HomeMy WebLinkAbout1000-117.-5-41 TOWN OF SOUTHOLD
Rental Permit
0024
Owner Ubaldo Gonzalez
Occupied as Seasonal Cottage (Unit A)
Located at 885 Orchard Street New Suffolk 117-5-41
Maximum Permitted Occupancy 4
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.
2/23/2022L 17
Code Enl!!�Inent Official
This Notice must be posted by the main entrance at all times
TOWN OF SOUTHOLD
Rental Permit
0025
Owner Ubaldo Gonzalez
Occupied as Seasonal Cottage (Unit B)
Located at 885 Orchard Street New Suffolk 117-5-41
Maximum Permitted Occupancy 4
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.
2/23/2022
Code Enforcement Official
This Notice must be posted by the main entrance at all times
a° SOUTHOLD TOWN Town Hall Annex
54375 Main Road
PO Box 1179 Southold,
Rental Inspection
r'
NY 11971-1179
Tel: 631-765-1802
` Fax 631-765-9502
u v� I 1
SCTM # -. - S-- c Date
Owner o p yj Zoje Phone
Address ffts
._ S� Zip 41-S6
S
Hamlet VJ S - -v Inspector µ, ._.
Addrs,visible from street?
LEVELS SUB 1 2 3
Smoke Detectors (#-bedroom detectors excluded)
Carbon Monoxide Detectors (#)
Fire Extinguishers (#) '
Exits (#
BEDROOMS 1 2 3 4 5
Smoke Detector Alarms (#)
Carbon Monoxide Alarms (#)
Egress (windows) (Y/N)
BUILDING SYSTEMS , e Y/N CONDITION OF PROPERTY
Heating system maintained/operational Building Interior is clean /maintained
Hot water system maintained/operational Building Exterior is clean /maintained
Electrical system maintained/operational Property is clean/safe/maintained
Mechanical system maintained/operational Handrails &guards present
POOLS Y/N POOL BARRIERS Y/N
Pool present Pool is completely enclosed
Pool surface alarm and/or door alarm Barrier is a min. 48" high
resent
POOL GATES Y/N All openings in barrier less than 4"
Self-closing, self-latching Max. 2" clearance @ bottom of barrier
Latch on pool side of gate, meets height Barrier capable of being locked &child-
requirements proof when unattended
COMMENTS:
`� oCC,tic
TOWN OF SOUTHOLD
Rental Permit
Permit No. 0025
--------------
3=
Owner Ubaldo Gonzalez
Occupied as Single Family Dwelling
Located at 885 Orchard Street New Suffolk 117-5-41
Address Village S/13/1-
Maximum
/B/LMaximum Permitted Occupancy 4 Unit B
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.
4/5/2019 John Jarski
Date of Issue Code Enforcement Officer
This Notice must be posted by the main entrance at all times
i�4
Town Hall Annex ,, j �jl " TvI'ephone(631)765-1802
54375 Main Road �� Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 ��UV�s'00-��d
BUILDING DEPARTMENT
TO OF SOUTHOLD
APPLICATIONRENTAL PERMIT
T.
Rental Permit Fee $200(Application must be renewed every twoyears)
Section .
Property Information:
Rental Property Address:
" _w Al.Y
_Tax Map Number: 1000 SECTION BLOCKSECTION
B.
OWNER INFORMATION:
Property Owner Name: '
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
4�1110�11
f
1�In
Telephone Number(s): 631 7 G
Property Owner Email Address:
Page 1 of
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 a " 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:U , 6i no Iv-
Property Owner's Signature:� I �" w�' °'"• .µ
Sworn to before me this day of ,C,.(` _ ,, 20
d
Official Notary Public Signature and Original Notary Stamp
Lori T McBride
,, NOTARY PUBLIC,STATE OF NEW YORK
Registration No OIMC6368447
Page 4 Of 4 tu' Qualified in Suffolk County
Commission Expires December 11,2021
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 ��� 0
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION ADDENDUM
Rental Dwelling Unit Identifier: ' w7
Requested maximum number of persons allowed to occupy each dwelling unit-
Number of Rooms in Rental Dwelling Unit: Z- °
Use and Dimension of each room:
}-0 0 2 x 12-
................
