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HomeMy WebLinkAbout1000-63.2-1-19 TOWN OF SOUTHOLD 3 T - Rental Permit Permit No. 0032 Owner Collette Clayton Occupied as Single Family Dwelling Located at 2555 Youngs Ave(Unit 8D) Southold 63.2-1-19 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. 4/9/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times a � Town Hall Hall Annex 765-1802 F�� - '� Telephone(631) 54375 Main Road Fax(631)765-9502 � P.O.Box 1179 Southold,NY 11971-0959DD n A BUILDING DEPARTMENT Mi A I' 2 7 TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION TOW1114 01FS0XTrjjw""-- Rental Permit Fee $200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION -Z —BLOCK LOT 9 SECTION B. OWNER INFORMATION: Property Owner Name: i 7 C�Lr9 i /V Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) .. __ Telephone Number(s): Property Owner Email Address: LOLZI P� 4-o-19 aD©- Page 1 of 4 eto 73�9 D 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: 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: .._...�...WW.._�....� 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 r Addendum." l� o� Rental Dwelling Unit Identifier: jt' L4 Requested Maximum number of persons allowed to occupy Dwelling Ll : 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. am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold. Page 3 of 4 Cf 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) Icertify 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 1 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. -.1-. Property Owner's Name: Property Owner's Signature ' ' Sworn-,Io before methis day of . 2 BRITTANY A.GENOINO Notary Public,State of New York. Official Nota ublic' °gnature and Original t4otary Stamp No.01GE 245154 Qualified Ira Suffolk County Commission Expires July 18,20-fl ��, Page 4 of 4 o0 TOWN OF SOUTHOLD BUILDING r DEPT. 7654802 INS���11111V, ECTION III. „III FOUNIDATI110IN 1 S-T 111ROUGH P111„,,,,,I,,,, „ . FOUINDATI110IN 2ND INSUIll„,,,, ,,,n III.. FIRMING I RAIPIRINGZINAIII......I��I I � II[; MINI N II[I°” INI S ""I Y III II[IIm ""n IIC HIRE FIE N ' IN'sCOINS"'NN"'IIR 1"III IIC „III F-11111111, III°�Ilf III '� IN 's II�IIfI 1111AT1110114 TIII I IIC „III I JN,,,,,,IECTIRIICAII,,,,,, (ROUGH) ECTIRICAll (IFIINAII,,,,,,� IIC „IIICOIDE V1110111.......ATI110NCAULIKIIING . .... ........... 1 ill � ��� w .WA t � INSPECTORDATE b v sa s v. O 7 b 010 .4 AJ v z � ww Pa a z El B� O dln 1 � . COP 0 �V s M r� R ww. n Cn a N C. M O �. 0 p v m V, 12 AN 10 ® O � v \1 s � p n v � ra � b9 O "* FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17178 Date AUGUST 9 r. 1988 THIS CERTIFIES that the building MULTIPLE DWELLING Location of Property 2555 YOUNGS AVENUE SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 063.2 Block 001 Lot 19 Subdivision FOUNDERS VILLAGE Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 24 1987 pursuant to which Building Permit No. 158392 dated APRIL 2 1987 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 BUILDING #8 UNIT D IN MULTIPLE DWELLING The certificate is issued to LIZDA REALTY LTD - FOUNDERS VILLAGE (owner, ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL S-54 APRIL 4, 1988 UNDERWRITERS CERTIFICATE NO.PENDING AUG. 4 1988 PLUMBERS CERTIFICATION DATED MICHAEL DUFF, INC. APRIL 14, 1988 Building Inspector Rev. 1/81 ad Town of Southold Annex 10/6/2011 R' 54375 Main Road Southold,New York 11971 15%�i yW. CERTIFICATE OF OCCUPANCY No: 35253 Date: 10/6/2011 THIS CERTIFIES that the building OTHER Location of Property: 2555 YOUNGS AVE SOUTHOLD, SCTM#: 473889 See/Block/Lot: 63.2-1-19 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 11/3/2008 pursuant to which Building Permit No. 36723 dated 9/28/2011 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: handicap,.ram addition to exist[ne condo uiiit 4 8D as appli l for. The certificate is issued to Clayton,Betty (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED —. it ri e Ign re 9/I� lg a= TOWN OF SOUTHOLD PROPERTY RECORD CARD STREET VILLAGE DIST, SUB. LOT E DORMER OWNER N E ACR, S W TYPE OF BUILDING RES SEAS. VL. FARM COMM. LAND IMP- TOTAL DATE REMARKS _ I = 67 x. x - _ - } Fter. �. a . � —a— FRONTAGE FRONTAGE ON WATER i TILLABLE FRONTAGE ON ROAD WOODLAND — — DEPTH MEADOWLAND' c BULKHEAD I HOUSE/LOT TOTAL I 4 _ I COLOR E t � - MASTER go BEDROOM � - ' - 22'6 'X13'0" U CL M =_ Foundation M. Bldg -I NI NO € - _ - i ' Extension Basement Extension Ext. Walls == Extension Fire Place IS Patio t L n Porch 1 Dormer x Deck Breezeway Garage Driveway -- - B s Pool i I ' 1f