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> FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22074 Date DECEMBER 30, 1992
THIS CERTIFIES that the building ADDITION
Location of Property 1080 FAIRWAY DRIVE CUTCHOGUE N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 109 Block 5 Lot 14.6
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 1, 1992 pursuant to which
Building Permit No. 20809-Z dated JULY 10, 1992
I
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 ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to THOMAS & ANNE M. BOUCHER
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-256122 - NOVEMBER 6 1992
PLUMBERS CERTIFICATION DATED_ N/A
uil ing Inspector
Rev. 1/81
roam NO. s
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)
NOi9 20809Z Date
Permission is hereby grant to:
~.....:..y..:....~.~...-
to . p..... .s Q.... n~~t....o~ ~Pr~ 9t ~....~-~t ~rn
ion .r.,.......a.
at premises located at ...~.Sa. .Q.....wT.QkS.~1. ~
County Tax Map No. 1000 Section Block A;W Lot No....~. :.W.........
pursuant to application dated J-4,641.. 1 194 4c., and approved by the
Building Inspector.
Fee S•.,`aj..:
I
.
: ding Inspector
Rev. 6/30/80
i
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,-NLI I CAIC01
(FOR NON*ELECTRIC HEAT) DEMON CRITERIA 6,00Degree Day*
O.A, 100? I.A. 700?
AF W 5 BhsaY n,
DhTkp
13 S VS ( A?2E ~...gaxrc^ °r peAHAi 2EMAR re
s
• v n hTrNG .
Exterior Walls (Opaque) ' n b C T
{ C1aring I _96 / 1 3S ~Lti jl?~ eF*- y' ~ f~-
r peers
Cbiling~ROOf (Nagne) ) -
Sk~llahts 96'" - -
i Floor 5 TL us u
Flundatien Wall.
_
Slab I-nsnlation
TOTAL -t 21- i , G z; Iitr,,° 4
Noteai i,;4 JUL ! -1992
'
Deilding Envelope Systems to Meet requirements of 781.f4
I NVAC,Fquipaent to meet requitements of 7815.11
E NVAC'S'ystewe to meet requtrements of 7815.11 ,
Not Systems to meet requirements of 7815.13
VEntilationn Systems to meet,requirements of 7815014
Insulation of Piping Systems to reet requirements'of 78115.15
service Water. Vesting Systems and Equipment to meet Regidre%ents of 7815.11
k Electrical and Lighting Systems and Equipment to meet requirements of 7H15.31
Tb tie blat of my Knowledge', of aE
belief, and ptofessisnal to
~F
E julgement, theme rlans are in
compliance with the code.
s r ~
1 V
S~ 032254-1
PE 10%
0208°5Z
THE NEW YORK BOARD OF FIRE UNDERWRITERS rAG>
951.97 BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
Date N01IFVA9R 06,1992 Application No.onfile 7$559392;92 N 256122
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
TOM BOUCHER, 1.080 ITATRWAY DREVSS, CliflMOGUE, NJ,
in thefollowing location; ? Basement E~ l.ct Fl. ? 2nd Ft. ATTIC Section Block Lot
wasexarninedon No V6tulm o,1992 andfound to be in compliance with the requirements of this Board.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
ECEPTACLES SWITCHES
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT K. W. AMT. K W. PMT KW AMT. K W PMT. H P.
7 14 a -1
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALRECPT TIMECLOCKS BELL UNITHEATERS MULTI-OUTLET DIMMERS
PMT K. W. Olt H. P GAS H. P. AMT. NO A. W G. AMT. AMP. AMT AMP$ TRANS. AMT H P NS . S OF YSTEMS FEET AMT WATTS
SERVICE DISCONNECT NO' OF S E R V I C E
. A. W. G
METER NO OF CC COND A W G. A WO
AMT. AMP. TYPE EQUIP 1,e' 9W 103W 303W 3,e' dW PER .e Of CC. COND NO OF HbLEG OF .1 LEG NO OF NEUTRALS OF NEUTRAL
OTHER APPARATUS:
WX, NOON NISAT7s'R 0-1..0 K.W.
MOTORS:2 r H,P.
