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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
Date: 07/16/07
NO: Z-32470
THIS CERTIFIES that the building AS BUILT ADDS/ALTS
Location of Property: 7325 BRIDGE
(HOUSE NO.)
County Tax Map No. 473889 Section 84
LA
(STREET)
Block 1
CUTCHOGUE
(HAMLET)
Lot 6.4
SUbdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
JUNE 21, 2007 pursuant to which
Building Permit No. 33182-Z
dated
JUNE 28, 2007
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" ADDITIONS & ALTERATIONS TO AN EXISTING SINGLE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to JOHN E & JEANNE D ZURAWSKI
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
116688C
06/12/07
PLUMBERS CERTIFICATION DATED
07/11/07 JOHN ZURAWSKI
~~
Authorized Signature
Rev. 1/81
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Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be tilled in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new nse:
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 2/1 0 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.
p. F'or existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
I. 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
I. 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. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
New Construction:
~ Old or Pre-existing Building:
Date.
7 ~ If ~ Or
( check one)
House No.
f$~ I OC:€
Street
L-A,
Cui<-H 0<:,..; Ii
Hamlet
Location of Property:
Owner or Owners of Property:
'30 H,J
~AVSKI
8'4
Block
t91
Lot
b,'-J
Suffolk County Tax Map No 1000, Section
Subdivision
Filed Map.
Applicant:
Lot:
Pennit No.
3;,t&2-
Date of Permit.
Health Dept. Approval:
Planning Board Approval:
~/1r
,.J lit-
,
Underwriters Approval:
Request for:
Temporary Certificate
Final Certificate:
/
(check one)
Fee Submitted: $
JS.",..l
Applicant Si
G.,~ j9- n'1
Co t:3<J t.f 1'0
FROM FINE STROKES PAINTING
FAX NO. 516-734-6486
Jul. 11 2007 12:59PM Pi
""-,<1:..---
Town Ha-H. 5309.'5 Main Road
P.D.. Box 1179
Southold, New 'York 11971..0959
Fax (531) 755-9502
Telephone (631) 76S~18Q:;;
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CER T IFICA TIO~
Date:
Building Permit No.3 3 182-
Owner: ~otf~ ~ Z I.(~ 4tA"f:A
(please pnnt) ~
P1Unlber:-::\o~..:). F- .';? I ~ f? Au'lSk
(Please pnnt
lead. I Cf)~ fua/;~:t~ t~edsu:; ;Jf/'YDs~n~' p~~
Sworn 1.0 before me this i I
daYOfN ,20~
~~
i\~ofary Pllblic, ~OUllty
MARY E. GREENE
Notary Public, Stale of New York
No. 01GR5050386
Qualifi.ed In Columbia Coun!Y/1 a
Commission expires Oct. 10, 2~
';j
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.
33182 Z
Date JUNE
28, 2007
permission is hereby granted to:
JOHN E & WF ZURAWSKI
7325 BRIDGE LANE
CUTCHOGUE,NY 11935
for :
AS BUILT ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY
DWELLING AS APPLIED FOR.
at premises located at
7325 BRIDGE LA
CUTCHOGUE
County Tax Map No. 473889 Section 084
Block 0001
Lot No. 006.004
pursuant to application dated JUNE 21, 2007 and approved by the
Building Inspector to expire on DECEMBER 28, 2008.
Fee $
400.00
ORIGINAL
Rev. 5/8/02
33' l-r-z-
TOWN OF SOUTH OLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING I STRAPPING ~ FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS: /l!ftJ- /: c: -4=- ~
~-'> J~)\ ~~
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DATE / -- i,--- ~ 7 INSPECTOR ~ ~
\
JAMESJ. DEERKOSKI, P.E.
260 Deer Drive
Mattituck, N.Y. 11952
(631) 298-7116
Date: July 9, 2007
To: Town of Southold
Re: Inspections
John Zurawski
Bridge Lane
Cutchogue, NY
Permit# 33182z
To Whom It May Concern:
Tins letter certifies that a footing, foundation, dampproofing, framing, plumbing, and
insulation, and venting inspections were preformed on the above mentioned structure.
