HomeMy WebLinkAbout53188-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#: 53188 Date: 08/10/2026
Permission is hereby granted to:
Brian Pessin
65 E 76th St 3DE
New York, NY 10021
To:
Install roof mounted solar panels to an existing single-family dwelling as applied for as per
manufacturers specifications.
Premises Located at:
3200 Soundview Ave, Mattituck, NY 11952
SCTM#94:2-5
Pursuant to application dated 07/02/2026 and approved by the Building Inspector.
To expire on 08/09/2028.
Contractors:
Required Inspections:
Fees:
SOLAR PANELS $100.00
CO Single Family Dwelling-Addition/Alteration $100.00
Total $200.00
Building Inspector
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APPLICATION FOR BUILDING PERMIT
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For Office Use Only C E E
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Applications and forms must be filled out in their entirety.Incomplete
appiicaticns will not be accepted W� ,ere the.Appfic,a is rest the or�erY ard u"dIn Department i'
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° OMCT PERSON-
Name: l g --
Name: Lo ry-A-;
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Mailing Address.-
Phone#: "
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CONTRACTCM IiEORPRt
Name-
Mailing Address: a q a V
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Phone#: ' Email: �9
DESCRUIP711 OF PROPOSED C10"MUCTION
❑flew Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estiated Cost of Project:
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Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? ❑YesNoh
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PROPERTY INFORMATION
Existing use of property: Intended use of property::
Zone or use d' rict in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes)Vo IF YES, PROVIDE A COPY.
*heck Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapter 216 of the'Town Code. APPLICATION IS HERESY 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.
Application Submitted By(print name): Lo y�-rau,� f/� ��o� 1Authorized Agent OOwner
Signature of Applicant: &A,4 � `XD4 ;OtA4, Date: 6 11,:Y42,
STATE OF NEW YORK)
COUNTY OF j -
Q 12 e CA-I" . 4:) ) PC,i-)t' being duly sworn,deposes and says that (s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the
(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
r 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
ay of D
Notary Pu is
AUTHORIZATIONPROPERTY OWNER
(Where the applicant is not the owner)
I, By 1'Gt Y� residing at -o o � 0 LL.1'�G vI t c V e-.
�1 .. r�ltln+e.�
do hereby authorize � 'f' l / 'l 7 to apply on
my behalf h Town of Southold Building Department for approval as described herein.
Owner's Signature Date
DEBRA A SEPULVEDA
NOTARY PUBLIC,STATE OF NEWy0R[X
Print Owner's Name RegisctadonNaOISFMI2697
Qualified in Stlif"olli: tatty
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