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Home My WebLink About1000-26.-2-17 TOWN OF SOI THOL 4 Rental Permit Xv Permit No. 0076 Owner Anderson W & J LLC Occupied as Single Family Dwelling Located at 715 Willow Terrace Lane Orient 26-2-17 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. 6/4/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT r "' Z{ 'yII r " TOWN OF SOUTHOLD J RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years "i�"ki ` �� i ±° T " ry9 F °ir , Section A. Property Information: Rental Property Address: 7l Tax Map Number: 1000 SECTION BLOCK LOIS 17 SECTION B. OWNER INFORMATION: �Q Property Owner Name: Property Owner Legal Address: U Property Owner Mailing Address: (Cannot be the same as Rental Property Address) Telephone Number(s): �« 3-2-7 67 Z ? Property Owner Email Address: (tea a lr)6 e✓/f-o rn"D ✓SO�y'1�'�"�� Page i of 4 e i "" Section . Authorized 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): -- 3711 Email Address: N i com S tiara D. Managing 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: E ON E A AGER 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 ION F. PROPS . Number of Rental Dwelling Units on property: .„ ............. 09 Cc 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:. 1 w f -refvace— Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: (0 P—ot MS� Use and Dimensions of each room in Rental Dwelling Unit: I mo "_ _ /S x G SECTION G. 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 bythe New York State Fire Prevention and Building Code Council. ❑ 1 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) "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: GL p g Property Owner's Signature: ,f4k, Sworn to before me this 30 day of Official Notary Public Signature and Original Notary Stamp Notary Public Stateof Florida Paula Frands ° y ComrnYssion dG 12224 �01 W Expires 07MO120,21 Page 4 of 4 Victor Cornelius WON, NYS LICENSED&INSURED ...�..�........ ................. HOME INSPECTOR HOME INSPECTION wininspec4ion@gmail.com Z4 Town Hall Annex 54375 Main Road4 00 P.O.Box 1179 �' a✓ '"i Southold,NY 1I971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a license architect,licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Pr " .ssiancal seal required for Architect or n ineer, licensed Home Inspector must provide copy cif valid current cerfica°tion Rental Property SCTM Number: y 73 SSR' Z6 2--( Rental Property Address: Owner/Name: WA Rental Dwelling Unit identifier: Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1-100 sq.,Bedroom#2-90 sq., etc.) , �,✓ .z.;5" • /� � �� — /�°-ate'r�-� Property Description (Include all improvements indicated on survey) I certifythat I have done a physical inspection of the subject rental dwelling unit and find that it fully complies with all the provisions of the Code of the Town of Southold,the Residential Code of New York State,the Building Code of New York State,the Plumbing Code of New York State, the Fuel Gas Code of New York State, and the Energy Conservation Construction Code of New York State. j Print Name and Titlevcoo Original Signature - QJG-0223 4(�oa000 c%ao Please place professional seal: s 'LA r 3Vf Z _ roX6 � NVA ' W x tl a fA,. 2 kw rT-T R Ivlo u z �' .. SL/DINC DR. 7 6 ............ ,w _ n iob 0 A pW E F,. k 4 I � I v Li h F :p 4 is m u i w wk' `8t q 't o � i ,3 u ... ......, W,i i %� / LU % /i / / / v r' gcn Pill %f l „,W i LL f1fj 'r1 O Q A Orr( TOWWOF SOUTHOLD BUILDING DEPTE 765-1802 INSPECTION [ ] FOUNDATION 1ST ROUGLJ PLUG. [ ] FOUNDATION 2ND INS ATION/CAULG. [ ] FRAMING /STRAPPING [ ] NAL [ ] FIIREPLACE& CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: ra/v " A lot 0 DATE A170 INSPECTO ppI > D m c k ❑ ,Ln OL O � ° — — < y 7 p j _ p mCL ati I i L y f CID ----- _.__. c p ID N Ln z v Gl 7 r�o m m m.. —I r� CD � m m ,"� �w. ...,.� � rol O C m � C v O O m , 7nZ Z c —I � D .. m Ur �� Gl Gl � ;., p m m O Z Z 03 O + G) m O D hC 2 MSI N� f 1 , , a � , Ln rr. r aj P a e. E r � i X v Gl a� o m m " m _. o o 0 o x x x ' N S S 7 ( 3 RA" (U vi cn rn d it i r 3 0 co �I s I p A %R'fil " fl .r I 1111 4 � �i 3 cp rtcn co C Qfl ❑ _ _. __ �. .._� _�.. CD t P. _. f cn:a ° _...__ . .m.....m.. .._ .: �. ._.�.. ._...�_ ..._. _._. �... .. ._,..,m.,� ... �" n --- .--- .._ .. ..... }. . ... .......... .............. � — a i s i s EE � r _ a FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy o. . . . Date .. . . . . , . . . . 19. 3 THIS CERTIFIES that the building located at .loll . Terrace .La , Street Map No.WlaQW. or . k No. . . . . . . . . . .Lot No. AT . . . . P.r4nt .... . . . . . . . . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . _ . . . . Doc. . . .1 19.72. pursuant to which Building Permit No. , . 2 dated . . . . . . . . . A6 . . . .Q. . . ., 19.79., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is .'." _ issped is . .ftiv The certificate is issued to Ar.e .];!1V41rd. XiWkp r of the aforesaid building. (owner, lessee or tenant) Suffolk County Department of Health Approval ®fit . , , , , 1 3 by. R.. .Vina UNDERWRITERS CERTIFICATE No. . . . . .111.08 . . . . . . HOUSE: NUMBF.R. . . .7.1 W . . . . . . .Street, . . . . . . � .Ter . Building Inspector