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Home My WebLink About1000-31.-7-5 TOWN OF SOUTHOLD CIO Rental Permit 0106 Owner 8620 Main Rd LLC Occupied as Single Family Dwelling Located at 8620 Route 25 East Marion 31-7-5 Maximum Permitted Occupancy 5 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. 10/5/2021 z ` Code Enforc int Official This Notice must be posted by the main entrance at all times � SOUTHOLD TOWN Town "all Annex '7 54375 Main Road PO Box 1179 Southold, CIO w°' Rental Inspection NY 11971-1179 N Tel: 631-765-1802 , ��µ.* Fax 631-765-9502 SCTM# Date � Owner Phone Address ,r Zig111,39 Hamlet InspectorXq address visible + BI � r LEVELS SU I 2 Smoke Detectors (#-bedroom detectors excluded) L'e'e' Monoxide Detectors(#) ¢ Fire Extinguishers (#) Exits (#) ENEEMMEMEM BEDROOMS 1 2 3 r4"M 5 Smoke Detector Alarms(#) ) Carbon Monoxide Alarms(#) ° Egress (windows) (Y/N) k BUILDING SYSTEMS CONDITION OF PROPERTY IN Heating system maintained/operational Building Interior is clean/maintained Hot water system maintained/operational Building Exterior is clean/maintained Electrical system maintained/operational Property is clean/safe/maintained Mechanical system maintained/operational Handrails&guards present POOLS 0YIN POOL BARRIERS 4�1 Pool present Pool is completely enclosed Pool surface alarm and/or door alarm Barrier is a min.48" high resent POOL GATES Y/N All openings in barrier less than 4" Self-closing, self-latching Max. 2"clearance @ bottom of barrier Latch on pool side of gate, meets height Barrier capable of being locked &child requirements proof when unattended COMMENTS: M e. v $ TOWN OF SOUTHOL Pv- ZZ Rental Permit Permit No. 0106 Owner 8620 Main Rd LLC Occupied as Single Family Dwelling Located at 8620 Rt 25 East Marion 31-7-5 Address Village S/B/L Maximum Permitted Occupancy 5 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. 7/8/2019 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 Fad(631)765-9502 P.O.Box 1 179 `Sbutl olo,NY 1 t971=0959 1' �^.UIJ ,D �N!y ,l EC"t1R`liyME�.�4,,w w � RENtAL P E RMIT APPLlC TION Rental Ilieirm it Fee$2,00 0(Appik afion n7fist,be mtiewecl every t,m' o yeaar's) „ � m iSection a ^ Property Informatiari: Rental Property dwre , .. ry(,rA 10 N ,. Tax Map Number 1100 SECTION '� - -LOT i IIIII o SL TIGIID OWN C IIIIk I l" ' Ifs IIATI l ". y Property Owner Name:,, ca 6i. o. JR,A-f IV c I'uraamrWyOwner legpd%ddr ss ,,m, 9,° 01W � 1Add,r'ess^. ^ c 2 .. - Telephone Number(s): Da time"6 E'r fin - Emer eny Property Owner Email Address: S� //,.JP d p Page 1 of 5 Town Hall Anne^z Telep 6hd(63 1)765-1802 54375 Main Road P 76 95@2 P.O.Box 1179 Southold,NY 11971-0959 Section Authorized A ermt Information: a Name of . . , Authoruzed Agent of dwelVnu°1g kin'it, if any , Authorized Agent (no P.O. Boxes) Address of _.,.... .. ____ Mailing Address of Authorized Agent: G Telephone Number(s): Daytime.----- :Evening Erne Email Address: i Section 1 Managin� gM,giiint Inforrnin Authorized Agent of dwelling unifl Name of e t, if any: VI/e Address of Authhdrized'Ag nt`,(nb'R d:'Bbkte,$)w Mailing Address of Authorized Agent., 6 M i r Telephone Number(s): Daytime-. � Evening mergence^ V ��a�I Acictres, ._ , . _ .. . m Tyo , .a SECTION E. SITE MANAGER INF+ .RMI IAT:IQN (required for,rental properties con?ining,8 or more rental!unjts) ' e1F xq ' of aging Agent of dwelling unit,,if any: N a,rri a Address of Managing Agent(no P.O. Boxes)„ �R - Page 20f5 Town Hl41,1,/pngx "1 eflepblone,,(63'1,765-1802 54,375 blain Road + °Fx(031)765-9502 P.O.Box 1 179 r Southold,NY 11971-0959 BUJL,DJN,G DEPARTMENT " �� MT�" ( � ; m ., , Mail°ung Address of Managing Agent-I., - Telephone Number(s): Daytime Evenir1 ... l:mmeirgeu�� .. .