HomeMy WebLinkAbout27382-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
Date: 06/13/02
No: Z-28515
THIS CERTIFIES that the building ACCESSORY FAIRWAY DR CUTCHOGUE
1080
Location of Property: (STREET)
(HAMLET)
(HOUSE NO.)
County Tax Map No. 473889 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
MAY 25, 2001 pursuant to which
Building Permit No. 27382-Z dated
JUNE 11, 2001
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 ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR.
The certificate is issued to THOMAS & ANNE M(OBOUERER
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
gLECTRICAL CERTIFICATE NO.
N 577606 12/04/01
PLUMBERS CERTIFICATION DATED
N/A
A h riz d Signature
Rev. 1/81
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
(THIS PERMITOMPLETIONBOFKEPT
UNTIL FULL
THE WORK AUTHORIZED)
PERMIT NO. 27382 Z
Date JUNE 11, 2001
Permission is hereby granted to:
THOMAS & ANNE M BOUCHER
PO BOX 1260
CUTCHOGUE,NY 11935
for .
CONSTRUCTION OF INGROUND SWIMMING POOL AS APPLIED FOR WITH FENCE
TO CODE.
1080 FAIRWAY DR CUTCHOGUE
at premises located at �_
ection 109 Block 000_ 5 _
Lot No. 014 . 006
County Tax Map No. 473889 S
pursuant to application dated MAY
25, 2001 and approved by the
Building Inspector.
Fee $ 150 . 00
AuthbVizea Signature
COPY
Rev. 2/19/98
Form No.6
TOWN OF SOUTHOLD �t
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPAN I C�
This application must be filled in by typewriter or ink and submitted to the Building Dep t gt
A. For new building or new use: lines, st ets, and r
1. Final survey of property with accurate location of all buildings,property
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 s a certificate
lead.
5. Commercial building,industrial building,multiple residences and similar buildings and installations,
of Code Compliance from architectding.
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 dwelling
1. Certificate of occupancy--Nessory building$00 0 Additions,Additions to dwelling
acces ory building$25,00,Businesses $50.00.
Swimming pool$25,00,
2. Certificate of Occupancy on Pre-existing Building- $100.00
3. Photocopy of Certificate of occupancy-$0.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of occupancy- Residential$15.00,Commercial$15.00
Date. 131 1 0 1
New Construction: ✓ pool Old or Pre-existing Building:
(check one)
Location of Property: O 8 O Street Hamlet
House No.
Owner or Owners of Property: 1 ht)m 2 S a yi A—
Suffolk County Tax Map No 1000, Section
lOq Block 0005 Lot O(L OUCo
Filed Map. Lot:
Subdivision
Permit No. o� "7 3 g a Z Date of Permit. I O t Applicant:
Health Dept.Approval:
Underwriters Approval:
Planning Board Approval:
Certificate
Final Certificate: ✓ (check one)
Request for: Temporary
Fee Submitted: $
Applicant Signature
THE NEW YORK BOARD OF FIRE UNDERWRITERS PirE 1
r1?yL BUREAU OF ELECTRICITY
40 FULTON STREET, NEW YORK, NY 10038
Date DECEMBER 04,2COI Application No. on fie rw - ';(_,0F
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of
T014 BOUCHER, 1080 FAIR WAY DRIVE, CUTCHnc
in the following location; ❑ Basement ❑ Ist Fl. ❑ 2nd Fl. Section Block Lot
was examined on NOVE14BER 16,2001- and found to be in compli'dneq with the National Electrical Code.-
FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. I K.W. AMT. K.W. AMT. K.W. AMT. H.P.
:1 1
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
AMT. K.W. OIL X.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WARS
i "
SERVICE DISCONNECT NO.OF S E R V 1 C E
METER NO.Of CC COND. A.W.6. A.W.G. A.W.G.
AMT. AMP. TYPE EQUIP. 1 0 YW 1 0 SW 3 0 JW 3 0 IW PER 0 OF CC.GOND. NO.OF HI-LEG OF HIdEG NO.OF NEUTRALS Of NEUTRAL
OTHER APPARATUS:
POOL-1
PANELBOARDS:1-3 CIR. 40
G,F.C.I:-1
-(SW MING POOL) This certificate
covers compliance at the date of
inspection only. Because of unusual
?%nvironments it is advisable to ---
have frequent test/qualified
pe or repairs L L
made by a qualified person.
