HomeMy WebLinkAbout1000-60.-2-8 TOWN OF SOUTHOLD
zf� } Rental Permit
0061
Owner 1220 Youngs Ave LLC
Occupied as Two Family Dwelling
Located at 1220 Youngs Avenue Southold 60.-2-8
Maximum 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.
6/14/2023
Cade En' gent MOM
This Notice must be posted by the main entrance at all times
{Fg Tu"WNUN OF SOUTHOLD
f4 Rental Permit
0062
Owner 1220 Youngs Ave LLC
Occupied as Two Family Dwelling
Located at 1220 Youngs Avenue Southold 60.-2-8
Maximum 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.
i
6/14/2023
Code `t
for ent Official
This Notice must be posted by the main entrance at all times
* ' TOWN OF SOUTHOLD BUILDING M
631 -765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLDG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAl
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE &. CHIMNEY [ ] FIRE SAFETY IN:
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII
[ ] CODE VIOLATION [ ] PRE C/O [
Sa v
4e- pepee-say c v
INSPECTORDATE �
F" Sof F I :
Town Hall Annex
SOUTHOLDTOWN
54375 Main Road
Rental Inspection PO Box NY 1 Southold,
^• NY 11971-1179
Tel: 631-765-1802
Fax 631-765-9502
SCTM # Cn a — - S Date'
Owner LLC- Phone 7a.1 — vtcog
Address I,2P-0 y0;.1JC05 Avg aAP—i /AZip /1?7'/
Hamlet 5O'L 1-40 WN Inspector APC
Address visible from street?
LEVELS SUB 1 2 3
Smoke Detectors (#- bedroom detectors excluded) I J
Carbon Monoxide Detectors (#)
Fire Extinguishers (#) O I
Exits (#) .2
BEDROOMS 1 2 3 4 5
Smoke Detector Alarms (#) 4 I
Carbon Monoxide Alarms (#) i
Egress (windows) (Y/N)
BUILDING SYSTEMS Y/N CONDITION OF PROPERTY Y/N
Heating system maintained/operational Y 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 14 Pool is completely enclosed
Pool surface alarm and/or door alarm Barrier is a min. 48" high
resent
POOL GATES Y/N All openin arrler less than 4"
Self-closing, self-latching Max. 2" clearance @ o of barrier
Latch on pool side of gate, meets height Barrier capable of being locked & c
requirements proof when unattended
COMMENTS:
L
r 5P— (,4,6&-L d , Bo t Lt52 s w.A t-Zi-0
TOWN OF SOUTHOLD
Rental Permit
0062
Owner 1220 Youngs Ave LLC
Occupied as Single Family Dwelling
Located at 1220 Youngs Avenue Southold 60.-2-8
Maximum 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.
6/14/2021
Code Enforcement Official
This Notice must be posted by the main entrance at all times
a'
So F
SOUTHOLD TOWN Town Hall Annex
54375 Main Road
Rental Inspection PO Box 1179 Southold,
NY 11971-1179
Tel: 631-765-1802
Fax 631-765-9502
SCTM # t —
Date' I
Owner , &(-c, Phone
Address VoukX�S ,A, t A(TZip 117-71
Hamlet Inspector
Address visible from street?
LEVELS SUB 1 2 3
Smoke Detectors (#- bedroom detectors excluded) f
Carbon Monoxide Detectors (#) )
Fire Extinguishers (#)
Exits (#)
BEDROOMS 1 2 3 4 5
Smoke Detector Alarms (#) J
Carbon Monoxide Alarms (#)
Egress (windows) (Y/N)
BUILDING SYSTEMS YIN CONDITION OF PROPERTY YIN
(Heating system maintained/operationalBuilding 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 YIN POOL BARRIERS YIN
Pool present Pool is completely enclosed
Pool surface alarm and/or door alarm Barrier is a min. 48" high
resent
POOL GATES YIN All openinar°rier less than 4"
Self-closing, self-latching Max. 2" clearance @-b f*,,,z� arrier
Latch on pool side of gate, meets height Barrier capable of being locked &c
requirements proof when unattended
NMI NNNEE=
COMMENTS:
i` C C / 041 - r .w / µ �l „
�00jt OWN OF SOUT OL
Rental Permit
Permit No. 0062
Owner 1220 Youngs Ave LLC
Occupied as Single Family Dwelling
Located at 1220 Youngs Ave Southold 60-2-8
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.
