HomeMy WebLinkAbout1000-31.-8-8 TOWN OF SOUTHOLD
Rental Permit
Permit No. 0102
Owner Gabrielle Mahon
Occupied as Single Family Dwelling
Located at 460 Bay Ave East Marion 31-8-8
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.
7/5/2019 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 °" CZ, 1
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHO
RENTAL PERMIT APPLICATION
Rental Permit Fee$200 (Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:6
4166 l kUc-- C- i /J
Tax Map Number: 1000 SECTION 3- /...—I3LOCK LOT
SECTION B.
OWNER INFORMATION:
Property Owner Name: / � !
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
I
L
Telephone Number(s): f/?- kgs--j-.9
Property Owner Email Address: i r-[.cC, A')
Page 1 of 4 ,
r
Section C.
Authorized Agent-information:
Name of Authorized Agent of dwelling unit, if any: 6 r, , 6` Yt)&, Z,_
Address of Authorized Agent (no P.O. Boxes): �'/� "��� /L � �,, l • `�y
Mailing Address of Authorized Agent:
Telephone Number(s): c( q/je a
Email Address.-
Section
ddress: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: I-1Vtk3 -
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:
� w
Requested Maximum number of persons allowed to occupy Dwelling Unit: iu
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 Cade 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 flaws adopted by the New York State Fire Prevention and Building Code Council.
EA,' I am requesting a fire safety inspection to be performed by a Code Enforcement Official
from the Town of Southold.
�Algw,5-
Y61u
Page 3of4 Sr/6 _��50�_�� a
❑ 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 LZLE /n 44-t)J , 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: (S�71y_° ?+ L Lc' 11))�Alldll)
Property Owner's Signature:
x,
Sworn to before me this/ 6 day of , 20
DENISE A. NAVARRA
Official Notary Public Signature and Original Notary Stamp NOTARY PUBLIC-STATE OF NEW YORK
No. 01 NA6191295
Qualified in Suffolk County
Page 4 of 42 C-1My commission Expires '"
1„ ..
Town Hall AnnexTelephone(631)765-1802
n�
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
ad�Ire q 7h,
BUILDING DEPARTMENT
TOWN OF SO HO
RENTAL PROPERTY CERTIFICATION
Form to be completed by a NYS licensed architect, NYS licensed engineer or licensed home
inspector
separate form is required for each individual Rental Dwelling Unit
Pro essional seed re aired car Airchitec't or En ineer. licensed Home Inspector must provide a
copV of a valid New York-State Uniarm Fire Prevention Building-Code gerti ication.
Rental Property SCTM Number: `
Rental Property Address
Owner/Name: �m r �2i ELC�� 1nP / ON
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.)
Property Description (include all improvements indicated on survey)
I certify that I have done a physical inspection of the subject rental dwelling unit and find that
the unit 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.
Print Name and Title Original Signature
Please place professional seal:
�vlcolj "71
T WN OF SOUTHOLD BUILDING DEPT.
765-1
wrc� 802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
i
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] L
1 [, ] FIREPLACE & CHIMNEY [ FIRE SAFETY" INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
DATE q INSPECTOR
so
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] FI .
[ ]
FIREPLACE &FIREPLACECHIMNEY [ FIRE SAFETY INSPECTION
T ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CA LKING
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No 8-24014 Date NOVEMBER 3, 1995
THIS CERTIFIES that the building Y DWELLING
Location of Property 460 BAY AVENUE EAST MARION, N.Y..
House No. Street Hamlet
County Tax Map No. 1000 Section 31 Block 8 Lot 8
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 5-24014 dated NOVEMBER 3, 1995
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 ONE FAMILY DWELLING WITH ACCESSORY SHED
The certificate is issued to JOSEPH DSENFAMSKI
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
B ldinInspector
Rev. 1/81
IIIIILU1111; DEVARIHI',111'
TOWN ON SOII'I'1101,1)
11OUSUR'. (:001'. I1151'UT'ION REPORT
LOCATIOU: 460 SAY AVE. EAST MARION, N.Y.
