HomeMy WebLinkAbout47582-Z ' °m TOWN OF SOUTHOLD
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BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
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#: 47582 Date: 3/23/2022
Permission is hereby granted to:
FI Union Chapel Inc _�. _.._............ _ . .
PO BOX 19_2
Fishers Island, kV-06"3"90 ........ ._. �w W.........___. ___ _._._ .......ma. � _ _.
To: Construct new entry vestibule and door changes at existing church as applied for.
At premises located at:
Crescent Ave., Fishers Island
SCTM #473889.w__ _www_.w_a....� ....� _._._.............. .w _ww................................
Sec/Block/Lot# 9.-2-12.1
Pursuant to application dated 2/10/2022.... and approved by the Building Inspector.
To expire on w 9/22/2023.
Fees:
NEW COMMERCIAL, ALTERATION OR ADDITIONS $275.20
CO-COMMERCIAL $50.00
—w--_............
Total: $325.20
Building Inspector
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 httns://www.sout'holdtownny.go-v
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. Building Inspector:.- 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:02/08/2022
OWNER(S)OF PROPERTY:
Name:Fishers Island Union Chapel Society SCTM#x.000-- 9 -- 2 -- 12.1
Project Address:821 Crescent Avenue Fishers Island, NY
Phone#:(631) 788-7898 1Email:contact@fiunionchapel.org
Mailing Address:Box 192 Fishers Island, NY 06390
CONTACT PERSON:
Name:David Burnham
Mailing Address.557 Hedge Street, Fishers Island, NY 06390
Phone#:(860)-867-6264 Email:davidelmadad@gmail.com
DESIGN PROFESSIONAL INFORMATION:
Name:Sam Fitzgerald Architect, PC
Mailing Address:15 E. Putnam Avenue, #234 Greenwich, CT 06830
Phone#:(860) 287-3808 Email:sam@sfapc.net
CONTRACTOR INFORMATION:
Name:BD Remodeling & Restoration c/o Harland Frazier
Mailing,Add ress:Box 447 The Gloamipg Fishers Island, NY 0639,0 .
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ro
Phone#:(631) 788-7919 Email:harland@bdrrusa.com
DESCRIPTION OF PRO POSED"CONSTRUCTION
❑New Structure *Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $50,000
Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? Wes ❑No
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PROPERTY INFORMATION
Existing use of property:Church Intended use of property:Church
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R_80 this property? ❑Yes *NO IF YES, PROVIDE A COPY.
I* 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 15 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( int na e . t � �` �� �y Authorized Agent El Owner
Signature of Applicant: mate:
ems
STATE OF )
SS:(�
COUNTY OF _)
Samuel W. Fitzgerald being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the Ag e nt
(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 7�
•� � "'
Notar o'bir `°r•,.ter _ m a
TN0TARYPUBUC0FCCNK9C]W
SERT L
PROPERTY OWNER AUTHORIZATION ission 9 1(Where the applicant is not the owner) �ss4sion Ex�i m
• sto �y
I,— y vrnh residing at S ►� �Tl.
do hereby authorize S�>, - � to apply on
my behalf to th own of Southold Building Department for approval as described herein.
,. -- 0. v _
Owner's Signature ate
Dcr�►d rn
Print Owner's Name
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