Rental Dwelling Unit Identifier:
Requested maximum number of persons allowed to occupy each dwelling un!
Number of Rooms in Rental Dwelling Unit: 0 s
Use and Dimension of each room:
c rvr w
Rental Dwelling Unit Identifier:
Requested maximum number of persons allowed to occupy each dwelling unit:
Number of Rooms in Rental Dwelling Unit:
Use and Dimension of each room:
New �lu f1�- 11�• — ��
*� TOWN OF SOUTHOLD BUILDING DEPT.
ar� y765-1802
INSPECTION
I FOUNDATION 1 C, � ROUG111,,,,I I-II
IIC, FOUNDATION 211MDINSULATION
FRAMING /s ri„ III I ,'I
111 F'IR IIG L CHIMNEY � � 11114 INSPECTION
ECT
IIS F1113 E m11m r coiiqs rIlUCTMN 1°111 IIIS AN"'r I:TNETIlATION
ELEc rRI L ( H) ELEc rRI L (FINAL)
CODE VIOLAI ION CAULKING
gY ;
......... ......... ... ........
S:97 _... _ _ ... ...._ _.......
_..__ ......... ... _ ... ...�.. _. .._.
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... .....
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e3aLF
oc r
D
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z105.7.9 Date . . . . , . , February. 16. . . . . . . . , , 1982,.
THIS CERTIFIES that the building s . . (0. 1. . . . . . . . . . . . . , . . , , , , .. . . , . , . . . ,
Location of Property . . . . . . . . . . . .. . . . . Orchard ,Street New Suffolk
House No. Street Ham/er
County Tax Map No. 1000 Section . . . . . .Block _95. . . . . . . . . . .Lot . . . 04.11 . , „ . , . ,, ,
Subdivision . .X. . . . . . . , , , , , , .Filed Map No. .X. . . . . .Lot No. X . . . . . . , . . . ,
Requirements for a private one-family dwelling built prior to
conforms substantially to the �4�)�oetiert'fe�l3�ilrcl,EFg��R#Af�liRrcr�vi-�1`ns.v} ;ce:ca£e�=
Certificate of
. i1 2I # , , , , , . 1 19 .5 Pursuant to which Brdtdirrg-Pexmft o..c. . . . . . . . .
ancy
210879
dated . . . , .February. 16 19 ,82, 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 . a . . . . . .
private one-family dwelling, and two accessory seasonal buildings,*and
. . . . . .
a two car wooden garage . Thelma DoddX . . . . . . . . . . . . . . . . . . . . . .
The certificate is issued to . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . .
town or,XPX4WW 404N)
of the aforesaid building.
Suffolk County Department of Health Approval . . . . nfir, , , , , , , , , , , , , , , , , , , , , , ,. . . , , ,
UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . nir. , , , . , „ , , . , . . , . . . „ , . , . . . . , , , , „ . , , .
*Each accessory rental building is a seasonal rental cottage, non-
conforming; dwelling.
Building Inspector
Rev.1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
$85 Orchard Street New Suffolk
Location iucriber da street Fume paIity
Subdivision X Map Na. X Lot(s) X
Name of Owner(s) Thelma Dodd
Occupancy R-1 owner
---Tt—yP T— owner-tenant
Admitted by: airs, Dodd. Accompanied by: same
Key available Suffolk Co. Tax No. 117-05-041
Source of request Thelma Dodd ,Date 10/20/81
DWELLING
Type of construction wood framed #stories 2
Foundation hollow the Cellar pax,tial Crawl space rest
Total rooms, 1st. F1 2nd. Fl 3 3rd. F1
Bathroom(s) 1 Toilet room(s)
Porch, type Deck, type Patio, type
Breezeway Garage Utility room X
werosene
Type Heat snace heater Warm Air X Hotwater
Fireplace(s) No. Exits 2 Airconditioning
Domestic hotwater yes _ Type heater as
Other
ACCESSORY STRUCTURES:
Garage, type const. 2 car wood Storage, type const.
Swimming pool Guest, type const.
