HomeMy WebLinkAbout1000-70.-7-18 �� a
INDIAN MUSEUM
Mill
1080 MAIN BAYVIEW RD
SOUTHOLD, NY 11971
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ARCHITECTURE ANTHONY PORTILLO, R.A., LEED AP
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LAUREL, N.Y. 11948
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LC 0:516-214-0160
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DETAILS
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1080 MAIN BAYVIEW RD
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nr ro„ rro '�.., r 4 r :•,mru.w rrrc,.�!, I ^"'"""" 1080 MAIN BAWIEW RD
soLl HOLD,NY 11971
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_ STORM WATER D"R1,Y..aW.M,ELL DETAIL
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INDIAN MUSEUM
or
1080 MAIN BAWIEW RD�E
n
"n SOUTHOL
D NY 11971
C., DR AMN TITIF
PROPOSED J S� ...f.... ......... N .._ ... ""`• /' SITE PIAN
OONG CURB DETAIL STORM DETAILS CALCULATIONS
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PROP00ED SOTS PLAN
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FOR INTERNA. USE C
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LAN USE DETERMINATION
SITE P
initial Deten ination _
_ � � � � �.. Date Sent:____,._�.....�� ...
Date*-. � j v�_ --�-_
Project Name:--
.
Project Address:,
Map No.:1000
_ 8 -�_ Zoning Dislric . )e
Suffolk County Tax �
--
(Note: Copy of luildir�g permit App
lication and supporting documentation
as to
proposed use or uses should be submitted.) 4 �
permitted.
Initial Determination as to whether use is
Initial Determination as to whether site plan is required" ,
Signature of Building inspector
Planning Department (P.D.)
Referral:
r L j Date of Comment:
p..D. Date Received: I J —
Comments:
. .
Signature of Planning �e .-Staff Reviewer
lira C i r 'I1nation
Dater_. -.
c��,„afi�rP of Riiildina InsnPator.._
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�1alwrtii � 'I
Date Received
APPLICATION FOR BUILDING PERMrr
For Office Use Only
PERMIT N0. _ 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
Owners Authorization form(Page 2)shall be completed.
Date:January 6, 2021
OWNER(S)OF PROPERTY:
Name:Incorporated Long Island Chapter of NYSAA.Southold Indian Museum SCTM#1000-70-7-18
Project Address:1080 Main Bayview Rd., Southold, NY 11971
Phone#:631-765-5577 1 Email:lmhemmick@gmail.com
Mailing Address:1080 Main Bayview Rd., Southold, NY 11971
CONTACT PERSON:
Name:Francesca Brennan
Mailing Address:1075 Franklinville Rd., Laurel, NY 11948
Phone#:516-214-0160 Email:fbrennan@amparchitect.com
DESIGN PROFESSIONAL INFORMATION:
Name:Anthony Portillo
Mailing Address:1075 Franklinville Rd., Laurel, NY 11948
Phone#:516-214-0160 ::
Email:aportillo@amparchitect.com
f CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
El New Structure ❑Addition *Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $
Will the lot be re-graded? *Yes ❑No Will excess fill be removed from premises? RYes []No
1
PROPERTY INFORMATION
Existing use of property:PUSeuuY1 Intended use of property: iv,�U,�(.[,uy-I
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
property?.._ ... MMM �..�.. ._,_�.�.., ....„„
thisDyes o IF YES,PROVIDE A COPY.
❑ „ m�_.
� hl��u�� r,i fie rr e,�d'ieg. The owner/contractorJdeslgn professional is responsible for all drainage and stone water issues as provided by
Chapter 236 of the Town Code. APPLICATION i5 HEREBY MADE UD the Building Department for the Issuance of a Building Permit pursuant to the Building Zone'
rdinance of theTown of Southold,Suffolk,County,New York and other applicable laws,Ordinances or Regulations,for the construction of buildings, -
Qadditions,aheratlons odor removal or demdition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code,
using odregulatlons and to admkauthorlred inspectors on premises and in buildings)for necessary inspections.False statements made herein are
hoce and
A misdemeanor pursuant to Section 210.45
of the New York State Penal Law.
punishable as a
Class
Application Submitted By(Prim name): PrarlC4�6cQ
!#uthorized Agent ❑Owner
Signature of Applicant: Ile- Date:
. ., �
STATE OF NEW YORK)
SS,
COUNTY OF
Y
b `cx bfe,`I i,IC ) being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the
(Contractor,A nt,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 trine to the best of his/her nowledge and belief,and
that the work will be performed in the manner set forth in the application file there �h ,=�i°IA h„N. 'Td&OY
Notary Pu biic t 1;.?Of i',Iew York
Sworn before me this No. Cv rA60d 6001
0a1Mfieri In Sufi6k flr"argtY
U O sir rr a Iran Expires 01/13J20.C �
day of 30
Notary Public
L/ TION
(Where the applicant is not the owner)
Lucinda Hemmick3060 Little heck Rd, C Ut hogu , NY
residing at _... � ��.._.. ��,._.. ..
11935 do hereby authorize � __to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
t January 5, 2021
Date
Owner Signa ur
Lucinda Hemmick
Print Owner's Name
2