� ,. s Ernaui Address: rye• "W ° M,a SECTION F sn: .,, PROPE��'y"�'_DESCOOT ON: r Number of Rental Dwelling Units on propertyi'. 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`�l (for example, Kitchen, Bedroom 1, Bedroom 2, Living Room) and the dimenslons of each a p s q ° ro+ m. p P Folz tib ertle's l '1 h multi fe'Renta ',D ei1fng�..�n is uAe.,� ° tai, er ito lC iqtj, n u. Rental welh ng Unit Identiffer• Requested' axl'hru"m nun-ll er cif°persons alld e to"oectipy f llil+°° Unif",,, Number of rooms in Rental Dwelling Unite Use and Dimensions of each room 1n Rental Dwelling Unit . w 6 Page 3 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road i 1 i x(63'1)165-9502 Y.O.Box 1179 Southold,NY 11971-0959 TKENT TO �H1 w " '�O O SECTION G. ®, I W P��pww I... •PSd.Ll. i..'._ Pursuant tb{ iT°d" "C-bfvthd Tla d'`dou .ld- aptgr 7;( n aJ Prop .: . .)q .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 re -&Mtfd ` f l'ii'g od "C i fca Iran rs ta�'r . t�tj;ri; f a e: r petty id is t er, r j cf . 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 re ulations> ft :'Cq nt zta .' o.l and i.,-.. by the laws adopted by the New York State Fire Prevention and Building Code Council. El I am requesting a fire safety inspection to be performed by a Code Enforcement ficial from the Town of Southbid-1, iVI am.s.ub.mlttin �l coMpletedlTown'. TSu.th6ld rtlfi .tion, or .!fro a1i1be se -..) , toy er sion� Venglpeei architect or a licensers rof s � p 9 n f' .SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFOLK) , certify under penalty of perjury,the f 6 Y P y ollowing: r arhAhe own.erof,t-he 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 Annexi V Telephone(031)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 " Southold,NY 11971-0959 BUILD]IINGDEPARTMENT '' + applicable laws and rules. I further acknowledge that I will notify the Town of 9vuthda', i �:�llll l�� el °t t µmei. if mllly 11�11m1 ofa �uremswith Aays,p any,ch angejT ,o. . III��ry yy�,Y�ry,�w�� ,. (l1heiI Po W. 3. 40,0 eedto Ni 'ih t rm r, . l will riciffly tllie lFbmin withini five (!15) business clays as ix) ainy change to t:IIWle info'°matiorm d regarding Authorized Agent, Managing Agent, or Site l' m1MWarlg1 Property Owner's Signature: ., Sworn to before me this /I day of fl �r Official NotaryPublic Si 11 ure and:Orl Inal Notar Stam e A ,� JWA. N A g_ Y p p llE . NAARR 'YORK No. OINA6191295 .Auallfied:ln Suffolk,Coun'ty My Commission Expires Ute- W Page 5 of 5 W.Y Town Hall Annex mill, Tellelrh6ne'Q631)765-1802 543'75 Marr Road Fix(6119 765.9502 P.O.Box 1179 Southold,NY 11971-0959 BUI WIT TOWtq'Ok'80Util6lb REN,I'AL. PROPERTY CERT I F I ' . ,1 I, I Form is to be completed by a license,architect, license�d,engineer.or-lice siddhdine 1&0cf r Separdtie, ormlis retllilr�ed for ch indiVidilal,,Rental:Divelllh ,iUnit •. w �" m � a 1. a" Rental -Property SCTM Nu p Y r .._iDl u Rental Property Address:,. Owner/Name Rental Dwelling Unit Identufier . " Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom##1 -100 sq., Bedroom#2.;''-90 sq' etc,i Property Description (Include all improvements indicated on survey) � I certify that I have dont a physical inspection of the subject rental dare"Plin �gunit and"find that it fully complies with all t ie`provlsions'of true' ode of th'e 6wn of Southold,'tlle ResidentIal Code' of New York State,the Building Code of New York State, the PliirAbin`g Corde'ofNew,YorkState, the Fuel Gas Code of New York State, and the Energy Conservation Constrdction Code:of N:ew: York State, F Print Name and Title ` , ' riginal Signature Please place professional seal: 07941 r V)v 5, 6 ,"� 5, m Oc TOWN OF' SOUTHOLD BUILDING DEPT,. 