HomeMy WebLinkAbout18076-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218138 Date NNE 23, 1989
THIS CERTIFIES that the building ALTERATION
Location of Property 1295 CLEARVIEW AVE. SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 070 Block 09 Lot 30
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this affice dated APRIL 24, 1989 pursuant to which
Building Permit No. 180762 dated APRIL 27, 1989
was issued, and conforms to all of the requirements of the applicable
provisions of the Law. The occupancy for which this certificate is
issued is ENCLOSE EXISTING PORCH (TO REMAIN UNHEATEB}.
The certaf icate is issued to MILDRED BONFIELB
(owner, }
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N074129 MAY 30, 1989
PLUMBERS CERTIFICATION DATED N/A
B ilding Inspector
Rev. 1/81
l08M NQ f
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N° g a 7 6 Z Date I9..Q.~
Permission is hereby granted to:
'...lam... ~-~:.D.....
to ..~I.CX:!~4:..rid.~l.<.v~.seraGl......y..il,:S.CJ/.I...C..~"D.:~1h~n.4ltaa...~.~:°:~1'~:4:I4:W-ll.~.......~r.r~+~...... .
at premises located at ../...a~.`~~.......4XFwk!~..4.ft.~? ::............SJ~~................
~ ....'-3r.. ~
County Tox Map No 1000 Section .....Q~:1?..... Block Lot No....~.4
pursuant to application doted ..~,`C
. 19.Q.g.., and approved by the
Building Inspector. I~
Fee 5..,~~.:.~'......
.,cc-~°-~ .............:~-s.~-
.
uilding Inspector
Rev b/30180
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TOWN OF SOUTIIOLD 4;~
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BUILDING DEPART?ICNT r ~
TOWN HALL t~~j
SOUTIIOLD, NEW YORK 1 197 1 BLDG. DEPT.
TUWN OF SOUTHOLD
765 - 1802 ~~rlr
HIS'" ~~,ur~•
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APPLICATION FOR CERTIFICATE OF OCCIIPANCY / p
NEW CONSTRUCTION .......OLgD OR PRE-E%ISTING HUILDINC. ~ ._VACANT LAND....__..
Location of Property.. /2./~.i C'~~~~/E/?/ SO ~L?Y.~L':~......
HOUSE NO. STREET HAMLET
Owner or Owners of Property .
CounCy Taz Map No. 1000 Section Block b~._.. Lot
Subdivision_......--.77 FLi~le/d Map ........Lot..~.j......,.[,
Permit No. fB6~~'`..Date of Permic !1c27~~~ .Applicant .+4~QlZ!Q~l:_5c~:~?~...
Health Dept_ Approval Underwriters Approval.
PlaaninC Board Approval
Request for Temporary Certificate Final Certificate
Fee Submitted: $
aCe ~~~e,
APPLICANT_.._......
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THE NEW YORK BOARD OF FIRE UNDERWRITERS PACE 1
lD~ula].
r BUREAU OF ELECTRICfTY
RAY 30, 1.989 85 JOHN STREET. NEW YORK, N6 W ~y489fS9 38 N 07A129
Dote Application No. on f11e
THIS CERTIFIES THAT
only the deetricd equipment a dncrihed hsloFO and introduced hY the applicant named on the ohooe application number in the promises of
NILDRBD BONPIELD, ].295 CLEARVIBA AVE., SOUTROLD, N.Y.
in thefolbleinR bcgRtp[E, 2 Basement ~ IAt FI. ? Ynd FI. Sertiun Block Lot
rcas examined on FIAT 6, 1`l6`J andfound to 6e in compliance with the requirements of thu Board.
IIXTIItl RXTUFBiS eANWf tXIOKINODecKS OVefYf M5X Af11eR5 eXMAUSTlAIES
twTteTE ACIlf SWITCNEE NuNDESCFNT PIUOMECFNT OTHER AMT. k. W. AMT. k. W. AMT. F.W. AMT. k. W. AMT. M. P.
3 2 3
DR17K RJeNACe MOTORS t41TtNE AFFBANtA Rwus snau EK'?T TIME ClOCK4 Eni uiKT tieilfuK MIXtl.0aT1lT f71EAAttef
AMT. k. W. dl N. P. GAS H. P. AMT. NO. A. W.O. NAT. AMP. AMT. AMPS. TEAKS. AM1. N. P. ~
~T AMT. WAIn
seRVfa oRiCONNeCT tEO.oF s E R v I r e
AMT. AMP. lER ~ 1 / iW 1 X tW ] R SW 7 / AV PER
#COND. d CC. COND. NO. d KLIEG HI Pq. Oi NEUMAIS OF ~NlUfOIIAI
OTNEE AF?MATUS:
PAUL R. BURNS LIC./2826
275 TORN HARBOR LANE
SOUTROLD, NY, 11971 p
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Per
This carKBtoh mwf not be o1Nrod in any manner; rNurn to tM offiw R[Lrd if incorrect. Inspectors. m be iden' y flleir ewdenfioh.
BUILDING DEPARTMENT. THIS COPY OF C IPIGT! Mali NOT 6E ALTERED IN ANY MMMER.
n ~~=SLia~~ ~ BOARD OF HEI,LTH / , .
U 3 SETS OF PLe1NS :~~Q : , ,
FORM N0.1 SURVEY
.
