HomeMy WebLinkAbout1000-55.-5-7 QNv .
1G� C3R INTERNAL LIL ON[y
SITE PLAN.
SOUTHOLD TOWN
PUNNING 6G�Ar17
Initialer mination
Date Seat: .___
Date: .._
Project Name:
Project Address: t ?,. m ;_�:a...__..... ._. _....._..
Zoning District: _.- ------ —
Suffolk County Tax Map No.: 1000- - `-_-- '
Request:
o of Building Permit Application and supporting documentation as to proposed use or uses should
(Note. Copy
be submitted.)
initial Determination as to whether use is permitted: _..._.... ___.. -.
initial Determination as to whether site plan is required:
Signature o u Iding Inspector
Planning Department (P.D.) Referral:
P.D. Date Received:
Date of Comment: �__�__�
� �-�
Comments: � �`
Signature of PIanni ept. Staff Reviewer
Final Determination
Date:
Decision:
Signature of Building Inspector
FOR INTERNAL USE ONLY
SITE PLAN USE DETERMINATION FEB 0 4 2025
SOUTHOLD TOWN
PLANNING BOARD
Initial Determination
Date Sent: —_ .-.
Dated �J
Project Name: ._
4& 5 2 D cliz__�._B--.) .:.. D_U�i r- - .. . _�.�.w_...._w_....... ww_.
Project Addressor......_._.__._........._._.. w._....,..._
Suffolk C zoning D i stnct` __�....�,.....�....___�_.�..w....�. .,_.�..�...w.._�_�
County Tax Map No. 1000- S
Request: ,....__ -. �. .. . . � . .._�._...
.�.._...�.._...___..�...�_.__....W._..�_....w�_i n Permit r m ht Application p.l...�..�......�t i.o n._a n.�...._.p p_...�.����.�......,g...........
of Build ica supporting documentation as to proposed use or uses should
(Note. Copy g
be submitted.)
Initial Determination as to whether use is permitted: ` .. .... ................w_..._...- ..._.-. -. -- _. .
Initial Determinationas to whether required.site plan is
- _ w.. .......
.._........... .. .� .�......n..�_...._._....
_....._ "
_ � "iiding Inspector
Signature o
Planning Department (P.D.) Referral: „m _e__. .....w,__,_. .....�.-----... ._
P.D. Date Received: —J� Date of Comment:
Co m m e
Signature of Planning Dept. Staff Reviewer
Final Detwermination
Date: —J—�
Signature of Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-0959
Telephone(631) 765-1802 Fax(631) 765-9502 hi c°:
Date Received
APPLICATIONFOR BUILDINGPERMIT
For Office Use Only
ft
PERMIT 1\10. Building Irospectaar.,e,,, _,..�.
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:December 6, 2024
OWNER(S)OF PROPERTY:
Name:Thomas J McCarthy SCTM #1000-55-5-7
Project Address:46520 County Road 48, Unit 5, Southold, NY 11971
Phone#:516-779-6386 Email:tmccarthy.tmccarthy@gmail.com
Mailing Address:46520 County Road 48, Unit 4, Southold, NY 11971 ��
CONTACT PERSON:
Name:
Mailing Address:
Phone#: 3 E Email:
DESIGN PROFESSIONAL INFORMATION:
Name:John Condon, PE Condon Engineering, PC
Mailing Address:1755 Sigsbee Road Mattituck, NY 11952
Phone#:631-804-5686 Email:condon77173@optonline.net
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition RAlteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $
Will the lot be re-graded? ❑Yes IgNo Will excess fill be removed from premises? ❑Yes iRNo
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PROPERTY INFORMATION
Existing use of property:Retail Intended use of property:Restaurant
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
Commercial I
this property? ❑Yes WNo IF YES, PROVIDE A COPY.
0 Check Box After Fieah i IIn ' 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 210AS of the New York State Penal Law.
Application Submitted B (printonon, PE ®Authorized Agent ❑Owner
Signature of Applicant:
Date: 12/6/2024
STATE OF NEW YORK)
SS:
COUNTY OF Suffolk
John Condon, PE being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the Agent/Engineer
(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
day of 20� . _ 4 ry Publi
N�ota
�1 Di��II, c,rvNirsl N�LV
ire tl
rp:
�.. .._. _....._ Red N+drl. 'i D16,02.47'2
(Where the applicant is not the owner) °,Ui,ii e �,I Suffolk County
Thomas J McCarthy residing at
do hereby authorize John Condon, PE to apply on
my beha, o the T wn of Southold Building Department for approval as describe4 herein.
Owner's ture Date
Print Owner's Name
2