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Home My WebLink About1000-125.-2-4.4 (2) FOR INTERNAL USE ONLY ! ` SITE PLAN USE DETERMINATION initial Determination Date: /�. _/�-- Date Sent: S f—LFLLN— Project Name: Project Address: tom Suffolk County Tax Map No.:1000- /d - -. _Zoning District: _ Request: Lts ,,s -►� (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: S' nature of Building Inspector Planning Department(P.D.) Referral: , P.D. Date Received:---j---J- 4- eceived: I / Date of Comment: Comments: 914 r � 'n Staff Reviewer ' pUG 1 $ 2Qgn f Planning pt. Final Determinati n Date: I / Decision: Rinn;;mm of Rididina InSnAC:tnr. TOWN OF SOUTHOLD • BUILDINGRMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do y have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO. _ Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit. Examined ,20 Storm-Water Assessment Form Contact: Approved 920 Mail to: Disapproved a/c S U Phone: Expiration ,20 Building Inspector • APPLICATION FOR BUILDING PERMIT Date I 1 a•- , 2010 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee 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 OrdinanFe 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 regul tions,and to admit authorized inspectors on premises and in building for necessary inspections. ( ignatur of ap 'cant cr name,if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Ie.SSe_L Name of owner of premises —C 6t_L,,ntiy% ry a,J (A4 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 No. Other Trade's,License No. A'Atli 1. Location of land on which proposed rk dill be done, House Number Street ._. " '' ' Hamlet County Tax Map No:1000 Section. 1 S - Block Lot__ �• 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 Wit►,,k k&nj i d arA* b. Intended use and occupancyo� ene-c r.c oke r te-3 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work Nugvt (Description) 4. Estimated Cost 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 ill excess fill be removed from premises? YES NO� 14. Names of Owner of premises 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 * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C:PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO * 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, PROVIDER COPY. STATE OF NEW YORK) SS: COUNTY OF ) 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 knowledge and belief.and that the work will be performed in the manner set forth in the application filed 6KA* tl IE CACOPERDO Notary Public,State of New y0*1 Sworn to before me this No.01CA515�4151 No. In Suffolk.Cou day of 20 )y Commissiori Expires O ffX4� Notary Public Si ature of Applicant �} File • Edit View Toolbar Window Help AMk Wiz 61 ,13I�I ► /I no• fD hitt 125 2 4 4 4730 t Autirr F3 S 1 ghrook katfitu k Sch s � l r�r►gnu, 7�M�Ij1 HOU N' r 2011 40qtr CC►h Irt 3d Mess #. nd AV goo rrdSixa ;'Total'AV: 0,800 E .. 4r�t may.; ilr# F"A NOW t �t ' ,' data� # 6 {� o-f 4� � s ' i�` >^S� �3 `�� / �� "Ip � `,'^s �` �2 d � � ,¢� �as',,�a��,.• Vis': t hJ � a a3h M � �,S• ,kdE t kz�k'. �v� RC a yip E � s � 77 M ., y 1 '4"". ,•yz /p 7` 1�a� � ik � A � Ij "AA Ai' ry�y ';��u �«- �f ,TyR��*�♦A�y'e�gR� � K .�i�,i y „,� 9 9 P 7 '"i3.y k !.*f nNYf fliWslw,+'y, 5 Ih �NX �R� f d.3 @ 7qw'{ d } R Y ExZ s¢ q T s e b / � w a DIM sm s•' a x rw'iFi ad, a z sly w+ f Ni: x �yoa � w 46, Y3 qr & n �M A_ ;r n 1'FOL � i St +wk ' Sssian A [24.W.� .�.._ tnbxlcressatc Outlook Search (Reid- 5 Versin 4-,[Cc►m..: 5URVEY OF PROPERTY 51TUATE: LAUREL �" N TOWN: 5OUTHOLD SUFFOLK COUNTY, NY W E SURVEYED 02-26-03. UPDATE 12-17-2004 PARKING EASEMENT 08-51-2005 FOUNDATION LOCATION 06-09-2006 S SUFFOLK COUNTY TAXES ,�-o,l-i 54" 1000-125-2-5.1— D NDS �k'S 11,5`-2"L %t CERTHMD TO: Ibrahim Kmog1u Stewart Title Insmwm Con"ny 0 OL Jpj mp 0 o�Q ��0�� O ° • 62 oV,643 % �-S/v � ° .430o Fc)- ZP po1v ��r m � � � ,, •g qse C. r� o).� sso o Vo a •• •• w0� moo/ hog o 1�1 All l o d ox ° �nj Sch Q � I AREA = 14/268 5F OR 0.33 ACRES JOHN C. S LAND SURVEYOR 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 6RAPHIG SGALE 1"= 30 RIVERHEAD,N.Y. 11901 369-8288 Fax 369-8287 REF.\\Compagserver\pros\03\03-116—gar stake.pro 6/9]OOb AM \�Lo 3 3-116