The URL can be used to link to this page

Home My WebLink About1000-18.-5-14.1 �� _t TOWS OF SOUTHOLD Rental Permit Permit No. 0069 a_. Owner Vincent & Terese Pette Occupied as Single Family Dwelling Located at 23530 Route 25 Southold 18-5-14 Address Village S/B/L Maximum Permitted Occupancy 6 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. 5/29/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times I Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 fl P.O.Box 1179 ` 3nG Southold,NY 11971-0959 „ a 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: C) z � Tax Ma Number: 1000 SECTION Map MIBLOCK Q 1 LOT 56C+ 1 1 L---, 141 I SECTION B. OWNER INFORMATION: Property Owner Name: 1 Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) u 0 ,. �W �_. dP� ti4 - Telephone Number (s): Property Owner Email Address: � ” . I Page 1 of 4 2 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent (no P.O. Boxes):_ 1,I� I S' t--e"�c Mailing Address of Authorized Agent: i i e\ Telephone Number (s): I tt Email Address: �" µ 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: IA- Address of Managing Agent (no P.O. Boxes): Mailing Address of Managing Agent: Telephone Number(s): Email Address: Page 2 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) 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 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: p Y Property Owner's Signature: /r),"i, %' .' E7, r` d Sworn to before me this?l day of G( , 2019 Official Nott y Public Signatu and Original Notary Stamp TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK Page 4 of 4 NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30.„ �1- 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, Q 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: �,, , I o ( Requested Maximum number of persons allowed to occupy Dwelling Unit: rl_o: Number of rooms in Rental Dwelling Unit: L� 4 Use and Dimensions of each room in Rental Dwelling Unit: !Lee -00o( Ian 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 la s,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 FORM NO_ TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 30328 Date: 08/05/04 THIS CERTIFIES that the building DWELLING AND ACCESSORY Location of Property 23530 MAIN RD ORIENT (HOUSE NO.) (STREET) (HAMLET) County Tax Map No_ 473889 Section 018 Block 0005 Lot 014.001 Subdivision Filed Map No_ Lot No_ conforms substantially to the Requirements for a ONE FAMILY DWELLING built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 30328 dated AUGUST 5, 2004 was issued, and conforms to all of th.e,requirements of the applicable provisions of the law. The oceupancl= for which this certificate is issued is ONE FAMILY DWELLING WITH COVERED ENCLOSED PORCH AND ACCESSORY GARAGE.* The certificate is issued to PEDER A FERREIRA & ANO. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF BEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. _ zed Si t� �t .... .... Aut osr: ure Rev. 1/81 BUILDING DEPARTME11T TOWII OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 23530 M_"_IN RD ORIENT SUBDIVISION: MAP NO_: LOT (S) NAKE OF OWNER (S) : PEDER A FERREIRA, & AITO. OCCUPANCY: SINGLE FAMILY DWELLING PEDER A FERREIRA & A170. ADPLITIED BY: PAUL HEFFERNA14 ACCOMPANIED BY: S:11.E FEY AVAILABLE: SUFF_ CO_ TAX MAP NO.: 1e.-5-14.1 SOURCE OF REQUEST: PAUL, HEFFERNA.N DATE: 08105L!jI D'WELLI:ITG: TYPE OF CONSTRUCTION: WOOD FR-PllE # STORIES: 2.0 # EXITS: 2 FOUNDATION: POURED CELLAR: FULL CRAWL SPACE: TOTAL ROOMS: IST FLR.: 2ND FLR_: 3 3RD FLR.: 0 HATI9ROOM(S): 2.0 TOILET ROOM(9) 0.0 UTILITY ROOM(S): YES PORCH TYPE: COVERED ENCLOSED FRONT DECK TYPE: PATIO TYPE: BREEZEWAY: FIREPLACE: GARAGE- DOMESTIC HOTWATER: YES TYPE OIL AIRCONDITIONING: TYPE HEAT: OIL BASE. WARM AIR: HOTWATER: OTHER: STREET GA,S FOR COOKING. SNOOD STOOP ON P.E'� OF DWLG 'CCESSOPY STRUCTURES: GARAGE, TYPE OF CONST_: WOOD FR-ANTE STORAGE, TYPE CONST_: SWIMMING POOL: GUEST, TYPE CONST.: OTHER: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE ��.W. LGCATION r DESCRIPTIOPT Al2T. I . �I it r REMARKS; RE-IITSPECTED 9/5/04 n INSPECTED BY: ' HATE Ox INSPECTION: 07/26/04 MICHKEL .7 VERLTY TIRE START: 10:05 111 END: 10:45 21.14 i4 9� 4 " } °w fi I / I 1 J fl� t N f � r „ d � f �II f 7 u r �w K P � y I I � r�,,, A„ a jjlj e„ A y 3 r a n I Mi w 4 I�f � ¢• � tl Mry VIII�� } I k r �ko u 4 J i f b u11� ------- m, ll�jjlvj10, a s �o 1 _ vi X LD dh { ' r amu.-"'",w''✓'"y N 41 n r r NA 00 TOWN OF SOUTHOLD BUILDING DEPT. gym, 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ]' ROUGH P'LRG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING f STRAPPING [ ] FIN L [ ] FIREPLACE & CHIMNEY iFIRE AFETY NSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING 1 -- i DATE 'NSP ` ? ctaP"s' m a 0 a m s - 'A STS zf OVSE i p co u W 169.3 CO -- N Z g z nJo/r c cT ORIENT m ,m f 0 BCS E ry a r� g �— h, I G 1' R lal Y FST C3 x 00 Lo 1 ( C s o awl Q m W 00 0 of ` z O H Z O O y.�) cv O vii :i W � Oho II N No z Lo 10 O - v azEr <o ( `�y coQ ✓� C!j Z C) ___I Q d xF V) Lo 01 1 7- -no 0 Ln 0 O 6 0 O m o CL co ro OZ ,«mIm p, . ... qW� 70 « 3:o� y— m — � Z y 0 m oEDp d. c Z P 0 co C m v. All « moo If Y / t r- -v O 70 O I fin. C m ;ow 1 D ey m m O O �� ,.� ! � CO �J d m Z All m D ; m n ��a o m �r UlWi N n i a r � ` u i a CJ . O N eb'• S �„ en ua I,"��,%/r��/i�Jl� �� La (D CID 0 // // .,° ,. V H A n• w:•_. ,,._._..._......... CJ X -11 o O d. D Lnrt '� fD CD .,a.._.. ..,.,..�. . .,.. ........._. .... ,_ ,....,_ .,.�.�... YD O ^�° Ci ^a O pXj i f ......... .P i <. ° 1P �" se,ti ` O O O '"� O _' e & 3 CL C+ O ht a4 �..w. .... q. Yd f k y ---------------- 'AD r _ f � f J