<<< Continued on Page 2 >>>
GENERAL MANAGER
Per
This cerflficate 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.
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGF
1195197 BUREAU OF ELECTRICITY
F 40 FULTON STREET, NEW YORK, NY 10038
DECEMBER 04,2001 N 5-1'1%60!6
Date Application No. on file
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of
TOM BOUCHER, 1080 FAIR WAY DRIVE,, CUTCHOGUE, NY
in the following location; ❑ Basement ❑ Ist Fl. ❑ 2nd Fl. OUT Section Block Lot
was examined on NOVEMBER. 16,2001 and found to be in compliance with the National Electrical Code.
FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT, K.W. AMT. K.W. AMT. K.W. AMT. K.W. n::7.
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET SYS EMS DIMMERS
AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS
SERVICE DISCONNECT: No.OF S E R V I C E
METER NO.OF CC COND. A.W.G. A.W.G.
AMT. AMP. TYPE EQUIP. 0 YW 1 0 JW J 0 JW 3 0 4W PER 0 OF CC.COND. NO.OF HI-lEG &HI-LEG NO.OF NEUTRALS OF NEUTRAL
OTHER APPARATUS:
SABAT ELECTRIC. LIC.#420LL
4 �
50 PAT LANE
MATTITUCX., NY, 11952 GENERAL MANAGER
11
Per
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.
o o — /o -s - ,GOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER STREET VILLAGE DIST. SUB. LOT
60 S DU # W , F4iX w p A,el vE �"'u 70_ '
FORMER OWNER N E
l ACR4�o�s
beock_ M -J� bj'e S W TYPE OF BUILDING
RNK e5,f0,5S - a1
ES. 0 SEAS. VL. FARM COMM. CB. MICS. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
S 7ia ; '�.ZD f✓�w :Jc+_rs ' t.
.2S So 5oao INC.�ol � l'AIIPw!W l',gt'/SaS !a • f�13/j� P 7; 09
d 9P2
/ � v d o U �'G o /0 Z" 3 a 7S SoLD
G 7000 0900 s 23 `7 (o/3o/7G /- Jo f' T3� �c� / /`
I E300 '710o YL)o �-or6700SZ-1 lr4:
Ico } 1 Io2. 132(0 �i��rz.C2c,� ,� oni7�o�V tF c I�ouo. ✓
1800 9300 ► I I 00"�_ 3 3 S 87 �—
�
uor 99 10 B� o20fi�04 - � t
8 0 0 0 0 0 .�
liable . FRONTAGE ON WATER
mdland FRONTAGE ON ROAD
mdowland DEPTH
Use Piot BULKHEAD
tol
• •R ,
IM 4-1
_ _ ----� - ■■■■i�■■■li■■■■■�■fir' ■�'i■■■■■■■■
Extension
Foundation Both Dinette
Porch
Basement
■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■
■C..■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■� FloorsK.
—*�o L-41(a a VVk X Ext. Walls 5 H I)V Interior Finish
Breezeway Fire®®
Place
• ••
PatioType Roof Rooms Ist Floor BR.
Recreation Room Rooms 2nd Floor
FIN. B
• B. Dormer Driveway
Total
--
• c ..
•
9000
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSU
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: �7°.��-� 1�-- G*zr5-
-!L-
Cr- (ly
;z
DATE INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INS TION
[ ] FRAMING [ FINAL
[ ] FIREPLACE A CHIMNEY
REMARKS:
DATE A INSPECTOR
FID INSPECTION REPORT bATB
-- _ COMMENTS $
s -= ¢-________=_____________=___________________=___
H\
FOUNDATION ( 1ST)
I
cl
FOUNDATION (2ND) M -
- ------- --
11
I I
I�
ROUGH FRAME ' �c
PLUMBING
Iu
cn
INSULATION PER N. Y.
STATE ENERGY F y�
CODE 6
Al� rr T H
FINAL /
ADDITIONAL COMMENTS:
/� oY
H
O q�'
z4
TOWN OF SOUTHOLD I °. +. BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTME r Do you have or need the following,before applying?