SfOWR 6ETSCTO@t-1
SABAT ELECTRIC L117,94204 E
50 PAT LANki
MATTCTUrK, NY, J1952 GENERAL MANAGER
Per 1.1 t'
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
INSPECTORS
Victor Lessard u FF0 r
Principal Building Inspector ~
Curtis Horton SCOTT L. HARRIS, Supervisor
Senior Building Inspector c~ a, 1
Thomas Fisher r',, rCt z } Southold Town Hall
Building Inspector dy 4gyo r 1 P.O. Box 1179, 53095 Main Road
Gary Fish ^y Southold, New York 11971
Building Inspector Fax (516) 765-1823
Vincent R. Wieczorekt^ Telephone (516) 765-1800
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
NOVEMBER 6, 1992
THOMAS s ANN BOUCHER
1080 FAIRWAY DRIVE
CUTCHOGUE, NY 11935
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
R%% An application for Certificate of occupancy is
not on file. (Enclosed)
XXX No Underwriters Certificate on file.
%xx The check is not on file.)$25.00,
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 20809-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
i
- Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
DEG 3 Q 1992 765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This ap,41catiorr moat°be filled in by typewriter OR ink and submitted to the building
inspector with the following: 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 a 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 - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5.' Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
AM41byi - odu -4(1,0Jc Date .
New Construction.......... Old Or Pre-existing Building...
Location of Property..I.,Q,3P.... Riff;gw..pr~~/e ~...Cyfc.l~j~~ Al
House No. Street Hamlet
Onwcr or Owners of Property„TM(~Y, Q--*...Q 1..An~ M j hp .
County Tax Map No 1000, Section... Q.{...... Block. ...,5 Lot..,~
Subdivision.. Foa lfl LUA~1.. Fa lrh?-5 (
q I ,Filed Map„SV,Q,(p4p, ,Lot.
Permit No. AQ.50. l Z , Date Of Permit.. Z. O, ,`f .Applicants An.n. A . rhQmgf?..~QUChe?'
Health Dept, Approval ..........................Underwriters Approval
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
Fee Submitted: $ q:S .OL.....................
ur , ' , _ ti ! A
7Ll APPLICANT
C C)
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[-I/FRAMING [ ] FINAL
REMARKS:
DATE MID' INSPECTOR
`V `~'1
M-1802
BUILDING DEPT.
t~ SECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
DATE4 'FNSPECTOR
7fl"
i
C_
M-1802
1 JBUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ I ROUGH PLOD.
[ ] FOUNDATION 2ND [ I INSULATION
[ ] FRAMING [ I FINAL
REMARKS-
DATE INSPECT
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [,.~N8ULATION
[ ] FRAMING [ ] FINAL
REMARKS:
E
i
DD
DATE /y INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN LATION
FRAMING [ FINAL
REMARKS:
i
4
DATE INSPECTOR d
1cLD G-*TM LNTC
H ~
TOUNDATIO _ (1st)
Cyr^y~t,~
~~Ti I ~
7OUNDATION (2nd) ~ja,
TOUGH FRAME & I C
0
-PLUMBING
01
m
:11SULATION PER N. Y. I y
STATE ENERGY ~I
CODE I r
. FINAL
ADDITIONAL COMMENTS:
- d
. k
H
y O
O ~O
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m
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H
BOARD OF HEALTH dB FORMNO.1 3 SETS OF PLANS
3 - RUC) TOWN OF SOUTHOLD SURVEY
BUILDING DEPARTMENT CHECK; .
TOWN HALL SEPTIC FORM
Ft SOUTHOLD, N.Y. 11971
TEL.: 765-1802 t:OT1FY;
Examined O , 19 CALL l 7,D
HAIL TO:
Approved v 1994-: Permit No.-?.491o!9 "2L .
Disapproved a/c
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date I}me, 29........, 1992.
INSTRUCTIONS
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
Dr areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
~ation.
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 permit
:hall 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 whatever until a Certificate of Occupancy
,hall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
2egulalns, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.'
he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and. regulations, and to
dmit authorized inspectors on premises and in building for necessary i~~Gfln cti~t.~PiL...-~
(Signature of applicant, or name, if a corporation) OWNERS
P 0 Box 1260 Cutcho
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Applican ts are the owners.
. of. the premises.
.
.
:ame of owner of premises cmas 69:k4 Apxt K., 13A1rcher .
(as on the tax roll or latest deed)
f applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. Owne
. r
Plumber's License No. . NO p(ltmlbing
Electrician's License 154k4l?I. /L1Q ~Fjj CMLtOk S~C{~a7t)
Other Trade's License No.
Location,of land on which proposed work will be done. .
1080 Fairway Drive.... Cutchogue
IIouse Number Street .
Hamlet
County Tax Map No. 1000 Section ...109............ Block ...5 14 :6
_ Lot
Subdivision Fairway Farms Filed 61a No. 6066
(Name) p Lot 7.4..........
