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Home My WebLink About1000-84.-1-6.13 TOWN OF SOUTHOLDRental Permit No. 0114 Owner Gail Toma & Daniel Rodgers Occupied as Single Family Dwelling Located at 5845 Bridge Lane Cutchogue 84-1-6.13 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. 7/15/2019 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 Roadtp-` Fax(631j 765-9502 P.O.Box 1 179 Southold,NY 11971-0959 ' it BUILDING DEPARTMENT TowN, OIF SOUTHOLD RENTAL PERMIT APPLICATION Rentei Peirrnit F::c!e 200(Application must be renewed vvyr two ye t-5) Section A: Property Information: Rental Property ro ety Aodr s.,�: , � LA Tax Map Number: 1000 SECTION ,0 C -I LO+ LOT 600 . , 3 SECTION B. OWNER MrORIVIA-tION: ::� Property Owner Name:. Property Owner Legal Addressa •;rQperty Owner.-Mailing ailin Address: � 63( (o Telephone Number(s): Daytimes Evening._ Emergently Property Owner Email Address: 671,51, 1 ( 1 a Page 1 of 5 A1/A Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 BUILDING G EPAR`MEN'T TOWN OFSOUTHOLD Stntion;C., i lthriized 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): Daytime Evening Ernerg�ency .o . . Email Address: u Section h4ainagiing Agqnt Illliii °f rii ati n: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent(rid' . oxes): - Mailing Address of Authorize gent:. l Telephone Number(s): Daytime.. Evening Emergency_ Email Address: INFORMATION:SITE MANAGER (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): Page 2 of 5 N� . Town Hall Annex Telephone(631)765-1802 54375 Main Road 4W_- Fax(63l)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 s 211 5 BUILD] DE ARTMEN,r TOWN,OF,SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime EveninEmergency Email Address: c.o ^� SECTION F. PROPERTY DIESC IPTIII ' II : Number of Rental D wellinnits 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 U%nit (for example, Kitchen, Bedroom 1, Bedroom 2, Living Room) and the dimensions of each room. For properties with multipleental Dwelling Units.use_" ental Per i , . cation,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: iJ Page 3 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT "��f(� TOWN OF SOUTHOLD ��(,,�i��. U �;' L`s D SECTION G. MAY - 8 2019 INSPECTION: Pursuant to the Town Code of the Town of Southold Chapter 207 (Rental Pr O 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 thefrovisions 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. ET�I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold 0 1 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) ) COIINTY OF SUFFOLK) I CIA iT,'o ti , 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 Page 4 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road "' F (631)7'05-9502 P.O.Box 1179 Southold,NY 11971-0959r l);t..DINO DEPARTMENT ENT TOWN, j OF $9 OLD applicable laws a rules. further acknowledge ill ti of l , it in epa nt-:o -,aby',chb nges,of.add ressvit:i fi z 5: ::a , nyc nes 3 i Kave miofa' am.r] mx!cemvei�iJ a copy�w�lll'��:Im i�ill:el 0 (::If.ilh �rMie.pf,the! p1mit of Sommq�]iold a in g Po I i t a r,e rl.l.rr ,mlmmmlc,l I.lmmm �mm mr.,. �. 4, I will notifythe gown within five (5) business days as to any change to the information regarding Authorized Agent, (Managing Agent, or Site Manages - Property Owner`s Name. ��;. � - �. , (YA,d"', Property Owner's Signa e* Sworn to before me thil-6day of 20LI Official Notary Public Signature and Original Notary Stamp CONNI I'D. u .H.;; Notary Public,State of New York No.0101 %"0 Oruallfied in 60n �`,pq+tm45sinn Fxoires April 14, Page 5 of 5 SOS TOWN OF' SOUTHOLD BUILDING DEPT. u , 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAOPINGINAL/40 ,44 &VliL�- [ ] FIREPLACE CHIMNEY [ FIRE SAFETY" INSPECTION I [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING D04 v M com ho [Apol� f T6 �ta 4vc DATE INSPECTOR nr)s r� ry a„t P 4k' Y o __ ...f ria rm r 1.1 rF fi d p a� a �a w h ` cr, `ti ,w torr t 1 S " a [r � A 110 wti[rn , �� a d Lr rl wvr � a rn i" rct rnx,d po 7} �° �n pp 1 nODC n 1. 