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Home My WebLink About1000-69.-1-6.1 ao_ TOWN OF SOUTHOLD Rental Permit x 0029 Owner SZCZEPANKOWSKI LLC Occupied as Single Family Dwelling Located at 37025 CR 48 Peconic 69.-1-6.1 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. 5/26/2023 Code E �oce t Official This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD BUILDING DEPT. as INSPECTION I FOUNDATION 1ST [ ROUGH PL13G. FOUNDATION 2ND INSULATIONICAULKING FRAMING /STRAPPING FINAL CHIMNEYFIREPLACE & [ IRE SAFETY INSPECTION FIRE RESISTANTI [ ] FIRE RESISTANT PENETRATION [ ) ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) VIOLATIONCODE /O RENTAL S: Z�� .!7 �7 ""),, a sso631-765-1802 �rr TOWN OF SOUTHOLD BUILDING DEPT.INSPECTION �CO1W , [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FRAMING /STRAPPING FI L [ ] FIREPLACE CHIMNEY [ ] ' FIRE SAFET INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [ ] CODE VIOLATION ] PRE C/O LiT L as __ �qgs( k- qhs DATE Town Hall Annex OWN SOUTHOLD T 54375 Main Road iJ % i /1i PO Box 1179 Southold, Ren I ills�� NY 11971-1179 Tel: 631-765-1802 Fax 631-765-9502 Owner Lte AddressCityor LEVELS SUB 2 3 Smoke Detectors (#- bedroom detectors excluded) Carbon Monoxide Detectors Fire Extinguishers (#) _..w.... _w� Exits (#) BEDROOMS 2._. S 4 5 Smoke DetectEE:: .............._..._ _ .w....__�_w......�,w_.__...._..._._�.._. _ ._. Carbon Mono .w...�..Egress (windo ...��. �.._...� .�..._._..._...w��.w.....� BUILDING SYSTEMS Y/N CONDITION OF PROPERTY Y/N Heatin �st�en maintairued/o)ertionaiBuilding Interior is clean /maintained Hot_water s stem maintained/operational Building Exterior is clean /maintained Electrical s seer' maintained/o°erational Property is clean / safe/maintained Mechanical s stem maintained/o,erational Handrails & guards present gilg: 1,ild jigillist;al COMMENTS: / ............. ........... ............... ...... .... ............ ........... ------- .......... .... ....... ............... .......... ------------------ ---------- ....... ------- ........... ....... ............---- ........... Rental Inspection Form 4/7/2021 Town Hall Annex SOUTHOLD TOWN 54375 Main Road J i > = PO Box 1179 Southold, Rentgjjn§ d�;, �' 7M[l NY 11971-1179 Tel: 631-765-1802 Fax 631-765-9502 SCTM # Date Cu <-l Phone (D2j Owner to P7 Address � 17 a fidZip City 'a t` Inspector LEVELS SUB 1 2 3 Smoke Detectors (#- bedroom detectors excluded) / f Carbon Monoxide Detectors (#) �— Fire Extinguishers (#) Exits (#) 1 BEDROOMS 2 3 4 � Smoke Detector Alarms Carbon Monoxide Alarms (#) Egress (windows) (Y/N) BUILDING SYSTEMS YIN CONDITION OF PROPERTY Y/N Building Interior is dean/maintained Heakwn�s spa tem maintained/operational g Hot water stem maintained/operationau - Building Exterior is clean/maintasned _ �a Electrical Property is clean /safe/maintained °' Mechanical s skarn maintained/o erakional Handrails & guards present "Comm OIL 111�&Lt Rental Inspection Form 4/7/2021 TOWN OF SOUTHOLD Rental Permit Permit No. 0029 Owner SZCZEPANKOWSKI LLC Occupied as Single Family Dwelling Located at 37025 CR 48 Peconic 69.4-6.1 Village 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. 4/29/2021 Code Enforcement official This Notice must be posted by the main entrance at all times SOUTHOLD TOWN Town Hall Annex 54375 Main Road PO Box 1179 Southold, Y Rental Inspection -- NY 11971-1179 � Tel: 631-765-1802 Fax 631-765-9502 SCTM # c—( — ( Date Owner' S �, L Phone Address Hamlet c°'<,c��, Address visible from street? LEVELS SUB 1 2 3 Smoke Detectors (#- bedroom detectors excluded) Carbon Monoxide Detectors (#) Fire Extinguishers (#) t Exits BEDROOMS 1 2 3 4 5 Smoke Detector Alarms (#) t �` Carbon Monoxide Alarms Egress (windows) (Y/N) BUILDING SYSTEMS Y/N CONDITION OF PROPERTY Y/N Heating system maintained/operational Building Interior is clean/maintained Hot water system maintained/operationalBuilding Exterior is clean/maintained Electrical system maintained/operational Property is clean/safe/maintained Mechanical system maintained/operational erational y p LL Handrails &guards present POO Y/N POOL BARRIERS Y/N Pool present /0 Pool is completely enclosed Pool surface alarm and/or door alar Barrier is a min. 48" high resent . POOL GATES Y/N All untag[ in barrier less than 4" Self-closing, self-latching Max. 2"clearance @ ottrr of barrier Latch on pool side of gate, meets height Barrier capable of being locked bhj11-.,- requirements proof when unattended COMMENTS: W 45-0 !firL LL 'SY OF SOUTHOLD RentPermit al Permit No. 0029 Owner SZCZEPANKOWSKI LLC Occupied as Single Family Dwelling Located at 37025 CR 48 Peconic 69-1-6.1 Address Village S/13/1- Maximum /B/LMaximum 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. 