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Home My WebLink About1000-83.-3-5.3 '/�� ) SITE PLAN USE DETERMINATION � � � � 0 �alrT 1a r,r ' p ' f C7T+tc Sent: c, f I, nrtda Ccterrntnatic�n bC +��^�icur Date- ' r Project Narne� � I � rrlurtririress: ....._ .. ., ��. .._ .. _C1. . .. . .` t1C '.., �� ._ Suffolk County'Tax Map No,: 1.000 Nye i est C 431 . ... .._ .�. . )i f (Note,,Copy of iauuldung krl ift Application and supporting documentation as to proposed use or uses should t a„ be sGukwrimw'tled.) � 6n�t�aE Detercnhna'tp'n at to whether use is permitted: V u ro ut a M.__.._ an is r � site plt*eluired:w _. �. r�rngns�to�nos to wwhether� �� ..�' C� -------------------------------------------------------------- Si�,nature of "ding Inspector �"` Nainning Department(P,D,) Referral: P.D. bate Received: ( A Crate of Comment', Comments: s � "a P � •. I ,:� _� I"sa ,ar w "C c a nA< Signature of Plannin ept.Staff Reviewer Finial Determination Date; eds on: Signature of Building Inspector 1 1 i RECEIVEC-) FOR INTERNAL USE ONLY SITE PLAN USE DETERMINATION __. Initial Determination Nanning ...Board Date: 2'+ Date Sent: 2- Project Name: qou of LL� �� 1 Project Address: 0 Suffolk County Tax Map No.: 1000- 3 - �J - rJ•3 Zoning District: L Request: �n01(1 --- -C—---------4- 1:8 QL -K L--kon- C-)+ 1 � — D-ff� (Note: Copy of Building Permit Application and supporting documentation as to proposed use or uses should be submitted.) Initial Determination as to whether use is permitted: Initial Determination as to whether site plan is required: _3 02 YW L41A Signature of `ding Inspector Planning Department (P.D.) Referral: P.D. Date Received: _�_� Date of Comment: Comments: Signature of Planning Dept. Staff Reviewer Final Determination Date: Decision: Signature of Building Inspector TOWN OF SOUTHOLD— BUILDING DEPARTMENT a, Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 httjj� Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT N 0, Building Inspector:_ ..... J t 11. 5 2 Applications and forms must be filled out in their entirety. Incomplete Building DeloRriment applications will not be accepted. Where the Applicant is not the owner,an Town of Southold Owner's Authorization form(Page 2)shall be completed. Date:7/8/2024 OWNER(S) OF PROPERTY: Name: 11 goo Oregon Road LLC SCTM # 1000-083-03-0053 Project Address: 11 goo Oregon Rd. Cutchogue, NY 11935 .......... ................ Phone#:631-734-2166 Email:martyk@unit2go.com ..........---....... ...... Mailing Address: 11 goo Oregon Rd. Cutchogue, NY 11935 CONTACT PERSON: Name: Martin Kosmynka .........—-------------- Mailing Address: 11 goo Oregon Rd. Cutchogue, NY 11935 .............................. .........--.........---........ .......... ........ ...... Phone#:631-384-9979 Email:martyk@unit2go.com DESIGN PROFESSIONAL INFORMATION: Name: DiGiovanni and Associates Architects Mailing Address:26 Preston Ave. Sea Cliff, NY 11579 ................................ Phone#:516-671-3624 Email:daa93@msn.com CONTRACTOR INFORMATION: Name:Martin Kosmynka ........................----........... Mailing Address: 11 goo Oregon Rd. Cutchogue, NY 11935 Phone#:631-734-2166 m I a! : artyk@unit2go.com Email: � DESCRIPTION OF PROPOSED CONSTRUCTION E]New Structure ElAddition *Alteration DRepair DDennolition Estimated Cost of Project: [--]Other Interior walls $�300,000 ................. .................. Will the lot be re-graded? E]Yes *No Will excess fill be removed from premises? OYes �No ............. ............ PROPERTY INFORMATION Existing use of property:Warehouse storage Intended use of property:Warehouse Storage Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to Ll this property? ❑Yes LINO 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 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): ❑Authorized Agent [I Owner Signature of Applicant: " � Date: 7 STATE OF NEW YORK) SS: COUNTY OF1�rYC�\ uw,,,, �1�, 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 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 LOWday of _M 20 ary Public r B L, C,A6,1' ' S» I•IWA B0RN NOrl'ARY i'k R1.IC,7l1�q ll OF. E YimIRK 01G 0274028 40 PROPER"ryOWNERCbrr lt�AUTHORIZATION "rccd ar« ajff(Alk�OU111y (Where the applicant is not the owner) O Tvni�sion LXpiresDec• a, it I, residing at _ww ... ...... .... _www__w�ww do hereby authorize .__...... apply on my behalf to the Town of Southold Building Department for approval as described herein, Owner's Signature Date Print Owner's Name ...�._.._ww_.w. 2