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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-19240 Date JULY 25, 1990
THIS CERTIFIES that the building ADDITIONS & ALTERATIONS
Location of Property 49925 MAIN ROAD SOUTHOLD NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 70 Block 5 Lot 2
Subdivision Filed Map No. Lot No.
conforms substantially to the Apglicatian for Building Permit heretofore
filed in this office dated MAY 11, 1989 pursuant to which
Building Permit No. 18125-Z dated MAY 19, 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 FOUNDATION ADDITION UNDER EXISTING DWELLING ALTERATION TO
ENCLOSE PORCH ADDITION & DECK ADDITION. ALSO GARAGE ADDITION AS PER
ZBA #3841 TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to GERARD GAUGHRAN
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. H-016119-MAY 25, 1990
PLUMBERS CERTIFICATION DATED MAY 14, 1990-PECONIC PLUMBING & HEATING
Building Inspector
Rev. 1/81
Fosas xa s
TowN of souTHOLD
Bli1LDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~ 1812 ~ Z Date 19.~,<..
Permission is hereby granted to: 4
taL~n~i'.tFs~,~.11G.4.~.G~.....eS~r~.~crq.••••~. .p n.
p~ .
at premises located at ...,~G~.~_./rr'~.~.1~..~...-~~/........r.....s~..r.~C.~•
Caunty Tax Map No. 1000 Section .........7Q.......... Block ............J~.......~L+ot No...........~~.~.`..........
pursuant to application doted .............~,'~.~,1..............................., 190./..., and approved by the
Building Inspector.
~r0
Fee $..~~~l....~
/~.~'r • g .~c
Bu n 'I for
Rev. 6/30/80
D Form No. 6
n~IC~
TOWN OF SOUTHOLD
~J N IA~fn BUILDING DEPARTMENT
L ~7 i~G7V TOWN HALL
765-1802
TOWN OF S0U7H0LD
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must 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 $15p00, Commercial $15.00
Date .7I~~/[~
New Construction.. Old Or Pre-existing Building
Location of Property....:-195as~ .................!~a.;n.~s3f..........~cx~.'nw.~o~
House No ~ Street Hamlet
Onwer or Owners of Property...: l.~-.~: . ~...~T.`Z."~ ~rwn . . . . . . .
County Tax Map No 1000, Section ..............Block... ~...........Lot..-2:
Subdivision ....................................Filed Map............Lot......................
Permit No..~ ~Ol~/.......Date Of Permit. ~ ~ pp
~`r ~ .A licant.
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporarr~y~~~Certificate........... Final Certicate...........
Fee Submitted: ~°nJ.:~'~........ -
C d~ 1(~ a~ APPLICANT • .
TEL. 7G5-1802
~Oc~uFF~Cl~ c0,, TO'R'N OF SD~JTHObD
;~1..;'~'L`i;'?±~;;. < OFFICE OFIIUILDIIJGINSPECTOR
~ P.O. IIOX 728 `
u°~~`"' ~}i.`I~' TOWN HALL
o~'Ol ~
y ~ ~'Y SOUTHULD, H.Y. 11971
' C E R T I F I C A T I O N
Date~,,ryry.~ /~9YJ
"u=1~' a
Huildirg Permit No._~~
Owner ~?C?(Q1`~ l"9-L2_cas,G n .
(please print
P 1 t:.:,b a r~~c./7?`1i~vC D~`~/r'T/~~
(please print)
I certify that the solder used in the water supply system
contains less than 2110 of to lead.
~ yG,~*'~~Gr~s - ~I
~b'
E`rs siynaturel
Sworn to befor= me tY:is
day of ~,isr~_.r' ~ .
19 t~ , ~ Notary Pub is
dotary I'ublic,t~~1~!
County
tr~sA~,o~aa svtaFtowstct
Notary i'ublic, State of Now Y®rk
No. 4a3g47ti2
Qualified fn Sufitolk CaaMy
Comm6salon Expires.NAarsb 3tL 18~I
apt
:;owMClars
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I7SULATIOf1 PER N. Y.
STATE ENERGY
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THE NEW YORK BOARfl OF FIRE UN13ERWRITERS 'ASE 1
~oi~14!+ _
BUREAU OF ELECTRICITY
8S JOHN STREET, NYSV YORK, NEWYORK 10038.
MAY 25,1990 6d6042ES9/89 N 0)ti119
Date Application No. on file
THIS CERTIFIEi3 THAT
only the elecerkwl equipment v described 6elouo and introduced 6Y eke appUcent nomad on [he ofwoe application numhsr in the prsatisp of
GERARO W. GAUC,HRAN, 6.9925 MAIN RO., LILCO-.f84, 50UIH9lD, N. Y.
in the dbtcin be t~f~ fAR/OU7 -
f p 1..L1 ~ment ~ Ixt Ff. ~ Pnd Fl. Section Block Lot r?
rma esamined on andJound to be in rnmpliance with the reyuirementx of this Boord. -
N1tiUR NiACIlS RXTUREf RANOK EiCKi OVENS qSN NWiS
OIIfttTS INCANDESCENT PlUGI1ESCENT GTMER NAT. K. W. AMT. W. AMt. R.W. AMT. K. W. AMT. M. P.