4/3/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times rjf SO 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 SOUTHOLD RENTAL PERMIT APPLICATION �� Rental Permit Fee $200 (Application must be renewed erre two y"), Section A. Property Information: Rental Property Address: .1 C "-- 1 3 Tax Map Number: 1000 SECTION '7 3FF7 BLOCK J LOT SECTION B. OWNER INFORMATION: Property Owner Name: " Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 3 3 Lf al . ... Telephone Number (s): / 2 " Property Owner Email Address: 'e a ® 1 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: it Telephone Number (s): Email Address: 1, (0 ad C Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: :6/4 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: 41 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 U r '! Number of rooms in Rental Dwelling Unit: 9rt, ' Use and Dimensions of each room in Rental Dwelling Unit: ;;XJ_;,5 4 1 f.6 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. ❑ I 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) Sce�' I g , 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: to before me thisC ay f 0L ['No Public Signature and Original Notary Stamp �� cn r Nor G'tl80";A0"J ga�TAVJ�-d un�¢Mc.W CoUnty Page 4 of 4 err TI)ISSio w L;0rreS tOarch 8„2qa: 1 peom '� TOWN OF SOUTHOLD BUILDING DEPT. �fJl 765-1802 INSPECTION III'. �lF0UlllMDXllrll101N i r IROUGI„,I 111„,,,,BG. 11FOU111MAnO1114 ME) INSULATION III �IF RI ,,, / Ir Il P 11IN ' III„ „III' �� ', ��,,, ��4 , �� FIRSAFETY INS ° III„ III I:::::�jjj” jjjn �jj",jjjj::: jjjISN r CONST111:1ucriiiN III„ 111:::1RE, ll�::IESllls miniAl 10114 III IIELEC I RICAI ( III,. „III �llElI,,,,,,IEC IF11RIll,,,,, (11MINAll IDIV1110111 A'-riiioiim „ CAU111 11KI1111MG ow DATE INSPECTOR? s o Y� 1 i f J +d 6 I ry s�.. r I M C � l a t i k I r, I w " Y � � w .�.�.......a.. ,,,,-....... wr�.,�...,..,.�.w�..,nr.o oorum rrrN.,w I r ................gym„ ......,.,. ,....,m,...,..,. „�........� ...,w.....�..� I fl " aw,.. h t c u N j n I 4 H tz� ........... FORM NO. 4 TOWN F' SOUTHOLD BUILDING D'EPARTMEN'T TOWN CTXRIrS OFFICE SOUTHOLM .K. Y. ITI FI CA,r CIF No. .. °, . Date . . . .. .. . . . ,....Feb. . . . . . . . .. .. .. 196 THIS C RT: IFIthat the building located at VIS, Middle 4 Read n(CR27t'reel Map Nay. . <e . . . . .. . Block .No. . . . .. .. .. , t Ot No. . .. . . . . . .. . . . conforms substantially the Application. for Building Permit heretofore filed in this office dated . . . . . . , . . . . Oat. . . . ,. 3-9- 67 pursuant to which Building n Permit No. -36597- dated 6597dated. .. . . . . . . . n : .- .. . . . .- - :t9. .g was issued, and conforms to all of the requn..are... rrmontq �nr the aonlim:µmnble pic)vi 'amus mit" the law. K'hembcMm.uj mmncy for which this Certificate is n4 QT_?Pd R _ . ° iVAtA. .GM0 -fn,n,A!...tips--dva11:11n x. . . . . . . .. . . . "w:.. 1. "mm�'��ax'�� ape' s ��,s $°�rgro1nti°1m�, :�5:� � yr � � wM �� Suffolk County Department of Health approval . . Building Inspector ` I FOR31 NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 3659 Z Dote ........................Q91;.0ox....A........ 19...6.7 Permission is hereby granted to: Southold. .......................................... to4 ct4 4.. i.. .....I...... at premises located atIR/.S.. dd18... 4tlid.....W271 ......... .......... ......... ......... .,...,.,n..... A04110,14 .Y. pursuant to application dated ..... ......... ..... °� ,.. ...,...., 19..§T, and approved by the Building Inspector. Fee $-.10.40......... 1 ;% ...... ... .............Building., ..inspector 3. ,Nature of work (check which applicable): New Building .................. Addition .]tvC7EK,,,..... Alteration Repair Removal ...............„., Demolition.................. Other Work (Describe) .m o...h d .•�C"°'1:k 4. Esti oted Cost ...5-io00.