765-1802 INSPECTION ,f [ ] FOUNDATION 1ST [ j ROUGH' PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /'STRAPPING [ ] INAL j ] FIREPLACE & CHIMNEY ,- [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING taw�y t ° oil WLt ATS INSPECTOR M t i � i w : a„ o S, >5�a"qo ..T CO mm �� y� I ,.amu:::. � •IX ....�:.., ,.. .,„f .,., *� 0 0 °�° Lp ° 'CD ^ ° Z a� m CL w to Ln J> 1 v com LA a w '17 \„ �a _ � . a 0... _.. k O r -n O O �p Cr'1y � 4 r 7C Z Z G�jGil �r ° i�m �•, fl m rn W co O O � u n no[r jai M. ( LO co D lb 1- G1N T � G1 W --0 v � p .. ✓0 f 00 f 54 r.nV e 1 i v� v. w l hair" 4.. t �a E u v � zi e �•y ,, au µ 10 7I n _0 3< (D E V 0 7 r (D CL 77 CO 3 -� In n I _. 1. �..�.. 8 , P ' � S w TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN IL-ILL SOUTHOLD, NEW YORK CERTIFICATE OF OCCUPANCY NONCONFORMING PREMISES No. Z11830 August 3, 1983 THIS IS TO CERTIFY that the / X/ Land / X/ Building(s) / X/ Use(s) located at 8620 Main Road East Marion Street Hamlet shown on County tax map as District 1000, Section 031 , Block 07 Lot 005 , does{not conform to the present Building Zone Code of the Town of Southold for the following reasons: land has insufficient area, width, and depth (Local Law 7-83) . Insufficient front yard, two (2) sheds are less than three (3) feet to property line. One fence is on line, and one fence is outside the street line. On the basis of information presented to the Building Inspector's Office, it has been determined that the above nonconforming /R-/Land /X/Building(s) 5_/Use(s) existed on the effective date the present Building Zone Code of the Town of Southold, and may be continued pursuant to and subject to the appli- cable provisions of said Code. IT IS FURTHER CERTIFIED that, based upon information presented to the Building Inspector's Office, the occupancy and use for which this Certifi- cate is issued is as follows: one-family dwelling with two (2) accessory (shed) buildings The Certificate is issued to GORDON E. RACKETT (owner, dessec-or-ten-arA) of the aforesaid building. Suffolk County Department of Health Approval _NIA UNDERWRITERS CERTIFICATE NO. NIA NOTICE IS HEREBY GIVEN that the owner of the above premises I-LAS NOT CONSENTED TO AN INSPECTION of the premises by the Building Inspec- tor to determine if the premises comply with all applicable codes and ordin- ances, other than the Building Zone Code, and therefore, no such inspection has been conducted. This Certificate, therefore, does not, and is not intended to certify that the premises comply with all other applicable codes and regula- tions. �.bze d6::r �n ,Tector FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. . . , . , . . .ZI?,536. . Date , . . . . , . . T June TT, , , , , , , , , , , , ,, 1984. THIS CERTIFIES that the building . . . . . add.. tQ ,s QQr:xd. .f1QQr. .Qf. dWg11ing, , . , Location of Property ?Q . . . . . . . . . . . . . . . . Malin. Road East .Mar,o . . House No. Street Hamlet County Tax Map No. 1000 Section . . . . .31. . Block .7 . , . . . , , ,Lot Subdivision . . . , . , . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . x . .Lot No. . . . . . . , , . . , conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . ,August. X25. . . . . > 1983.pursuant to which Building Permit No. . . 125662 September 4 dated . . . . . M . « . . . . . . . . . . . . . . . . . . . 19 .8 3. ,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 . . . . . . . . . a�1da, �ori ,to, second floor »of an. existing one-family dwelling. The certificate is issued to . . . , , , , . _ LOIS PARADISE LATIMER . . (owner,de ee-�lessee-or-tenant) of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . . . .IVA . . . . , , . , . . „ . „ » , . . . , UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . .N3A549. . . . . . . . . . . . . . . . . . . . . . . . Building Inspector Rev.1/81 f