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SITE PLAN USE J E"i"'' !f' LN,6 1. ANsoUT 2 7
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PLANNING BOARD
initial
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Determination
Project Narne; _....._ . ... .�.. w:. .. . _� _.........,..
Project Address:
.......—._ _ _ .. _ .."__ _. .... _ zoning District:
Suffolk Count Tax Map No.: 1000-11 .
Request:
(Note: Copy of Building Permit Application and supporting docun"ientation as to proposed use or uses should
be submitted.)
Initial Determination as to whether use is permitted: ._.....
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Initial Determination as to whether site plan is regUired:
Signature Building Inspec
--------------------------
Planning Department (P.D.) Referral:
P.D. Date Received: _ _/ Date of Comment:
Comments: tG^�
Signature of Planning Dee i. taff Reviewer
Final Determination
Date:
Decision:
Signature of Building Inspector
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FOR INTERNAL USE ONLY � ' �1221
SITE PLAN USE DETERMINATION JAN 2 2 2025
SOUTHOLD TOWN
PLANNING BOARD
Initial Determination
d� as Date Sent:
Date: a i a 5
Project Name:
Project Address:
Suffolk County Tax Map No.: 1000- I- - 1 Q - v� Zoning District: _._.. �_..
Request �� ......_w_.. _ .. ._.. _.. .....
(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: S
Initial Determination as to whether site plan is required: w
Signature Building Inspect
Planning Department (P.D.) Referral: ...._. .�_w_...w _. .w .m_ ._w _ w_�.._.._....._.._ _ w_..w......._
P.D. Date Received: _f_, Date of Comment: -J
Comments..�. .....�..�_.- .w.__....�...�......- ..�..w._�.._._....�....ww....._,�._._-..w_.._.__,,�._._,....�................�.._w.--...�......�.,__..... w._..
Signature of Planning Dept. Staff Reviewer
Final Determination
Date:
Decision---..--,,
Signature of Building Inspector
5001
235
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Revision#: Scale: Landscape Plan: 2-8-24 = Landscape Design by: Dave Cichanowicz
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Creative Environmental Design
Date: 11/6/2024 '� David CichanoWlcz Jr.
--
GROWSPAN"ROUND ECONOMY HIGH TUNNELS
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Diagram may show a different but similar model. Economy high tunnels include film roof and film end panels.
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SOUTHOLD TOWN
PLANNING BOARD
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anti-billow rope and nine(9)117063 AND POSSIBLE INJURY,INSTALL THE G1
ANTI-BILLOW ROPE IN SHORT LENGTHS x
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FA2061 eyebolts per side.Circled NOT INSTALL ASA SINGLE LENGTH TIED
point shows the end of each rope AT EACH END.DOING SO WILL RESULT IN
and the location of two(2)117063 A LOOSE SIDE PANEL SHOULD THE ROPE z
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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 lt; ^�,� w °. dto%
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only lJ L 1J LS
f� f
PERMIT NO. Building Inspector:
�n I
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date: 11/21/2024
OWNER(S)OF PROPERTY:
Name: David Cichanowicz Jr SCTM#1000- r7,— 10 — w
Project Address: 1625 Leslie Rd. Peconic NY 11935
Phone#: (631) 405-0948 Email: daviecich@gmail.com
Mailing Address: 1425 Arshamomaque Ave Southold NY 11971 United States
CONTACT PERSON:
Name: David Cichanowicz Jr
Mailing Address: 1425 Arshamomaque Ave Southold NY 11971 United States
Phone#: (631) 405-0948 Email: daviecich@gmail.com �
DESIGN PROFESSIONAL INFORMATION:
Name: David Cichanowicz Sr
Mailing Address: P.O. Box 160 Peconic NY 11958
Phone#: (631) 445-4875 Email: Creativeenvdesign@yahoo.com
CONTRACTOR INFORMATION:
Name: N/A
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
XNew Structure ❑Addition ❑Alteration ❑Repair []Demolition Estimated Cost of Project:
❑Other $ 5000
Will the lot be re-graded? DYesXNo Will excess fill be removed from premises? ❑Yes Zlo
1
PROPERTY INFORMATION
Existing use of property:Agriculture Intended use of property:Agriculture
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
A /' this property? ❑Yes XNo 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): David Cichanowicz Jr ❑Authorized Agent kowner
Signature of Applicant Date: t/ 11)0)q
STATE OF NEW YORK)
SS:
COUNTY OF Suffolk
David Cichanowicz Jr
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 applicatio ilP MSS MAI= ETt N�
NOTARY PUBLIC,STATE OF NEW YORK
Sworn before me this Registration No. OIMA6402379
Qualified in Suffolk County
21 day of November 20 24 Commission Expires Deeember30th,2027.
Notary Public
PROPERTNOWNER AUTHORIZATION
(Where the applicant is not the owner)
1, residing at
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name
2