TOWN HALL 1 �Y 2 5 ��''���� Board of Health
SOUTHOLD,NY 11971 t `�-- - 3 sets of Building Plans
TEL: 765-1802 _ E?�''.__ �_. � p Surveyk
PERMIT NO. L`�� Chec
Septic Form
N.Y.S.D.E.C.
Trustees
Examined 120 Contact:
Approved Mail to:
Disapproved a/c
Building Spector
APPLICATION FOR BUILDING PERMIT
Date .S�i 7 , 20 U(
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 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 a Certificate of Occupancy
is issued by the Building Inspector.
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.
46&7 X lea-5 G7-z).
(Signature of applicant or name,if a corporation)
�/ o -Box 9 ez rd lg- et) - ti9a�
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
e,0AJ7;?,9e>d;
Name of owner of premises 7201 4 xV�N25' -Z56Lg../G/Z
(as on the tax roll or latest deed)
If applicant is a corporation, sipatureX duly authorized officer
ame and title of corporate officer)
Builders License No. /S-F/G J —
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 %d.9 Block Lot /15!
Subdivision pWg/y s Filed Map No.1 ty�6 Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy / 67o7L y rZ ��
T �
b. Intended use and occupancyL ��y NuesG p vsy �.� G�au.Jhv.rs�r,.2sE'. r�ea-
3. Nature of work(check which applicable): New Building Add' 'on Alteration
Repair Removal Demolition er Wor �L.y.s.. �
(Description)
4. Estimated Cost Fee o0
(to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front '7' Rear g� r Depth :q '
Height Number of Stories / 2
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front /9S Rear 9S Depth 2 o 9 /I
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated 2Eyi,4L
12. Does proposed construction violate any zoning law, ordinance or regulation: /UO
13. Will lot be re-graded Will excess fill be removed from premises: (�O NO
14. Names of Owner of premiseSrA-Y4A"0 -BC4.CA4--X Address/os-e) r. a2 Phone No. �3
Name of Architect Address Phone No
Name of Contractors war -,P,,u Address-,yc� $cxx 9 ej±rke,dPhone No.
15. Is this property within 100 feet of a tidal wetland? *YES NO Y
e IF YES, SOUTHOLD TOWN TRUSTEES 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 Or 11
,LtU4Cst — e//;..-7-4-4c being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the
(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 knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn t ore me this
day of tM20 D'
_��
ottapr�y Public Signature of Applic
(� an
Notaryk.G L4873 N York
05
Qualified in Suffolk Cou
Commission Expires Dec.8,
LANE
u N MAP OF pQOPE)2TY
o SueVEYED Fce
- w
a � f
TNO•MAS BOUCNE2
L._,ria
6, ib -FAIRWAY FAXZMS"
�¢`ra6K�Y[/nL 200.47 �D � } ��-- SupPoy� Ca NPAi+ Ko. 6066
�Kavob .od xrd
/,,, c�z _ __ . _-�._ ____._- w GuTciE,ryGyE, N• Y.
� bl�ra�tnarr - _ �. •C
fil 1 8 I �SCAL 40W"
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ry
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T/cor Tr�IE Baarw.ftdE Co., !o sent of
t.
flte (�esn�Gtond e/A ioad to the Odwer-5
be onsifered
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t �. � Gva c tees In5¢a"�n � ir¢\ ♦ � � '
7 � 1
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c
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W H m w +tJ ¢
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13-8'Plain Panels(08-009) I Leal LL a O Q Fm z
2-6'Plain Panels(08-014) I I I f—� • W g = U-
r e�v7 O
1-4'Pain Panel(08-016) E F a H J F+— K —+i J { Z a a Z O °d U V.0 . z _OZ O �y
1-90a Corner Set(08-020) Ca ct i a 0 � 5 O m z v7 0 0
$. $. $. p. 12-Eronarny Braces(08.210) SIZE A B C D E F 6 H J K L Q 06 m O05
Z Z
V 1-Steel Hardware Kit(08-204) 20'.40' sa eo r6• 3'r 13'e• ts'e• 7' e 6' r s'r p O►— w ' 02 Q z I F u, C WE 2
1-20x40 Straight(oping 6'Radius(10-003) gaols WNW" 20' 40' S'6• s'4• 13'6• 1S'6• 1' 4' 6' r rr 9 ' ,Q z 2 N z0 G of O w w H O
6 I-90 Coping Comer Set(10.004) �� a Q ? LL z0 U _ ¢ CC
N 0 U
8' 1-Vinyl liner(see options below) po '{v� a7 0 Q O F D• v~7 z z cc
0
• o- \ mNZC = J � Z00 0
A 9 6'Step-Remove 2-(08-009)8'Panels and � W. F W --t � j O U.¢ z u m J Lu Q o W
$ A 8. 1408-016)4'panel. Insert 1-(01-006) �Q .,n QO LL Z r- LL
O r t�/� U p
and 2•-(008-013)7'panels.