3.".:TOGE LANE 1 puv (��}r2r.Tr,n..� ,® CIJl'-1lGJCU�_`.gY.`l. (19 5 _ i_� __ i; n�w t I � 1 4 0.g ITT pp 1M _ r rlw SRI "rT k h„ ® ® ® no `^ p cr O d „. ,` G p ® (a, y fl f r LA LAJ u I r I i �W J Fr µ„ e 0 ...._.. i fn re� ,.. cd y —n m m,rf m D3 p —n u m�� I � ” G '� re �iouuul c v 0 0 I �1 �,Tya p r m D y �� I � � r 10 co Z Z > � m. y > � �� Ire re�, l�r ON b &z' wAm, d 4 m —d INN co ni r . r Z o0 , , cki N ( f ry A ., � ei!i r I I II rV 00 > ! j O OIT ? !I l p fD Cl f1 N (D W — N S S (n N aFj , i� O I.Aj µ d 1 \jI ��E Oq r o n CD q — _ 1. m ... m � 3 o _w o O — 7 _. o l --„w w i u� f •S I O 8 NN 11 � 1 D .... ....r.....m......�. _ .� 0 °o :: 0 �..,n I wa C m. _.__.. . .. _.. rr p r 7C p 7� _ Ll— m..r I � .;: rOgM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. X. Certificate Of Occupancy__ No. Z7402— Date . a . . . . . . . . . . . . . Zoe— . .3, , . ., 19, � THIS CERTIFIES that the building located at Hrid' s . ' ' ' . . Street Map No.gyloret 'SstBlock No. . . . . . , . . . :Lot No. . . ,,i.3 . . .Cutc�o4 . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . _ . . . . . . . . Ju3.y. . .ap, 19 76 , pursuant to which Building Permit No. • 87522' dated . . . . • . . . . • • • • jUly• • • •2619 76 was issued, and conforms to sill of the require- ments of the applicable provisions of the law. The 9C-cupancy for which this certificate is issued isPri• ^ate- -o fami1y•dV61l . . . . . , . , . . . w , , . , . . , . . . , . . . The certificate is issued to . .Frederick 'RO . ' ' " • " . . • . , " , ` , e r, lessee o� nant) of the aforesaid building. Suffolk County Department of Health Approval -NOV —30 ' -1976 • .by 'B:- Milia ' ` ' UNDERWRITERS CERTIFICATE No.X30el,60. . . . .0tt. .tg. . .1976 . . . .. . . . . . . , . . . . . HOUSE NUMBER . . . . . . 5&5. . . Street • -f,` . . . . • Cntcho . . . . . . . . Building Inspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. . .Z92 183. . . . Date . . . .Qotobor. . .31. . . . . . . . . . ., 19. . .7.8 THIS CERTIFIES that the building located at . . .5$45 . .A 'id;e, T anee Map No. . . .6390. . . . . Block No. . . . . . . . . . .Lot No. . . . . . . .1.3 . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . .October. . , .5. . . ., 19. 7 pursuant to which Building Permit No. 99674 dated . . . . .QctobIPP. . . .5. . . . ., 19. 78, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . . . . . . . . . . . . . Accessory building The certificate is issued to . . . . . . .Fredrick .Maser. . . (owner,JggV9CRWA§trqn `x of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . . . .N/,q . . . . . .. . , . . . . . . UNDERWRITERS CERTIFICATE No. . . . . . . . . . . . . . . . . . . . . . N./.R., . . . . MOUSE NUMBER . . .58.4.5 . . . . . . Street . . . . . . . . . .Bridge.Lane. . . . . . . . . . . . . . . . . . . ague" Y.Y. . . . . . . . . . . . . . . Building Inspector County Tax Map 1000-84-1-6. 13 t Town of Southold 10/11/2020 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41514 Date: 10/11/2020 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 5845 Bridge Ln, Cutchogue SCTM#: 473889 Sec/Block/Lot: 84.-1-6.13 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 2/17/2016 pursuant to which Building Permit No. 40485 dated 2/25/2016 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: additions and alterations, including vor h Ct rs, deck ark ��ara c alter l to family room,with entry stairs an exi single family dwelling as applied for. The certificate is issued to Toma,Gail&Rodgers,Daniel of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 40485 6/14/2016 PLUMBERS CERTIFICATION DATED ..�__ tlx r... .. ....W i ignature