HomeMy WebLinkAbout34204-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-33345
Date: 10/21/08
THIS CERTIFIES that the building REPAIR
Location of Property: 650 ORCHARD ST
(HOUSE NO.) (STREET)
County Tax Map No. 473889 Section 25 Block 4
Subdivision
Filed Map No. Lot No.
ORIENT
Lot 8
( HAMLET )
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 7, 2008 pursuant to which
Building ~emit No. 34204-Z dated OCTOBER 7, 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 PORCH REPAIR AS APPLIED FOR.
The certificate is issued to SUSAN J & EUGENE MOISA
(OWNER)
of the aforesaid building.
S~FFOLK COUI~TYDEPART~FFOF HKALTHA~PROVAL N/A
ELE~-~'KICAL c~KTIFICATH NO. 1191238 01/30/04
PLU~EP.S CERTIFICATION DA'r~43 N/A
/ri ze/S ign~ure
Rev. 1/81
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
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 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate
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 Bnilding - $100.00
3. Copy of Certificate of Occupancy - $.25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Cmmnercial $15.00
New Construction:
Location of Property:
Date. OcT 1'7,
Old or Pre-existing Building: i-'~' (check one)
House No. Street Hamlet
Owner or Owners of Property: ~'U
Suffolk County Tax Map No 1000, S~c~l~on$8~-/
Subdivision
Permit No. -~ q/~Oq ~.
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ ~,.~ ~, OO
o,--.S Cl5, A/
Block
Filed Map.
Date of Permit. ~ 7 ,~OO,ff" Applicant:
ooo ~4
Lot
Lot:
Underwriters Approval:
Final Certificate:
~" (check one)
Applicant Signature
BY THIS CERTIFICATE OF COMPLIANCE THE'~'' ~ -~
NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
40 FULTON STREET - NEW YORK, NY 10038
CERTIFIES THAT
Upon the application of upon premises owned by
Q.C. ELECTRIC INC. MR. & MRS. MOISA
P.O. BOX 518 650 ORCHARD STREET
LAUREL, NY 11948-0518, ORIENT, NY 11957
Located at 650 ORCHARD STREET ORIENT, NY 11957
Application Number: 1191238 Certificate Number: 1191238
Section: Block: Lot: Building Permit: BDC: ns11
Described as a Residential occupancy, wherein the premises electrical system consisting of ,='1
electrical devices and wiring, described below, located in/on the premises at:
First Floor, Outside,
was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was
found to be in compliance therewith on the 30th Day of Janua~¢, 2004.
Name QTY Rate Ratin~ Circuit Twe
Appliances and Accessories
Oven 2 0 4.5 KW
Dish Washer 1 0 1.2 KW
Wiring and Devices
Receptacle 11 0 General Purpose
Switch 9 0 General Purpose
~ Fixture 16 0 Incandescent
Dimmers 5 0 Va
Receptacle 1 0 20 amp Laundry Va
Receptacle 3 0 GFCI Va
seat
This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. Va
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. 34204 Z
Date OCTOBER 7, 2008
Permission is hereby granted to:
SUSAN J & EUGENE MOISA
650 ORCHARD STREET
ORIENT,NY 11957
for :
PORCH REPAIR IN PLACE, IN KIND AS APPLIED FOR. THIS PERMIT
REPLACES BP 29972.
at premises located at 650 ORCHARD ST ORIENT
County Tax Map NO. 473889 Section 025 Block 0004 Lot No. 008
pursuant to application dated OCTOBER 7, 2008 and approved by the
Building Inspector to expire on APRIL ,.--%, '2~4~0. / ~
Fee $ 150.OS ~ ~~ /
/ '~r~rize~)gnature
ORIGINAL
Rev. 5/8/02
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. ~9~72 Z Date DECEMBER 23, 2003
Permission is hereby granted to:
for :
PORCH REPAIR IN PLACE,
SUSAN J MOISA
650 ORCH~LRD STREET
ORIENT,NY 11957
IN KIND AS APPLIED FOR
at premises located at 650 ORCHARD ST
County Tax Map No. 473889 Section 025 Block
pursuant to application dated DECEMBER 12, 2003
Building Inspector to exq~ire on JUNE 23,
ORIENT
0004 Lot No. 008
and approved by the
2005.
