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HomeMy WebLinkAbout1000-37.-5-17 OF SOUTHOLD Rental Permit Permit No. 0023 Owner Nancy Chin Occupied as Single Family Dwelling Located at 180 Knoll Circle East Marion 37-5-17 Address Village S/B/L Maximum 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. 4/4/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times Town Hall Annex ',r Telephone(631)765-1802 54375 Main Roada Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959r BUILDING DEPARTMENT nDD ,z 7 TOWN OF SOUTHOLD11'- ' 19 209l, RENTAL PERMIT APPLICATION Rental Permit Pee$200 (Application must be renewed every two years) �., Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION '? BLOC 5-- LOT /17 SECTION B. OWNER INFORMATION: Property Owner Name: " ;: 1 ,.✓ � Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) /& IniAAGL 2d A/V a 6) Telephone Number(s): - 57603 Property Owner Email Address: ' =, f ryj m Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: q�2 Address of Authorized Agent(no P.O. Boxes): lMwM_ ���- 211 030 Mailing Address of Authorized Agent: E Telephone Number(s): J S-16 - 6a 3-1 ?6, Email Address: /mm �,5 :l 07 aiyJ D,+ a yv�✓� 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: 0A1 a- i-& i 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 Uni � — Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: S&%;-- racc o e- pi- Ai 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. f'l am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold. PL ;; r CW14, 2�1 f!jU 6 Page 3 of 4 6--g- 6 0 5 I� ❑ 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) P ' iN certi'fy 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: Ali-A iIU -- S7 L-1, ,e 4;eo - Property Owner's Signature: Sworn to before me this day of ' 20/f W00CHUL 1<1N Abldry ftbfic,SWO of piew y A/4" Nm 01KN232-"q Official Notary Public Signature and Original Notary Stamp Cona t IM Id In u cras Doc 2a ? Page 4 of 4 Kvro (c4e000p 1� suwa l0000-, fsol TOWN OF SOUTHOLD BUILDING 11111302 1 ,NSPECTIOP ��77inniw I�IIyI w Illlnnno III un' iON mnInnr „ Ila' IIID u IryIIpI ��pg w�III7 1 III �iw „1111 iI N VIII "ri ON FRAMING � ININWwww � wn nn Inill�' nniW' P G VIIIl!! PlACE CHIMNEY FIRE SAFETY' I E l" IEirR L. R, ISI f 1 E l N R'iI I CODE V110LA 110N , CAUl ILww I l iG 0 - DATE INSPECTOR N (1J I a � I �� 9 ` 1 i Z e 1 r i e d I I R ¢ I L�t I < 1 z — l Co 4�'"...��ry I I �m a d I �p ,✓_,,� rp I I 1 ��i P All y k CD 1 1.C gig I I y p 1 M 1JR-, a� FAIR...YEATB�B� -�tIY DESIGN Aa9N%cIII1�^ INC�- Bl O�X�5 �-- 413 113..M.•I �IFN 9TRBL1•6RELNPIRP N.Y. 11844 -631-47 9752 85 _ L ® OEM — SS Z L ry w J CV 14 s g "; N 0 y J u � , � 21 Cp ! ��I m a , Ca �Yl, -77 1 ,. .k _�l p r i am � ip — � u N c ... �racw .y I -µ w ,,41, ° cu n L�SIGN AS � •CREENPORY N.Y.-11944 •631-477-9752 I+AIRWTrATHEI[-BROWN B SOCIATES iNC BOX 511 413 MAINSPREBT co n Q rTl _ a 71 N ri Ulz 4 �. � 0 70A Sp _ G 1 IR i C q rR � rr " _ m n P I — d¢'.P y N W -A 1 1rA1F1 J 1 { MAIN S1 Q136T M Y.*1 CItBQNPOQIL N. 1=. Lj 944 631-477-9752 • 9 — ..: e am r� m e-BROWN DESIGN ASOIAT �INC BOX a�1 413 m7 ., r","4 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: E- 27280 Date: 08/29/00 THIS CERTIFIES that the building DWELLING Location of Property 180 KNOLL CIR EAST MARION (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. + 73,889 Section 037 Block 0005 Lot 017 Subdivision Filed Map No. Lot NO. conforms substantially to the Requirements for a ONE FAMILY DWELLING built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCMpANCY pUMM S- 27280 dated AUGUST 29 2000 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 CONCRETE PATIO.