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Home My WebLink About33978-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33115 Date: 06/23/08 THIS CERTIFIES that the building ALTERATION Location of Property: 170 ORCRARD (HOUSE NO.) COunty Tax Map No. 473889 Section 25 ST (STREET) Block 1--- ORIENT (HAMLET) Lot 3.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 2, 2008 pursuant to which Building Pennit No. 33978-Z dated JUNE 12, 2008 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 "AS BUILT" KITCHEN ALTERATION AS APPLIED FOR. Tbe certificate is issued to GINA M MAXWELL (OWNER) of the aforesaid building. SUFFOLK COIJlIITY DEPAR'l14EHT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 08-4173 06/16/08 PLUMBERS CERTIFICATION DATED 06/13/08 GARY STAHL ~,L,4~ Rev. 1/81 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 - \ I~ ,; r' , f~ 2 .j'i. I ......-:) ! .~ y'/( /y Yj----- {,/ c " -- --- APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the.:Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. '"'~ 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of I % lead. 5. COHlmercial building, industria! building, mt!ltiple resid~nces and silnilar buildings and installations, a cel1ificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building. $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy. $50.00 5. TemporafJi'Ceiti.ficate of Occupancy - Residential $15.00, Conunercial $15.00 New Construction: Date. updated CO for One Family Old or Pre-existing Building: X May 7.200K dwelling (converted (check one) from fire house} Location of Property: 170 Orciard Street. Orient. N.Y. House No. Street Hanliet Owner or Owners ofProperty: Gina Maxwp-l1 Suffolk County Tax Map No 1000, Section 25 Block J Lot 3.1 Subdivision Filed Map. Lot: PermitNo 33'1/$$ Date of Pem,it. Applicant: Health Dept. Approval: Underwriters Approval: converted Planning Board Approval: Request for: Temporary Certificate ~ Fee Submitted: $ t;)C ~ol,. txJZ:?,;':> 115 f4 L 'I '-Is I~ Final Certificate: OLSEN & OLSEN LLP 32495 MAIN ROAD PO BOX 706 CUTCHOGUE, NY 11935 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971-0959 Fax (631) 765-9502 Telephone (631) 765-1802 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date: ~/;~ftl> { I Building Permit No. 73 r:if 33 '178 Owner beAJAr JflA-XUJl;"l.J.- (Please print) Plumber ~i 'S,-~/,- (Please print) 301l fl1.p I certify that the solder usep in the water supply system contains less than 2/1 0 of 1% lead. FO lZ.... *u... 2.!:-A FLOOR. 'PL.'" m.1t> 'J.J~ . 7f!v Swom to before me this I::; daYOf_~_, 20 0 '6" Jtj'l~- / Notary PUbliC'~-( County '.'~. .... 1I'_....""~i-.~.. , .i"'!"t t;ft .'~? :,:,1\ ~ . GAlLL.A88ETT'O' ; 1 ." NofaJyPubllo=.lr'bk , i 'No.01 'Ii I ,," ~InSullolkCOunlY 10 ,: CoownIssion Expires.lan f8.}O_ ,. ~ ~""", .~:,' -""", .'. . , .~<_,;'~ III- """~.. _.. ...,..~'.. / Dominick Salvati & Son Architects Established in 1910 May 30, 2008 Building Department Town of South old Town Hall Annex P.O. Box 1170 Southold, NY 11971 Re: Gena Maxwell 170 Orchard Street Orient, NY SCTM# 1000-25-3-3.1 Dear Sirs, Site observation this date reveals that the existing septic system meets all current New York State Health Department specifications for a single family dwelling. For any other questions regarding this matter, please call. Sincerely, ~vati \" '::. -'l. / './ 'v ,,<-. /' ,./ 26 Court Street, Suite 1804, Brooklyn, NY 11201 (718) 855-4686 ))'\ '- /."