Fee $ 150.00
! Authori zed- Signature
Rev. 5/8/02
ORIGINAL
BUILDING DEPT.
INSPECTION
[~..']~FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] Fou~u~IDATION 2ND [
[ ~]'"F~ING [
[ ] FIREPLACE & CHIMNEY
REMARKS:
] INSULATION
] FINAL
DATE
INSPECTOR
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] INSULATION
[ ]FRAMING / STRAPPING [ ~NAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PF.I~t ~.ATION
REMARKS: ~~~.
DATE
//~O//~/~ INSPECTOR ///~/~///~
OWHER
Ii
TOWN OF SOUTHOLD
BUILDING DEPA~. TMENT
TOWN HALL
SOUTHOLD,'NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www. northfork.net/Southold/
Examined
Approved
Disapproved a/c
PERMIT NO.
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
3 sets of Building Plans
Planning Board approval
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail to:
Phone:
Expiration ' '~;~
Building Inspector
:APeLICATION FOR BUILDING PERMIT
INSTRUCTIONS Date~ 'k ]t~~
,20 0.3
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location 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 Pemait.
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 Southold, 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.
~'~ignature of applicant~r naSne, if~-corporation~
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises ,5 C/,5,0-tl/ ~. /~ 0/$~
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No. c~ l C) [ ~ --' ~
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
House Number Street
Hamlet
County Tax Map No. 1000 Section
Subdivision
Block ~t Lot ~
Filed Map No. Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed consl~mction:
a. Existing use and occupancy
b. Intended use and occupancy
3. Nature of work,~heck which applicable): New Building
Repair ~ Removal Demolition
4.
5.
Estimated Cost
If dwelling, number of dwelling units
If garage, number of cars
Fee
Addition Alteration
Other Work
(Description)
(To be paid on filing this application)
Number of dwelling units on each floor
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front
Height_ Number of Stories
Rear De[~,
Dimensions of same structure with alterations or additions: Front
Depth Height Number of Stories
Rear
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear .Depth
9. Size of lot: Front Rear _Depth
10. Date of Purchase
Name of Former Owner
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO__
13. Will lot be re-graded? YES __ NO__Will excess fill be removed from premises? YES__ NO__
14. NamesofOwnerofpremises ~'qSg-,~ ~ P/o/.~Address 15-$ rp/~C/¢,0~/) 5rPhoneNo.
Name of Architect Address Phone No
Name of Contractor ~ob~2F- J'*'lC Go/~ Address P~b/jv J~O (2~Pd~e No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES __NO ~ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet ora tidal wetland? * YES __ NO__
* IF YES, D.E.C. 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.
STATE OF NEW YORK)
SS:
COUNTY OF )
~(,{S~f ~ 1~) ~ ~'~<'1 being duly swom, deposes andsaysthat(s)heistheapplicant
(Name of individual signing contract) above named,
(S)He is the C) L&) N' ~
(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 tree to the best of his knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn to before me this
/~ day of~ 20 ~,..~
~ Not airy P~b~ic
~ Signatur~[Jof P~pplic~4~t
/~oo- ~. ~/. ~ TOWN OF SOUTHOLD PROPERTY REC:ORD CARD
OWNER STREET ~C) VILLAGE DIST. ' S, UB. LOT
,ES. ~"16 SEAS. VL. FARM COMM. CB. MISC. Mkt. Value
~ND IMP. TOTAL DATE REMARKS
AGE BUILDING CONDITION -~- ,
N~ NORMAL BELOW ABOVE
FA~ Acre Volue Per Volue
Acre
loodland
wampland .. FRONTAGE ON WATER
rushland ; FRONTAGE ON ROAD / ~ o ~ ~"~ ~ 7 ~ 0
louse Plo, DEPTH /~ ~
BUkKH~D
M. Bldg.
Extension
Extension
Extension
Porch
Porch
Geroge
Total
Foundation
Basement
Ext. Walls
Fire Place
Type Roof
Recreation Room
Dormer
Driveway
,z( 77
Bath
Floors
Interior Finish
Heat
Rooms ] st Floor
Rooms 2nd Floor
Dinette
LR.
