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PLANNING BOARD
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FORM NO. 3
® U- 2 0
TOWN OF SOUTHOLD g
BUILDING DEPARTMENT
Boad
SOUTHOLD,N.Y. `rni
NOTICE OF DISAPPROVAL
DATE: July 19, 2018
TO: Ashokkumar B. Patel (Handy Pantry Stores)
930 Ostrander Avenue
Riverhead, NY 11901
Please take notice that your application dated May 29, 2018:
For permit to alter existing space to personal service(barber shop) at:
Location of property: 150 New Suffolk Avenue, Mattituck, NY
County Tax Map No. 1000— Section 114 Block 12 Lot 331
Is returned herewith and disapproved on the following grounds:
Pursuant to Article Ill Section 2SI�12 .the proposed use reuies site plan approval
from the Southold To anni - Board.
ou now pply to this gency .directly.
cid Si nature
Note to Applicant: A , ban ration to the above referenced application,
may require further review by the Southold Town Building Department.
CC: file, Planning Board
�AT
_s FOR INTERNAL USE UNLY
j
SITE PLAN USE DETERiVI[I�IATIO
Initial Determination
- - Date Sent*----., -�-
Date:
i :&—
q � .
Project Name:
Project Address:
Zoning District .
Suffolk County Tax Map No.:1*000- j® ll�iS
VjC'ji( a
Request`� ..
porting documentation as to
. li tion and su.pp 9
(Note: dopy of Duildin Percy it App
_proposed use or uses should he submitted.)
Initial Determination as to whether use is permitted:
Initial-Dete.rrnination as to whether sit an is
ired:
lure of ng In £ d
Department (P.D.) Referral: .
planning $ u_-
P.D. Date Received:=_— i= Date of Comment
t '
_ f ,
Comments: s
a
Dept.-Staff Reviewer
- Signature of 1''1 n" .
Fi lei Det nmf =
Decision:
C1; ,nnf irP of Rioldino In.-qnertor
TOWN OF SOUTHOLD BUILDING PFRMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do yoi, ae or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 4 sets of Building Plans
TEL: (631)765-1802 Planning Board approval
FAX: (631)765-9502 Su-vey
Southoldtownny.gov PERMIT NO. Check
Septic Form
N.Y.S:D.B.C.
Trustees
C.O.Application
4 Flood Permit
Examined .20 Single&Separate
Truss Identification Foran
JUL —2 2018 Storm-Water Assessment Form
Contact:
Approved 20 BI}II� B '
Disapproved a/cTOWN —
Phone. " '
Expiration .20 7�
Building Inspector
APPLICATION FOR BUILDING PERMIT
,
INSTRUCTIONS .Date 20
a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans,accurate plot plan to scale.Fee according to schedule.
b.Plot plan showing location of lot and ofbuildings on premises,relationship to adjoining premises or public streets or
areas,and waterways.
c.The work covered by this application may not be commenced before issuance of Building Permit.
d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant.Such a permit
steal I be kept on the premises available for inspection throunhoufthe work.
e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector
issues a Certificate of Occupancy.
f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date:If no-'zoning amendments or other regulations affecting the
property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an
addition six months.Thereafter,a new'permit shall be required...
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,addifions,or alterations or for removal or demolition as herein described.The
applicant agrees to comply with all applicable laws,ordinances,building code,housingcode,and regulations,and to admit
authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant or name,if a corporation)
(Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Name of owner of premises Holy l i tEy l N Sf 0 as .
s on de tax roll or latest deed)
If applicant is a corporation,signature of duly authorized officer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. r a io +:and o vvhic proposed work will be done:
150 A/ � LA � �� o
House Num&r '' _ Street Hamlet
County Tax Map No. 1000 Section I Bloch Lot ��
ouuulviS1V11 I-11cu 1vlay 1w. 1_,UL
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy
3. Nature of work(check which applicable):New Building On-
Repair
nRepair Removal Demolitionar W-6-r J� ji6 _ .C?
(description)
Estimated Cost I
r f?..' � d on filing this application)
If dwelling,number of dwelling units Number of dwelling li reach floor
'If garage, number of cars
All I
jut
If business,commercial or mixed occupancy,specify Kure and extent of each type of use.
I �_ >.
Dimensions of existing structures,if any:Front
d Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front Rear.
Depth Height Number of Stories
Dimensions of entire new construction:Front Rear —Depth
Height Number of Sfbries`
N. Size of lot:Front Rear Depth
lei'.Date of Purchase Name of Former Owner
Zone or use district in which premises are situated
,qZ.Does proposed construction violate any zoning law,ordinance or regulation?YES NO
\�3. Will lot be re-graded?YES NO' Will excess fill be.removed.from premises?YES NO
Names of Owner of premises Address Phone No.
Name ofArchitect Address Phone No
Name of Contractor Address Phone No.
15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO
*IF YES, SOUTHOLD TOWN TRUSTEES'&D.E.C.PERrVIITS MAY BE REQUIRED.
b.Is this property within 300 feet of a tidal wetland?*YES NO N
* IF YES,D.E.C.PERMITS MAY BE REQUIRED.
16.Provide survey,to scale,with accurate foundation plan and distances to property lines.
17.If elevation at any point.on property_is at 10 feet or below,must provide topographical data on survey.
18.Are there any covenants and restrictions with respect to this property?*YES NO-'�,—
*IF YES,PROVIDE A COPY.
STATE OF NEW YORK.) -
SF SS:
COUNTY OF CI
Q1 f1 being duly sworn,deposes and says that(s)he is the applicant
(Name of individual siginc tract)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 application;
that all statements contained in this application are true to the best of his knowledge and belief;and that the work will be
performed in the manner set forth in the application filed therewith.
TRACEY L.DWYER
Sworn tobefore me this NOTARY PUBLIC.STATE OF NEW YORK
day of -TUIIS 20NO.01DW6306900
QUALIFIED IN SUFFOLK COUNTY
Z;j- COMMISSION EXPIRES JUNE 30,2L2P`
NotaryPu lic Signature of App Iicant
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