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Home My WebLink About1000-65.-1-7 a TOWN OF SOUTHOL Rental Permit Permit No. 0107 Owner Lorraine Parra Occupied as Single Family Dwelling Located at 430 Terry Lane Southold 65-1-7 Address Village S/13/1- Maximum /B/LMaximum Permitted Occupancy 2 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. 7/9/2019 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 TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two J a � 2M Section A. Property Information: Iwo : Rental Property Address: TO-9-R- 8 Tax Map Number: 1000 SECTION --BLOCKLOT� SECTION . OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: ® 11—, "® 0 Telephone Number(s): I aytlme%3 :�1145 EveningSI. 3"E merge ncy ;( /4 Property Owner Email Address: rra 1- 1 ° (f .. Page 1 of 5 9; r a Town Hall Annex Telephone(631)765-1802 54375 Main Road #'91fa(AWk '°otam�wmr Fax(631)765-9502 P.O.Box 1179 �U ,m N moo.—uuo ,emajw .11+.,r' Southold,NY 11971-0959 BUILDING DEPARTMENT TOVAST OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent(no P.O. Boxes): gle r�' 11 I Mailing Address of Authorized Agent: Telephone Number (s): Daytime �! Evening mergency, 31-4.73 r L Email Address: IL ' Ma r 1 r Section D. Managing n 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 _Emergency Email Address: SECTION . SITE MANAGERINFORMATION: (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 s Town Hall Annex Telephone( 1)765-1802 375 Main Road Fax(631)765- 1179 Southold, 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number O: Daytime Evening_ .... . Email s.SECTION , .....,_.. F. PROPERTY DESCRIPTION: Number of Rental Dwelling its on property: _._ UN I T- -I— For each _.. .......... Rental Dwelling Unit set forth the Rental DwellingIdentifier , Unit , Unit 2, Unit , );the use of each room in the Rental Dwellingit (for example, Kitchen, , Living Room) and the dimensions room. For properties with multipleI Dwelling Units use "'Rental Permit Application Addendum.►► Rental Dwelling Unit Identifier: ?�J IT' ._... ,..... Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: mm . Use and Dimensions of each room in Rental Dwelling Unit: Page 3 f r f Town Hall Annexe Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 � i Southold,NY 11971-0959 BUILDING DEPARTMENT SECTION . 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 . DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) ) COUNTY OF SUFFOLK) q f4LPA_, 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 f Town Hall Annex Telephone(631)765-1802 54375 Main Road �w / Fax(631)765-9502 P.O.Box 1179 " ref Southold,NY 11971-0959 ` 110, BUILDING DEPARTMENT 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. 1 I 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: Property Owner's Signature: qTn Sworn to before me this day of °w ' / 20- Official -Official Notary Public Signature and Original Notary Stamp Page 5 of 5 a- BUILDINGeA TOWN OF SOUTHOLD 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] IN L [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: I DATE 6111 f*q INSPECTOR l4hort^j I Ic 0 I 7E 170 0 m c (n cr m IM -n .......... oL EL w to o ... .. ............. m . ....... C, NIf" r. CD C3 . ..... 4 ............ Ln (D f Li m 0 El 91 IS CD ........ ..... 04 o co co M ........... .......... CA ou -n 11 V1111- rc- O�u '00 . .......... 0), rn m ............�l ry ov Ln ;ul eA 44 Ln :�T X, z C, GF) ie -01 m (A O G) j I m m �^ t O (( X+ x �A wa I � all h N I t 1 J i A� iw 1 11 w � f m NI I I � JRA ,tiJr.. 4 0 li ill� �N to it r U l m _ x fl o a C m fl r I O 0 O .. , I � —r. O ......�p O O O e 3 Fy N ra to to O N T 1TT O O G' 1 y J � " I 1 1 1 J 4 I j i FORM NO. TOWN OF SOUTHOLD BUILDING office of the Building Inspector Town Hall Southold, N.Y. EXISTINGPRE CERTIFICATEc 317 0 15 MIS DWELLING Location of Prtypffrty HO ( 3.) (STREET) (HAMLET) County Tax Map . 