HomeMy WebLinkAbout1000-88.-4-34 'V,
TOWN OF SOUTHOLD
f'
Rental Permit
0105
Owner Melvin Parker
Occupied as Single Family Dwelling
Located at 905 Bay Haven Ln Southold 88.-4-3!�
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.
7/5/2023
Code Enf rce4, t Official
This Notice must be posted by the main entrance at all times
TOWN OF SOUTHOLD
r
a
Rental Permit
Permit No. 0105
Owner Melvin Parker
Occupied as Single Family Dwelling
Located at 905 Bay Haven Lan( Southold 88-4•--31
Address Village s/g/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.
7/8/2019 John Jarski
Date of Issue Code Enforcement Officer
This Notice must be posted by the main entrance at all times
TOWN OF SOUTHOLD BUILDING
631-765-1802
INSPEC ION
[ ] FOUNDATION 1ST [ ] ROUGH PL13G.
[ ] FOUNDATION 2ND [ ] INSULATION/CAU
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INS
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PEI
[ ]
ELECTRICAL (ROUGH) [ ] ELECTRICAL {FII
CODE VIOLATION [ ] PRE C/O P F
; � "
Town Hall Annex t 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 years)
P3y .:won
Section A. � ��.� �, � 201
Property Information:
Rental Propert� Address: 4y' N(V SOLS 11 �
CC
Tax Map Number: 1000 SECTION b -BLOCK -LOT _
SECTION B.
OWNER INFORMATION:
Property Owner Name:
Property Owner Legal Ad/dreJss:/ Property Owner Mailing Address:
Al 11.. 1
Telephone Number(s): Daytime �!� S� Evening Emergency
Property Owner Email Address: � e"r,9'U
"),C-M r
Page 1 of 5
s
Town Hall Annex v�y Telephone(631)'765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1 179 �*
Southold,NY 11971-0959
BUIL DING DEPARTMENT
TOWN OF SOUTHOL D
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any:
Address ofAuthorized Agent (no P.O. Boxes): _
Mailing Address of Authorized Agent:
Telephone Number(s): Daytime Evening (Emergency
Email Address:,,
Section,I .
Managing IInforma :i6 :
Name of Authorized Agent of dwelling unit, if any:
Address of Authoriz.ed�Agent jho R.O. Boxes_): �r
Mailing Address of Authorized Agent:
Telephonii'Nuirnbelr(s): Daytime .Evening Emergency
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)..,
Page 2 of 5
lk..
Town Hall Annex Telephone(631)76.5-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1 179
Southold,NY 1 1 971-0959
BUILDING DEPARTMENT
TOWN OF S.OUTHOLD
Mailing Address of Managing Agent:
Telephone Number(s): Daytime ,Evening Emergency
Email Address:
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units 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 Dental Dwelling Unit
(for example, Kitchen, Bedroom 1, Bedroom 2, Living Room) and the dimensions of each
room. _
For properties.with.multlple Rental Dwellin.g,Units use ,'Rental,Permit Appl°i-cation
Addendum."
Rental DwellingUnit
Identifier: 0 �� e,
Requested Maximum number of persons allowed to occupy Dwelling U t:
Number of rooms in Rental Dwelling Unit: Y 0 0
Use and Dimensions of each room in Rental Dwelling Unit:,
Page 3 of 5
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
Y.O.Box 1 179 k
Southold,NY 11971-0959
of
BUILDINGDEPARTMENT
TOWN OF SOUTHOY D
SECTION G.
INSPECTION:
Pursuant to the Town:Code,of.the Town,of.5outhold,.Chapter207 (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.Codlr Certification is.leclgiired 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.a"nd
by the laws adopted by the New York State Fire Prevention and Building Code Council.
V/11 am requesting a fire safety inspection to be performed by' 'a Cade Enforcement Official
from the Town of Southold .
❑ I am submitting a completed Town of Southold ertif cation form fro ,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)
COUNTY OF SUFFOLK)
I, l /� �✓"� certify under penalty of perjury,the following:
1. 1 am the owner of the property identified,.i,n."Seir1o17 A'°of this application.
2. The property owner's legal address set., C mi i ' e Torr 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
?t
Town Hall Annex Telephones(631)765-1802
54375 Main Road Fav(631)765-9502
P.O.Box 1 179
Southold,NY 11971-0959
ve " r j "
BUILDING.DEPARTMENT
TOWN-OF BOUT HOLD
applicable laws and rules. I further acknowledge that I will notify the Town of Southold
iUid"Mg Dep:rar°trnlit ofany chao s cif ad&d °Wfhifi five (S) day ,, f any chahgeis
thereto.
3.. Ihave 'reg d reg 6verc�'a c �py'�r 1.6r °.�t ob�20y�, i"i�l iiu��'1�1' d':�� a��f the�'lll..i�'N" i� of q�)lnh�'bld �auii1d
agreed to aul,)id byih e a irne,
4. l wili notify the Town within five (5) business days as to any chnange to the information
_> a
regarding Authorized Agent, Managing Agent, or Site Manager.`
Property Own el's Na'rrie:
(L
Property Owner's Signature: A2::� ............
}
Sworn to before me thi day of 2
� w ^
Official Notary Public Signature and Original Notary.Stamp
o0NNIt O.13UNCH
Notary Public,State Of NOw York
No.01 BU618W50
Duelaied in Suftlk County
Commission on xpires April 14,
Page 5 of 5
Lh/ Sa✓-�o Id
° O
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
i
[ ] FOUNDATION 2ND [ ] INSULATION
[ ]
FRAMING STRAPPING [IIINAI-Xe4�4
] FI
REPLACE & CHI N [ IRE SAFETY" INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
I
[ ] CODE VIOLATION [ ] CAULKING
aREMARKS:
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FORM NO. 4
� S
TOWN OF SOUTHOLD
BUI?DING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
UPDATED
CERTIFICATE OF OCCUPANCY
No: Z-28277 Date: 03/13/02
_._....
THIS CERTIFIES that the building NEW DWELLING�
U
Location of Property_ 905 BAY HAVEN LA S UTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 88 Block 4 Lot 34
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
_
filed in this office dated SEPTEMBER 21, 1999pursuant to which,
Building Permit No. 28138-Z dated NOVEMBER 8, 1999
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 COVERED FRONT PORCH ANDATTACHEDONE CAR
GARAGE AS APPLIED FOR..
The certificate is issued to DONALD D & DONNA M ZIMMER
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVALR10-99-0135 - 0"5/2700
ELECTRICAL CERTIFICATE NO. 42827 05/09/00
PLUMBERS CERTIFICATION DATED 05/19/00 G.A.H. PLUMBING
This Certificate of Occupancy replaces 40# Z-27110
A a .Aorized Sig ture
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-29161 Date: 12/30/02
THIS CERTIFIES that the building ADDITION
Location of Property: 905 BAY HAVEN LA �.� SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 88 Block 4 Lot 34
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 6, 2002 pursuant to which
Building Permit No_ 28158-Z dated MARCH '11, 2002
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 "AS....._..I BUILT" DECK ADDITION AS APPLIED FOR,
The certificate is issued to MELVIN
& DIANE PARKER
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED _ ..m._._......N/A_
._. _.. 1/ized SZ gnature
Rev. 1/81