Ei
]-(08-016) panel.p Remove (Inseeso
rt 1401-002)8's ep \ I �
a nd
4 and 1-108-01416'panels. FIEEPT e „
I CORNERS ® •� •.t
1 $ 8 $ 8, $r •• • I aimn �.d
Replace 4.8'plain ppaanels(08.009)with: 61 �• .J
1-9'skimmer panel(08-0111 PANELS sp,wti., M., � �-
1-E'inlotponeh(09-010) L.L u.7
STEEL1-11'right panel(OB-012) •. .•
V
' 8'Steel Step(side)Remove �°—
H-6:(03-605•CS),(03-605-LS),(03-605-RS) 2-(08-009)8'panels. Insert �..1..� Z r CM
$ I-8:103-205(5),103-108-15),(03-205-RS) 1-(08.301)8'steel step, >W V 4 } -;1
S-14:(03-305-CS),(03-305-LS),(03-305-RS) 1•(08-013)7'panel,1408-167) �,,� Z O
45°x1'filler panel and Z�
7 NSPI TYPE 111 1408.168)4'filler panel. � = =1-(10.083)steel step coping ''AA U -4
• set and 1•(10-085)coping CD]D6'
corner set required.See page 1.
8 $ 6 8'Steel Step(end)Remove �� �2408-009)8'panels and1-(oe-016)4'panel. Insert
1-(08-301)8'steel step,(�' 72-(08.167)45ax 1'filler panels,
2-(08-015)5'panels and
8 TOPAZ STERLING STONETITE 1-0083))steel step coping set
0- economy braces.
(03-605) (03-105) (03305) and 2-063
and 2-(10-085)coping corner
NON DIVING LINERS sets required. lee page 1. d*I...,,o..l.. h i,y«w r pan,b liy b m..6 d 4•,ohry vo lar ro dd y,F P i, �-p
H-6(03.643) 1-8(03-143) S-14(03-343) "•d w p°°°" "°"d°° "O •""q�''°"°°P" " °n.d J O z.
iH15 DOCUMENT I5 iqt ILLUSTRATIVE PURPOSES QNLr W r..7 d fl.
raer YNLNE P 6M MC,SI a S 32 73 DRIVE, 0 F,I—
e. • • Fwv k.,«J,dw,.r•wneM1liam ,+or.+wad �n.. R wAYIE.M 11101 BSA (2141l77J771 I t—SJ•E F-
1 • o w,.myy MMyy o•r np,wne,Iom,W,ml.nh,«cnMwa•od. F R O N T 1=R J Q
Diogonah given to 90 point of corners. Thaw dig dim cions w^dy,1h d»N.l I Spa°nd Pool 6y,,.dea4r/cnna,W Is, wmw,.g«diro«ry ma o, F'O O L S "Awl"roan,• Q J a
Inch"wggnled mlmmum,Wdwd,for rndnrhol pool, pm4,c*dbyFWP on aw,bma66 b Aw d•Ilw/,onl.wW onfr' rho 0 Z
GENERAL NOM EXCAVATION • 0 diving Iwwd,w 4k6 or•b Is.u,•d vdlh 0,1 pod,pl.m• d•14r«canewW-ho.0,w-0-14 ypr pool is n nldep.ndnl FRN-005 0 0 w
I M-,.ncd dim.mym on ll n 4nr ah,nwa on d 1.Soil b Iww minimum h•w cw wh*4 KM6C rw'1 imh cfi %wd Av Nanond SPI 8 Pod cw.0 o d i,ror an egr+n•mplq..of FWP iM con+wicen ,1,cL
pad+ "Ie c vixay of 7000 PS.r 3 Eecalalim,hdl 6.7 Iwgw Ilan pool J mound. Ins iM•'F mini y ,Wdwd,pr'Iw w fnssA ng d.r bowl,w in.Ihod,Awroad h•n on .and appl,«d/I.namd s.n „lam , , W w U cc
2.loml•by d pod m I.00 6-a6ov wnowding Rfl void,wdw bowel pond,Ind Wv W111 Jilin on IMw pooh Fm inbrmdian cw.cwnng tJSPI minimum grpwd wd;ywn Dw*moyL o 1b0.d p..caubom o d/w MAY l.0 A 40 Z 0
S Iw d•tP
ows,! ,bndord,,verily NMionol Spa 8 Pod In,=711 I Elsw,16 .w m•Ihod,d,«n.osm% rho ngwn 6ilil a+1.cw+wW7 1 en[ RERANGIE 6"RADIUS to
t A.•rw•A1.wdrio,VA 77314.703/838 0083 "S 2 >a7
I COP1•,Orm 1•H,IMI WAIM POdN.IN' U�aJ
Z
LU
IN-GROUND SWIMMING POOL WILL BE CONSTRUCTED OF STEEL WALLS SUPPORTING A
VINYL LINER THAT WILL HOLD APPROXIMATLY 35,000 GALLONS OF WATER.
