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Home My WebLink About1000-97.-7-13 rrW- TOWN OF SOUTOL Rental Permit Permit No. 0020 Owner Antoinette Doroski Occupied as Rental Dwelling Unit Located at 555 Beebe Drive Cutchogue 97-7-13 Address Village S/13/1- Maximum /B/LMaximum Permitted Occupancy 6 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. 3/28/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times , 1 „ Town Hall Annex Telephone(631)765-1802 54375 Main Road t Fax(631)765-9502 P.O.Box 1179 Southold,IVY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200(Application must be renewed every t rs Section A. Property Information: Rental Property Address: ewe-bz, ly: Cu,�c�oque- I iq35 Tax Map Number: 1000 SECTION 7 BLOCK `-7 —/-AOT SECTION B. OWNER INFORMATION: Property Owner Name: Atom}c C C) - > Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) ... CT 0, 80k I i' � i .) i w� f 1 Telephone Number(s): 6 2. - — 0 f Property Owner Email Address: ` 2 (� k1 AjL Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: 1v 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: A 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:. _ On - 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: )al Use and Dimensions of each room in Rental Dwelling Unit: f p � as l t6 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) 1 rtify 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 Owner's Signature: Sworn tofore me this dav of ��a Uf. . 20 yypp � Nancy Messer Noutry 1 blk, tate eYork Original Notary Stam 01ME61a7�2�s6 Official Not Public S ature and g y p I E 1 PuBUC s Quadi11 fi 10 SJiffitilt CIDUHIY Page 4 of 4 O� r Dr.. C'u"o ifl" S 765.,1802 IN PECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ L [ ] FIREPLACE & CHIMNEY [to FIRE SAFETY IN [ ] FIRE RESISTANT CONSTRUCTION [ j FIRE RESISTANT P [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F [ ] VIOLATION [ ] CAULKING . fit ..................... � e DATE v -)OWI a INSPECTOR ,*- 01- 1 1 yt � P�: l a E-' -u, E �r oe - o � Ab 4 w =. _ ;' 7-1 < ..m " 9 ' ul� py r. o» 7_ �. .... i Y !O 3 �, w 70 re + W n I 4 p r` yp � w1� ti.. to E Tres 4'D G" b�Vnr^ ava c8uam¢ .-"ol m.DLt i ro , � :� zeKz �pryz ,r. M +szk Yli fv �...® .........,..-...�.....��.._...o,_.:wrr'�.w .m.e........_....,,....�. »:yu. ra ' I' r, I 11 w u r a FO 14 ID14-1 ioN h G'Q - 11f PI^Y o en So4� �G PAom 4770400 W Mein Rwd GR I'r%POR i.N Y.11914 nom. ,hn C C o Iacct, -- FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-28891 Date: 09/26/02 THIS CERTIFIES that the building NEW DWELLING Location of Property: 555 BEEBE DR CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 97 Block 7 Lot 13 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 27, 2002 pursuant to which Building Permit No. 28701-Z dated AUGUST 27, 2002 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 SINGLE FAMILY DWELLING WITH ATTACHED TWO CAR GARAGE AS APPLIED FOR. The certificate is issued to WALTER M DOROSKI _ ..._ .........._, (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 87-SO-182 11/14/20 ELECTRICAL CERTIFICATE NO. N-034549 09/21/8 PLUMBERS CERTIFICATION DATED 08/22/88 PECONIC PLUMBING & HEAT. ut rized S 9 nature Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29063 Date: 11/07/02 THIS CERTIFIES that the building ADDITION Location of Property: SSS BEEBE DR CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 97 Block 7 Lot 13 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 21, 2002 pursuant to which Building Permit No. 28702-Z dated AUGUST 27, 2002 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 ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to WALTER.-M DOROSKI & WF �._........_.._ (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED „A + tho zed ign ature Rev. 1/81 F PROPERTY RECORD CARD OWNER STREET VILLAGE DISTRICT SUB. LOT e lei FORMER OWNER- _ rr N E ACREAGE r �1 •. - TYPE OF BUILDING RES. O SEAS. VLA# FARM COM . IND: CB; 4 MISC: LAND IMP, TOTAL DATE is ) to S� A ,� NORMA BE I AB VE ti / •L �_ ,� e Acre alre �K, Tillable 1 I pe}� � Tillable 2 Tilloble, 3 Woodland Swampland Brushland House Plot Tota? I - 1 97.-7-13 12/2013 { 5. M B(d r X — �, Foundation Bath ' Exterst"on - " Basement Floors s 3 _ �� ' Extension Ext. Walls /? Interior Finish , ,p „ Extension Fire Place Heat y L 16 Porch Attic L[ Porch Rooms 1st Floor Breezeway Patio Rooms 2nd Floor I Garage .r Driveway O. B. 00 5