5/16/2019 John Jarski
Date of Issue Code Enforcement Officer
This Notice must be posted by the main entrance at all times
01
Teleph,/, ( 1 �� 5
Town Hall Annex -1802
54375 Main Road °� ,��
��� Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 '4
BUILDING DEPARTMENT
TOWN OF SO HOLD
RENTAL PERMIT APPLICATION
Rental Permit Fee $200 (Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address: 971/
� I
Tax Map Number: 1000 SECTION --&D--BLOCK LOT
SECTION B.
OWNER INFORMATION:
Property Owner Name: Yp -LC-
v
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Perty Address)
�7�/Q N�4—zi
� ..
16-5
Telephone p one Number (s).(�� µ ' /- 2
Property Owner Email Address: -Z7—L-110 � - u-
p Y
Page 1 of 4
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any: � 'R
Address of Authorized Agent (no P.O. Boxes):��� _ A�
Mailing Address of Authorized Agent:
Telephone Number (s):
lJ
Email Address: AP r'0-50-
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:
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 Unit:
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 horne 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.
V, am requesting a fire safety inspection to be performed by a Code Enforcement Official
from the Town of Southold.
Page 3 of 4
❑ lam 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)
i 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: all
Property Owner's Signature: A__� ,_.
Sworn to before me this Jr—day of AIDIr 1 , 20j3
.,
4ficia�Na
y
Public Sign ure and Original Notary Stamp
TRACEY L. DWYER
NOTARY PUBLIC,STATE OF NEW YORK Page 4 of 4
NO,01 DW6,306900
QUALIFIED IN SUFFOLK COUNTY
COMMISSION MISSION EXPIRES JUNE;SCI,2
..
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502� � ,, �;y
P.O.Box 1179
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION ADDENDUM
Rental Dwelling Unit Identifier: lT
Requested maximum number of persons allowed to occupy each dwelling unit
Number of Rooms in Rental Dwelling Unit:
on o
Dimension each room:
Use and �$ Z3�� �- ✓'� �X �� 8
� 8 ax 7
fx , — � "
Rental Dwelling Unit Identifier:
Requested maximum number of persons allowed to occupy each dwelling u t:
Number of Rooms in Rental Dwelling Unit:
� � ' e
_ of each room: _
Use an Dimension $X � . � X
_. _ —
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:
S,4-0 d
�/2.e a (
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING l STRAPPING [ ]�1NAL�
[ ] FIREPLACE CHIMNEY [ FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL(ROUGH) [ ] ELECTRICAL(FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
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ffftfr Town of Southold 6/27/2016
P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CF r IFICATE OF OCCUPANCY
No: 38366 Date: 6/27/2016
THIS CERTIFIES that the building AS BUILT ALTERATION
Location of Property: 1220 Youngs Ave, Southold
SCTM#: 473889 Sec/Block/Lot: 60.-2-8
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
4/8/2016 pursuant to which Building Permit No. 40669 dated 5/5/2016
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:
°'.as built"interior alterations to convert a one,faini dwe lg into a two dwelli asm gpl iqj :(c ..
The certificate is issued to Gabriel,George&Ors.
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
............... ._ _ .........._
Aotl�o .� e Si a atta
Town of Southold 7/5/2016
53095 Main Rd
Southold,New York 11971
_W
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: 38367Date:Date: 6/27......e�_....... .
TMS, CERTIFIES that the structure(s)located at: 1220 Youngs Ave, Southold
SCTM#: 473889 Sec/Block/Lot: 60.-2-8
Subdivision: Filed Map No. Lot No.
conforms substantially to the requirements for a built prior to
APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 38367
dated 6/27/2016 was issued and conforms to all the requriements of the applicable provisions of the law.
