The URL can be used to link to this page

Home My WebLink AboutZ-9268FO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . 655..B~'oadwa.ters. Rd ..... ~ Map No .... 71t9 ..... Block No ........... Lot No ........ 388 ...................... RE(~UIRI~iENTS FOR ONE FAMILY DWELLING BUILT PRIOR TO conforms substantially to th ......... · ~FIC4%TE..OE OCCUPANCY dated .... .Ap.r.i..1 .... 2..~ ...... , 19..5.7. pursuant to which ~ No.: Z9268' dated .... .O.cJ;o.b.e?..2~ ......., 19.7.8.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Priv. ate..One. F~mil.y..I~elling. with. Agcessa~'sr. building.. The certificate is issued to ......... Cha~[Les. J....&..The],ma. Raus¢l% ................ owner. Jessee_ nr ~-n-nt) of the aforesaid building. Suffolk County Department of Health Approval ............... P.~..e.-~ .~c,i..s~.~ng ....... UNDERWRITERS CERTIFICATE No ........................ .P?.e.-..E~x..i.s.t.i..rig. ...... HOUSE NUMBER ...... 6..5.5 ..... Street ........... .B.o...a~w..a.t. 9.~.s' .R.d.: .............. Building Inspector Housing Code Inspection October 17, 1978 665 Broadwaters Road R-1 Nassau Point. Cutchogue, N.Y. 11935 Tax Roll: Charles J. Rausch & wf. occupied: Upon receipt of an application for a Pre-Existing Certificate of OccUpancy, I made an inspection of the dwelling on this premises; I began this inspection at approximately 1:00 P.M. with Dotie Neece. Located on this property is a one story, split level, wood frsmed dwelling. On the rear of the property is located a small steel utility building. Most of the dwelling has a Certificate of Occupancy already. The front section consisting of a ~mily room has a c/o, ~,mber Z6218 - the back section consisting of two bedrooms, full bath- room and a two car garage underneath has a c/o, Number Z5472. The center section which I inspected, consists of a living room with fireplace, a dining room and a kitchen. The rooms are heated electrically. Both the inside and outside of this dwelling are in very good shape. No violations of the Housing Code, Chapter 52, Code of the Town of Southold, N.Y. were found: Inspection completed at approximately 1:30 P.M. Respectfully submitted, CURTIS HORTON Building Inspector IPORM NO. 6 TOWN OF SOUTHOLD Buildin9 Department Town Clerks Office Southold, N. ¥. 11971 APPLICATION FOR C:ERTIFIC:ATE OF OC:C:UPANC:Y Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey o~ property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date . ~/~..../,~ ./~..,~... ................. /l~ew Bui~ .................... Old or Pre-existing Building ...... ~ ............. Vacant Land ............................ ----.~._ Location Of Property ~.~'~..~.~..~'.~..~''~./~'J..~/~'~.~..Z~/q~.~.~d~z';~*~''c~'~'~:~.~%....~..[~4.~.~.. · of Property ................................................... ................................................................ ,o. ,o ............. Permit ~o ..................... ~ate Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and per~t~ll applicable codes and regulations. Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal)