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Home My WebLink About1000-103.-13-13 x 00TOWN OF SOUTHOLD Rental Permitz Permit No. 0040 Owner Luisa Sulich Occupied as Single Family Dwelling Located at 875 W. Creek Ave. Cutchogue 103-13-13 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. 6/3/2021 Code Enforcement Official This Notice must be posted by the main entrance at all times Town Hall Annex kW S UTHOLD TOWN54375 Main Road Mm4 Rental Inspection PO Box 1179 Southold, NY 11971-1179 ' Tel: 631-765-1802 Fax 631-765-9502 SCTM # 1 0 3.— 3 " 3 Date 6 Z Owner L U U I C V\ Phone Address ? ,- W Cf eel, hvr, lzip q 3 Hamlet C-ur" a V C, linspector Address 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 (#) 7 Carbon Monoxide Alarms (#) - Egress (windows) (Y/N) BUILDING SYSTEMS XIN CONDITION OF PROPERTY VN 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 POOL BARRIERS Y1 Pool present 7 Pool is completely enclosed Pool surface alarm and/or door alarm Barrier is a min.48" high resent POOL GATES 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: TOWN OF SOUTHOLD Rental Permit 4 Permit No. 0040 I Owner Luisa Sulich Occupied as Single Family Dwelling Located at 875 W Creek Ave Cutchogue 103.-13-13 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, 5/1/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times r n Telephone(631)765-1802 Town Hall Annex 54375 Main Road a � r 'ti'` � Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959' WELDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200(Application must be renewed every two years) Section A. Property Information: Rental Property Add"er�LZ,121 I Ja Tax Map Number: 1000 SECTION X0,3 BLOCK 13 LOT 43 SECTION B. OWNER INFORMATION: Property Owner Name: U/. Ammm Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 47Lc )'t'.".f .� Telephone Number(s):_r,6L�j..., _ ik�n Property Owner Email Address: Ll Aj �'�. Page 1 of 4 Section C. Authorized Agent Information: � �= La Name of Authorized Agent of dwelling unit,if any: n'1 L /� �1,)CA4A) Address of Authorized Agent (no P.O. Boxes): ,k, Mailing Address of Authorized Agent: Telephone Number(s): Email Address: r m, Lj fill Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent(no P.O. Boxes); mmmmmm�_��_ 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: B Number of Rental Dwelling Units on property: r 5111 La fr3� r r �n1G 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: ,V :_ d" I1 1 �o Cal ° Requested Maximum number of persons allowed to occupy Dwelling Un,14- Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: gaamfti ji-r44os rn 1 `7 n k /0 001,)b Roam /9 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 ❑ 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) s,;= 1� �;�-� � � � .. , 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: ZL1 4 v, �.._..... Property Owner's Signature. .../ jia Sworn to bcf me day of _.. ....... 20/1 "T I°IARTIN FLATLEY C,:�il"in ial ry Publ iiynatur and Original Notary Stamp Notary Public.state of New York ` No.(li FL4894602 Page 4 of 4 Qualified in Suffolk County Commission Expires May 11,2019 A i ^n14) A' d , �, TOWN F S ' Ill H 1D BUMILDING ISE " a -1 802 INSPECTION IFOLMDA-FIO "U E'VT C)UG ,,1 ll"ILBG. FRA'M VI INN S I , .'PFRI C ��,Ill�'�IES,I �IIIb,,,,, III",,�III III.....°, III.. FIRE w;'A I',n I , m " VIS I° ,;; 1; ,,,�n,I� Ill°°lRE R'ESISTAM' °'r F„Il,,, ', Il°E�.`SIST III RIEE'EUIE,;;;;TFIATIO OIE.. Ill;;;';, /'Il l,,,,All°'IlON �� CAL11b,,,J lllllel(.3 IISE F KS' . j ... .. .. . _ --... ... _�� A _ . .' .,.._ Ill' m III0I r � c 3 � I _. I I o I b w+ b r ' r IL Q � a - 1 e 1_5 wxm"�mom 7 .«..7�. Rey„ H j •J w Ml � _. i N4 *Map OWN& 1 � r 3 i I v a ro 9 I a �C w �rrt II�i 9' i I i G� V t v J n 0 i i I I 1-�-r1 y" i J FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 4- . . . _ . Date . . . . . . . . . . .Deo. . .19. . . . . . . . , 19.72. THIS CERTIFIES that the building located at .Vilest.Creek. Axe . . . . . . . . . Street Map No. .xx. . . . . . . . . Block No. . apt. . . . _ .Lot No. .xx . . .Cutohogue . . Roy. conforms substantially to the e is f ' oa 1 �01 code bul i"ic to occupancy efor. . .April, 23 19 57 pursuant to whichC 1 , dated . . . Deo. . . _ . .9 . . . . ., 19.72., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Privrate. .one. family.. .dwelling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . .Fred,eriek .J.. Seltzer .A .wife . .ownars. . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Pro-P. existing. . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE No. pro., .existing. . . . . . . . . . . . . . . . . . . . . . . . . . HOUSE: NUMBER. . . 97.5. . . . _ .Street. . . . .We•at•Cre-ek•Ave . . . . . . . . . . . . . . . . . . 8xoeption to hosin codes No light switch at point of entry to front enterance ...�. r..e` Seo 529b BmIding, Giispccior 3 UVVN QF 5UUTHOLD PROPERTY RECORD CARD ------------ OWNER STREET - VILLAGE DIST.. SUB. LOT 33`` - FOR'ME R OWNER;-, N _ ACR. S TYPE OF BUILDING SEAS_ IVL. iFARM COMM. CB. MISC. Mkt. Value LAND IMP- TOTAL DATE REMARKS AGE BUILDING CONDITION N EW NORMAL BELOW A FAR:&A T Acre Value Per Value Acre Tillable 2 Tillable 3 W00;iund Swampland ,FRQWT4A rE--6N-�, TER~ Brushland FRONTAGE ON ROAD _ House PlotDEPTH j (BULKHEAD Tota l JDOCK F > - 1,tr g l e COLOR Ta 1 3 oi - s N i _ t I I TRIM .m -42 1 s 3 x 103.-13-13 4/09 M. Bldg. Foundation Bath Dinette Extension Fcsement Floors K. Extension I Ee. Walls Interior Finish LR. Extension 'Fire Place Heat DR, ;Type Roof ` Rooms 1st Floor I BR. PorchRecreation Room Rooms 2nd Floor FIN. B- Porch Dormer Breezeway Driveway I Goroge Patio - O. B. I Total