TOWN OF SOUTHOLD CHECK •S. ~l.`~y..
f'
S~ BUILDING DEPARTMENT SEPTIC FORft
"~"'°~^r-'°'~-°•^^~-----~ TOWN HALL
^=n SOUTHOLD,N.Y.11071 NOTIFY ,tf71„
' TEL.. 7651802 CALL
MAIL TO:
Examined . ~.4~.~ a~.. , 19~~. '
~,,,,,,U
\Pprove Ulc~t,+.. 19a~.. Permit No. ~.~07 b'L
Disapproved a/c
...............................Y~.~........... .
(Building Inspector)
APPLICATION FOR BUILDING PERMIT A
Date . !'4 ~t:t1.. 15 8
INSTRUCTIONS
a. Tlus application must be completely filled in by typewriter or in ink and submitted to the Budding Inspector, with
' sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan shoving location of lot and of builduigs on premises, relationship to adjoining premises or public stree
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app
cation.
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 issued a Building Permit to the applicant. Such perm
shall be kept on the premises available For inspection throu;tiout the work.
e. No builduig shalt be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan~
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bmlding Permit pursuant to ti
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances .
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descnbe~
Ttie applicant agrees to comply with all applicab3e laws, ordinances, bull ing code, hqustn~ code, rid regulations, and
admit authorized inspectors on premises and in building for necessary msp eo~ns. /Q//~G,
.••..•f
(Signature of"applicant, or Warne, if a corporation)
oTD ~'ouN~.. RoA~... ~Eirsb.P,r~ _ //f`!~! .
• (Mailing address of applicant)
State wnhether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde
L~'enera.I eonf'r4cfor'
Name of owner of premises ...(~!.~?{.rrsl.~o»~P/c1~
(as on the [a~ roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builder's License No. . 139. 3 E'~• Z; , , , , , ,
Plumber's License No .
Electrician's License No . .
Other Trade's License No . . .
1 Location of land on which proposed work will be done . .
...1295 .................Gl.eartria,w,!4,V'ertup;......... Soi,+_+bot-~
House Number Street, p Hamlet
County Taa ivfap Na I000 Section ........T ~ Block .....1 , , , , , Lot 3.~
Subdivision Filed niap No. Lot
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction. !
a. Eristmg use and occupancy ~ P.dn „EIal~.pl~,e,°nC?;rr1'~,'.Plo,ore,~~. c9.yC.r.e~.~??~`~h:...... .
b. Intended use and occupancy enelosecl, p.4r.~l~, ,k!y~?,~al-ed . . . . .
.W
3. Nature oCwork (check ~rh~ch applicable) New Isuildmg Addrhon ration I/
Repatz Removal Dcmofrt~on ~
tnGlosed tatsh„q ca~.e,'e,LpoTC~ wtH'' slider nr,,d w~oetoufl~ unbC4l.c.e ~ (Dcscnpno~
4. Esttmatcd Cosi .+/Po4 Fee .
(to be paid on filing this apphcatton}
5. If dwelling, nwn6er of dweltmg units ~ , Number of dwelling units on each floor .
Ifgaragc,numbcrofcars
6. IC business, co ercial or mixed occupancy, specify nature and ceten[ of each type of use .
7. D~mensrons of xuting structures, tf any• Front Rear Depth ,
Hcrght .......NumberofStoncs
Drmens~ons of ame str~l~r~/tvtth altcrati~of s or addttrons~ Front Rear ,
Depth , q:1'tl~r~tz'/ • . . Number of S[ones , .
8. Dimenstans of tuc new constructwn. Front Reat Depth .
Hctgttt ...............NutnberofStoncs...................
9. Size of lot: Front Rear..................... Depth
10. Date of Purchase . .Name of.Formcr Owner
1 1. Zone or use dtstnct m which premises are situated . hilll4!?I:! .
12. Does proposed constructzon violate any zoning law, ordinance or regulation. h,o, , , , , , , , , , , , , , , , • , , , - , , , , ,
13. 1Vt11 Iot be regraded d... .....1Vt11 excess fill be removed from premises: Yes
14. Name oC Owner of premises . M~ldtSd .L~.°."~~~0~.... Address lk4s ute!WU!'wMe. ,~f?~. Phone No. Zk~`..15, Zb, , , ,
Name of Architect ....Address ..Phone No.............
Name of Contractor . Darte(.~~PS~`°Y , , .........Address?4 ~:k!~.t?'~. ~P,C.-....Phone No. ~F77.~.46 ~o
15.Is this property located with in 300 feet of a tidal wetland? *YES..,.NO.
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAh1
Locate clearly and dtstrnctly ail buildings, whether exuung or proposed, and indicate all set-back dimensions fn
property lines. Give street and block number or descnpt~on according to deed, and show street names and mduate whet;
tntenor or corner lot.
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• G4RA6t
STA'CE OF tiEw YORK,
COUtiTY OF .
• • • • • • • • - • . being duly sworn, deposes and says that he is the apphca
{Name of individual signing contract}
above named.
iietsihe
(Contractor, agent, corporate officer, etc.)
oC said owner or owners, and rs duly authonzcd to perform or have performed the said work and to make and Gle t:
appluaLOn, that all statements contained m this apphcat~on arc true to the best of fus Lnowledgc and belief, and that t
work wdl be performed m the manner set forth m the apphcat~on Glcd therewith,
Sworn to before me this
U
rotary Public, ;","".?rte. ~ N,~.~!$e:"........ County ..c~/I~...
HELEN K.1)E VOE
~No~4767878 $u8ulkfqunYak ($i;nazure oCapplica:
Term Expires Meech 3fl, I