HomeMy WebLinkAbout1000-117.-3-4.1 TOWN OF SOUTHOLD
_4
Rental Permit
0139
Owner Given JB III 2012 Irr Trt
Occupied as Single Family Dwelling
Located at 199 Old Harbor Road New Suffolk 117.-3-4.1
Maximum Permitted Occupancy 10
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.
4/30/2024
Code n rc ent Official
This Notice must be posted by the main entrance at all times
* , TOWN 0T SOUTH OLD BUILDING
� 631 -765-1802 //J-wgsw
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAI
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN;
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII
[ ] CODE VIOLATION [ ] PRE C/O [
REMARKS: 944tX�
DATE
,2�-4- 11NSPECTOR
,M y Town Hall Annex
Town Of Southold 54375 Main Road
Rental Inspection Report PO Box 1179
Southold, NY 11971-1179
Tel: 631-765-1802
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S,
CUM # ? Date �oa2
Owner Phone
A......... ..... .oo M�� w..,... . �..V �....../ �.. ...........awa... .....
ddress �/d /7R2�p Visible
Hamlet S pp Inspector
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Floor Level qu....w_.....a.,� . ............ �... ._............... . ... -......
Quantities Sub 1 2 3
bedrooms)d located in b(not lo Detecto
rs ors caero /
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Carbon Monoxide Detectors
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Fire Extinguishers
Exits
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Bedrooms 1 2 . ... .., 3✓..... 5 ... . 6
Smoke Detectors
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Occupant Count eZ
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BuildingSystems Maintained &Operational _[Condition of Property
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Heating Building interior
m Building exterior
Hot water �
.. _.Property clean, maintained
ntained &safe
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Mechanical ... Handrails& uards installed
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Pool Safety Pool on Sitew.....
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Surface water alarm Date of CO issuance ff
Pool
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ins present O's for all ate esent PriorRental .� .�.._
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TOWN OF SOUTHOLD
r
Rental Permat
0139
Owner JB Given 1112012 Irr Trt
Occupied as Single Family Dwelling
Located at 199 Old Harbor Road New Suffolk 117-3-4.1
Maximum Permitted Occupancy 10
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.
7/29/2021
Code Eforc t Official
This Notice must be posted by the main entrance at all times
-U5K4W-)- l WO
Town of Southold July,9, 2021
Building Department
Renewal of Rental Permit
Last Name:Given
Tax Map Number: 1000-117.- - .1
Permit Number:0139
Expiration Date:8/5/2021
To Whom It May Concern:
We wish to renew our rental permit as referenced above and state that there have been no changes to
the property/structure since the last inspection and issuance of the current permit.
Sincerely,
James B. Given
Trustee
199 Old Harbor Road
New Suffolk, NY 11956
Town Hall Annex
SOUTHOLD TOWN 54375 Main Road
PO Box 1179 Southold,
tRental Inspection
NY 11971-1179
r o w Tel: 631-765-1802
rFax 631-765-9502
SCTM # —.3 _Li C Date 7
Ownerj b i`lr�1�1 Phone
Address ( }����OiI' �� Zl,p 1
Hamlet N'e lA/ S v f �o Inspector
Address visible from street?
LEV11 E11 LS 3
Smoke Detectors (#-bedroom detectors excluded)
Carbon Monoxide Detectors (#)
Fire Extinguishers (#)
Exits ('#)
BEDROOMS 1 2 3 4 5
Smoke Detector Alarms (#)
Carbon Monoxide Alarms (#)
Egress(windows) (YIN)
BUILDING SYSTEMS OY CONDITION OF PROPERTY
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 pr nt
POOLS Yl- POOL BARRIERS Y/N
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 1proof when unattended
COMMENTS:
f TOWN OF SOUTHOLD
��o Gym
M- Rental Permit
Permit No. 0139
Owner_ JB Given 1112012 Irr Trt
Occupied as Single Family Dwelling
Located at 199 Old Harbor Rd New Suffolk 117-3-4.1
Address Village S/13/1-
Maximum
/B/LMaximum Permitted Occupancy 10
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.
8/5/2019 John Jarski
Date of Issue Code Enforcement Officer
This Notice must be posted by the main entrance at all times
Town Hall Annex 'N `� Telephone(631)765-1802
54375 Main Road ,.`r � Fax(631)765-9502
P.O.Box 1179'=y"
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN'OF SOUTHOLD
RENTAL PERMIT APPLICATION
Rental Permit Fee $200(Application mustbe renewed every two years)
Section A.
Property Information:
Rental Property Ad ress:
, qq
o r I
2 f
Tax Map Number: 1000 SECTION I I BLOCK 3 LOT T` I
SECTION B.
OWNER INFORMATION:
Property Owner Name: � CVV���j '�> . 6 t uen ( t-"
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
�i q,,
Telephone Number(s):
Property Owner Email Address: 61�`2�1 (J Wl
Page 1 of 4
e ,
01 �f
Town Hall Annex f °dig Telephone(631)765-1802
54375 Main Road $� Fax(631)765-9502
P.O.Box 1179 -O
Southold,NY 11971-0959 �� y
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
DENTAL PERMIT APPLICATION INSTRUCTIONS
Rental Permit Fee $200(Application must be renewed every two years)
The items listed below are required to be submitted with the completed
application.