FENCE WILL BE CHAIN LINK CONSTRUCTION,4' HIGH WITH SELF CLOSING GATES THAT
WILL MEET TOWN CODES.
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28515 Date: 06/13/02
THIS CERTIFIES that the building ACCESSORY
Location of Property: 1080 FAIRWAY DR CUTCHOGUE
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 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 MAY 25, 2001 pursuant to which
Building Permit No. 27382-Z dated JUNE 11, 2001
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 ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR.
The certificate is issued to THOMAS & ANNE M BOUCHER
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N 577606 12/04/01
PLUMBERS CERTIFICATION DATED N/A
A h riz d Signature
Rev. 1/81
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. 27382 Z Date JUNE 11,- 2001
Permission is hereby granted to:
THOMAS & ANNE M BOUCHER
PO BOX 1260
CUTCHOGUE,NY 11935
for
CONSTRUCTION OF INGROUND SWIMMING POOL AS APPLIED FOR WITH FENCE
TO CODE.
at premises located at 1080 FAIRWAY DR CUTCHOGUE
County Tax Map No. 473889 Section 109 Block 0005 Lot No. 014 . 006
pursuant to application dated MAY 25, 2001 and approved by the
Building Inspector.
Fee $ 150 . 00
Auth&ihzed Signature
COPY
Rev. 2/19/98
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT Ck'A CVI. ,
TOWN HALL <
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPAN
This application must be filled in by typewriter or ink and submitted to the Building Dep tt1khg-1
A. For new building or new use:
1. Final survey of property with accurate location of all buildings, property lines, st ets, and r
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. 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. Photocopy of Certificate of Occupancy-$0.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy- Residential$15.00,Commercial$15.00
Date. 1 31 101
New Construction: ✓ 12 0 Old or Pre-existing Building: (check one)
Location of Property: ► O 8 0 Ea t r W ayIrl ve-�( '�t,�.toca vve�
House No. Street Q._ Hamlet
Owner or Owners of Property: V10YY12 S a+n A A-n nv l�LA C he r-
Suffolk County Tax Map No 1000, Section 10q Block 00015 Lot OI y,00(o
Subdivision Filed Map. Lot:
Permit No. oZ "7 3 8 a Z Date of Permit. I 01 Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: ✓ (check one)
Fee Submitted: $
u n 1 Applicant Signature
log
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1195197 BUREAU OF ELECTRICITY
F 40 FULTON STREET, NEW YORK, NY 10038
Date DECEMBER 04,2001 Application No. on file r : y; %0 . N 577606
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of
TOM BOUCHER, 1080 FAIR WAY DRIVE, CUTCH
in the following location; ❑ Basement ❑ 1st Fl. ❑ 2nd Fl. Section Block Lot
was examined on NOVEMBER 16,2001 and found to be in comp"rwith the National Electrical Code.
FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCMDESCENJ FLUORESCENT OTHER AMT. K.W. AMT. I K.W. AMT. K.W. AMT. K.W.