Other 2 seasonal non-conforming dwellings--see attached sheets
VI'O'LATIONS: Housing Code, Chapter 52
Location Description Art. Sec.
cellar no cellar doors III 52-30-C
kitchen kitchen floor & walls need repairing,,
badly LII 52-32-C
;Mair up no rail & ste s too high II 52-27-An B
roof leaks in several places III 52-31-C
ceilirj�„ l°uol,es an ce Idra i � vne°xasaa laL-,es thru
out dwelling III 52-32-C
mora e corn letel rotten III 52-30-A C
i
Remarks:
Inspected by:� Date of Insp.-Oct. 30, 1981
Curtis W. Horton Time start 9: 15 end 10: 15
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location
number & street Nunicipa ity
Subdivision Map No. Lot(s)
Name of Owner(s)
Occupancy
typ e owner-tenant
Admitted by: Accompanied by:
Key available Suffolk Co. Tax No.
Source of request Date
DWELLING: WEST RENTAL COTTAGE
Type of construction wood framed #stories one
Foundationpiers,,, cement block Cellar _Crawl space
Total rooms, lst. F1 2 2nd. Fl 3rd. Fl
Bathroom(s) 1 Toilet room(s)
Porch, type x Deck, type_ Patio, type
Breezeway Garage Utility room
Type Heat none alarm Air Hotwater
Fireplace(s) No. Exits Airconditioning
Domestic hotwater Type heater
Other
ACCESSORY STRUCTURES:
Garage, type const. Storage, type const.
Swimming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Location Description Art. Sec.
t ide some of the sills are bad III 52-30-A
no shut off V 52-52-E, 6
Remarks:
Inspected by: Date of Insp. Oz:: . 30t r98'1
Curtis W. Horton Time start 9 : 15 end 10:15
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location number & street Municipality
Subdivision Map No. Lot(s)
Name of Oi-mer(s)
Occupancy
type owner- enan
Admitted by: Accompanied by:
Key available Suffolk Co. Tax No.
Source of request Date
D' ELLING: EAST RENTAL COTTAGE
Type of construction_ wood framed #stories one
Foundation iers cement block Cellar Crawl space
Total rooms, 1st. F1 2 2nd. F1 3rd. Fl
Bathroom(s) 1 Toilet rooms)
Porch, type Deck, type Patio, type
Breezeway Garage Utility room
Type Heat none alarm Air Hotwater
Fireplace(s) No. Exits 1 Airconditioning
Domestic hotwater Type heater
Other
ACCESSORY STRUCTURES:
Garage, type const. Storage, type const.
Swimming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Location Descriution Art. Sec.
no v' lations
Remarks: _
y:
Inspected b � Date of Insp. Oct. 30„ 1981
P
Curtis W. Horton Time start 9:15 end 10: 15
FOAM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD', N. Y.
CERTIFICATE OF OCCUPANCY
No. -43;Vl—...... Date ......................... W-Ch. ... 1....... .. 19....6P
THIS CERTIFIES that the building located otQrCShard.• Street
Map No. ...XCXC......... Block No. ......,-L . ... Lot No. ... . [9K. ... . . .................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.................................Xwoe.....26..............1 1962.... pursuant to which Building Permit No. .Mlx 56...
dated ...........................4IMP.....26....... 19.x?/2.., 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 ..........
44
OA,.J.2...=10...x'.autal..tll.a: tage................ ................... .........---.............
This certificate is issued to .....................Ow.mDr.-9......................
(owner, lessee or tenant)
of the .aforesaid building.
Building Inspector
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. 214700. . . . , , . . . , Date .. . . . gJ4y .24. . . . . . . . . . . . . . . . . . .. 19 86
THIS CERTIFIES that the building . . . . .Alteration M . , . . . . . . . . .
Location of Property 8 ,QRCHARD S T.. . . NEW SUFFOLK
House No. Street Hamlet
County Tax Map No. 1000 Section , . 17. . . . . , .Block . .5 . . . . . . . . . . . .Lot
Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
JUNA .17. . . . . . . . . . . . . . . 19 .$5 pursuant to which Building Permit No. .14 O,U Q Z, , , , , . . . . . . . .
dated . . . , , JUNF, , 17, , , , , , , , , , , , , 19 8 5 ,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
. . . . . .Cpl+'iPLET.> LY. RENQVAT' .BX15 INA .QNE. F'AMIAY.DWELLIN.G
The certificate is issued to . ,Wg41N9. ENTERPRISES .INC. . . . . . . . . . . . , . y
(o'w�^uer
of the aforesaid building.