/ . r-. .c, FORM NO. 3 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) PERMIT NO. 33978 Z Date JUNE 12, 2008 permission is hereby granted to: GINA M MAXWELL PO BOX 553 ORIENT,NY 11957 for : AS BUILT KITCHEN ALTERATION AS APPLIED FOR at premises located at 170 ORCHARD ST ORIENT County Tax Map No. 473889 Section 025 Block 0003 Lot No. 003.001 pursuant to application dated JUNE 2, 2008 and approved by the Building Inspector to expire on DECEMBER 12, 2009. Fee $ 400.00 ORIGINAL Rev. 5/8/02 , . FIELD INSIIECTION REPORT I DATE I FoUNbATION (1ST) --------------,----------------------- FOUN]!)ATlON (2ND) ROUGH FRAMING & PL UMBING INSULATION PER N. Y. STATE ENERGY CODE EINAL -- . ---e-- ~//3 { I -- COMIYIENTS /l-.A..f(. C.... // Pd. r/1. 7-. (/ ~_...1../ / / / ADDITIONAL COMMENTS -c . . .' ~~ ~~ ~>-J ~"" ~.~ '\ .c:: I' ~CI:l ~t'l ~' \ ~9 1::.,:' ~~ ~~ :::,. !' . ~ ::r: ~~ ~~ ~. ~ \ rr-,IJ/ J. to_-I- )-..,_, I -/ / "J . ~. i2 0 \ ::;: ,~ ~ ;C ~ , \ '\' ~t'1 \'-:. i:;J ~ ~ , >-J ~ 23 \\;, :z: ~ \ ! "d ..., Town of Southold PROPERTY LOCATION: S.C.T.M. #: Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM District Section Block ~ THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM-WATER, GRADING, DRAINAGE AND EROSION CONTRDL PLAN CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. Item Number: (NOTE: A Check Mark (~) for each Question is Required for a Complete Application) 1 2 3 4 5 6 7 8 9 Will this Project Retain All Storm-Water Run-Off Generated by a Two (2") Inch Rainfall on Site? (This item will include all run-off created by site clearing and/or construction activities as well as all Site Improvements and the permanent creation of impervious surfaces.) Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size & Location? This Item shall Include all Proposed Grade Changes and Slopes Controlling Surface WaterFlow! Will this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand (5,000) Square Feet of Ground Surface? Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction or within One Hundred (100') feet of a Wetland or Beach? Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Vertical Rise to One Hundred (100') of Horizontal Distance? Will Driveways, Parking Areas or other Impervious Surfaces be Sloped to Direct Storm-Water Run-Off into and/or in theq,ire.ction of a Town right-of-way? Wilt this Project Require the Placement of Material, Removal of Vegetation and/or the Construction of any Item Within the Town Right-of-Way or Road Shoulder Area? (This item will NOT include the Installation of Driveway Aprons.) Will this Project Require Site Preparation within the One Hundred (100) Year Floodplain of any Watercourse? Ves No /[J /[J [J / [J -.L [J r' [J (' [J /' [J L [J I NOTE: If Any Answer to Questions One through Nine Is Answered with a Check Mark in the Box, a Storm-Water, Grading, Drainage & Erosion Control Plan is Required and Must be Submitted for Review Prior to Issuance of Any Building Permit! EXEMPTION: Ves No Does this project meet the minimum standards for classification as an Agricultural Project? Note: If You Answered Yes to this Question, a Storm-Water, Grading, Drainage & Erosion Control Plan Is NOT Requlredl --./ STATE OF NEW YORK, COUNTY OF ........................................... SS That It V~~...~441..~..."..."...... being duly swam, deposes and says that he/she is the applicant for Pennit, (Name of individual signing Document) CONi':'lIE D. BUNCH And that he/she is the ...............~.............................................................N~.~:g:~fIlW~roew.XQrls............ (Owner, Contractor, Agent. Corporate Officer, etc.) Com qua'ffied in SuffOlk Coo~ mISSion Emires AnriI 14 ,,'1 Owner and/or representative of the Owner of Owner's, ,md is duly authorized to perform or have pertonne"rtnt!s ~and to make ,md file this application; that all statement' contained in this application are true to the best of his knowledge and belief; ,md that the work will be performed in tlle manner set fortl, in tl,e application filed herewith. Sworn to before me this; .............a:-.0..d.................... day of .......~.t.\.P............"... ,2$7- Notary PublIc: .~.d......0.....Z.