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HomeMy WebLinkAbout1000-78.-7-51 TOWN OF SOUTHOLD Rental Permit 0009 Owner William & Jeannette Ayers Occupied as Single Family Dwelling Located at 122 Hickory Avenue Southold 78.-7-51 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. Expirab is two (2) years from date of issue. The operator is responsible for arranging for the bi-annual inspection. 6/14/2023 ce Cod nforceent Official This Notice must be posted by the main entrance at all times r C631-765-1802 INSPECTION FOUNDATION 'IST [ ] ROUGH PLBG. FOUNDATION 2NDC ] INSULATION/CAULKING C ] F I 1 STRAPPING FINAL CHIMNEYFIREPLACE & I FIRE RESISTANT CONSTRUCTION [ FIRE RESISTANT ELECTRICAL (ROUGH) C ] ELECTRICAL C CODE VIOLATION [ PRE C/O .............. ....... DATE I...w. _ �u..,.....�.....�..ww.,... S ur w "� �.�..._.�.....�. ." .. soI ZZ t C/6,ix !�� TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 INSPECTION FOUNDATION 1ST ROUGH PLEIG. FOUNDATIONINSULATION/ClAULKING FRAMINGSTRAPPING I L FIREPLACE IMNEY FIRE SAFETYINSPECTION FIRE RESISTANT CONSTRUCTION FIREIPENETRATION ELECTRICAL I ) ELECTRICAL 1 CODE VIOLATION PRE 1 � � INSPECTOR T �WN OF SOUTHOLD tz Rental Permit Permit No. 0009 Owner William & Jeanette Ayres Occupied as Single Family Dwelling Located at 122 Hickory Avenue Southold 78-7-51 Address Village 5/B/L Maximum Permitted Occupancy 10 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. 3/19/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times so Town Hall Annex y Telephone(631)765-1802 54375 Main Road CA Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOU'T'aEOLD � w°°° , l RENTAL PERMIT APPLICATION M3 1 4 2U,) Rental Permit Fee $200 (Application must be renewed every two years) T. "I'D Section A. Property Information: Rental Property Ares : Tax Map Number: 1000 SECTION 7F BLOCK 7 LO SECTION B. OWNER INFORMATION: t n A—Y-e 1'5 Property Owner Name: E Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) „/ Telephone Number (s): )el 16 3 WO Property Owner Email Address: ! / 'IJ e- q/ 40 Page 1 of 4 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: A&-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 o 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. ❑ 1 am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold. Page 3 of 4 ❑ I 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) ,, 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 I 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. Property Owner's Name: , Property Owners Signature: , 20� Sworn to before me this V4day Ma 1 13Official No y Public SignaOriginal Notary Stamp TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK Page 4 of 4 NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES MUNE 30,20201 �Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 " BUILDING DEPARTMENT TOWN OF SOUrrHOLD RENTAL PROPERTY CERTIFICATION Form to be completed by a NYS licensed architect, NYS licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Fro ssi; real sea!re aired vrArcl7ltect c►r Ery irreer licensed hforne 1»s ectar must r�rvlde coa a valid New Yorlr State lrai array Fire Rreverti�ar Buildirl Cade Cerci icatitrrl. Rental Property Number: Rental Property Address: Owner/Name: (iCLVI Rental Dwelling Unit Identifier: Number &Square footage of each bedroom as depicted in the attached floor plan: ( e. Bedroom#1�-�100 sq�. B Broom#2-90 sq., etc.) .� P Property Description (Include all improvements indicated on survey) u p ..., . �i C t- i . 1 � I certify that I have done a physical inspection of the subject rental dwelling unit and find that the unit 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. riginal Signature Print Name and Title c. Please Idt pr A N � � l So1 R�6'+ *` TOWN OF S+OT . SlIIL.OI G OT. 765®1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION-2ND - [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] INAL"te [ ]- FIREPLACE & CHIMNEY" IV FIRE SAFETY INSPECTION ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: Q ........... 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Myr J L .J L tl6'!fE± lltlM 33Y ,v -I"OG'NpM p E'M4 ,' OUDLMLL d I r t y- ,H1IUIdI' / .w,py HOAH HO11H m I I r r ) I / r �r a�RE Town of Southold 2/28/2019 P.O.Box 1179 53095 Main Rd Southold,New York 11971 ail CERTIFICATE OF OCCUPANCY No: 40236 Date: 2/28/2019 THIS CERTIFIES that the building SINGLE FAMILY DWELLING Location of Property: 122 Hickory Ave., Southold SCTM#: 473889 Sec/Block/Lot: 78.-7-51 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/4/2017 pursuant to which Building Permit No. 41638 dated 5/15/2017 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: 9rz &:Lq ly d,! glj ng.w ith unci shed basement, .,4 un ezq�rer� o t porch:and rear deck as appjed. L The certificate is issued to William&Jeannette Ayers of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-16-0066 1/24/2019 ELECTRICAL CERTIFICATE NO. 18-46831 8/21/2018 PLUMBERS CERTIFICATION DATED 1/2/2019rU � rbert Wis 'ng aa rz d Signature a E TOWN OF SOUTHOLD PROPERTY REC 3 /14 IxA M r DIST �NERSTREET - - - y ,§ - VILLAGE [ SUB LOT F £F= - - - r z I FORMER OWNER M N IE � ! ACR. SOF YPE BU. DING 6 � T IL v� RES. SEAS. VL. i / FARM COMM, CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS J � 47e - E �re f —g y r z �j y1-7 = - AGE _ BUILDING CONDITION NEW NORMAL BELOW ABOVE e FARM Acre Volue Per Value l " o Acre ( a_ Tillable ; FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowl-and DEPTH ,3—�v House Plot BULKHEAD I E ' Total DOCK i i COLOR y _ TRIM I I 1 i I € E I l € I I T - j � ; =I I I a € i k f I o 1 ! E a Extension — I l u- s Extension I ExtgpsiinT _ i otttatio BEI I Dinette i Porch Basement lFloors _ K. i Porch I � Ext. Walls Interior Finish j LR. Breezeway Fire Place 'Heat l DR. Garage — - ype Roof - Rooms Ist Floor BR. .r y. x Patio - i Recreation Room Rooms 2nd Floor =FIN. B O. B. Dormer -Driveway Total I COLOR TRIM 3 1st 2nd 3 _ _ _ Foundation` Fin. B. Bath Dinette Extension , ,, £ , ? ' , Basement Floors Kit, ` �� �- Extension Ext. Walls 3 Interior Finish L R. re _ - t---v---g -- Heat D.R. Extension I Fire Place Woodstove BB Portio Dormer Baths I Porchli --- I Dock Fam. Deck ::Rm, A.C. I I 330 �� O B �� tl£. Pool i