Suffolk County Department of Health Approval . . . . . N A. . . . . . . . . . . . . . . . . . . . . „ . . . . . .
UNDERWRITERS CERTIFICATE NO. . . . . . . N7344.01 , , . . . . . . .
PLUMBERS CERTIFICATION JULY 23 , 1986
jo
Building Inspector
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 Z17496 Date NOVEMBER 7 1988
THIS CERTIFIES that the building ADDITION
Location of Property 815 ORCHARD ST. NEW SUFFOLK
House No. Street Hamlet
County Tax Map No. 1000 Section 117 Block. 05 Lot
41
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUG. 22, 1988 _____pursuant to which
Building Permit No. 17384✓a dated SEPT. 1 1988
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 EXISTING NON CONFORMING SEASONAL COTTAGE.
The certificate is issued to UBAL,DO GONZALEZ M.D.
(owner, )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. NA
PLUMBERS CERTIFICATION DATED N/A
�jd �
Building Inspector
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 Z18179 Date JULY 17 1989
THIS CERTIFIES that the building ACCESSORY
Location of Property 885 ORCHARD & 1405 FIRST ST. NEW SUFFOLK
House No. Street Hamlet
County Tax Map No. 1000 Section 117 Block 05 Lot 41
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 25 1989 ______pursuant to which
BuildingPermit No. 181592 dated JUNE 1, 1989
w,.
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 ACCESSORY SHED.
The certificate is issued to UBALDO GONZALEZ
(owner, xxxxxxxxxxxxxxxx)
of the aforesaid building_
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO_ NIA
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
FORM NO. 4
TOWN OF SOU THOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20517 Date FEBRUARY 3, 1992
THIS CERTIFIES that the building ADDITIONS
Location of Property885 ORCHARD STREET NEW SUFFOLK N.Y.•,
House No. Street Hamlet
County Tax Map No. 1000 Section 117 Block 5 Lot 41
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY' 28 1991 _____pursuant to which
Building Permit No. 19701-Z dated MARCH 8.L1991
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 ADDITION & FOUNDATION UNDER EXISTING ONE FAMILY DWELLING
AS APPLIED FOR.
The certificate is issued to UBALDO GONZALEZ, M.D.
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-212503 - NOVEMBER 11, 1991
PLUMBERS CERTIFICATION DATED JAN. 31,-1992-PERFECTION PLUMB.& HEAT.
Iuilding Inspector
Rev. 1/81
TOWN OF S T TOL P OPS TRECORD �
OWNER STREET VILLAGE DISTRICT SUB, LOT
FORMER OWNER\1)aN I, E —�� ACREAGE
r
1 TYPE OF BUILDING
RESZrj(j ( SEAS. VL. FARM COMM. IND. Cly MISC. Est. Mkt. Value
LAND IMP, TOTAL DATE rREMARKS -5
3
F s �/�•.`� = _ _ —
s
t
P
7 �� �( . 3�! 0
1212 �
ltD Seo � I/2 a
GE— BU 11�a-CONDITALON
z
ABOVE FRONTAGE ON WATER
Farm Acre Value Per Acre Value FRONTAGE ON ROAD r
Tillable 1 BULKHEAD
Tillable 2 DOCK
Tillable 3 R 1 = - l` - -
Woodland ` 74-4
_ g _ A_ yam:
_g
Swampland , , 1*7
Brushland
House Ploy `r 1• �
Utz, �
e
collo
Tonal /1 ���JC �p
�-
COLOR
lel
� I
v 3
\ ti a
I
—71\ 1�
.... I TRIM
\ ` I
M Bldg-, Foundation a - _
Bath Dinette
Extension Basements Floors
SLAB _
a� . Extras °, .," Ext. Wallsce ' Interior Finish .