+/....................................Fee ......1Qy. a,QQe X01 lta , paid on filing this application) 5. If dwelling, number of dwelling units .....ona................Number of dwelling units on each floor .,,..,..,..,.,........ ..y. Ifgarage, number of cars ....................................... .. ....... „ , .,,...,.. ..,.................,......... .....,.,. 6, If business, commercial or mixed occupancy, specify nature and extent of each type of use ............... .......'.,.. TDimensions of existing structures, if any: Front............................ hear ................................ Depth __............. Hei` ht . .................. Number of Stories ........,,.,,., Dwrr en,sions, of some structure with alterations or additions: Front .... Rear ...,,. ,„.,...,... Deth ,, ....... .............. Height ...,.... . ,,,,,,,..,..,..Number of Stories ......,,, .... ...,, , . .....,. 8. Din enrsions of entire new construction: Front ..........1.. .....................Rear.....11f.................. Depth . .,.3lF..., , Height .................... Number of Stories .,,.., a"d ......,......,..,,.,.........,.........................,.....................................,. 9. SIZ@ of lot: Front ...&C*y+Eklae......... Rear .................................... Depth ................................ 10, Date of Purchase ........................................................Name of Former Owner ...................,.,.,,,......................... 11. Zo e or use district in which premises are situated .....ttAtt..d j.0 r,................................................................... 12, Does proposed construction violate any zoning law, ordinance or regulation? .,..210........................................ 13, Not ne of Owner of premises ,.�gta.n.LF3y...Se•pe1aooklddress ,.....Sout-bog_<.j................... Phone No. .............,. ,,.. Name of Architect ............:........................................Address .....,. ........,,....... Phone No. ..... i Nci'ne of Contractor ....Jp1'in..HepOYiiG Address .....,gip—d-ihold................... Phone No. ............,., i PLOT DIAGRAM Local clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions h am. property Innes. Give street and block number or description according to deed, and show street names and indic'te whether in, erica or corner lot. a D t"xtsTi0a PRO I � Mr.. 4 I STATE OF NEW ` fid S.5' COUNTY Ol . tg ..... fir.,,,,,, ... ,)' JYaaam••Ha)'��t"1 ,.,,..,being duly sworn, deposes and says that he is the oppli III me of individual''signir g application) above named. He is the ...................0ontractor........................, .....,.................................... ...... (Contractor, agent, corporate officer, etc.) of said oraer oar owners, and is duly authorized to pertarm or have performed the said work and to make and file this apply aluonr that all statements contained iri this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the npplicotion filed therewith, � Sworn to efore rave this ,. day of .... .... . ......t3 tobel,,.,,,,_. ., 19..,�+°�. //VV'v Notary Pu�lalia, * ,w• rvi[tt t a ounty: dm:' ^(Sie ofapplircant)....... ........... MCITARX Nb",, a W7SV(dlCaJwp , iter., W tirJt1 ury,w�h 3 , )� TOWN OF SOUTHOLD PROPERTY RECORD CARD a� __ --- -- --- OWNER STREET z VILLAGE DIST SUB LOT iv AOR. REMARKS - 77 TYPE OF BLD, a r.. ! - - _ F PROP r`P _ _ CLASS S �t l7. r Irl II.rt ,j F - - LAND IMP TOTAL DATE ' • " t I i I t I FRONTAGE ON WATER ILLAB E I FRONTAGE ON ROAD WOODLAND 3 DEPTH MEADOWLAND BULKHEAD HOUSE/LOT j `OTAL 3 � TOWN OF SOUTHOLD PROP i EkIT- KC%.WIKD CARD � OWNER STREET = VILLAGE DIST.! SUB. LOT - FORMER OWNER A= . S ` ; W TYPE OF BUILDING RES. SEAS. VL. FARMJ COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE I REMARKS � 1 4 m F BU [ ING CONDITION 3- - - Nt a NORl 3 FARM Acre f "Value Per ��Value Acre : J Tillable - FRONTAGE ON WATER Woodland® FRONTAGE ON ROAD I Meadowland DEPTH — I � House Pio BULKHEAD Totalv . ; DOCK � � 3 e e _ E COLORTRIM --E . - i E 4 E r i I I i 1 j I c 4 r - r E n ( i E e s i Y € E l e i F t E e -4 M. Bldg. Extension a i Extension _ I Extension —, v Foundation Bath Dinette Porch Basement Floors Porch Ext. Walls 4_ - f !Interior Finish _ LR. — F Breezeway Fire Place ! y Heat DR. GarageType Roof Rooms l st Floor PR. I Patio Recreation Room Rooms 2nd Floor FIN. B O. S. Dormer Driveway Total s