HomeMy WebLinkAbout1000-110.-5-37 _
T U N OF "0" 2THOLDRental Permit
"W" b U
0147
Owner Andrew & Ellen Folts
Occupied as Single Family Dwelling
Located at 240 West Road Cutchogue 110-5-37
Maximum Permitted Occupancy 6
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.
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8/24/2021
Code Enforcement Official
This Notice must be posted by the main entrance at all times
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SOUTHOLD TOWN Town Hall Annex
0xzp 54375 Main Road
o Rental Inspection PO Box 1179 Southold,
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NY 11971-1179
Tel: 631-765-1802
. .°� Fax 631-765-9502
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LEVELS5 �
Smoke Detectors (#- bedroom detectors excluded) ESC j
Carbon Monoxide Detectors (#)
Fire Extinguishers (#)
Exits(#)
BEDROOMS 5<
Smoke Detector Alarms (#)
Carbon Monoxide Alarms (#)
Egress (windows) (Y/N)
7
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BUILDING SYSTEMS YIN (CONDITION OF PROPERTY Y/N
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/operationa'C vr Handrails&guards present
POOLS Y N POOL BARRIERS Y/
Pool present Pool is completely enclosed All 0
Pool surface alarm and/or door alarm Barrier is a min.48" high
resent
POOL GATES Y/f4 All openings in barrier less than 4" WA
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:
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s�FFotx�o TOWN OF SO-UTHOLD
Rental Permit
Permit No. 0147
Owner Andrew & Ellen Folts
Occupied as Single Family Dwelling
Located at - 240 West Rd Cutchogue 110-5-37
Address Village S/13/1-
Maximum
/B/LMaximum Permitted Occupancy 6
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.
8/12/2010 John Jarski
Date of Issue- Code Enforcement Officer
This Notice must be posted by the main entrance at all times
94jM A -A
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 , f'
BUILDING DEPARTMENT JUN 1 ;
TOWN OF SOUTHOLD 2019
RENTAL PERMIT APPLICATION,
TO"*V,N OF souy s Z��
Rental Permit Fee$200(Application must be renewed every two years) Y
Section A.
Property Information:
Rental Property Add s :
_ .
Tax Map Number: 1000 SECTION,,- -BLOCK LOT., 7,
s
SECTION B.
OWNER INFORMATION:
Property Owner Name:-,A,Jo_� � �� �`� � -
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Property Owner Legal Address: Property Owner Mailing Address:
t 9 = r -j I/k,- o
?g�9; 2
Telephone Number(s): Daytime � 3q3qEvening Emer enc
Y
Property Owner Email Address: AF0 Gl)�.4 ;
Page 1 of 5
Y
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax`(631)765-9502
_P.O.Box 1179
Southold,NY•141971-;0 59
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PERMIT.APPLICATION INSTRUCTIONS
Rental Permit Fee $200 (Application must be renewed every two years).
Y:3
The items listed below are required to be submitted with the completed
application.
® Floor Plans: Floor plans of each Rental Dwelling Unit, please show location of
all smoke &carbon monoxide detectors. ;,
/certificates of Occupancy and Pre-Certificates of Occupancy: Certificates of i»
occupancy or Pre-Certificates of Occupancy for each rental dwelling unit. _ _ _ __ J7
❑ Certification of Code Compliance(form enclosed): Must be submitted by a
license architect or engineer or license home inspector if an inspection by Town of
Southold Inspector is declined.
❑ Rental Permit Fee: $200.00 '
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1 179 s A
Southold,NY 11971-0959x
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent:
Telephone Number(s): Daytime,,_ w Ev Emergency
Email Address: _
SECTION F.
PROPERTY DESCRIPTION:
A'Y
Number of Rental Dwelling Units on property:
For each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier(for example, °f
Unit 1, Unit 2, Unit 3 or Apt A, B, Q 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."
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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:'
foo
f�AUdsn ,2 � V7 24
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
TOWN OF SOUTHOLD
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: �k
Section D.
Managing 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:
1
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):
v
Page 2 of 5
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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
i
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 ,a
thereto.
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3. 1 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
j
regarding Authorized Agent, Managing Agent, or Site Manager.