LR
Isxtnsts _ I Fire Place �0 beat �< _ D.R,
� - l ��t - t� 735
Pato Woodstove BR,
Porch y Dormer Fin. B.
Dec }7 ='9 � ;
Attic
zeway
.¢ Rooms 1st Floor
Bree � �, �.�, � � '��, ��
Garage Driveway Rooms 2nd Floor
O.B.
F -75
�u Pool =- - Liz C, -
3
z �
U1
2-/c,am
E
t-
\\\ \O
ID
fldg
9 FOUndotion Both
tion _ - Basement Floors
- -
17
-- Ext. tills � Interior Finish
CA- _
Extension Fire Place Heat
m-
f ., orch Roof hype :
- Porch Rooms I st Floor
3
s s
rt_
_
Rooms 2nd Floor
Drivewo Y Dormer z >
j
—44'3
P,
F � x
--
F�
i
4
TOWN OF SOUTHOLD
Rental Permit
Permit No. 0024
Owner Ubaldo Gonzalez
Occupied as Single Family Dwelling
Located at 885 Orchard Street New Suffolk 117-5-41
Address Village S/13/1-
Maximum
/B/LMaximum Permitted Occupancy 4 Unit A
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.
4/5/2019 John Jarski
Date of Issue Code Enforcement Officer
This Notice must be posted by the main entrance at all times
Town Hall Annex �� � �,,' + ' � ir� Telephone(631)765-1802
54375 Main Road �J '�� d Fax(631)765-9502
P.O.Box 1179 p j
Southold,NY 11971-0959 '
bfbbb'�4 4 I`
BUILDING DEPARTMENT
RENTAL PERMIT APPLICATION
Rental Permit Fee $200(Application must be renewed every two years)
Section A.
Property Information:
Rental PropertyAddress:
>r-C
Tax Map Number: 1000 SECTION . BLOC1 SECTION
B.
OWNER INFORMATION:
Property Owner Name: 6 a d °:t,
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental
�.Proey Address)
Telephone Number(s): C a l 7 4
Property Owner Email Address:
Page 1 of
❑ 1 am submitting a completed Town of Southold certification form from a licensed
architect, a licensed professional engineer, or a licensed home inspector who has a valid
New York State Uniform Fire Prevention Building code Certification.
SECTION H.
DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit.
STATE OF NEW YORK)
)
COUNTY OF SUFFOLK)
1 )
4,4, L' -am, certify under penalty of perjury,the following:
1. I am the owner of the property identified in "Section A" of this application.
2. The property owner's legal address set forth in "Section B" of this application is my legal
address and I understand the Town will use the address for service pursuant to all
applicable laws and rules. I further acknowledge that I will notify the Town of Southold
Building Department of any changes of address within five (5) days of any changes
thereto.
3. 1 have read and received a copy of Chapter 207 of the Code of the Town of Southold and
agreed to abide by the same.
4. 1 will notify the Town within five (5) business days s to any change to the information
regarding Authorized Agent, Managing Agent, or Site Manager.
Property Owner's Name: r61W
Property Owner's Signature: w
Sworn to before me this,m- day of QAC—V\ , 201(
Official Notary Public Signature and Original Notary Stamp
;.:.-.- Lori T McBride
NOTARY PUBLIC,STATE OF NEW YORK
Page 4 of 4 " q„ Registration No.01MC6368447
Qualified In Suffolk County
Commission Expires December 11.2021
Town Hall Annex Telephone(631)765-1802
54375 Main Road �� r Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 2 q$ll
_ow
BUILDING DEPARTMENT
TOWN OF SO ;SOLD
RENTAL PERMIT APPLICATION ADDENDUM
Rental Dwelling Unit Identifier:
Requested maximum number of persons allowed to occupy each dwelling unit-
Number of Rooms in Rental Dwelling Unit: 2- W
Use and Dimension of each room:
ba 1-o o m 2 X /
Li' ! M
Rental Dwelling Unit Identifier:.
Requested maximum number of persons allowed to occupy each dwelling un! .
