HomeMy WebLinkAbout1000-135.-3-44 TOWN OF SOU HOL
Rental Permit
Permit No. 0101
sf
Owner Liberty Equities
Occupied as Single Family Dwelling
Located at 1070 Mill Creek Dr Southold 135.-344
Address Village S/B/L
Maximum Permitted Occupancy 8
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.
7/3/2019 John Jarski
Date of Issue Code Enforcement Officer
This Notice must be posted by the main entrance at all times
Town Hall Annex ��� j�Jl' � 1 �y �" Telephone(631)765-1802
54375 Main Road �i�zir `¢ Fax(631)765-9502
P.O.Box 1179 � �,����� ac
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION.
Rental Permit fee $200 (Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
/0-4d_M:, Crock O0C.,,e
Map
Tax Ma Number: 1000 SECTION
SECTION B.
OWNER INFORMATION:
Property Owner Name: Li �cr � .,1,444, . ®r _..
Property Owner Legal Address: Property Owner Mailing Address:
L31- Sti3-gloo031- VIfm 1-If
Telephone Number(s): Daytime ___ ___, Evening. .... Emergency.) .,......
..�.
Property Owner Email Address: sit �_ _m. co
Page 1 of 5
��„ � �'u' lr '�,, Telephone(631)765-1802
Town Hall Annex
54375 Main Road � �r��„ ,/1 Fax(631)765-9502
�J
P.O.Box 1179
Southold,NY 11971-0959 ”
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any: , w6.% � �_..,.��...._ r
Address of Authorized Agent (no P.O. Boxes): 7 »�
Mailing Address of Authorized Agent 0'r d � c n ss
Telephone Number(s): Daytime,.__....._ Evening_ Emergenc:y,
Email Address: ...._.._._ Ck r It 4k....__._ C s r __..._
Section D.
Managing Agent Information:
Name of Authorized Agent of dwelling unit, if any: r;s 4r-p�,e-r �-
Address of Authorized Agent (no P.O. Boxes):,, _
Mailing Address of Authorized Agent: T
I®
Telephone Number{s): Daytime Evening Emergency ,_,_
Email Address: r c
SECTION E.
SITE MANAGER INFORMATION: (required for rental properties containing 9 or more rental units)
Name of Managing Agent of dwelling unit, if any:
Address of Managing Agent (no P.O. Boxes)' rk M� ....
Page 2 of 5
e, t �
Town Hall Annex 1 �) Telephone(631)765-1302
54375 Main Road �� �',' Fax(631)765-9502
P.O. Box 1179 .,
Southold,NY 11971-0959 7� s
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent:
(1141- 6*43-tW (s3l-
Y01I' YyOy G31 - `Ifr`1►- yyoY,
Telephone Number (s): Daytime Evening _. Emergency.__
C Vvi CYN A r-%c-r o, _Q- P1 Ct c. ,L� r k -C-
SECTION
............._. .._
Emall Address:
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on property: ,- �a,r•t1 I,.re��.� �cs��c.3<<
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."
p 11
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:
Page 3 of 5
Town Hall Annex �P'� ���� '„�n prti„, Telephone(631)765-1902
N � ' 1 ,.,
54375 Main Road ���� Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
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 licensed architect, a 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
❑ I am submitting a completed Town of Southold certification form from a licensed
architect or a licensed professional engineer.
SECTION H.
DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit.
STATE OF NEW YORK)
}
COU NTYOF SUFFOLK)
I - m mmc� ,certify under penalty of perjury, the following:
1. I 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
Page 4 of 5
Town Hall Annex „� 1 ��� �` Telephone(631)765-1802
Fax(631)765-9502
54375 Main Road
P.O.Box 1174 ���y $�g
Southold,NY 11971-0959
BUILDING DEPARTMENT
Town OF SOUTHOL.D
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 as to any change to the information
regarding Authorized Agent, Managing Agent, or Site Manager.
Property Owner's Name: �C .�.6,s -o %,%
Property Owner's Signature:
o n to before me t is day of _.. 20
lci i Notary Public m n tur
Off' ' .g e and riginal ota 'Stamp
,
2
eonvn,to6jon.
, ',2
023
Page 5 of 5
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Town Hall Annex f �� ? � � ' Telephone(631)765-1802
�»
54375 Main Road Fax(631)765-9502� '!� �� �
P.O.Box 11794,Vat,
Southold,NY 11971-0959 a1
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
�f s.sionol seal er�uireel °Archit ct c " nrlr"ra cr r"" ensed Uome..lrrspgctor Ln1 rg1
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Rental Property SCTM Number: ..... � ..m. _ •' > mm -.
__.
Rental Property Address. �I i �� i — � -�-
Owner/Name . �� ° .�_ "` i
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.)
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Property Description (Include all improvements indicated on survey)
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I certify that 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 � ' . � °"""�.��, o�, �„�„
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TOWN OF SOUTHOLD BUILDING DEPT.
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765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] INA
[ ] FIREPLACE & CHIMNEY
[ FI E SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL'(ROUGH) [ ] ELECTRICAL (FINAL)-
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
DATE
3 INSPECTOR
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Town of Southold 5/24/2019
P.O.Box 1179
53095 Main Rd
Southold,New York 11971
............
CERTIFICATE OF OCCUPANCY
No: 40420 Date: 5/24/2019
THIS CERTIFIES that the building SINGLE FAMILY DWELLING
................... .....................
Location of Property: 1070 Milt Creek Dr., Southold
SCTM#: 473889 See/Block/Lot: 135.-3-44
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
5/15/2019 pursuant to which Building Permit No. 43750 dated 5/15/2019
.............................
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.
_wtil ttiflInislied bi"iscineUti., ('11OV(Ted trorit em r wood deckmd �Mlaclicd mo Cffl-
qWlied for.
The certificate is issued to Liberty Equities Corp
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL RI0-16-0085 4/8/2019
ELECTRICAL CERTiFIcA!rE NO. 41292 2/21/2018
PLUMBERS CERTIFICATION DATED 9/14/2018 M i0lact ary
tit ize( Signature