Property Owner's Name:_ Vt. r
Property Owner's Signature:
s$
Sworn to before me this_day of 20��
Official Notary Public Signature and Original Notary Stamp
t
CONNIE D.3i NG6
Notary Public,State of New
No.01 BU6185050
Qualified in Suffolk Coiwi�
Commission Expires Ansi
Page 5 of 5
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Town Hall Annex � . Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
CP-
px}.Box /\79
Southold,NY 11971-0959 .
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BUILDING DEPARTMENT ,
TOWN OF SOUTHOLD
�
SECTION G. �
INSPECTION: . ^
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Pursuant tothe Town Code ofthe Town ofSouthold Chapter 3O7 (Rental Pnop asefot« /
inspection 6mCode Enforcement Official isrequired. |fthe owner chooses not tohave 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 isthe subject
.�
of the rental permit application is in compliance with all of the provisions of the code of the ,
Town mfSouthold,the laws and sanitary and housing regulations ofthe County ofSuffolk and �
by the laws adopted bythe New York State Fire Prevention and Building Code Council. !�
�04am requesting a fire safety inspection to be performed by,a Code Enforcement Official �
from the Town ofSouthold '^
. �
`
[] 1 am submitting a completed Town of Southold certification form from a licensed `.
architect oralicensed professional engineer. �
�
SECTION H. � Q
DECLARATION: Signature must be notarized and MUST bethe owner mf the dwelling unit. �.
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STATE OFNBNYOR0 ^
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,
COUNTY OFSUFFOLK)I,, An, r
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certify under penalty ofperjury,the following:
1. | annthe owner ofthe property identified in "Section A"ofthis application. �
2' The property owner's legal address set forth in "Secti6ri 13�ofthls'application is my legal �
address and I understand the Town will use the addres§46r service pursuant to all '
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Page 4of5
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1 -
of
SOUIyo�
# # TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] INAL
,&r/Wt
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
RE RIGS: I ff`'r "d-.,
y � N *e,
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L
DATE INSPECTOR
Z 0 � �a vii► 1n.
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# * TOWN OF SOUTHOLD BUILDING DEPT.
coum��'' 765-1802
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPINGVFIRE
INAL�G� �,IG•ZFIREPLACE & CHIMNEY SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
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61 IVA
0 T� fo Six V4��f �
DATE INSPECTOR
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_ TOWN OF SOUTHOLD PROPERTY RECORD
OWNER STREET f: elf i VILLAGE DIST. SUB. LOT
l ti Fro f - I y.� - 3 J{ .,i" �.;
I-ORMER OWNERGt� < 'I�t E l0 ACR. '
`nAhe"I -W-r G.� IIS -Catl(D,
S W TYPE OF BUILDING
rt�r s�J-r�J 10,!✓��f t'1 D � _r• �f
1 RES. �? SEAS. VL. FARM COMM. CB. MICS. Mkt. Value
LAND IMP. TOTAL DATE REMARKS Jte V� /!ld
/
/ �r✓ 3 3 d '7 .�� �'/2/;�4 �1a/c:' �vp0a� �/aJ�,e� Tia /�i� v
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I �'c7 r� �f� i li "�,J C7 �fEJ .7°�!`�!`" lCl�r Y'Zzt.0 -/e? rDt-, })E 4- 01,`�
lao�/flS�L I s lin��-- YYl-c3r�e 5 (A-tt,�
AGE ` BUILDING CONDITION
NEW NORMAL I BELOW ABOVE
FARM ( Acre Value Per Value
Acre
Tillable i FRONTAGE ON WATER
Woodland FRONTAGE ON ROAD
Meadowland DEPTH
House Plot
Bid L-K- EAT(B�,j"�,.,��.
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Total f ' I 9GC-iC
COLOR - TRIM
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4- TI
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�:r�' 3^' �+.n AF:hr-"��r'"'"��,.sca '�'•�dk,.2:��,;•�'�+,'�"'�rc.�,...,,� 1 F+ — V.� _�_ __ —_� ,
b q / ,J/
17 T
i G
M. Bldg. �\ s , _ I ! I
f
Extension
Extension
5`,C � �., ,� � ✓ � � aha° I � I � I i � i f I i � f
Extension
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(Foundation , Bath ,Dineite
PorchBasement Floors J
.orch
�, Interior Finish I ! P.
_ 5 x �1-1/ Ext. WaIIs 1(� ,
jr � , -��r �, C� a , " i qo i Fire Place 4 Heat o� �DR.
Garageyp t, I Type Roos: Rooms lst Floor SR.