Number of Rooms in Rental Dwelling Unit: Roo n2 s
'
Use and Dimension of each room:
►3ecf Loon 5
0 M w' -Qg�
Rental Dwelling Unit Identifier:
Requested maximum number of persons allowed to occupy each dwelling unit:
Number of Rooms in Rental Dwelling Unit:
Use and Dimension of each room:
TOWN OF SOUTHOLD BUILDING DEPT,�
IN
carr, ' 7654802
INSPECTION
F:::- NI DA°IIf°ION °m IIC° �, „IIS IIROUGIIH P1 IIS " ,
IIN NINi IIN NI IIINI III„ 1� 111111 SNI IIN�III
IIF III IIN " / S IIN IIS PPIIN °' III.. � IIIIIN IIN.....
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FORM NO,4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. .21.0$.7.9 Date . . . . . . . February. 15. . . . . . . . . . . .. 1982.
THIS CERTIFIES that the building s . . (4.). .. . . . . . . . . . . . , . . . . . . . , . . . . ..
Location of Property . . . . . . . . . . . . . . Orchard StrMeet New Suffolk-
House ar. Srr s Hamlet
County Tax Map No. 1000 Section .? ??. . . . . . . .Block . .a5. . . . . . . . . . .Lot . , , 0.4.1
Subdivision . .)�. . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. .X. . . . . .Lot No. X . . . . . . . . . . .
Requirements for a private one-family dwelling built prior to
conforms substantially to the �.p�l�ontiea#e�13� ilg�l�Af�l� �i�ir1=�'isr�A-�ce:da£ea=
Certificate of Occupancy
r i 1 2 3. . . . . . . . , 19 .5 jpursuant to which Buitilirrg-P�emi't No. . . . . . . . , . . . 9
dated1 b 82
. . . . . . . . .Febr.uary. . . . . . . . . . . . . . . . . . 19 . . . , 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 . a . . . . . .
private one-family dwelling, and two accessory seasonal buildings,*and
a two car wooden garage . Thelma Dodd
The certificate is issued to . . . . . . . . . _ _ . . . . . . . . . . . . , , , . . ,
(owner,�Axei4")
of the aforesaid building.
Suffolk County Department of Health Approval . . , . nor, . . . . . . . , , . . . . . . . . . . . . . . . . . .
UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . n/r,, , . . ._. , . . , . . , , . . . .
*Each accessory rental building is a seasonal rental cottage, non-
conforming dwelling.
Building Inspector
Rev.1/81
BUILDING DEPARTMENT
TOVM OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location 885 orchard Street Newk
c�
number & street Municipality
Subdivision X ,Nap No. X Lots) X
Name of Owner(s) Thelma Dodd
Occupancy R-1 owner
type (owner—tenant)
Admitted by: Mrs. Dodd Accompanied by: same
Key available Suffolk Co. Tax No. 117-05-041
Source of request Thelma Dodd Date 10/20/81
DWELLING•
Type of construction wood framed #stories ?
Foundation hollow tile Cellarparti"al Crawl space rest
Total rooms, 1st. F1_ 6 2nd. Fl 3 3rd. F1
Bathroom(s) t Toilet room(s)
Porch, type Deck, type Patio, type
Breezeway —_ _____Garage Utility room X
Type Heat - acc� �1jeater "farm Air X Hotwater
Fireplace(s) No. Exits 2 Airconditioning
Domestic hotwater ves Type heater gas
Other
ACCESSORY STRUCTURES:
Garage, type const. 2 car wood Storage, type const.
Swimming pool Guest, type const.
Other 2 seasonal non-conforming dwellings--see attached sheets
VIOLATIONS': Housing Code, Chapter 52
Location Description Art. Sec.
cellar no cellar doors III 52-30-C
kitchen kitchen floor & walls need repairing
badly III 52-32-C
sta�ir no rail & stens too hJgil II 52-27-A, D
roof leaks in several palaces III 52-31-C
¢
ceill.s °s s�tnle in �i l kn,R a'a VIn ars^ laces thru�
out dwelling III 52-32-C
R.gr r rom letel rotten III 52-30-A, C
Remarks:
Inspected by: ° � Date of Insp. oct. 30 1 81
Curtis W. Horton Time start 9 : 15 end 10: 15
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location
number & street Municipality
Subdivision Map No. Lots)
Name of Owner(s)
Occupancy (type) owner--tenaxat
:
Admitted by: Accompanied by:
Key available Suffolk Co. Tax No.
