HomeMy WebLinkAbout49462-Z F a TOWN OF SOUTHOLD
Gy BUILDING DEPARTMENT
y x ' 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#: 49462 Date: 7/11/2023
Permission is hereby granted to:
Merlo, Michael
1120 Bridge Ln
Cutchogue, NY 11935
To: demolish existing accessory barn as applied for.
At premises located at:
1120 Bridge Ln, Cutchogue
SCTM #473889
Sec/Block/Lot# 85.-2-6
Pursuant to application dated 6/5/2023 and approved by the Building Inspector.
To expire on 1/9/2025.
Fees:
DEMOLITION $229.60
Total: $229.60
Building Inspector
L a
�g�f.FOlt46" TOWN OF SOUTHOLD—BUILDING DEPARTMENT
C2 x Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 https://www.southoldtownny.gov
1# �
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only '•-=1 ' ' ! r�
PERMIT NO. Building Inspector:
JUN - 5 2023
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:
OWNER(S)OF PROPERTY:
Name: -- - t-- SCTM#1000- J (��'�' L -----------..
Lav
ProjectA ss:e `.l l �_D___��-
Phone#: Email:-----
--- -- _ - ----- 2b- -- ----- - ---- -- -- - ---
Mailing Address:
CONTACT PERSON:
Name:
Mailing Address: ii 11 nn
Phone#: 21�p �S Email: ` com
- _.tel_- _.__ _ _ _ _ --- - e -
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration E]Repair%beholition Estimated Cost of Project:
❑Other Old
Will the lot be re-graded? Yes El No Will excess fill be removed from premises? Dyes o
1
s ,
PROPERTY INFORMATION
Existing use of property: Vp Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
.___________ __ _____ ------ - ---- --� this property? ❑Yes []No IF YES, PROVIDE A COPY.
❑ 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 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 By(print name): � ❑Authorized Agent Owner
Signature of Applicant: Date:
CONNIE D.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
No.01 BU6185050
SS: Qualified in Suffolk County c '
COUNTY OF ) Commission Expires April 14, 2C 'I
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/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
-Jjday of 20� v17�' )M�
tque� CA
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
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
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