Floor Plans:Detailed floor plans of each Rental Dwelling Unit,please show location
of all smoke&carbon monoxide detectors
Certificates of Occupancy and Pre-Certificates of Occupancy: Provide copies of
Certificates of Occupancy or Pre-Certificates of Occupancy for each rental dwelling
unit
Certification of Code Compliance(form enclosed):Applicant has the option of
having a rental dwelling unit inspected by the Town of Southold or by an architect,
engineer or home inspector of their choosing. If the Applicant elects not to have the
rental dwelling unit inspected by the Town,the Applicant must submit a Certification
of Code Compliance completed by a NYS licensed architect or NYS licensed engineer
or a licensed home inspector who has a valid New York State Uniform Fire
Prevention Building Code Certification.
Rental Permit Fee:$200.00
(Please Note:The Building Department does not accept cash. Payment must be in
the form of a Check,Credit Card or Money Order.)
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)7659502
P.O.Box 1179
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOU MOLD
Section C.
Authorized 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 Emergency
Email Address:
==
Section D.
Managing Agent Information:
Name of Authorized Agent of dwelling unit,if any: tV)
Address of Authorized Agent(no P.O. Boxes),;L
Mailing Address of Authorized Agent:,
Telephone Number(s):Daytime. _Evening Emergence
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: OL
Address of Managing Agent(no P.CS. Boxes)t. .
Page 2 of 5
Town Hail Annex Telephone(631)765-1$02
54.375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent: � - .c dam"V,
Telephone Number(s): Daytime,�3 - "A�kvening -13 A ergency 17. �6
Email Address: c Lj
h Co
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, 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: ✓ Cedaw
Requested Maximum number of persons allowed to occupy Dwell!n Unit: . 10
Number of rooms in Rental Dwelling Unit: _CIO ✓lanm ' IQ
Use and Dimensions of each room in Rental-Dwelling Unit
l�f` l ' � Il `'�c I� ' 1 15� 1• '1 �
Page 3 of 5
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(6.31)765-9502
P.O.Box 1179
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUMOLD
SECTION G.
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.
ZI m 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 H.
DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit
STATE OF NEW YORK)
COUNTY OF SUFFOLK)
l `raar'a I-,kah 1 ,.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 1 understand the Town will use the address for service pursuant to all
Page 4 of 5
Town(tall Annex Telephone(631)765-1802
34375 Main Road Fax(631)765-9502
P.O.Box 1179L
Southold,
179-
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUMCKM
applicable laws and rules. I further acknowledge that I will notifythe 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. I will notify the Town within five(5)business days as to Any change to-the information
regarding Authorized Agent; Managing Agent,or Site Mana$er.
Property Owners Name::-
Propeli ty Owners Signature-
Sworn to before me this da f
Official Notary Public Sig ature.and Qriginal Notary Stamp
MELANIE V BROWN
Notary Public,State of New York
No.01 BR4908712
Qualified in Suffolk countyAo I
Commission Expires October 19,.....
Page 5 of 5
CONSENT TO INSPECTION
e' Z
& %vtV1 V4 I�"` —e,' , the undersigned, do(es) hereby state:
Owner(s) ame(s)
That the undersigned (is) ( rthe owners of e pre ses in t e To n of
Southold, located at q I 6� D�
which is shown and designated on the Suffolk County Tax Map a istrl'ct 1 00,
Section ,Block , Lot
That the undersigned (has) (have) filed, or cause to be file, an agplicatipin the
Southold Town Building Inspector's Office for the following: K
That the undersigned do(es) hereby give consent to the Building Inspectors of the
Town of Southold to enter upon the above described property, including any and all
buildings located thereon,to conduct such inspections as they may deem necessary with
respect to the aforesaid application, including inspections to determine that said premises
comply with all of the laws, ordinances, rules and regulations of the Town of Southold.
The undersigned, in consenting to such inspections, do(es) so with the knowledge
and understanding that any information obtained in the conduct of such inspections may
be used in subsequent prosecutions for violations of the laws, ordinances, rules or
regulations of the Town of Southold.
Dated:
qk/V(Signa re)/� ,
W-V S l�
(Print Name)
(Signature)
(Print Name)
'AhpF SORoo,& UOMJ SJ��Dlk ll-+.— -5-- q • I
l UIy
* # TOWN OF SOUTHOLD BUILDING DEPT.
Quo,��'' 765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] INAL eAPuw;4
[ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
NA A AN LA
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DATE INSPECTOR
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Woodland FRONTAGE ON ROAD.
Meadowltm,od i DEPTH
`House Plot BULKHEAD
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FORK NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No. ...$..390.......... Date ...........................&1 t...9.7........eeo
_ THIS CERTIFIES that the building located at. ,..Reid..r•. �..i?�d•.11 b4iC. .......
Map No. ..mm............... Block No. ..... ............Lot No=.......W6W..04tQ ....l41A....................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.............................A ue1r,...21....... 1955$....,pursuant to which Building Permit No. IA1.2..................
dated ...............r........... t...%,........ 1959....,was issued,and conforms to all of the requirements
of the applicable 1prropvii]siio/n�ss ofthelow, The occupancy for which this certificate is issued is..............
......................... X17JG9M9:..T11w1i..6•V1 .. ��}t Atl ..........................................................................I......
This certificate is issued to 1PXGd...l3 V9t 9x..........(...iq mm)................................................I................
(owner, lessee or tenant)
of the aforesaid building.
. .....................................
CC 1
JS
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. 5