Source of request Date
DWELLING: WEST RENTAL COTTAGE
Type of construction wood framed #stories one
Foundation Piers „ cement block Cellar Crawl space
Total rooms, 1st. F1_ 2 2nd. F1 3rd. F1
Bathroom(s) 1 Toilet room(s)
Porch, type x Deck, type Patio, type
Breezeajay Garage Utility room
Type Heat none alarm Air Hotwater
Fireplace(s) No. Exits 1 Airconditioning
Domestic hotwater Typ e heater
Other
ACCESSORY STRUCTURES:
Garage, type const. Storage, type const.
Swimming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Location Description Art. 1, Sec.
ar ij't.s r d e
some of the sills are bad III 52-30-A
ga >k.[:ve no shut off V 52-52-E, 6
Remarks:
Inspected by:�, w Date of Insp. Oct. 30 1981
Curtis W. Horton Time start 9 :15 end 10: 15
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location
number st:'reet :unicipality,
Subdivision Trap No. Lots)
Name of Owner(s)
Occupancy
type ,owner- enant
Admitted by: Accompanied by:
Key available Suffolk Co. Tax No.
Source of request .Date
DWELLING: EAST RENTAL COTTAGE
Type of construction wood framed stories one
Foundation�iers conient block Cellar Crawl space
Total rooms 1st. F1_ 2 2nd. Fl_
3rd. F1
Bathroom(s) 1 Toilet room(s)
Porch, type Deck, type Patio, type
Breezeway Garage Utility room
Type Heat none Warm Air. Hotwater
Fireplace(s) No. Exits 1 Airconditioning
Domestic hotwater __Type heater
Other
ACCESSORY STRUCTURES:
Garage, type const. Storage, type const.
Swimming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Location Description Art Sec.
Remarks:
Inspected by: Date of Insp. Oct. 30, 1981
Curtis W. Horton Time start 9:15 end 10: 15
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No. .4317.............. Date ......................... W-Gh. ..� ....... .. 19...6P
THIS CERTIFIES that the building located at0re-h .rd..&-41-r—ot...........................••.... Street
Map No. ...XX=......... Block No. ......x=. ... Lot No. .....�m, =.......Ngt-..ftf fo . .................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.................................fTI=P.....26............... 1562.... pursuant to which Building Permit No. .743A56...
dated ...........................A=q.....R.6....... 19.6/2.., 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 ..........
nlox..U..11Y :Lt.)..x'.a,ntal.c.C3t-tage................................................. ...., ... ...,.,, .».........,.,...,.
This certificate is issued to ... ....... .........—owno "a......----.......
(owner, lessee or tenant)
of the .aforesaid building.
Building Inspector
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. 214 7 0.01 . . . . . . . . . Date . » . . .qu4y. .2 4. . . . . . . . . . . . . . » , » . „, 19 .8 6
THIS CERTIFIES that the building . . . , .Alteration
Location of Property 885 ORCHARD ST. NEW SUFFOLK
House dUt1„ " ' ' Su et „ Hamlei
County Tax Map No. 1000 Section . .1 1 7. . . . . . .Block . .5 . . . . . . . . . . . .Lot . . , , 41
Subdivision . . . „ . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
JUNA ,17, , , , , , , , , , , , , , 19 A5 5 pursuant to which Building Permit No.
dated JU.N.F , 17. . . . .. . - - . . . 19 A5 ,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 . . . . . . . . .
. . . . . .COMLDLETELY. RFNOvAT1; .FXV9TTP4.P .QVA .FAMILY ,DWELLING. .
The certificate is issued to . .MOHRING, ENTERPRISES _INC. . . . . . . .
(owner,�*XXrX X
of the aforesaid building.
Suffolk County Department of Health Approval . . . . . Wk , . . . , . . „ » . . . . . . . . . . . . . . . . . . . . . . .
