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Home My WebLink About1000-140.-3-4 0 y N O c00 75 on clo a > v r u;it�G eK t war; 0 I oDisn,+Y WE Ek xff _ FC�f;f Y 601 rim 5T 72x34i75 ��49.30 54:90 As I OFFICE MATTI ICK NY iov pow BUILT IN ELEC I DISPLAY I a5,'t ) POLE ! - TABLE y _ (1)DUPLEX* GIFT AREA 8 9" (1) 115V LL i1612'WALLMMIr GOHZ SINGLE ` 0 PHASE PLUG _}= g . N STORAGE _ ' CHEESE c U 0 = I N a 0 a IA ? z � CHEESE � � aRoaaourcrs<oesieK 4'-IC DISPLAY 9 OMB5N1 i 'C7 ,r s ) l7 I ami ]] PASTRY 2'x5 COUNTER WITH BASE CASE j � STORAGE WCHALK BOARD ON WALL I ! L !SCALE BUILT IN ELEC POLE U � i 0 E (1)DUPLEX4 ' m 1 E o q (I)115V ! j cd I GOHZ SINGLE PHASE PLUG v x cti,uc ' O X) Q REGISTER a T LL COUNTER I I 7-I CL o V i °' a I".Piarax O I — I ` n p °o t %YW c9 T v Y Ttal ] I ° Z _ ' IF00200 a � a ? 0 -a im c ctLL� v° n A v < Z CL 0p rI y A . ' FOR INTERNAL USE uNLY SITE PLAN USE DETERMINATION Initlal Deternfinat �KJ l f, Y ui',A ate Sent:_ Date: _�� Southold fawn Plannina Board— Project Name: oardProjectName: Project Address:.._ .._.... .... Oct- 46 Suffolk County Tax Map No.:1lOCf� Zoning Dist — . 1KI JAI Request -"� ortin docurnentation,a5 to of S,uiidirtq Permit Applicat"son and su_pp � g (Note: Copy • proposed use or uses should Ise submitted.) Initial Determination as to whether use is permitted: Initial Determination as to whether site p required: Ian ssmmr .� Signa na ure o _ for �Iuil i g Planning Department (P.D.) Referral: Date of Comment:= P..D. Date Received:�_�— Comm ents• , Cx FOS Signature of Planning Dept f Reviewer F°in l� I)e er ina�lon Date: �= Decision: -� a In�nPctnr e;,inafiirP of Riiildin 50-791/214 DATE ............ PAY TO THE elr—� ORDER"JE___................................................ ...................... ................. __DOLLARS Capoltal0ne"i8ank Capital One.NIA FOR......__..___.__..._....._ :D 2 i 4 D 7 9 L 2 is 7 5 ................... :02LL,0?9 & 21:?S ?3 S 13 911- Contact: Approved 120_ Mail to:— Disapproved a/c............... Phone: Expiration............. 20_ D Building Inspector (7, J-�:, via • PLICATION FOR BUILDING PERMIT S, .1__-_1`_ E) 10 Southold Town 0 ling I i arming Board Date L4 11� NOV 3 20114 INSTRUCTIONS a, e coi pletely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of rate plot:plAh to scal according to schedule. b.plot plan showing location of lot and of buildings 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 shall be kept on the premises available for inspection throughout the 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,additions,or 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 for necessary inspections. e AL (Signature of applicant or dme,if a corporation) (Mailing address of applicanty State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder Name of owner of premises 01 a-k-J(� (As on the 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 Other Trade's License 1. Location of land o which proposed work will be done: & 0 0 �IK6 JTR6'97_ A 7_1/ T VC K House Number Street Hamlet County Tax Map No. 1000 Section- Block Subdivision- Filed Map No. Lot. .. .................................... 2. 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 r>e C;a-ff 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal DemolitionOtherWork /,r)a 'A'5- (Dts&iption) 4. Estimated Cost D`-V7 Fee (To be paid on filing this application) 5. If dwelling,number of dwelling units Number of dwelling units on each floor If garage, number of cars — 6. If business,commercial or mixed occupancy,specify nature and extent of each type of use. 7. Dimensions of existing structures,if any:Front —Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction:Front Rear Depth Height Number of Stories 9. Size of lot:Front Rear Depth 10. Date of Purchase Name of Former Owner 11.Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law,ordinance or regulation?YES NO 13. Will lot be re-graded?YES—NO Will excess fill be removed from premises?YES-NO- 14.Names of Owner of premises( ZAk161,-Address Phone No. Name of Architect 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 X * IF YES,SOUTIJOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED. b.Is this property within 300 feet of tidal wetland?*YES NO-X * 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) SS: COUNTY OF-..........j being duly sworn,deposes and says that(s)he is the applicant (Name-�fir individual contract)above named, CONNIE D.BUNCH Notary Public,State of New York (S)He is the No.01SU6185050 (Contractor,Agent,Corporate Officer,etc.) Commission Expires April 141,2-9 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. Sworn to before me this day of 20 14 Notary Public Signature of Applicant