HomeMy WebLinkAbout1000-141.-4-31.7 sk.'
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FOR INTERNAL
SEP I B 2025
SE DETERMINATION1
PLANNING BOAR'
SITE P LAN
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_ initial
.. Date
Sent'.
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Pro ect Marne _
Project Addre��
� Map Zoning DEstdet:
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Suffolk c
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W . ",o and supporting door
n tort as t0
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d 01 s o
propose
�� rm�tte d� �����
. . Det r *''i t��on
a to ,whether use is � � � w . ��'
Initial
� ,►; ., �`t � �� ' required:
gyred:
� whether s is r +� �.
teEetermi-ntia as to l n�tia
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�. Inspector
.. .� � Building
Signature of �
Po. Referral,
n Department � � �..
Planning
D atb of COMMen --
P.D. Date Received*
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" Pt-Staff Reviewer
S i r�aturo of planr�,n
nation
Flnal' Determt
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4 I+C.-
FOR. INTER Nab ONLY
2025
SEP 18
IN USE PLA SOUTHOLD TOWNSlTE". ERMINATION ' BOARD
........
Detennination,
initial Z
Date �..J n t• ������ w
D ate
project ProjectName.
Addw�
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Tax Map No.:�Ooo "
Suffolk CountyI.............................
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upport•ng documentation� � urnentatior� as to
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Note* C oP�� ofB u ildir�
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prop lsled use or
uses hauld
.................... *F-A�-A
Initial Determin,
1 o n a to ether use is rrrYitted. ..
plan is required... .
!n iti al �ete ri-n In ati o as to whether sit
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Planning Cie Ppartment (P-D-)
Ref
' �cite of l...o. �..
P.D. pate Received. ry
Comments:
t,-staff Reviewer
Signature of Planning De p.
ation
Final Deter''irnini,
Date,
.:....... ..
«
Decision
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C;r-,nnt"1 lrP. of Riiildina In-,qnP-rAnr
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-"UTHOLD BUILDING DEPARTMENT
m Tow Hall Annex 54�37 Mw�n.RoRoadP. 0. Box 1179 Southold,,NY 11971-�959
n.
Telephone(631) 7+6 -180 Fax (631)765-9502 L
Date Received
APPLICATION FOR BUILDING PERMIT
E C E WE
For Wice Use On�f f
A[J
PERMrf NO. Building Inspector.
Build"Ing Department
Applications and f6rms must be filed out in drew entirety.Incomplete
Town of Southoold
applications will not be accepted; whew the Appkant is not the owner,an
owner's Auttwrkat on fix n(Page 2)sue!be VLte d.
Date:
OWNER(S)OF PROP'ERTYO
a
Nam................e: � _ :SCTM#1000- .�, �� ii
I I'
...........
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Project Address: yr' ` ,�,� � '��'�`'�C
fPhone#: nn
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. Eail. DI --- cc C CV-1 S � �� �,.,ti�► .
----------
Mailing Address:
CONTACT PERSON:
Name:
Mailing Address: Go)( 14
U�
Phone#: l'P'3 �� Email:1
�� " ,.
1p
PRMEZIONALl ,� N ,
off\
Name:
Mailing Address:
Phone#: Email:
COfflMAC TOR INFORMATION:
C �
Mailing Address:
Phone#: Email:
DESCRIPTHM OF ED CONSTRUCTION
Fl hlew Structure ElAdd" n Alterat on D geprair ❑Demolition Estimated Est of Project:
Other .
Will the fat be re-graded? Fl Y+es NO Will excess fill be removed from Premises? ❑Y+es ❑No
IMP
i
PROPERTY INFORMATION
Existing use of property: intended use of property:
Zone or use district in which premises is sictuaMted: Are there any covenants and restrictions with respect to
this property? FlYes RNo IF YES, PROVIDE A COPY.
Reading:0,Check Box After ii* . r co,rt c r/d _ m professkv1=d is respa sr le for aN&Mnage wW stmi, mho bsues as provi&d by
0wVtw 236 of Tow n 't ` ?� S y D�e� fior the' asam, *of asusdft,forma pwsuant tD#be Building Zone
Town of
Nm"Y`o k� AAfs,0 m*s or for t� of buildings,
of##�e .�o�x�r ���,c'.�o+ucrtiyr
A ��n �, ns or�r�r � .� ,�. a m; �l as � � � o �' tor�arrq�y a�iith aB '� � ��b
" n bu&ft w de,
04Mhosing code aWveguiabilom and fo,a&v audw&ed inspectims, on P m,. ,arw in btumng(s)for necessary iropections.Fad statenwnts,made herein are
pun�ie as a Class A to section 210AS of the New Yoh stye Penal Law.
N
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- . C�
�� Ofowner
Sknabve of
Ikan1t.*(
* .. . �MIMnAIVMumm•, i CONNIE
/(/�MY.yj] BUNCH
Notary Public,State of New York
STATE of NEW Y+ORK)
No.01 BU6185050
Qualified in Suffolk County ..
SS. corer ission Expires April 14,
CCU U NTY OF
being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named, j
(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;than all statements contained in this application are true to the best of his/her knowledge and belief;and
pp ,
than the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
�a
,y
day of 74N 20
Notary Public
PROPERTY2
*.RNA"
q
ii
(Where the applicant is not the owner)
1, residing at
herebydo authorize
to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
i
Owner's Signature Gate
Print owner's Name
would like to convert 50% of the space I into living space for myself, while continuing to operate the
lower shop out of the second half. My 'Intent is to explains the existing bathroom to facilitate a shower,
ilso giving access to employees to use the facility during work hours. And install a small kitchen. The
existing structure will remain exactly as is.