4738,89 Section 065 Block 0001 Lot 007 substantiallySubdivision , Filed Map No. _ Lot No. - conforms ts for a ONE FAMILY DWELLING 1957built prior to APRIL 9, .__ pursuant to which CERTIFICATE OF - 31761 dated AUGUST 15 2006 was issued, and conforms to allof the requirementsthe applicable pxovisions of the law. The occupancy for whicht i issued is ONE FAMILY ]3' ttl The certificate is issued to ROBERT W�WRY (OWNER) of the aforesaid building. REPORT.SUFFOLK COUSTy DEpARTMENT, OF HEALTH APPROVAL N/A ELZMICAL CERTIFICATE NO. ___VA PLUMBERS CEWIFXCATIOK DATED __ALA *PLEASE SEE ATTACHED INSPECTION 2 Authbrizedit tsar° Rev. 1/81 BUILDING DEPARTMENT TOWN OF SO OLD IjOUSIXG CODS INSPECTION' REPORT LOCATION- 430 TERRY LA SOUTHOLD - SUBDIVISION-- M" NO. Lor (S) mm OF Omm (S)- OCcuPAMCYt SINGLE 3771?ArT.V D"LLING ADM PATRICIA 140ORE_ ACCOMPASM By- lT= STs . SAME 3W AVAILABLM: AU". CO. TU MW ED.s 5.-1-7 SOURCM OF RHOURST: PA RICIA NOORE3 ATTY 7 18 06 DRTZI 2§jj5jo6 DWELLING-s Tr]PZ OF CONSTROCTIONT WOOD FR—AMS S'MZS'- -1--o FQUEMTIOW: BLOCK--� Ca"M3 CRpJm SISM.- ToIRL ROOMS-g IST FLa..- 4 21D PLR.s 0 3RD M.s 0 BATEMCKM(S): 1.0 701LW ROOM(S) 0.0 UTZI&M ROOM(S): PORCH 7y=-. FRONT&SIDE CONCRETE ENTRY D= TM-. PJ=0 TTM: SRRKZKlW-. rmpxAm. CARA=- DOMMUMC INYMTER: __.MS— TrM MM: _ELECTRIC _ AIRCOMOrKIORM TYPE NZAT.- —M-GAS HKON AIR-3 — WT17d'XR' OTHER: ACCESSORY STRUCTURESz QRRAM, TTFM OF COWST.s 2TORRM, TrFM CONST.: SWIMMMIG POOL- Gum". Trm CONST.: OTHERN VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PRSVZNTION & BUILDING CODE LOCATION DESCRIPTION T.................. SEC 2211ARKSz BP #32271-Z-COZ-31'7'c0 JOIAS BLT" RAMP ADDITION) INSPBCTED By,a DATX ON ZKOPEMION: 22L2-6L0' MICHABI, J. VERITY T33M grENIT: 91 sm. 1,03:00 AM ........ ........ ............... FORM NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Town Hall Southold, N.Y. CERTIFICATE -3170811510 THIS C12MFIM that the building ADDITION Location of ® 43 SOUTHOLD ( .) (STREET) County Tax Map . 473889 Section 65 Block 1 Lot 7 Subdivision . Lot NO. conforms substantiallyto the ApplicationBuilding i t cr filed ' Building Permit No. 32271-Z AUGUST 4. 2006_ issued,was to all of the requirements the applicable provisions of the law. The occupancyo c this rt i t issued is "AS BUILT" RAMP ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED . The certificate n issued (OWNER) of the r it i .. SUFFOLK WaRTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO PLUMBERS CBRTIFICATICK DATED N A atki Signature Rev. 1/81 _..... ....... �......... Town of Sovabold Amon 2/25/2014 P.O.Box 1179 54375 Main Road Soutbo]4 New York 11971 CERTIFICATE OF OCCUPANCY ® 36782 Date: 2/25/2014 THIS CERTIFIES that the building ELECTRICAL Location of Property. 430 Terry Ln. Southold, SCTM#: 473889 ® 65.4-7 Subdivision: FNed Map conformssubstantially to the Applicationt heretofore filed in this officed dated 2/9/2012 / was issued,and conforrns to all of the requirementsi si or which this certificate is issued is ELEQIRIQALIERYI1Jl a The ate b issuedr (OWNER) of the aforesaid building. 'MLK COUNTY DEPANFIMENTHEAELECTRICAL CERTIFICATE NO. 36985.LTH 02-21-2014 PLUMBERS CERTIFICATION DATED i �� tr Town of Southold 2/12/2016 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 38096 Date: 2/12/2016 THIS CE RTMES that the building ELECnUCAL LocationSouthold SCTM#: 473889 Sec/Block(Lot: .-1- Filed Map No. Lot NO. substantiallyconforms Application hadofore, Med in this office dated 10/22/2014 puoa lding Permit No. 39300 dated 10/2212014 was issued,and conforms to all of the requiren=ts of the applicable provisions of the law. The occupancy for which this certificate is is: 150 ..AMP_.. i°lll l .,�"KCAL 8MVICE The certificate of the aforesaid building. a F OLK COUNTY DEPARTME,NT OF HEALTH APPROVAL ELECTRICAL CE T d CATE NO. 39300 02-02-2016 PLUMBERS CERTMCATION DATED Authorized Signature