The occupancy for which this certificate is issued is:
vxoc�el trance ona�l l�il yg lin N a i agerLt a k_ a.Y,all accc�sc a sty ra , a�a�ldi:ng �d zn 11 ac, e soa hair *
. .
lr szcl c
Note:BP 40669, rR s 'La
lt cgtion fTQ1! one,fit
The certificate is issued to Gabriel, George Gabriel, Ors
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF BEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT. `
Mcg Sia 11 re
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
TIOUS:TNG CODE 1'NSPEC`ION RE,POJL1
LOCATION: 1220 Youngs Ave,Southold ,..m... _ . ....,.�
SUBDIVISION:
SUFF.CO.TAX MAP.� T S
NO . 60. 2 8
NAME OF OWNER(S): Gabriel,George
OCCUPANCY:
ADMITTED
DATE: 6/27/2016
_
SOURCE OF REQUEST Gabriel, orgy
el Ge •�
:
.... ..�
DWELLING:
#STORIES: 2 #EXITS: 3
Brick
........ CRAWL SPACE: 3/4
FOUNDATION:
BATHROOM(S): 1 UTILITY ROOMS)
k _
2 B T....
CELL
( PATIO TYPE: Concrete
TOILET ROOM
PORCH TYPE: DECK TYPE
mmER: _ Yes TYPE HEATER:_. NationalGrid AIR CONDITIONING:
TYPE HEAT: Nat'l Grid WARM AIIt: HOT WATER: X
_.._
#BEDROOMS: 4 #KITCHENS: 1 BASEMENT TYPE Unfinished
OTHER:
ACCESSORY S-R'1ZUC'ITRES:
GARAGE,TYPE OF CONST: ST OF
ST: Small Stg
Bldg
SWIMMING POOL: GUEST,TYPE OF CONST:
OTHER: Small Barn
VIOLATIONS: --
REMARKS: .,— ......—......... �.
INSPECTED BY: GARYF DATE OF INSPECTION: _ 12/28/2015
TIME START: END:
-
i
OWNERE VILLAGE DIST. SUB. LOT vr ST
'
FORMER OWNER NE E = ACR.
4-f-u
y S W TYPE OF BUILDING
_ o
R SEAS. VL. FARM COMM. CB. MISC. Mkt. Value
-"LAND IMP. TOTAL DATE REMARKS
0 iz7 1 ig0 - -
-2 4-'Zh
14
AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE
FARM Acre Value Per Value
Acre
Tillable 1
Tillable 2
Tillable 3
Woodland
Swamped E FRONTAGE ON WATER
I
Brushland FRONTAGE ON ROAD
House Plot DEPTH
BULKHEAD
I
DOCK
Tota I
II
€ y I
COLOR
13
_ 11
i
i
TRIMI I
( I
s
-r
60.-24 09/2016
(
Id - PoundaEiY �
on Bath Dinette
- 1 �
Extension t g Basement E Floors K.
m ® - [
Extension j � � �o� Ext. Walls
Interior Finish LR.
Extension Fire Place Heat ( - DR.
Type Roof Rooms 1st Floor QZ, Vrr I M BR.
-
Porch Recreation Roo Rooms 2nd Flo*rL UIT, I rA N. B., - -
3 � � � � -
Porch I Dormer
Breezeway Driveway
Garage
Patio - _0. B. ® �
Total
_ �
T UW'km " F 0"' UTHOLDe Rental Permit
0061
Owner 1220 Youngs Ave LLC
Occupied as Single Family Dwelling
Located at 1220 Youngs Avenue Southold 60.-2-8
Maximum 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.
6/14/2021 O
Code Enforcement Official
This Notice must be posted by the main entrance at all times
"JY
Town Hall Annex
SOUTHOLD TOWN 54375 Main Road
o ;F PO Box 1179 Southold,
Rental InspectionNY 11971-1179
�pk
4
Tel: 631-765-1802
r ' Fax 631-765-9502
SCTM# a -- -- Date / t
Owner" i �°® v Phone i6 - 771 1 - of CO
Address 1,2 PLo YO . ,ave , Zip /1?7/
Hamlet Sam-7 Inspector
Address visible from street?