1 1
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECTT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. N.P. SYSTEMS AMT. WATTS
NO.OF FEET
SERVICE DISCONNECT NO.OF S E R V I C E
METER NO.OF CC COND. A.W.G. A.W.G. A.W.G.
AMT' AMP' TYPE
EQUIP. 1 2\Y 1 JW J SW 4W PER 0 OF CC.COND. NO.OF HI-LEG OF HI-LEG NO.OF NEUTRALS OF NEUTRAL
OTHER APPARATUS:
POOL-1
PANELBOARDS:1-3 CIR. 40
G.F.C.It-1
*(SWIMMING POOL) This certificate
covers compliance at the date of
inspection only. Because of unusual
environments it is advisable to
have frequent test/and or repairs
made by a qualified person.
L
<<< Continued on Page 2 >>>
GENERAL MANAGER
Per
This certificate mutt 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.
THE NEW YORK BOARD OF FIRE UNDERWRITERS PACE 2
1195197 BUREAU OF ELECTRICITY
40 FULTON STREET, NEW YORK, NY 10038
DECEMBER 04,2001 ": i N 577606
Date Application No. on file
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of
TOM BOUCHER, 1080 FAIR WAY DRIVE, CUTCHOGUE, NY
in the following location; ❑ Basement ❑ .1st Fl. ❑ 2nd Fl. OUT Section Block Lot
was examined on NOVEMBER 16,2001 and found to be in compliance with the National Electrical Code. .
FIXTURERECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENJ FLUORESCENT OTHER AMT. I K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC-PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
AMT. K.W. OIL H.P.. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. N.P. NO.OF FEET AMT. WATTS
SERVICE DISCONNECT] NO.OF S E R V I C E
METER
AMT. CC COND. A.W.G. A.W.G. A.W.G.
AMT. AMP. TYPE; EQUIP. 1/2W 1/3W J/JW /4W PER/ OF CC.COND. NO.OF HI-LEG OF HIdEG NO.OF NEUTRAL! OF NEUTRAL
OTHER APPARATUS:
SABAT ELECTRIC LIC.#42014 L L
50 PAT LANE
MATTITUCK, NY, 11952 GENERAL MANAGER
11
Per
This certificate must not be altered In any manner;return to�he 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.
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INS
[ ] FRAMING [ FINAL
[ ] FIREPLACE 8 CHIMNEY
REMARKS: OJIOA(--tE- -Gtz�
-¢' �i�/Lie✓Cr' � 1/lam /�✓o
DATE / /0Jr-"/6lx/ INSPECTOR -
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INS TION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: � W
DATE ll INSPECTOR �c
FI INSPECTION REPORT DATE COMMENTS
II �w
y�
FOUNDATION ( IST)
t '
i
I d�
FOUNDATION OND) I
II'I' If�
l�ry
ROUGH FRAME ' I�
N •�
PLUMBING
INSULATION PER N. Y. s ;
STATE ENERGY
CODE
FINAL
1
ADDITIONAL COMMENTS:
ZZ
tV
y\
O�
�1
TOWN OF SOUTHOLD 4,L.11 z ' BUILDING PERMIT APPLICATION CHECKLIST
��;
BUILDING DEPARTME € � Do you have or need the following,before applying .
"MAY 2 5 �,� ��
TOWN BALL Board of Health
SOUTHOLD,NY 11971 3 sets of Building Plans
TEL: 765-1802 �, �s' .,. d �y Survey
PERIV�TT NO. ° �,L�.�a _ Check .
Septic Form
N.Y.S.D.E.C.
Trustees
Examined ,20 Contact:
Approved 20_ Mail to:
Disapproved a/c
Buildingspector
APPLICATION FOR BUILDING PERMIT
Date .5�! , 20 O/
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 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 a Certificate of Occupancy
is issued by the Building Inspector.
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.
4eJtZ74X 7kr.L-s G-7-b.
(Signature of applicant or name,if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
4y,OAJ
Name of owner of premises -56LA!!. �,Z
(as on the tax roll or latest deed)
If applicant is a corporation, signature,9f duly authorized officer
(&a-me 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:
ekz�Cie-
House Number Street Hamlet
County Tax Map No. 1000 Section %p Block S_ Lot /5!