( 1111i,lcr A Strc(It .�° ... mun�cmpalll'y
.':IIIIOIVI.,JON HAI' NO. 1.0'l'(n)
IIAHI•: 111 OMNI II (,;) JOSEPH DZENKOWSKI
OCCl1PANCY SINGLE FAMILY
,...._..�.....--_...��'yll C )..s...,...� __.__..... ...�.... ..........._._ .....m. ,,,�.,.._.—.__....`r1N11Cr-1 @117111t/
A10111"I'lt0 RY: LINDA LEE SPANGET. ACC(ttIVANIED IIY: SAME
KEY AVAII.AIN I^....�. ...-....�.._..�..—_._..,—,_— aII R .(;6�. "II`�wl! YlA'Rw 1801..
SOURCE* OF RligllliS'r: WILLIAM', PRICE,TA17IY ----- —DATE OCT
I1NIil.l.]NC:
'I'YI'li -C C(1N5`r101C'rION WOOD PRAMS 1 STORIES 2 1 liRiT!i 3
FOIINI)ATION CEMENT CEiLLAK FULL CRAWL Sl'ACE
TOTAL KO(1M3: IST FIJI, 3 2110 FI.R. 3 31UU 171.1t.
IIAT'NROOH (s) ONE T011.li
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-34814 Date: 01/21/11
THIS CERTIFIES that the building ADDITIONS/ALTERATIONS
Location of Property: 460 BAY AVE EAST MARION
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 31 Block 8 Lot 8
Subdivision 1. Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 5,, 2011 pursuant to which
Building Permit No. 36119-Z dated JANUARY 5, 2011
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 ALTERATIONS AND ADDITIONS, INCLUDING COVERED PORCH, TO AN EXISTING ONE
FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to SARA WELSH
(OWNER)
of the aforesaid building.
SIIFFOLR COUNTY DEPARTMENT OF HEALTH APPROVAL N/A__
ELECTRICAL CERTIFICATE NO. 01-6487 OIfS 06.
PLUMBERS CERTIFICATION DATED N/A
i
Wthor` ped Signature
a
Rev. 1/81
Town of Southold Annex 1/15/2015
14 P.O.Bog 1179
54375 Main Road
Southold,New York 11971
CERTIFICATE OF OCC C
No: 37384 Date: 1/15/2015
TRIS CERTIFIES that the building RESIDENTIAL ADDITION
Location of Property: 460 Bay Ave, East Marion,
SCTM#: 473889 Sec/Block/Lot: 31.=8-8
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
3/28/2014 pursuant to which Building Permit No. 38782 dated 4/14/2014
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:
ADDITIONS AND ALTERATIONS INCLUDING A FRONT CO"�RED ORCFF RAR SCREENED PORCH
AND OUTDOOR SHOWER STALL TO.A ONE FAMILY DWELLING AS APPLIED.FOR
The certificate is issued to Mahon,Gabrielle
(OWNER) �....
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 38782 12-24-2014
PLUMBERS CERTIFICATION DATED
A 1, riz Si ure
FFagr CA Town of Southold 7/27/2017
Ell P.O.Box 1179
53095 Main Rd
Southold,New York 11971
•rte
CERTIFICATE OF OCCS C
No: 39085 Date: 7/27/2017
THIS CERTII+'IES that the building ACCESSORY ALTERATION _..�
Location of Property: 460 Bay Ave.,East Marion
SCTM#: 473889 Sec/Block/Lot: 31.-8-8
subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
3/7/2016 pursuant to which Building Permit No. 40589 dated 4/4/2016
was issued, and conforms to all of the re uirenients of the applicable provisions of the law. The occupancy for
which this certificate is issued is: l
ALT1 1tAT1CI lS TC Al l PIwE-1�I.sT111C NCIH-CCI + I x ACESS 11Y BUILO11 tC A8
APPL
EDFFR
The certificate is issued to Mahon,Gabrielle ......
of the aforesaid building.
SUFFOLK COUNTY IIEPARTIEIT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 40589 06-28-2017
PLUMBERS CERTIFICATION DATED
_. ut "rized Signature