HomeMy WebLinkAbout49502-Z ur TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
4$7,. 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 #: 49502 Date: 7/21/2023
Permission is hereby granted to:
deC Blondel Jr J Rev Trt
_ ............
165 Charles St Apt 221_1'____.'1'_
New York,....NY 10014.. „ _......... ...e., .------_--------_1 ..........
To: Construct an interior alteration to a single-family dwelling as applied for.
At premises located at:
Private Rd, Fishers Island
SCTM # 473889
Sec/Block/Lot# 4.-6-5.2
Pursuant to application dated 5/5/2023 mmm and approved by the Building Inspector.
To expire on
pi 1/19/2025.
Fees:
SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $207.20
CO -ALTERATION TO DWELLING $50.00
Total: � $257.20
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 h11 s;//vn w.sout'noldtownnv, av
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only L
1�p�/ n
PERMIT NO. `�n Building Inspector MA 0 2023
RED,
Applications and forms must be filled out in their entirety. Incomplete Towcwsolmm
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date: 4/26/2023
OWNER(S)OF PROPERTY:
Name: John Bloedel SCTM# 100
ProjectAddress: 18073 East Main Rd.
Phone#: 917-861-4157 Email,john.blondel(cD-9s.com
Mailing Address: 165 Charles St. Apt 22 New York, NY. 10014
CONTACT PERSON:
Name John Blondel
Mailing Address: 165 Charles St. Apt 22 New York, NY. 10014
Phone#: 917-861-4157 Email John.blondel�9s.com
DESIGN PROFESSIONAL INFORMATION:
Name: Jacob D. Albert/ Albert*Richter*Tittmann
Mailing Address: 33 Union St. 4th Floor Boston, Ma. 02108
Phone#:617-451-5740 Email:artarchitects-com
CONTRACTOR INFORMATION:
Name: HP Broom Housewright/ William A. Bartlett
Mailing Address: P.O. BOX 70 162 Ferry Rd. Hadlyme, CT. 06439
Phone#: 404-401-3109 1 Email: bill@hpbroom-com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition igAlteration ❑Repair ❑Demolition Estimated Cost of Project:
[]Other $65,000.00
Will the lot be re-graded? ❑Yes imiNo Will excess fill be removed from premises? ❑Yes RNo
1
PROPERTY INFORMATION
Existing use of property: Single family Intended use of property: N/A
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? Dyes®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 210.45 of the New York State Penal Law.
Application Submitted By(print name): Wi I I Karn A. Bartlett ®Authorized Agent 00wner
Signature of Applicant: Date: 04/28/2023
STATE OF NEW YORK)
SS:
COU
NTY OF
V 10 i ll ism A. Bartlett being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the
contractor
(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
u23 �\
Ls aday of
Notary Public
ROPE T OWNER i%U�.).. ��0) 1ZAfl
(Where the applicant is not the owner)
John Blondel18073 East Main Rd.
residing at W
William A. Bartlett
do hereby authorize to apply on
my behalf to the T w If Sout gld ilding Department for approval as described herein.
iqlv
wner's Signature Date
Jon Blondel
Print Owner's Name
2