LEVELS SUB 1 2 3
Smoke Detectors (#- bedroom detectors excluded)
Carbon Monoxide Detectors (#)
Fire Extinguishers (#) 0I
Exits (#,) 1
BEDROOMS 1 2 3
Smoke Detector Alarms (#) q 1
Carbon Monoxide Alarms (#) f
Egress (windows) (Y/N)
11111gip 1111
BUILDING SYSTEMS Y/N CONDITION OF PROPERTY Y/N
Heating system maintained/operational y 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 systern maintain dleper tional 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 Atll openwn ;s-law?,arrier less than 4"
Self-closing, self-latching Max. 2" clearance @ t atr pf barrier
Latch on pool side of gate, meets height Barrier capable of being locked &c
requirements proof when unattended
COMMENTS:
S �= - Z 06 ,
Y=om
TOWN OF SORT OLD
Rental Permit
Permit No. 0061
Owner 1220 Youngs Ave LLC
Occupied as Single Family Dwelling
Located at 1220 Youngs Ave Southold 60-2-8
Address Village 5/B/L
Maximum 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.
5/16/2019 John Jarski
Date of Issue Code Enforcement Officer
This Notice must be posted by the main entrance at all times
64 Y 3
/ h��
Town Hall Annex / /y r/ 1 olelah n ( l 7 n 1 '0
' �'� ' Fax (631., 76x5-9.502
54375 Main Road � ���, ,�j �
P.O.Box 1179
Southold,NY 11971-0959 , ° ✓�1��%"
e.g
<r�n
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION
Rental Permit Fee $200 (Application must be renewed every two years)
Section A.
Information:Property
Rental Property Address
Tax Map Number: 1000 SECTION BLOCK LOT
SECTION B.
OWNER INFORMATION:
Property Owner Name: "�r . .v., �.p y1c .,
Property Owner Legal Address: Property Owner Mailing Address:.
(Cannot be the same as Rental Property Address) �
- �
)L--z
Telephone Number (s):Q �
_
Property Owner Email Address: " ,.m .. � "°�"
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): _ ��w � "�� :,
Mailing Address of Authorized Agent: -
Telephone Number (s):
Email Address:
Section D.
Managing Agent Information:
Name of Authorized Agent of dwelling unit, if any: ...- m"�'
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:
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 Unit:
Number of rooms in Rental Dwelling Unit:
Use and Dimensions of each room in Rental Dwelling Unit:
SECTION .
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.
V, 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)
� 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:
Property Owner's Signature: ................. ..................................
Sworn to before me this j —day of Apir 1 , 20j3
Official N a� Pubiic
,fir ry Signre and Original Notary Stamp
TRAC Y I_, DWYER
NOTARY PUBLIC,STATE OF NEW YORK Page 4 of 4
NO.01 DW63 6900
QUALIFIED BMJ SUFFOLK COUNTY
�ltf
Telephone(631)765-1802
Town Hall Amex
54375 Main Road �Ii�� a �°���1 Fax(631)765-9502
P.O.Box 1179 ���r
Southold,NY 11971-0959 0'�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
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:
Dimension of each room:
Use and . P 4� /? 6 p
Rental Dwelling Unit Identifier: I ell, i�
Requested maximum number of persons allowed to occupy each dwelling urnrt:
Number of Rooms in Rental Dwelling Unit:
Dimension of each room:
Use and Dimen
w
C 62
.
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 SOUTHORILD BUILDING! DEIP'T.
"x"5 .1''SWCI�.2
y
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING!STRAPPING [ ] MNAL1
[ ] FIREPLACE CHIMNEY [ FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL(ROUGH) [ ] ELECTRICAL(FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
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�lVF0jjt Town of Southold 6/27/2016
P.O.Box 1179
53095 Main Rd
, ,�01 JL Southold,New York 11971
CERTIFICATE E OF OCCUPANCY
No: 38366 Date: 6/27/2016
THIS CERTIFIES that the building AS BUILT ALTERATION
Location of Property: 1220 Youngs Ave, Southold
SCTM#: 473889 Sec/Block/Lot: 60.-2-8
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
4/8/2016 pursuant to which Building Permit No. 40669 dated 5/5/2016
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:
"as built"interior alterations to convert a one farm dwell pginto a two family dwelling as appliett for.