* The certificate is issued to ERIC ISBISTER & WF (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A MXCTRICAL IFICATE NO. 8/28/00 Pending PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPOR Authorized Signa re Rev. 1/81 w. BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATIOB: ................ SUBDIVISION: _... I1AP M.: LOT (S) SAM OF CIffi= (S). ERIC ISRISTE.R & WF OCCUPANCY: SiL ERIC ISAISTER & WF AUMITTED BY: -sE T i$I�'C ACCQD?AHM BY: Ste, EEY AVAILABLE: SUFF. CO. TAX !AP NO-: SOURCE OF REQUEST: _. DATE: 08/29/00 DWELLING: TYPE OF GoBBTAUCIIOH: WOOD FRAME R' STORIES: 1.0 # EXITS: 1 FOUEDDATIOH: CELLAR: YES CRANL SPACE: TOTAL RO@RS: IST FLR.: tee` 2ND FLR.: 0 3RD FLR.: _Q BATHROOM(S) 2.0 TOILET ROCK(S)- 2.0 UTILITY ROM(S)-. PORCH TYPE: DECK TYPE: PATIO TYPE: CONCRETE BRSBLEIR\Y- FIREPLACE: ) __... .. GARAGE: _....... D(BMWTIC HOTHATER: YES TYPE HEATER: E'LE=1C AIRCD®ITIOHIHG: TYPE HEAT-. OIL IBM AIR: HOTHAMM' OTHER- ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST.-- STORAGE, TYPE CONST.: .. ............. .. POOL: �.. GEST. TYPE CONST.: OTHER: VIOLATIONS: T ER- VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE � M N I d I � V 1 � � l � I I U I I � 1 I M � I G Q REMARKS: BPj'- /-Z rN rs—C.01a- 12 L9 IS6PEem BY: DATE ON ISSPECTION: 07/07/00 JOH oupiS TAUS START: 10:00 AM Ems: 10:30 AM FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30181 Date: X5/07/04 THIS CERTIFIES that the building ADDITIONS/ALTERATIONS Location of Property: „ 180 dK,.NOLL CIR EAST MAR (HOUSE NO.) ION (STREET) (HAMLET) County Tax Map No_ 473889 Section 37 Block 5 Lot 17 Subdivision Filed Map No_ Lot No_ conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER-9,--2_002 pursuant to which Building Permit No_ 28754-Z dated SEPTEMBER 19 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 ADDITIONS AND ALTERATIONS WITH BRICK PAYIO PERGOLA ACF�a SLATE STOOP AS APPLIED FOR PER ZEA #30181 DATED 4/17/03, The certificate is issued to NANCY D CHIN (OWNER) of the aforesaid building_ SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-02-0135 04/29/04 ELECTRICAL CERTIFICATE NO_ 1104919 02/04/011 PLUMBERS CERTIFICATION DATED 04/05/04 PECONIC PLUMBING & HEAT Authorized Si ture 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-27279 Date: 08/29/00 7HI8 CERTIFIES that the building REPAIR Location of Property: 180 KNOLL CIR EAST MARION (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 37 Block 5 Lot 17 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 8, 2000 pursuant to which Building Permit No. 26734-Z dated AUGUST 23, 2000 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 REPAIRS TO AN EXISTING ONE 'FAMILYDWELLING AS APPLIED FOR. The certificate is issued to ERIC ISBISTER & WF. (OWNER) of the aforesaid building. SUFFOLK CODPTY DETARTHMT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLEB C MIFICATIOP DATED 08/08/86 COMPLETE PLUMBING & HEAT Authorized Sign 11cure Rev. 1/81 BARD DISTRICT - SUB. LOT v e FORMER CWNER N E ACREAGE S w TYPE OF BUILDING RES. A� SEAS. FARM comm. INCB MISC. ILAN �� TOTAL DATE REMARKS a a � x s _ s AGE B U1 ING; 0IT ._ 5 I NEW NORMAL BPL B,a,,,'E ---- Farm _acre Value Per Acre Value TIIlob! } T Icbl T '1 e rush-and - r House o 14 _w COLOR I'l e4 € l - N , ' TRIM i a � L 3 _ 3 d 37-5-17 water side view 1/04 1st 2nd PC I Foundation c Fin.B. Bath f Dinette Etrsion Basement FU COM Floo sKit r sLaa c - - � I A Z�M � Extension s s Ext. Wall - Interior Finish LR. Extension a Fire Place Heat D.R k 2-oP s Woodstove BR, I Porch � � 2 13A Dormer Baths — _ Decd Dock � Fam. Rm. A.C. Garage Uus — — b f g l . z a a r c {, - � 3 41 IF e M. Bldg � �I �, ��� i ,Foundation a �I Both 9ath Extension asertt Floors ii i f Extension _ _ dolls Interior Finish /J _ Extension ���, - E Fire Place e Heart — �— Attic Porch �fl7SL' Porch