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HomeMy WebLinkAbout1000-78.-9-71.3 TOWN OF SOT - OL Rental Permit Y Permit No. 0057 Owner Philip Sicuro & Kristen Oliveri Occupied as Single Family Dwelling Located at 490 Victoria Dr Southold 78-9-71.3 Address Village S/13/1- Maximum /B/LMaximum Permitted Occupancy 5 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. 5/16/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times 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 DA2 A TOWN OF SO THOLD PR 2 f' r01 RENTAL PERMIT APPLICATION FYI . � : q,, Rental Permit Fee $200 (Application must be renewed every twoTJW OF SOUTdul-li� Section A. Property Information: Rental Property Address: ./ ` Q V Tax Map Number: 1000 SECTION BLOCK LOT13 g� SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) � . Telephone Number (s): ✓ Property Owner Email Address: b - ry` c' 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): f Authorized Agent \ 1 Iq3� Mailing Address o g 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: Page 2 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: 1� 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: µ y , Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: L1 Use and Dimensions of each room in Rental Dwelling Unit: w ewym g mmp rv. ,.., C n ° °r*C . "',''.__ d' r m�+'•.:N"'�" oIU+ ,, ,,y,w .... Y' V, �" �"' P^ "y w w✓ i �w W ..mow 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. XI am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold. ', /l A A 1nteff & Page 3 of 4 � �� �� 0 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) 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 Owners Name: Property Owner's Signature: Sworn to before me this-Wday of 201 ✓ KELLIE PLATIS flicial Notary Public Signature and Original Notary StampNOTARY PUBLIC-STATEOF NEW YORK No,01PL6266825 Qualified in Suffolk County Page 4 of 4 y commis ion Expires 08-06.20,20 r' TOWN OF SOUTHOLD BUILDIN,G DEPT. yN� - 1802 INSPECTION ,. N HVA l N IS ROUGH PLBG. FOUNDATION 2ND INSULATION FRAMING „II„ I” P I 04N IFIF,::t Pl.... NIM IIP '�� FIRNG 7FAL911 NII X116 „ IIE � , ,1" �'"I III FAIN IIN III l„ T` PENE"T"RATION' I` CONS ELEG I,HNACX1,,,,. (FINAI , El r l,, (N' m�f DE V101-Al�IION III,,,,, IV NG r� ............. .................. ............ ...... t R osW��T h u ;lits a _ LI H ] i z � a � w �fl a r ry*w a �a ry I �, kj. ...... a FORM NiO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No.2.3398. . . . . Date . . . . . . . . .. . .Dacember . .31 ., 19.68. THIS CERTIFIES that the building located at Edtg. .Vletoria.,).r . . . . .. . Street Map No. . XxX . . . . . . Block No. .X.)a. . . . .. .Lot No. xx . . . 6outh03.d• • • • .N.yr conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . . .arch • . 8 19.67. pursuant to which Building Permit No. 33982. . dated . . .. . . . . . . :+:ariuh. . . .15 19. 67, 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 . .Fri.vate ona• •fa>•r,11y. .dwelling . The certificate is issued to ij.j._Lj.j;ar. liaLj . .•ton . . . . .. . . .ownej% . . . . . . . .. . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. ,Suffolk County Department of Health Approval . .sT3nre .21 1967. by- ,i Villa- Btiilding Inspector 04/09/2019 TUE 11: 25 Fax 0001/006 FORM NO,a TOWN OF SOUT14OLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.zI I30.Ct . , , . . . . Date . . . ov��1�® ; . 9. . . . . . , . . . ., 19 ?. '1'141S CERTIFIES that the building , . , w , , , . . . . . . . . . . . . e . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property . 0 . . . . . . . . . . . . . C ,Victoria, ,Drive . , . Southold err;asp baa. . . Srr@er . • . .1.1em1®f County Tax Map No. 1000 Section . . 0.7.Q. . , , ,Block , . A9 , , . . . . .. . .Lot . . P 9, Subdivision , X. . . . . . . . . . . . . • . . . . . • • . ,Filed Map No, x. . . . . . .Lot No. . , , . , conforms substantially to the Application for Building Permit heretofore filed In this office dated 19$?.ptmuant to which Building Permit No. .,1,19?3, .7. . . . . . . dated . . :s a t e mt��x 21 . , , , , . 198?. ,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 , , „ , . . , ,em, ,qP1;Zom1jp©. Ajr. AP ,exl;q�AM cle�c:,lc: . . . . . . , . . . . . . . , . , The certificate is issued to . . . . . ..j9pApti. M t!eMary Kilkenny , . . . , W of the aforesaid building, Suffolk County Department of Health Approval . . . r►/r UNDERWRrrERS CERTIFICATE NO. . . . . . . . . . . . .nlr , . . . , e S o n . . Building inspector Rev.9/81 ti d td w ..