HomeMy WebLinkAbout1000-69.-4-9.1 TOWN OF SOUTHOLD
Rental Permit
0152
Owner John Sepenoski, Jr.
Occupied as Single Family Dwelling
Located at 37430 CR 48 Peconic 69.4-9.1
Maximum 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.
6/8/2023
Code Enfti<rce t Official
This Notice must be posted by the main entrance at all times
TOWN OF S
UNTi 631 -765-1802
[
FOUNDATION 1ST [ ] ROUGH PL13G.
[ FOUNDATION 2ND [ ] INSULATION/CAI
C ] FRAMING / STRAPPING [ ] FINAL
C ] FIREPLACE & CHIMNEY [ TIRE SAFETY INI
C I FIRE RESISTANT CONSTRUCTION [ FIRE RESISTANT PE"
C l ELECTRICAL (ROUGH) [ ELECTRICAL (FI!
C ] CODE VIOLATION [ ] PRE C/O [
0 tz c so (1 060v
631 -765-1802 6�7
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
] FOUNDATION 2ND [ ] INSULATION/CAL
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INS
] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE
j ] ELECTRICAL (ROUGH) [ ELECTRICAL (Fit
( ] CGDE VIOLATION [ ] PRE C/O [�
C ) o 1cl P" r-004'ex
wl
DATE c2- d 3 INSPECTOR
e� � ��'�, Town Hall Annex
SOUTHOL® ®WN 54375 Main Road
PO Box 1179 Southold,
iA
leu%� ental 10§pR_Cti0n NY 11971-1179
/M ti Tel: 631-765-1802
Fax 631-765-9502
SCTM # _ ( � � Dated
Owner Phone
Address Zip
City Inspector
LEVELS SUB 1 2 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) (Y/N)
MONSOON BUILDING SYSTEMS Y/N CONDITION OF PROPERTY Y/N
Heath , s stern maintained/operations& Building Interior is clean/maintained
� q� yst � Building Exterior Is clean l maintained
H_ot waters stem maintained/operational Bui g ....
Electrical sten! maintained/operational Property is clean /safe/ maintained
Mechanical s I'Ming:11
stem maintained/operation erationai _ Handraiis & guards present
COMMENTS:
Rental Inspection Form 4/7/2021
soft
TOWN OF SOUTHOLD BUILDING DI
631 -765-1802
INSPECTION
C ] FOUNDATION 1ST C ] ROUGH PTBG.
[ ] FOUNDATION 2ND C ] INSULATION/CAL
C ] FRAMING / STRAPPING [ ] FINAL
] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INS
C ] FIFE RESISTANT CONSTRUCTION C ] FIRE RESISTANT PEI
C ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII
[ ] CODE VIOLATION C ] PRE C/O C F
REMARKS:
W—,I , s
1� - e'—A&
OVV4 ma 1lil- b.v.log 5 ep—le,
------------
DATE INSPECTOR ,
�r
Town Hall Annex
SOUTHOLD TOWN 54375 Main Road
PO Box 1179 Southold.
Renta III s �®Cl NY 11971-1179
Tel: 631-765-1802
Fax 631-765-9502
SCTM # �" Date
Owner ..... _ � oslL-c __ ........ Phone
Address 3 � 3U G!����..���._.�w... _ Zip...�.. �..��
City Inspector
LEVELS SUB �� 2 3
Smoke Detectors (#- bedroom detectors excluded) — - --
Carbon Monoxide Detectors
Fire -xtin, uishers (#)
Exits
BEDROOMS _ 1 2 3
Smoke Detector Alarms (#) _ww_ ._..__..w. _�_- _...._ .........w_......_..... .._.............
.....
Carbon Monoxide Alarms (#) .. ... .....�__�.w__. ..... ....��w__.. _...__.... ww......-.-..
