HomeMy WebLinkAbout53196-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#: 53196 Date: 08/11/2026
Permission is hereby granted to:
Douglas A Dey
4745 N Bayview Rd
Southold, NY 11971
To:.
Install roof mounted solar panels to an existing single-family dwelling as applied for.Additional
certification may be required.
Premises Located at:
4745 N Bayview Rd,Southold, NY 11971
SCTM#79:3-24.1
Pursuant to application dated 07/27/2026 and approved by the Building Inspector.
To expire on 08/10/2028.
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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TOWN OF SOUTHOLD—BUILDING DEPARTMENT
y Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959
Telephone 631 765-1802 Fax 631 765-9502 htt, `/wwrww���W,SoUtholcltownny g0V
Date Received
APPLICATION I FOR BUILDING PERMIT
For office Use Only E
PrMi N . ° 4 /�
- Building Inspector
Applications and forms must be filled out in their entirety,Incomplete
applications will not be accepted, Where the Applicant Is not the owner,an Building Department
Owner's Authorization form(Wage )shall be completed. Town of Southold
Date: -7 L
Name: John Reverand
Project Address:4745 N Bayview Rd. Southold, NY`11971
Phone##: 01-585-0185 EmaiC:
i,ohn,reverandgmail.corn
Mailing Address:same
CONTACT PERSON: ;RflLel Xt
Name:Sunrun Installation Services
Mailing Address:177 Cantiague Rack Rd, Westbury, NY 11590
Phone##: 'V ": . � EmailLlPermits@sunrun.com
DESIGN PROFESSIONAL INFORMATION:
n
Name: ( "� �
Mailing Address: / 21. llnl 1113
Phone##: ,�,5 99'k '7k,S— Email.
CONTRACTOR INFORMATION:
Name;177 Cantiague Rack Rd, Westbu r , NY 11590
Mailing Address:177 Cantiague Rock Rd, Westbury, NY 11590
Phone : 57 "f ( Email:177 Cantiague Rock Rd, Westbury, NY 11590
DESCRIPTION OF PROPOSED CONSTRUCTION
E]Newnr Structure OAddition OAlterati'on ®repair ElDemolition Estimated Cost of Project:
C10therSotar $ D `
Will the lot be re-graded? DYes o Will excess fill be removed from premises? ElYes P416,
1
PROPERTY INFORMATION
Existing use of property: t- Intended use of property♦..
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? Eyes 21 o IF YES, 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 inbuilding(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 Subm ed By(print name): Yt.�� . 2W,-S4w/ 1����171-?r WAuthorized Agent ❑Owner
Signature of Applicant: pate: -712,t112,
STATE OF NEW YORK)
S
COUNTY OF )
)� ° J being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the Contractor -
(ContractC!Z�m
Corporate Officer, etc.)
of said owner or owners, and is duly authorized 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 0/1
23rdday of July 20 26 1 � r `
Notary Public
by John Reverar*ho did take an oath.
Notarized remotely online using communication technology via Proof.
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
��+� CPM..i5Si0N F%PiPES
hne]P.30]i
A, John Reverand residing at South Old
NY do hereby authorize Sunrun Installation Services to apply on
my behalf to the Town of Southold Building Department for approval as described herein,
J�!� 07/23/2026
Owner's Signature Date
John Reverand
Print Owner's Name
2