~v.\..w~................ FORM - 06/07 / I / / I / S :7 1's5' .," 'n ../{)- C GRANlrc r, i 04'S ! 2'5'E: ORcq~Rb SURVEY OF PROPERTY AT ORIENT TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK 1000-25-03-03 SCALE: 1"=20' APRIL 6, 2001 II / ~/ il !~~ / ---------- ~~ 13070 S 76"57'30_ E: ~--~ , STR88T ; ; ,;.,1 ~I 1 i ------- -- !J !# ~ '" ~ ~ ~ ~ "- ~ <:- fi ~ rc 1,6'", o'B'C N 76"57'30_ rc a,IN 0,3'101 CD (631) 7 p, 0. BDX 1230 TRAVELER STREET SDUTHDlD, N, y, 11971 ANY AL T!:RATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF TH!: NEVI YORK STAT!: EDUCATION LAVI EXCEPT AS PER SEPION 7209-SUBDfVISION 2, ALL CERTIrICATIONS HEREON ARE VALID rOR THIS MAP AND COPI!:S THEREOF ONL Y IF SAID MAP OR COPIES BEAR THE IMPR!:SSED SEAL or THE SURVEYOR VlHOSE SIGNA TURE APP!:ARS HER!:ON, . =MONUM[NT AREA=8,401 S. F. 01-109 PERMIT NO. 3"2:>'1'":\-~..z- BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.N orthFork.net Examined ~:::-y Approved Disapproved alc Contact: Mail to: 2 ,20 ._ <._------".-..:.\ ' ~ ~ \ ~ J i g ector , J 1\ :.J ,PPLICATION FOR BUILDING PERMIT ~, :J._! Date :S-r.t~ INSTRUCTIONS tU-- Phone: -4:4S--{~ Expiration " L. , 20 (; ~ a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing loc~tion of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. . 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 issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. 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 South old, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or 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 for necessary inspections. tffl (Signature f applicant or name, if a corporation) ? d !3tJY 5i3, ()~ t 1Ur; //16"7 (Mailing address of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ff~ () I N f1 I'/f/XttJ e t.-- t.- (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer {)1,u tiA........- ~ ' Name of owner of premises (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which 'proposed work will be done: /70 O,(CHIt-/(D S-r. House Number Street ()I!I~N I Hamlet County Tax Map No.1 000 Section Subdivision ;)5 Block Filed Map No. ~ Lot :S. / Lot 2. State existing use and occupancy of premises and intended use and occupancy of p;oposed construction: ,. fui,ti"g~md"_"" S'''9/~ I'Om,/,/ daJe//""i " JA. I\. (( Sl II b. Intended use and occupancy - IJ .4 Itll-T KtTlt(etJ 3. Nature of work (check which applicable): New Building Repair Removal Demolition Addition Other Work Alteration (Description) 4. Estimated Cost Fee 5. If dwelling, number of dwelling units If garage, number of cars (To be paid on filing this application) Number of dwelling units on each floor 6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Height Number of Stories Rear Depth 9. Size oflot: Front Rear Depth 10. Date of Purchase Name of Former Owner O,(IEAJ; FIRe iJEPIM?THEN r ,(esIOlElVnlJ-(., 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO /' 13. Will lot be re-graded? YES_ NO ~l excess fill be removed from premises? YES_ NO-----L:: Phone No. Phone No Phone No. Address Address Address 14. Names of Owner of premises Name of Architect Name of Contractor 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES _NO ..k' * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES_NO_ * IF YES, D.E.e. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES_NO L * IF YES, PROVIDE A COPY. STATE OF NEW YORK) ss: COUNTY OF ) ML-LI<AJVL ~ being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, ~--- (Contractor, Agent, Corporate Officer, etc.) CONNIE D. BUNCH Nolary Public.. Slate of New York ~o.OlllU6185050 Commission Expires April 14, o.l.b (S)He is the 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 know ledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to ,before me t~(; ~("\ d day of l..U\...R. 20 ~ ~~ fS~~ Notary Public