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Home My WebLink About1000-86.-2-11 TOWN OF SOUTHOLD Rental Permit Pet - F Permit No. 0005 Owner Robert & Elizabeth Schupler Occupied as Single Family Dwelling Located at 3635 Wells Road Peconic 86-2-11 Address Village S/B/L Maximum Permitted Occupancy 8 Is in compliance with all of the provisions of the code of the Town of Southold, the laws and sanitary and housing regulations of the County of Suffolk and by the laws adopted by the New York State Fire Prevention and Building Code Council. Expiration is two (2) years from date of issue. The operator is responsible for arranging for the bi-annual inspection. 3/13/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times °F sa�� Town Hall Annex Telephone(631)765-1802 54375 ai nd Fax(631)765-9502 S 'P.O.Box 1179 outhold,NY 11971-0959 a BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: Ta ' u x Map Number: 1000 SECTION BLOCK ,LOT SECTION B. OWNER INFORMATION:PA C/Li i 6L Property Owner Name: 1 Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) � N w Telephone Number (s): Property Owner Email Address: k'U j MAR 4 2019 Page 1 of 4 . A 7 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent (no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number (s): Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent(no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number(s): Email Address: SECTION E. SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units) Name of Managing Agent of dwelling unit, if any: Address of Managing Agent (no P.O. Boxes): Mailing Address of Managing Agent: Telephone Number(s): Email Address: Page 2 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: For each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier(for example, Unit 1, Unit 2, Unit 3 or Apt A, B, C);the use of each room in the Rental Dwelling Unit (for example, Kitchen, Bedroom 1, Bedroom 2, Living Room) and the dimensions of each room. For properties with multiple Rental Dwelling Units use "Rental Permit Application Addendum." Rental Dwelling Unit Identifier: Requested Maximum number of persons allowed to occupy Dwelling Unit Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: SECTION G. INSPECTION: Pursuant to the Town Code of the Town of Southold Chapter 207 (Rental Properties), a safety inspection by Code Enforcement Official is required. If the owner chooses not to have said inspection performed by the Town, a certification from a NYS licensed architect, a NYS licensed professional engineer or a home inspector who has a valid New York State Uniform Fire Prevention Building Code Certification is required stating that the property which is the subject of the rental permit application is in compliance with all of the provisions of the code of the Town of Southold,the laws and sanitary and housing regulations of the County of Suffolk and by the laws adopted by the New York State Fire Prevention and Building Code Council. am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold. Page 3 of 4 ❑ 1 am submitting a completed Town of Southold certification form from a licensed architect, a licensed professional engineer, or a licensed home inspector who has a valid New York State Uniform Fire Prevention Building code Certification. SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFOLK) I6�r "-�, certify under penalty of perjury,the following: 1. 1 am the owner of the property identified in "Section A" of this application. 2. The property owner's legal address set forth in "Section B" of this application is my legal address and I understand the Town will use the address for service pursuant to all applicable laws and rules. I further acknowledge that 1 will notify the Town of Southold Building Department of any changes of address within five (5) days of any changes thereto. 