The certificate is issued to Gabriel,George&Ors.
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
.... ......
�.... ut ...... —
ho d ai uutta�•
s ° Town of Southold 7/5/2016
O 53095 Main Rd
VIIA
Southold,New York 11971
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: 38367 Date: 6/27/2016
THIS CERTIFIES that the structure(s)located at: 1220 Youngs Ave, Southold
SCTM#: 473889 Sec/Block/Lot: 60.-2-8
Subdivision: Filed Map No. Lot No.
conforms substantially to the requirements for a built prior to
APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 38367
dated 6/27/2016 was issued and conforms to all the requriements of the applicable provisions of the law.
The occupancy for which this certificate is issued is:
wood frame one fa, CWgjl ng with side concrete patio small accessory storage building and sma[l accessory bora.*
mole w1 I?40669, ""as bit""alteration from one family to two family CO7,3'`
.. 8366
The certificate is issued to Gabriel, George Gabriel, Ors
(OWNER.)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT. `
r
Ate iel Si �ie
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 1220 Youngs Ave,Southold
SUFF.CO.TAX MAP..NO.:
: �._
: 60.-2-8 SUBDIVISION:
NAME OF OWNER(S): Gabriel,
_-.�._u_......_... ......� .�e... ................_....._ _
el,George
OCCUPANCY:
ADMITTED BY:
SOURCE OF REQUEST Gabnel...
,George DATE: 6/27/2016
DWELLING:
#STORIES: 2 #EXITS: 3
FOUNDATION: _ Brick CELLAR: 1/4 CRAWL SPACE: 3/4
2 TOILET ROOMS
m UTILITY ROOM(S):
BATHROOM(S): .. ).
PORCH TYPE: DECK TYPE: PATIO TYPE: Concrete
BREEZEWAY: FIREPLACE: GARAGE:
DOMESTIC HOTWATER: Yes TYPE HEATER: National Grid AIR CONDITIONING:
TYPE HEAT: Nat'l Grid WARM AIR: HOT WATER: X
#BEDROOMS: 4 #KITCHENS: 1 BASEMENT TYPE: Unfinished
......... ......... .. ...
OTHER:
ACCESSORY STRUCTURES:
GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: Small Stge Bldg
SWIMMING POOL: GUEST,TYPE OF CONST:
OTHER: Small Barn
VIOLATIONS:
REMARKS:
INSPECTED BY: GARYF DATE OF INSPECTION: 12/28/2015
TIME START: END:
TOWN OF SOUTHOLD PROPERTY RECO
OWNERSTREET VILLAGE DIST. SUB. LOT
FORMER OWNER N "-.CR
S w TYPE OF BUILDING
R ZSm�' - SEAS. VL. FARM CCMM CB. MISC. Mkt. Value
LAND Imp- TOTAL DATE REMARKS
ir
in-v
A-
Q-1
AGE
BUILDING CONDITION
NEW NORMAL BELOW ABOVE
FARM I Acre Value Per Value
Acre
Tillable
Tillable 2
Tillable 3
Woodland
Swampland FRONTAGE ON WATER
Brush!and FRONTAGE ON ROAD
-44-
House Plot 1 DEPTH
BULKHEAD
Total iDOCK
I
ba
-
e
COLOR
_ - E
3
TRIM
S mt
i
-
. I [
y
e
�� _ �
e
i
x
�:2-8 09/2016 � _
M. Bldg ; Foundation Bath Dinette
Extension ; Basement =` Floors K.
Extension a Ext. Walls Interior Finish [ LR.
Extension s y k ,. ` Fire Place Heat DR.
4
Type Roof Rooms 1st Floor1LA,
h4T I VIA
, i BR.
Porch _ - .� = i Recreation Roont Rooms 2nd Floo
jLrL WT,,
Porch I Dormer
Breezeway I I Driveway
Garage
Patio
Total