UNDERWRITERS CERTIFICATE NO. . » w . . . , N.7344.0.1 . . . . . . . . . . . . . . . I . . , „
PLUMBERS CERTIFICATION JULY 23 , 1986
Building Inspector
Rev.1/81
g ,
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 217496 Date
NOVEMBER 7_, 1988
THIS CERTIFIES that the building ADDITION
Location of Pro'pe'rt'y 815 ORCHARD ST. NEW SUFFOLK
House No. Street Hamlet
County Tax Map No. 1000 Section 117 Block 05 Lot 41
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUG. 22, 1980 —pursuant to which
Building Permit No. 173842 dated SEPT. 1, 1988
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 EXISTING NON CONFORMING SEASONAL COTTAGE.
The certificate is issued to UBALDOON7d1LEZ, M.D.
(owner, xxxxxxxxxxxxxxxx)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL—_ N A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N A
Building Inspector
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 Z18179 Date JULY 171989
THIS CERTIFIES that the building ACCE'SSOR'Y'
Location of property 885 ORCHARD & 1405 FIRST ST. NEW SUFFOLK
House No. Street Hamlet
County Tax Map No. 1000 Section 117 Block 05 Lot 41
Subdivision Filed Map No. Lot No.—
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 5. 1989 pursuant to which
Building Permit No. 18159Z dated JUNE 11 1989
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 ACCESSORY SHED.
The certificate is issued to UBALDO GONZALEZ
(owner, )
of the aforesaid building_
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NLA
UNDERWRITERS CERTIFICATE NO_ N/A
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
FORM NO. 4
TOWN OF SOU THOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20517 Date FEBRUARY 3 1992
THIS CERTIFIES that the building ADDITIONS
Location of Property_ 885 ORCHARD STREET NEW SUFFOLK N.Yw,
House No. Street Hamlet
County Tax Map No. 1000 Section 117 Block 5 Lot 41
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 28, 1991 _____pursuant to which
Building Permit No. -19701-Z dated MARCH 8 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 ADDITION & FOUNDATION UNDER EXISTING ONE FAMILY DWELLING
AS APPLIED FOR.
The certificate is issued to UBALDO GONZALEZ M.D.
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL Nl,
UNDERWRITERS CERTIFICATE NO. N-212503 - NOVEMBER 11 1991
PLUMBERS CERTIFICATION DATED JAN. 31, 1992-PERFECTION PLUMB.& HEAT.
Building Inspector
Rev. 1/81
-a-7
TOWN OF SOUTHOLD P9OPERTY,' R`ECORD
z s
OWNER STREETVILLAGE DISTRICT SUB. LOT
3.
T U _ xf
FORMER OWNER.\1bQ` ;� 60076tjeN, E —� ACREAGE
s
I -FYPE OF BUILDING
SW
�e�
RESr,/l.� SEAS. VL, FARM COMM. IND. CB; � It< . Value
MISC � Est. MVI
LAND IMP, TOTAL m DATE 1ARK5
a
v
L o :
04 g74 dM V leir/ < 0 dwe)
F
/ I =
CC 7;Y oc, �, 3/! g p
- B It� tND1T01 � __
-- £, ABOVE FRONTAGE ON WATER = =+
Farm Acre Value Per Acre Value FRONTAGE ON ROAD �f
Tillable 1 I BULKHEAD
Tillable 2 DOCK
as
Tillable 3
Woodland
Swampland E �� �9` D
���
—_ 9
Brushland
E
'House Plot I -
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COLOR
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lot TRU v
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M Bldg-, s s Foundation � Bath Dinette l
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Extension E`a F, g Basement sL L �) Floors „t_ Kit.
Exon gym, 4v
Ext Walls #t
t - �, ,__- _ Aa n�- "
�� �, Interior Finish � L R
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Ext ;nsit �� Fire Place -;'eat �, � . .
, 1 a 10 2,t 0 73S �� ® R
fat o zi Woodstove BR_
3 30
Porch Dormer Fin- B.
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Attic
Br�ezewa
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Garage Driveway Rooms 2nd Floor
0.13
Pool
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FOUndation r7 Both
o� aser neni Floor s
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Extension _. _ cxr. Walls Interior Finish
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Extenn D Fire Place Heat
Porch Roof Type
tr
PorchRoo,o,ns lst Floor
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FewaE _ Rooms 2nd Floor
y
Dormer
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