Everything was all done as per plan, and meet all state and local building codes. A pressure
test was also performed on the plumbing system. Any questions please feel free to call.
\\'-
sl Deerkoski P.E.
i\
>
FIELD INSPECTION REPORT DATE I
.
FOUNDATION (1ST)
FOUNDATION (2ND)
COMMENTS
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INSULATION PERN. Y.
STATE ENERGY CODE
FINAL
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ADDITIONAL COMMENTS
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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/Southold/
PERMIT NO. ~-=<, l<?:}- "'2:-
BUILDING PERMIT APPLlCA nON 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
Contact:
Examioed
Approved
Disapproved ale
y
, 20-----'F--
,20_
Expiration
,20
Mail to:
Phone: 7&S- , q 10
.,
I ikD'J.OEPT
1_19'ffl'1J2E. SC'\'THQL;)
APPLICATION FOR BUILDING PERMIT
Date
,~ .2-(
,20~
INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets.ofplans, 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 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.
Sf't~,.J c. LtoJV'Af2...D, ':D0C.
(Signature of applicant or name, if a corporation)
f. f>. f3u'f:- I S-)....~
(Mailiog address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
b~~TDrJ.-
Name of owner of premises
.YOMJ
~.
2'-'MvJg~\
(As on the tax roll or latest deed)
authorized officer
Icant is a c~tion, s' ature of dul
(Name and title 0 rporate officer)
B ilders License No. :2'1/1,)- ~t-f
umbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
B t \ 0 t:;,c- L-..-\-
House Number Street
c..v TU-lDIo ~
Hamlet
County Tax Map No. 1000 Section
Subdivision
<?i
Block 0 r
Filed Map No.
Lot " . ~
Lot
(Name)
2. State existing use and occupancy of pr~ises and int,ended use and occupancy of FA~~~ed construction:
a. Existing use and occupancy ---'1.S2Q 117\).0 f':> 5r ~G.Lt1 <---( I:> u..J t!:LJ,.....,,.} C;
b. Intended use and occupancy s:~~
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
~~c; 8UrLlAlteration
Oth
(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.
Depth
7. Dimensions of existing structures, if any: Front
Height Number of Stories
Rear
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 oflot: Front
Depth
Rear
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. Names of Owner of premises
Name of Architect
Name of Contractor
Address
Address
Address
Phone No.
Phone No
Phone 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.e. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a 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.
18. Are there any covenants and restrictions with respect to this property? * YES_NO_
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
/' ~" l~:
COUNTY OF:::::>J 1\.... )
~ IfV.... hoe D'v'\.cA-J being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)Heisthe ~
( (Contractor, .,l;,at, CefJl"""t-. OffiPPT, P'P .)
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.
s~o ~~"" I
L dayof ~
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Notary Public
2rJr
L
BARBARA AN UO ER
Notary Public. 5t e of ~ w York
No. 48. S605
Quellfied In 5u folk ount~ 0
Commission Expires A rll14, ~
PP OVED AS NOTED
t B.P. # ,~9> I ~~H:",
~~~IF BUILDING ~~:P:~~ ';
765-182 SAM TO 4PM FOR THE
FOLL ING INSPECTIONS:
1. FO NDATION - TWO REQUIRED
FO POURED CONCRETE
2. RO GH .. FRAMING & PLUMBING
3. INS LATION
4. FIN L - CONSTRUCTION MUST
BE
ALL CO STRUCTION SHALL MEET THE
REQUIR MENTS OFTHE CODES OF NEW
YORK ATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
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AS REQUiRED AND CONDITIONS OF
SOUTHOLD TOWN ZBA
^:;u~HOLD TOWN PLANNING BOARD
~JUIHOLD TOWN TRUSTEES
N.Y.S. DEe
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OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
RIGHT ELEVATION
SCALE: 3/16" = 1'-0"
FRONT ELEVATION
SCALE: 3/16" = 1'-0"
( BUILT FRIOR 2003 )
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SRIDGE LANE, CUTCHOGUE, NY
June 13, 2001 eCA~E 3/11&" = 1'0"
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