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy One-family residence
b. Intended use and occupancy Aame , ,(one-fain? ~Y, reS~derice)
3.
Nature of work (check which a PPl ..e).; .New Building Demolition (31 x 20)
Re Repair Removal al . Addition X 1 storyAlteration "
P '
Other Work
4. Estimated Cost . (Description)
..$12,000..(IQ .
Fee
(to be paid on filing this application)
5. If If garage dwelling, number umber of of cars dwellinS' units ...One , , , , , , , , Number of dwelling units on each floor .
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ,
7. Dimensions of existing structures, if any: Front 9?: ' ' ' ' • ' • ' '
. , .......Rear . ,Sams Depth 2$',
Height . Number of Stories . 1 x„ " " " " '
Dimensions of same structure with ai"fienms.Ur additions: Front .92:. Rear .
Depth $.f. Q1 '.rl@W Ad trl)Flcight . 25 91+.'. .
8. Dimensions of entire new construction: Front 92.. , • . ' ' ' ' ' ' Number of Stories J1 . , , , , , ,
Height .25 Number of Stories Rear ...94 . , Depth . , $9, , , , , , , , , ,
9. Size of lot: Front . 195 ] 95f
10. Date of Purchase „O(Ztobe;' 19,91 Rear Depth .20,4E N, , . , , 200:-. S.....
11. Zone or use district in which premises are situated Residential .Own..er.. . .......1.........i . .........1. , ; , , , , ,
12. Does proposed construction violate any zoning law, ordinance or regulatiolation n: No . .
13, Will lot be regraded Will excess fill be removed from premises: Yes No
14, Name of Owner of premises Xh g,, A Anne. ~vpbp Address ]?Q. BQx 12FjQ, ,Gt}tGh,, Phone N5,
Name of Architect ..LaxYy, ,T trill, , , , , , , , , Address Box.162+ .Greenpq;t ,phone No.4,7,7.-Zb52. .
Name of Contractor . .I,• . Address . . • • • • .
15. Is this property within 300 feet of a tidal wetland? eyes.. No.. I. No .
*If yes, Southold 'down Trustees Permit may be required, No.
PLOT DIAGRAM
Locate clearly and distinctly all -buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
Please refer to plot plan on attached drawing #3 of 3.
e it
111 T / v
I
TATE OF NEW YORK,
OUNTY OF S1~,f~Z S,$
Thot.mas Boucher and Anne M.' th y are
Boucher being duly sworn, -deposes and says that Ife is the applicants
(Name of individual signing contract)
)ove named.
°is t1rL .
(Contractor, agent, corporate officer, et
said owner or owners, and is duly auth m or Lave performed the said work and to make and file this
p~ication; that n amod in this application are true to the best of his knowledge and belief; and that the
om to before me this cwitla'
th.. day of ,I .~tR1e . . . . . . . . . . . . 19.92
tary Publig; Lt#f Q71S. , , , . County
JOYCE BERSOIi L~
NMaryPublk,8tateofNewYork THOMAS and ANNE M. BOUCHEASignatureofapplicant)
No 4721004, Suffolk Cuu tI~L
Commission Expires March 30, 9s,/
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hrLU,- ?On' rio~ Exi~T~,~y
DATE: B.RN 1 - Ekis7~nic
umomRmal nulE FEE: Q-A- - BY: 'I REQUM NOTIFY BUILDING DEPARTMENT AT
765-1802 1 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS: of NEW y
I FOUNDATION - TIN' REQUIRED 0
FOR POURED CONCRETE yh ~~~c TUj ¢
2. ROUGH - FRAMING & PLUMBING o ?gory ~ Phone 477-0400' M:Iin P oaa GREENPORI, N.Y. 11944
OCCUPANCY OR 3 FINAL:aa" FINALULATION CONSTRUCTION MUST A. FINAL. i0'NSTP.UCTION MUST 1 ~UNLAWFUL BE COMPLETE FORC.O.
r .:10 ~r Aaor~s~~ _ MK .*-MKg 774ONA5 'L?YJCNC- -{aer 5_2~-9z
USE IS i ALL CONSTRUCTION SHALL MEET, yQ 022541
WITHOUT USEIS NLAW CERTIFICATE THE REQUIREMENTS OF THE N.Y. ~+IpfESNIQ ~~p ~ ES7 UiCFf'~NSAEK, '
OF OCCUPANCY STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR G S v P~ DWG ELEVPTlotds
DESIGN OR CONSTRUCTION ERRORS PLANNO. !'t(o3 F' scale "JY =10' 6F_3
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