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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-32469
Date: 07/16/07
THIS CERTIFIES that the building AS BUILT ACCESSORY
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 28, 2007 pursuant to which
Building Permit No. 33183-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" ACCESSORY SHED IN THE REQUIRED REAR YARD AS APPLIED FOR.
The certificate is issued to JOHN E & JEANNE ZURAWSKI
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N/A
PLUMBERS CERTIFICATION DATED
N/A
~~
Authorized Signature
Rev. 1/81
I-~----~- ...----1
Im.~~:~I]Wi
Bi....D\_.i. DEPT.
T .w~"-Qf ~"!dJHOI:J I
------'
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:
I. 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.
.
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 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: ~ /l<Jl~"~d or Pre-existing Building:
Date. 7~{ r~G 7
( check one)
c...uID-'D/"'';.r
Location of Property:
e,.Z.,Obe
LA
Street
Hamlet
House No.
Owner or Owners of Property: .T c.?H ~
'.2-0~Si<!.1
Suffolk County Tax Map No 1000, Section
~~
Block
01
Lot b. 't
Subdivision
Permit No.
73[33
Date of Permit.
Filed Map.
Applicant:
Underwriters Approval:
Lot:
Health Dept. Approval:
:J;
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ ZS" _..J
Final Certificate: /
(check one)
&...<<--.1') \ 1 '1
co't. 3;1. 'iH
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.
33183 Z
Date JUNE
28, 2007
Permission is hereby granted to:
JOHN E & WF ZURAWSKI
7325 BRIDGE LANE
CUTCHOGUE,NY 11935
for :
CONSTRUCTION OF AN "AS BUILT" ACCESSORY SHED IN THE REQUIRED REAR
YARD 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 28, 2007 and approved by the
Building Inspector to expire on DECEMBER 28, 2008.
Fee $
200.00
'-
ORIGINAL
Rev. 5/8/02
-".,
Date: July 9, 2007
To: Town of South old
Re: Inspections
John Zurawski
Bridge Lane
Cutchogue, NY
Permit# 33183z
To Whom It May Concern:
JAMES]. DEERKOSKI, P.E.
260 Deer Drive
Mattituck, N.Y. 11952
(631) 298-71 16
This letter certifies that a foundation, and framing inspection was preformed on the above
mentioned Shed and was all done as per plan, and meet all slate and local building codes.
Any questions please feel free to call.
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,
33/-g31--
TOWN OF SOUTH OLD BUILDING DEPT.
765.1802
INSPECTION
( ) FOUNDATION 1 ST ( ) ROUGH PLBG.
( ) FOUNDATION 2ND ( ) INSULATION
( ) FRAMING I STRAPPING p<(FINAL
( ) FIREPLACE & CHIMNEY () FIRE sAFETY INSPECTION
( ) RRE RESISTANT CQNS11lUCTlON ( ) RRE RESISTANT PENmATlON
REMARKS. /,/;4 f)t.-..~ ~
. J- fY. t= ( --I:i- -
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DATE 1.--- f .---/) 7
INSPECTOR ~#-
FIELD INSPECTION REPORT DATE I . COMMENTS ~~
FOUNDATION (1ST) ~~
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FOUNDATION (2ND) 7: [:i ~
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PLUMBING
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INSULATION PER N_ Y. -- ..,
STATE ENERGY CODE
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FINAL ~ I:'
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ADDITIONAL COMMENTS \~
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TOWN OF SOUTHOLD PROPERTY-RlCORD CARD
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VILLAGE
DIST.
SUB.
LOT 4
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FORMER OWNER
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STREET
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ACR.
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TYPE OF BUILDING
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W
LoRRAINE
Oe-HNAI! 4. fiNo
tES. J! D SEAS. VL. :J FARM COMM. CB. MICS. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
&0 CJ & t!6 2/'il/!;' z../ZI JPA ~0 17 oco. I-h- 1-1 rrJAW 7c:--- l2iCl\..Al Y'lvl .:r~( L-'l S"-IG \)-141
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/
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iI/able FRONTAGE ON WATER
loodland FRONTAGE ON ROAD )
ISO
\eadowlond )
DEPTH flv ~?g
ouse Plot BULKHEAD
Dtal
e
II:> e 7
M. Bld6,5t'~)(/:3-::: ;:'"(.. ) Nid
ExtenSto@ 9 'I II '" 9 q \
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ExtenS~ / $7)( ~ 2. ':: .s 7'
Extension
Porch
q I ,..1' JL.z.
Porch
Breezeway
Garage
Patio
,Z; )I ,). ~::- 'f t. 1-
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Total
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Foundation /' Bath ) Dinette
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Basement -, Floors gw, K. I
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Ext. Walls /A/ " interior Finish '" ~.. , .', LR. I
.