! Patio _ —� Recreation Room Rooms 2nd Floor I FIN. B
1 i i
0. B. ` Dormer !Driveway j
Total —
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y
CORRECTED
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No 30726 Date JANUARY 27, 2005
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 240 WEST ROAD CUTCHOGUE, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 110 Block 5 Lot 37
Subdivision Filed Map No. Lot No.
conforms substantially to the Requirements for a One Family Dwelling built
Prior to: APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z-30726 dated JANUARY 27. 2005
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
I
issued is ONE FAMILY DWELLING WITH ACCESSORY GARAGE*
The certificate is issued to CAROL A. MORRIS
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*THIS CORRECTS PRECO Z-9564 DATED 6/22/79 TO INCLUDE ACCESSORY GARAGE.
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i Authorized Sign ure
Rev. 1/81
BUILDING DEPARTMENT
O',-,'N OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location 240 West Road Cutcho ue, New York
number & street Municipality
Subdivision --- Trap No. --- Lot(s) ---
Name of 0%,mer(s) Da-id C. & Anna Mae Walker
Occupancy R-1 Owner
(type) owner-tenant
Admitted by: Mrs. Walker Accompanied by: Mrs. Walker
Key available Suffolk Co. Tax No. 1000-1 10-05-037
Source of request James E. McGiff, Esq. Date June 19, 1979
DITELLING
Type of construction Wood frame rstories two
Foundation cement block Cellar 3/4 Crawl space rest
Total rooms, 1st. Fl 5 2nd. Fl 3 3rd. Fl xxx
Bathroom(s) 2 Toilet room(s) xxx
Porch, type screened in Deck, type xxx Patio, type xxx
Breezeway xxx Garage xxx Utility room xxx
Type Heat electric 71arm Air_ xxx Hotwater xxx
Fireplaces) one No. Exits four Airconditionirg xxx
Domestic hotwater yes Type heater electric
! Other
ACCESSORY STRUCTURES:
Two Garage, type const. wood Storage, type const. xxx
Swimming pool^ xxx Guest, type const. xxx
Other
VIOLATIONS: Housing Code, Chapter 52
Location Description Art. Sec.
back step Step too-high
Remarks:
Inspected by:�U,rl _Date of Insp. June 22, 1979
!' r+ic Hnrton Time start: 10:30 aend 11 :00 am
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold,N.Y.
Certificate Of Occupancy
No. . . .. . . . .7 . . . . . . Date . . . . August. .. . .' 86
. . . . . . . . . . . . . . . .. 19 .
deck addition
THIS CERTIFIES that the building . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Location of Property ,24o West- .Road. . . ,: . . , Cutchogue ,• •New. York
Hose No. � Sheet *Ham/er
County Tax Map No. 1000 Section . . .1 10. . . . . .Block . . . . . Q5. . . . . . . .Lot . . U 7. . . . . . . . . . .
Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . .Lot No. . . . . . . . . . . . . .
conforms substantially to the Application for,Building Permit heretofore filed in this office dated
D e. .e m. e r . 10.,- , 19 8'4 pursuant to which Building Permit No. . . . . 6 4,7 Z , , , . .
daM&e. . e r 21 , . . . . . . . . . . . . . . . 19 $4 ,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 . . . . . . . . .
Deck addition to existing dwelling.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The certificate is issued,to . . .. . . . .Arnold Blair - : . - : - . . .
{owner,tYixtl�r�t�
of the aforesaid building.
Suffolk County Department of Health Approval . . . . ,N/A . , . , , , , , , , , , , , , , , , , ,
UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . , FAA ... . . . . . . . . . . . . . . . . . . . . . „ -
• • - - . .
BuildingInspector
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Rev.1181
- �''suFFotK
o�p Town of Southold 8/12/2019
P.O.Box 1179
53095 Main Rd
y�oaf¢ Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 40608 Date: 8/12/2019
THIS CERTIFIES that the building HVAC
Location of Property: 240 West Rd,Cutchogue
SCTM#: 473889 Sec/Block/Lot: 110.-5-37
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
8/7/2019 pursuant to which Building Permit No. 44046 dated 8/7/2019
f 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:
i AS BUILT HVAC SYSTEM AS APPLIED FOR
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The certificate is issued to Folts,Andrew&Ellen
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 44046 08-08-2019
i PLUMBERS CERTIFICATION DATED
Authorized Signature
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