DR.
BR.
FIN. B.
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971-0959
Fax (631 ) 765-9502
Telephone (631 ) 765-1802
March 26th, 2008
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
2Nb NOT'J:CE
Susan ,7. Moisa
650 Orchard Street
Orient, N.Y. 11957
RE: 650 Orchard St.
5.C.T.M. # 25.-4-8
Dear Ms. Moisa,
Please be advised that your Building Permit # 29972 issued Decembe~ 23rd, 2003 and
Building Permit # ?937§ issued May 14th, 2003 have expired. According to the Code of the
Town of Southold, a Certificate of: Occupancy must be issued prior to use of the structure.
To renew your Building Permit's, please submit o fee of $300.00; at that time we can
schedule an inspection by one of our Building Inspector's.
If you have any questions, please call us at 631-765-1802.
Respectfully,
5OUTHOLD TOWN BUILDING DEPT.
BP# 29972 - PORCH REPAI'R - $ 150.00
BP#29375 - ABOVE 6ROUND POOL - $ 150.00
Town Hall Annex
54375 Main Road
P.O Box 1179
Southold. New York 11971-0959
Telephone (631 ) 765-1802
Fax (631) 765-9502
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
SEPTEMBER 12th, 2008
FIN,~L NOT'~¢E
Susan & Eugene Moisa
650 Orchard Street
Orient, N.Y. 11957
RE: 650 Orchard St.
S.C.T.M. # 25. -4-8
Dear Mr. & Mrs. Moisa,
Please be advised that your Building Permit # 29972 issued December 23% 2003 and
Building Permit # 29375 issued May 14th 2003 have expired. According to the Code of
the Town of Southold, a Certificate of Occupancy must be issued prior to use of the
structure.
To renew your Building Permit's, please submit a fee of $300.00: at that time we can
schedule an inspection by one of our Building Inspector's.
If you have any questions, please call us at 631-765-1802.
Respectfully,
SOUTHOLD TOWN BUILDING DEPT.
BP# 29972-Porch Repair-$150.00
BP# 29375-Above Ground Pool - $150.00
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
July 18th, 2006
Susan J. Moisa
650 Orchard Street
Orient, N.Y. 11957
RE: 650 Orchard St.
SCTM# 025 0004 008
Dear Ms. Moisa,
Please be advised that your Building Permit #29972 issued December 23rd, 2003 has
expired. According to the Code of the Town of Southold, a Certificate of Occupancy
must be issued prior to use of the structure.
To renew your Building Permit, please submit a fee of $150.00 at that time we can
schedule an inspection by one of our Building Inspector's.
If you have any questions, please call us at 631-765-1802.
Respectfully,
SOUTHOLD TOWN BUILDING DEPT.
COMPLY WITH ALL CODES Of
NEW YORV STATE g TOWN CODES
AS RE ::IU!PES ~,NB Z ONOITIONS OF
S.~ ~OL. OWN
LC TOWN P~NN~NG ~A~
SO~MOLC TOWN TRUSTEES
. N.¥,S. DEC
ALL CONSTm~ Ic"rlON SHALL.
MEET THE RE: -' :~','~ENTS OF THE
CODES OF 'NEW YORK STATE,
FLOOD ZONE
COMPLY WITH CHAPTER "4(~"
FLOOD DAMAGE PR_..~V.E~TION
SOUTHOLD TOWN -CODE.
UNDERWRITERS CERT1FtCA'rE
APPROVED AS NOTEO REQUIREO
FEE:
NOTIFY BUILDiN:~ DEPARTMENT AT
765-1802 8AM TO 4:M FORTHE
FOLLOWING IN.S°ECTION$:
1. FOoNDATION ' TWO REQUIRED
~ FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR ¢.O,
AIL CONSTRUCTION SHALL MEET THE
REGUIREMENTS OF THE CODES OF NEW
YORI~ STATF_ NOT RESPONSIBLE FOR
DES~N OR CONSTRUCTION ERROR~
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFI(J;~TE
OF OCCUPANCY f"
CERTIFICATION OF
NAILING & CONNECTION8
RE .(~.)RED .....
- . '/.t,;-,,,~c ..