Subdivision F1.1,gwAy r-4a.YS Filed Map No. /_�G Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy / S 6;,yz�, rz. ,yam.«
b. Intended use and occupancy/3s ���Y . l4emsC s�Ti� iy_��cxrc�h .�w.,�•,-,.,
3. Nature of work(check which applicable):New Building Ad ' n Alteration
Repair Removal Demolition er Wor _Av2;
- (Description)
4. EstimatedCost �oa.vt� Fee �'i�. 00
(to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front JL7' Rear g2 ' Depth ego
Height Vim' Number of Stories i 2
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front 195-1 Rear /9S Depth 1 U9
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated �5i �wi,�c
12. Does proposed construction violate any zoning law, ordinance or regulation: /UO
13. Will lot be re-graded Will excess fill be removed from premises: (�O NO
14. Names of Owner of premiseSfb0i4 -&4,e#WX Address>as-v y: a,Z Phone No.
Name of Architect Address ycrWal Phone No
Name of ContractoreA&a.4 L71> Address-pr, -Bcw 9 of r Phone No. �3y�GLS-
15. Is this property within 100 feet of a tidal wetland? *YES NO Y
e IF YES, SOUTHOLD TOWN TRUSTEES 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 O
U� � /�i7tJ,C being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the
(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 knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn t ore me this
day of
otary Public Signature of Apphcan
No.NP ooi�Q�LEW
York
9505
Qualified in Suffolk Cou
Commission Expires Dec.8, WI-noa
reE LAu�'
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i N MAP Oj' AWP 2ry
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1
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nsidered ���•�
ant^,.;ep ssai shat!not tro Cn :7 J � .•try. �47 •Y' �p /.
. �i to be 3 valid uue c.'�PY e:wn s`s:9 rfn .- �QL k.K�4 -_1�AR'.♦�X�►� P. 4.
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11 \./ ` � p-�.0 c m�am/.Bo•:ernr.•e � ..:� _-.�.�._._.._--
P.
iu: n t.a.�ar:es?fe rof 4 l.I fi�hrs�'id..�L�'t1� �LPYCyd�S j
toy .snna�ins.itut ors or su s�4.ieK
av~ '0 -ea N'bort; v. Y.
i e 1 e e 1 : • • • e � A ( QS W Z N Ui O �
D T � � � oc m � � zw �+- �
qc g 1,3
13-8'Plain Panels(08-009) c tz z L6 W Q W m z
2.6'Plain Panels(08-014) I + + e•— W = LL °� N O
1 4'Plain Panel(08-016) LE F +�'�-- a —+i H J tom-- K JL Z Q a Z 0 r Cd V V y z O
1-90•(orner Set(08-020) H o: �: 't O 5 0z :, z N O a
8' 8' 8' 8"
12-!( Braes(08-210) SIZE A B C D E F a M J K L � m m 0 ori ZO i 1,. O O z ~ N
1•Steel Hardware Kit(08-204) 20'x 40' 20' 40' i'6' 3'4' 13'6' 15'0- 7' 4- 6' i' f'Y G Ve I- W V 2QQ to LL P W 5 = N
1 20x40 Straight Coping 6'Radius(10-003) n {p' f'6' 3'4' 13'6' 15'6' 1" 1' 6' r YYLAJ q Z N Z G d ZO W - Z
(j 1-90 Coping Comer Set(10-004) CORNER ADJUSTABLE p a D Q ? E z v r N V
8' 1•Vinyl Uner(see options below) TYPICAL
� 5a3C9QD F aNDZOZW
8 6'Step-Remove 2-(08-009)8'panels and ""� 1ii U. _
QAC 1-(08-016)4'panel. Insert 1-(01-006)6'step Q �p ti!IW p O O °C z LL m 1 z � O w
8 and 2-(08-013)7'panels. • D LL z n LL N ai � Q 1— cn V o
8'Stip-Remove 2-(08-009)8'panels and PLATV°"
6 I-(08-016)4'panel. Insert 1-(O1-002)8'step \'
r 4 and 2-(08-014)6' nets. FILLET 0
Aro
CORNERS ® `: • 9 ,u
8 8 8 8'
PANEL OPTIONS on SAIND
Replace 4-8'plain panels(08-009)with: •ntr•
I-8'skimmer panel(08-011) PANELS '°w.rt ssw.