Fi re Place - Heat 6 "i;J DR. . /
,-',,:/; I
Type Roof Rooms 1st Floor BR. :]
Recreation Room Rooms 2nd Fioor FIN. B
Dormer Driveway
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/Southoldl
BUILDING PERMIT APPLICATION CHECKLIST
----.-
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans /'
Planning ~ approval
Survey
Check -#>-
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
PERMIT NO. .:s <:S I%') C-
Examined
Approved
Disapproved a! c
'20~
Mail to:
Phone: 7~5 - I~ 10
Expiration
..
i'~ '
i.! r
,'. 'J
\'u
APPLICATION FOR BUILDING PERMIT
Date
~~?r
,20 <J7
INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
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 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.
~w c.... L~ I \:TN c.. .
(Signature of applicant or name, if a corporation)
('C. f31.1 lS'd
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
c..zN~
Name of owner of premises ~OJ-I J
~
1=:.
2-~A-v...) StZ ,
(As on the tax roll or latest deed)
authorized officer
cant is a~oration
(Name and title corporate officer)
uilders License No. ;2.e>; 7/o2e 11
lumbers License No.
Electricians License No.
Other Trade's License No.
I. Location of land on which proposed work will be done:
fS 1-.1 0 C..;- '-A-
House Number Street
C,....J jC.....{ a t,;;,...,';-
Hamlet
County Tax Map No. 1000 Section
Subdivision
'if'f
Block 0 I
Filed Map No.
Lot b. 'f
Lot
(Name)
2. State existing use and occupancy of prejpises and intended use and occupancy of pro
a. Existing use and occupancy Ii CL ~'5 S"fL'1 13,-, 1'-':> ,~ '
sed construction:
'3 H-G'..D
b. Intended use and occupancy
5~
, )
3, Nature of work (check which applicable): ew Buildi
Repair Removal
*,~J~Y- Addition
Other Work
Alteration
(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.
7. Dimensions of existing structures, if any: Front
Height Number of Stories
Rear
Depth
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear
Depth
9. Size oflot: 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_
Phone No.
Phone No
Phone No.
Address
Address
Address
14. Names of Owner of premises
Name of Architect
Name of Contractor
IS 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 of a tidal wetland? * YES_NO_
* IF YES, D.E.C. PERMITS MAYBE 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)
L7" V_ ~S:
COUNTY OF~~
:.. ~"- c.r:", \..e.bV\o.r-C- being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the ~
~ractor ~Itl, Cen'l'6fat8 gf;;~pr 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 to b~ me this,
. day of
Notary Public
BARBARA ANN RUDDER
Notary Publio. State of New York
No. 4855605
Qualified if I Suftolk County "'''I 0 \
Commission expires IIpr1l14, ~
~ AS N01ED
DATE!- B.P. #
cE~~ c
r y NT AT
NOTIF BUILDING ,,~PA F R THE
765-1802 8 AM TO 4 PM
FOLLOWING INSPECTIONS:
1 FOUNDATION - TWO REQ IRED
. FOR POURED CONCRETE
2. ROUGH _ FRAMING & PL MBING
3 INSULATION UST
4' FINAL - CONSTRUCTION
. BE COMPLETE oOR C.O. MEET THE
ALL CONSTRUCTIONT~~~L DES OF NEW
REQUIREMENTS OF .
YORK S1 . ER
DESIGN OR CONSTRUCTION
LEFT ELEVATION
~ O? SCALE: 1/4" = 1'-0"
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FRONT ELEVATION
SCALE: 1/4" = 1'-0"
REAR ELEVATION
SCALE: 1/4" = 1'-0"
RIGHT ELEVATION
SCALE: 1/4" = 1'-0"
( BUILT PRIOR 2003) pc;, I
AS BUILT
BRIDGE LANE, CUTCl-lOGUE, NY
J I 2 eCALE
une 8, 001 1/4" = 1'0" JD
i.
b
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20'-0"
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10'-0"
FOUNDATION PLAN
SCALE: 1/4" = 1'-0'
FLOOR PLAN
SCALE: 1/4" = 1'-0'
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( BUILT FRIOR 2003) PG.
AS BUILT
BRIDGE LANE, CUTCI-lOGUE, NY
June 18, 2001 &CALE
1/4" . 1'0"
2
JD
ASPHALT ROOF
1/2" SHEATHING
2X4 RR @24"OC
2X4 CJ @24"OC
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2X4 STUD WALL
@24"OC
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A5 BUILT
BRIDGE LANE, CUTCI-lOGUE, NY
June 18, 2001 5CALE 1/2" = 1'0"
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