HomeMy WebLinkAbout52689-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 52689 Date: 02/25/2026
Permission is hereby granted to
First Baptist Ch Grpt
650 Main St
Green port., NY 11944
To:
Construct access landing and ramp at existing Church as applied for.
Premises Located at:
10420 Route 25, East Marion, NY 11939
SCTM#31.41-7
Pursuant to application dated 08/22/2025 and approved by the Building inspector.
To expire on 02/25/2028.
Contractors:
Required Inspections:
FOOTING/REBAR, FRAMING/STRAPPING,. DRAINAGE, FINAL,
Fees:
Commercial-Addition &Alteration $350.00
CO Commercial-Addition/Alteration $100.00
Total 450.00
Building Inspector
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Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-0959
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� cur Telephone (631) 7+ 5-1 02 Fax (631) 765-9502 � ���
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Date Received
APPLICATION FOR BUILDING PERMIT
LC
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For Office Use Only
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PERMIT NO., AUG 2 2 2025
Building Inspector*_ WIN
OF
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Applications and farms must be filled out in their entirety.Incomplete
applications will not be accepted. 'Where the Applicant is not the owner,an ,'men'
Owner's Authorization form(Page 2)shall be completed. O
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Gate: 2 2 OZZ 2w4f
OWNER(S)of PROPERTY:
Name: s+� SCTM#1000-.AiC-1 I 2m
Project Address: k 0 4__
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Phone#: < _7 Email:
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Mailing Address: &``, /'
CONTACT PERSON:
Name: j M
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Mailing Address:
Phone#: TE
DESIGN PROFESSIONAL.INFORMATION.
Name: P-64�*.
Mailing Address:
D' S
4-70
Phone#: ( Email: 6V
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION of PROPOSED CONSTRUCTION
❑New Structure F�Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $
Will the lot be re-graded? ❑Yes ❑No Will excess fill be removed from premises? ❑Yes ❑No
1
PROPERTY INFORMATION
Existing use of property: Intended use of property,
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
❑this property? []No No IF YES, PROVIDE A COPY.
c k 13 ox After Re,v it ; Theo n�er,c ractor"desi n professional is responsi le for all drainage andstonn water,issues as provided by
Cl,,ap r o n ,e wn od • pp I N 15 1t Y to a ld n Department for the Issuance,of a BuildingPermit,pursuant the Su Wing lone
rdinan Town r" ol 3uf`pi County,New,York,and other applicable ws,ordinla'noes or regulations,f r the,construction o 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 r+egula dons.and to adn ift authorized inspectors on premises and in building($)for necessary inspections.False statements made herein are
p4n,ishaible as a Class A,misdemeanor pursuant to Section 210.451 of the New York State pen l Law.
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Application Submitted By(print name: tad ithorized per,
Signature of Applicant: Date: - ••��,,.
7 ,
STATE OF NEW YORK)
SS:
COUNTY OF U
being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
N he is the
(Contracto Agent, or rate Officer, etc.)
of said owner or owners, and is duly authorized to 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
da I ' u 1 .01 LA
of 0 45 2)
Notary Public
M O OF
TAR, 3L IC,pST4, OF NE"W,IY,ORK
PROPERTY( OWNER AUTHORIZATION NG.0 !6
(Where the applicant is not the owners w 1 �� K �d a� ry
1 JU %1j
I� 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