is job ready for inspection?: YES n✓ NO n Rough In ❑ Final Do you need a Temp Certificate?: 11 YES NO Issued On 'Temp Information: (All information required) Service Size111 Ph 3 Ph Size: A #Meters Old Meter# ❑New Service❑Fire Reconnect[]Flood Reconnect❑Service Reconnect❑Underground❑✓Overhead #Underground Laterals 1 2 H Frame n Pole Work done on Service? Y EIN Additional Information: PAYMENT DUE WITH APPLICATION