2$'inlet panels(08-010) "
1-8'right panel(08-012) 111 STEEL STEP •.
TIONS COPING LAYOUT iss.
STEEL STEP LINERS : 1.
8'Steel Step(side)Remove {�
IS-
2-(08-009)
-6:(03-605-CS),(03-605-LS),(03-605-RS) 2-(08-009)8'ponels. Insert s W
er n 8r n 8 8:(03-205-CS),(03-205-LS),(03-205-RS) 1-(08-301)8'steel step, �+ V
14:(03.305-CS),(03.305-LS),(03-305-RS) 1-(08-013)1'panel,1-(08-167) Q.
6 45•x1'filler panel and •
6 7� NSPI TYPE III 1-(08-168)4'filler panel.
I-(I(M3)steel step coping
OPTIONSVINYL LINER set and 1-(10-085)coping
n comer set required.See page 1.
6 8'Steel Step(end)Remove r� �.��.� r
r 8'panels and
1-(08-016)4'panel. Insert
1408-301)8'steel step,
(� 6' 7 2408-167)45ax 1'filler panels,
2•(08-015)5'panels and
TOPAZ STERLING STONETITE 2-(08.210)economy braces.
$ 8 8 8 8 1-00-083)steel step coping set
(03-605) (03.205) (03-305) and 2-(10-085)coping corner
sets required. See page 1. An nNon aoaleen h is responsibility to see Aat A» FWP is
NON DIVING LINERS del—ed so vod awe..�r�NO o� '°n•'r Via°ns
H-6(03.643) 1-8(03-243) S-14(03-343) " '""° '°" —j
Uj
THIS DOCUMENT IS FOR ILLUSTRATIVE PURPOSES ONLY FW WATNE POOL%,WK.510 SUA M PRIVr.
' ADDITIONAL • FWP makes only Arose nspresentoti which ace staled n in w.ibn F R O N T I =111?
R WkYK M 46M a5A (219)4324731
• o won eAr rsosemeru's,«con*w%n odet4
Dioganals given to 90 point of corners. these dig dimensions comply w sh Ar National Spa and Pool a A7�M ' °", ,ega ding any matergls P O O L S• M•WWO NVPe••e _J O.
ksshtus• s.d minimum s4nd«ds hsr r•sidem of s
K�Dg•s pad ped„e.d by FWP« •r� .b
.a ,trblin dealer/cane000r only T6 .� .•�'
NOTESGENERAL • • N diving boards«slides am a be used wish Arose pooh pleos• dealer«CwWoclo,who��a i yaw n an i,depe dem FRN-OOS 0 0 6
corm*Ar monu(ocM.r's instructions and A»National Spo 6 Pod conhocRu and is not an a o1 FWP The wrisoucnon
I /1A•,Io of dimemam am hom krnr estrsnrom an a1 pods I Soil to 6.•minimum b•«ing capaciy of 2000 P.S.F. 3 Excavation OWbe 7 brg•r Awn�1 oe oramd. MnBWIe's minimum sbndards pray b inoJ..Indgi-.. boards« nyq�iMusrol•d hem om and apply only b normd eAn m►1 0'r-
2�� pod of host 6'ahem wrrotmd rp 4.Esock(il.4 non-expaill-ods wAv bow onnsi.parighand mp we, *md«ds,..r s Notional &Pool Inc sriiiuft.21111 EiwndJ w m�O=1 wn+uvaion. IM A»c 'or+mcwrand/« y ZO'X 40' UJ
"6 =" -
$$ppoo RECTANGLE b RADIUS a.G
� Avern,e Aktnandrio,VA 22314•703/838 0083 1995
COs ymM 1•••.Pact WyM1 P00"•,IM U '•�.
Z
W
Is
IN-GROUND SWIMMING POOL WILL BE CONSTRUCTED OF STEEL WALLS SUPPORTING A
VINYL LINER THAT WILL HOLD APPROXIMATLY 35,000 GALLONS OF WATER.
FENCE WILL BE CHAIN LINK CONSTRUCTION,4'HIGH WITH SELF CLOSING GATES THAT
WILL MEET TOWN CODES.