3. 1 have read and received a copy of Chapter 207 of the Code of the Town of Southold and agreed to abide by the same. 4. 1 will notify the Town within five (5) business days s to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager. w Property Owner's Name: Property Owner's Signature: � • Sworn to before me this � day of 201 Official Notary Public Signature and Original Notary Stamp PATRICIA REUL Page 4 of 4 Notary Public,state of New Fork Nu,.ff1.RE5011.965 Quaiified in Orange C0,1113tY certificate r1Ged in New Yorkourbt' comrdissw on ExPirea june 1511,20 cc M rk r r, s C C) r -C)q J ,u ^ � U3IJRIHOHdA7L7YN1S � m'^ +fuN `� � 6 H „J. .. -. ....._ ..-;—�y ,, -•,�� w+a �wmyr w � r a+w uv r=gym nrt m J'Sf'YOM'-J'1"dl"'I�tib'FS r�.' ,'e'Cp `s; 51 3pdk5nd xNa YjC}j 3i7HIMal3L8S3H�, wymuw m a w nw a wR r w^W WS J0 NQUIJDd ANV dq Nb llafl p J3� _` @• w fix .. >�nwo�nd.nd wi;� +mu ww re�w,?WmF��.wumrwwww,wY` u,:�wum�•wu, w�. MPG°op UVId Asx �Y' a QDI— r i p s i „ II ay t,y,,,•:„ .f A '� i � P },. �� rad' Y q�".« r a m 5 9 $ LS 15 h i �Y•F Y`�, � iri��r� ��',4 k� �`� a e•�',�^'f � ,A �,G(' . I. Fy 19a i- e' M. �Y i 3 ' '�xcTy,eawa Ug�$ •4+P 8 Wig. •,,,��---0„ � �i'a 4 • u , 7 � � dt � 49- -T ' 9- i. � � :I��' `• . ';;., .. 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CERTIFICATE OF OCCUPANCY No Z-20601 Date MARCH 19 1992 THIS CERTIFIES that the building„ NEW DWELLING Location of Property 3635 WELLS ROAD PECONIC N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 86 Block 2 Lot 11 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 27 1.991 ursuant to which Building Permit No. 19749-Z dated APRIL 1 1991 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 ONE FAMILY DWELLING WITH GARAGE IN BASEMENT AS APPT.Tr7n FOR. The certificate is issued to DANIEL MAGGIO (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 86-SO-208-JAN. 16 1992 UNDERWRITERS CERTIFICATE NO. N-226460 - MARCH 3 1992 PLUMBERS CERTIFICATION DATED JAN. 31 1992-SCOTT SCANLON Building Inspector Rev. 1/81 7 Town of Southold Annex 4/1/2011 54375 Main Road Southold,New York 11971 S + x:avaMa,o eo CERTIFICATE OF OCCUPANCY No: 34883 Date: 4/1/2011 THIS CERTIFIES that the building DECK Location of Property: 3635 Wells Rd, Peconic,NY 11958, SCTM #: 473889 See/Block/Lot: 86.-2-11 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 12/17/2011 pursuant to which Building Permit No. 36186 dated 2/17/2011 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: deck addition to an existing ons•l ilI'lly_dwellln��la�ed for. The certificate is issued to Schupler_, Robert& Schupler, Elizabeth "....., ......... (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED ..u., arra.... __ Sign .ure TOWN OF SOUTHOLD PROPERTY RECORD CARD L ok OWNER STREET 31 , VILLAGE DIST SUB LOT ACR. -7- Z7Z REMARKS 0, TYPE OF BLD. U PROP. CLASS D a '7] 2F`ft LAND IMP TOTAL DATE fT A 300 -7 ,11I ' : FRONTAGE ON WATER TILLABLE FRONTAGE ON ROAD WOODLAND DEPTH MEADOWLAND BULKHEAD HOUSE/LOT TOTAL TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET VILLAGE DISTRICT ' SUB. T s FORMER OWNER N E ACR SCE � x) (� S W TYPE OF BUILDING iw 3 RES. - SEAS. j L. FARM COMA. , 1ND. CB. MISC. I LAND IMP- TOTAL DATE REMARKS i } p a /rt t 1 A d — jffj _ ,.-, 0_ 2-f -` _f 3 IIS 3 CA D 3 e _ r _ _ AGE '° BUILDING CONDITION NEW NORMAL _ BELOW ABOVE Farm Acre Value Per Acre Value Tillable i Tillable 2 Tillable 3 I Woodland i Swampland Brushland House Plot i I a , '41! s a e e Qt- 86.-2-11 3/2014 i �-7 I Foundation Both Basement Floors 1. �` 17 p Ext. Walls V1v1Interior Finish Extension Fire Place Heat jr;d �U Porch '. Attic rC�K tLPorch Rooms 1st FloorZ -2- Patio Rooms 2nd Floor T � � - Garage = Driveway I O. B.