36 2 6Q 36 1 1.2 3 F -
DRYOS RIERIAC! M070R5 t1g11M AMt1ANCJE RRENEE RRCIT iRAE pGC1I8 tlEll IRIIT IIEAlERS MU1140YTElI DYAIAEEi
AMT. N. W, pl N. P. GAS H. 1. AMT. NO. A. W. G. AMT. AMI. AMT. AMPS. TRANS. AMT. M. P. ~T AMT. WATTS
S f.. 1
SERVICE DISCOlpi[CT NO. /)f S E R V 1 C E
AMT. AMr. Trre ER~1lRR t p evr ; y xw a A' Svr a/ AW icoNO. a cc
c°oiro. No. 8r n.tEG ~ ~ xl No. or NeuTEAU ~ t ~
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OiNEII AKAEATUS:
INTERIOR WTRTN6-!
6.F.f.I:-3
6ERAR0 W. 6AtltiHRAN
c.
1763 EVERSREEN AVE.
e
E. MEADOW, NY, 11554 a~ Q
ii
Per
ThiE urNfiwttt noq ba altered in any maRnar; rotum to tM ofiia of 11u Board if inc , a Ins E mey,.:ba
AL }
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/j~~y,~ T65-1802
(U BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ~ ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ FINAL
REMA KS: ~/C2~t~e..~-.~
a~~ - /1 .rz ~
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ti 1
DATE ~ ~ INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( } !ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ 7 FRAM{NG [FINAL
~ c,~a...~ /
REMARKS:~i£6r ,9~;T~° GYll-~ i
~ /
DATE ~ INSPECTO ~
/ ~ . ~ 765-1802
G ` BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ' NSULATION
[ ]FRAMING [ ]FINAL
REMARKS: c9~
~7 ~
DATE ~ ~ INSPECTOR
/ ~ T65-1802
s~
r ~ BUILDING DEPT.
l
I NSPECTiON
[ ] FOU~D~ N 1ST ( } ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
s
REM RKS: ~,~,~t--
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BOAKD OF HEALTH
' 3 SETS OF P1?ANS
FORM NO. 1 SURVEY
TOWN OF SOUTHOLD CHECK ~.'d.~.
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL NOTIFY /
8OUTHOLD, N.Y. 11971 CALL - -~lv.S-~- S j a
TEL.: 765-1802
MAIL T0:
Examined 19
Approved 19~~Fermit No~~~~.~~
Disapproved a/c .
ii EJI
°E'`~`'~r MAY 111989
~~J l's~ x
C' )c r i
fLiij ir5~ ia- ue ~ !3
~~-'%~•Fi1• ui... g Inspector) a 2 ~
~~,~.,dri~, .M
APPLICATIO FOR BUILDING PERMIT /
Date [ 19~.
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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
' d. Upon approvai of this application, the Building Inspector will issued a Building Permit to the applicant. Such 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 pazt for any purpose whatever until a Certificate of Occupancy
shall 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
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 inspe^^cnnti•on~s.
..~.L1..
(Signature of applicant, ame, if a corporation)
%~O..~9:
Ec....l.q .Q.a_. ~a~~.Q.~if r~ .
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.....~.o.n~v~,~;Far- .
Name of owner of premises ..~~~4V'CX.W:. ~Q~"-
( son the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
ALL CONTRACTOR'S MU$$T BE SUFFOLK COUNTY LICENSED
Builder's License No. ~/3 .
Plumber's License No. . LL~~ .
Electrician's License No. tf .
Other Trade's License No . .
1. Location of land on which proposed work will be done . .
/ '
`15.~a~
House Number Street Hamlet
County Tax Map No. 1000 Section ...~~P Block Lot .
Subdivision Filed Map No. Lot...............
(Name)
2. State existing use and occupancy of premises and intQendednuse annd occupancy of proposed construction:
a. Existing use and occupancy .....'..F~-1-~..~-? .
II CCJJ
-
b. Intended use and occupancy S X 1~.~-44~ ,,~S.U.~X~,~, , 1~~ `J .
3.' Nature of work (check which applicable): New Building Addition Alteration .
Repair Removal Demolition ..............Other Work .
(Description)
4. Estimated Cost 1• ~j. ~ Fea .
(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 na~ure and extent of each Hype of use r........ .
7. Dimgensions of existin structure, if any: Front Rear a2'a . Depth . ~2 ~ .
g
Hei ht e~(~... , Number'of Stories ~ .
Dimensions of sam~,e structure with alterations or a)lditions: Front Rear . ~.3 .
Henri ~siq>~~~ iiw constru Height ..o2.lq....~ Number of Stories .
_ 8. Depth S........ Num ction: Front ...~3......... Rear ..,2~......... De th , a`2.1...........
~ P
g ~er of Stories c2,......... ~ ~ .
9. Size of lot: Front S . Rear .....1.3.n/' Depth ~ e/.~..4l/.f?KS.~i .
10. Date of Purchase .....:/t/. .Name of Fo er Owner N14rgaret,Salgofiq~ ~Qhq (sa~,4,mq~-!--
1 1. Zone or use district in which premises are situated ..~~5!~Cn fi0..I. ~fJ'9 fi~~t~~~`a! ~c~ar~l.G-au~~!Y;~.
12. Does proposed construction violate any zoning law, ordinance or regulation: ..~'?.C~ .
13. Will lot be regraded ...h;C?... ~
. . ..............Will excess fill be removed from premises: a No
14. Name of Owner of premises ~'rffk!~, ~A.w~C<?.a:~ ....Address aP.r. S+Plyrhr ~S~i~a~Phone No. 7g`.~.: 04
Name of Architect :S'0t+,'~.~~.4+'y~<btr Address'~•kn. sl?+!c .Sou-~sa~~.. Phone No..24~~5`~..... .
Name of Contractor GvJGa»~..~,~w~y............ Address .i~4$~1~. ,~w-7~n(~! .Phone No. 7~~-s~'t.~:-.. .
15. Is this property located Within 300 feet of a tidal wetland? *Yes No X
*If yes, Southold Town Tru$tees Permit ma be required.
PLOyT' DIAGRAM
Locate cleazly and distinctly all Ibuildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block dumber or description according to deed, and show street names and indicate whether
interior or corner lot. ,
~Eb9NEl1" bi!&~&.6J~k~~ ,~~'V~41sV/pe~ .~;;'rYNItT 1R90~
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f,Rt1.~0.t. t;5bfi1~°StnEJ~."Y ...~.,..;.,..A....--- ia~A.A~i+C(~$"CI~IJdI'II{1Ra .....:,..,.._.~r~...
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I
- STATE OF NEW YORK S.S
COliNTY~ qF
l.~,J. g being duly sworn, deposes and says that he is the applicant
(Name of individual
sial nit)
above named.
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'iset forth in the application filed therewith.
Sworn to before me this
.........day of i, ..~4u,f 19
Notary Public,~...9~......... County
LINDA J. COOPER ' (Sig nt)
Notary Public, State of New Yo
Term Expves6Decambelr 8to jnrya,,,;(/
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ENERGY,"CODE CALCUL~ATION.S. - ~~oa
N~-~«~TQ,~ ~~.~T~ ; -
Fca.~-y_~ ~an ' P6.o. ~...n~y~ S""{~'•/1 ~ 1 ~E,v~y~.+ Cn/rEa.~ 6000 bEyIFE fines _
- - - - DATED ~ -.a.'•., - - ~ 0.~4.: /OF I.A.: 70"F
.SuBSYSTEn\ AREA Il Ljes,.FV Ac~owae ~~siyv Actcwea ,QE/\\.4,Qh3 - -
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EXT£QlOQ\VdLLS (C,,,3c~5S) //y~ D•/7 //G7° I
EXTE,QI~A \vQLLS(~AL~G~UE) gy3 iq o.05 I Zs3o
GGAZ/Nli 2~ % 2~f3 •31 -0-58 yglo ~je,~.rs~. f~- 1'e~•~~'/n•ice
pOOR...S fB 0.yO ~3 P~
GE/UNC~S ~,Q.L~F ~3 S / ~ I O.'O3 p o /C e ~
F"LGu.4 .S~-3 ~ / O.o3 ou X600
SNF/L'TCAT/ON g i ~fJ I Q-O~d 87 So ~ 79'~
i(J~ To-rlcs po' 2 p p} C G o
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1) HEATING EQUIPME[ST TO MEET 7813.23 - 758 EFF. ~SEOf NEIy Yp ~ TO THE BEST OE MY RNCWLIDGE, 5~°~c~m rod"fi .
2) HEATING CONTROLE 7U MELT 7813.13 r rcE r~ 9~ BELIEF, AND PROFESSIONAL + ~
RANGE 45 1V 75 DEGREES fe~E~^SOIT. ~ ~S~r ~e t( JUDGZ7EA"1' THFS£ PLANS ARE ~ a H ~ W
~ IN C7hSLIANCE WITH THE CODE. ~r'~_--:~~ _
WATER HEATING PER 7813.31 TABU .38. ~ ` ~ L„~
PIPE INSULATION 7813.19 - ~ ' ~ ~ ~ _ w ~ ~ ~o-'+• p
- T .r O '°~O 03:254-0 ~l.
i) WIDIDCE~S -DOUBLE GLA55. ~ ~ _ aszz5a-7
C~I.STRUCTION TC7 MEET N.Y.S. ENERGY CODE. J'o0 - ~qNF FSS1oN4y _
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