_.._
Egress (windows) (Y/N)
7____Y�_
G SYSTEMS Y/N CONDITION OF PROPERTY Y/N
Bulling Wnterior is clean /mai ntained
r� maintainedperationa�te
Bui@ding Exterior is clean /maintained
Hot waters ,�terl�z maintained/open' ional _
Electricals sten maintained/opra�tio�'ra�i _ mmProperty is clean / safe/maintained
Mechanical s sten"u maintainectt'o erational Handrails & guards present
C.
COMMENTs: _ _. F
�A A dA_ _.
Rental Inspection Form 4/7/2021
TOWN OF SOUTHOLD
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RentalPermit
Permit No.
0152
Owner John Sepenoski, Jr.
Occupied as Single Family Dwelling
Located at 37430 CR 48 Peconic 69-4-9.1
Village S/B/L
Maximum 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.
8/15/2019 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
` R
BUfEDING E�EPARTMENT
TOWN OF sou rrHoLD
RENTAL PERMIT AEPLI ATION,
Rentaj'Femit.IFee:, .00�A Ji at or.�<a a�� e,re-ne r d e�erY-,t q years)
a
Section A.
Property lnform ion:
Rental Property Address:
Lr /�
"' .,
w q 'P s-o
Tax M 'a . "
ap Number: 100
0 SECTION °� � OLOGI{ "�. .. _
b
IECTI N"B,_ L
OWNER INFORMATION:
Property Owner NaMe: J"
Pirojpeirty QWper (Legal,Address- Property Owner Mailing Address:
.( annpt be the same as IRent V Property AdOr ss)
Telephone Number (s). _
Property Owner Email Address:
'
Page 1 of 4 -
? �,"
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):
Email Address-'
Section D.
i
Managing Agent Information:
s
Name Authorized Agent ofdwelling unit, if any: '"
Address of Authorized Agent (no P.O. Boxes):
Mailing Address of Authorized Agent:
Telephone Number(s):
Email Address: `
x
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):
Mailing Address of Managing Agent:;
Telephone Number(s):
Email Address:
Page 2 of 4
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."
G
r
Rental Dwelling Unit Identifier:. . _.
Requested Maximum number o_f persons allowed to o cupy Dwelling U
4
Number of rooms in Rental Dwelling Unit: . ...
Use and Dimensions of each room in Rental Dwelling Unit: ... -t- "0e .
Loll " '
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 NYS Iicensed-architect,a NYS 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.
Page 3 of 4
❑ I am submitting a completed Town of Southold certification form from a licensed
architect, a licensed professional engineer, or a licensed home inspector who has a valid
New York State Uniform Fire Prevention Building code Certification.
SECTION H.
DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit.
STATE OF NEW YORK)
COUNTY OF SUFFOLK)
I:��`'. : " �"� ,certify,under penalty of, erjuryAhe°foNa inge.
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 a
applicable laws and rules. I further acknowledge that I will notify the Town of Southold
k
Building Department of any changes of address within five (5)idays of any changes
thereto.
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 s to any change to the information
regarding Authorized Agent, Managing Agent, or Site Manager.
Property Owner's Name: .-
Property
ame: —Property Owner's Signature:
fy
Sworn to before me this day of i µ 2p,
Official Notary Public Signature and Original Notary Stamp
SABRINA M BORN Page 4 of 4
Notary Public,State of New York
No.0160 0170 It,Suffolk County
Commission..Expires Dec.22,20
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BUILDINGTOWN OF SOUTHOLD
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ FINAL `
[ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
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INSPECTOR
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� yytgt Town of Southold 8/15/2019
"; 53095 Main Rd
Southold,New York 11971
E EXISTING
CER'" I °ICATE OF OCCUPANCY
No: 40623 Date: 8/15/2019
THIS CERTIFIES that the structure(s)located at: 37430 CR 48,Peconic
SCTM#: 473889 Sec/Block/Lot: 69.4-9.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the requirements for a built prior to
APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 40623
dated 8/15/2019 was issued and conforms to all the requriements of the applicable provisions of the law.
The occupancy for which this certificate is issued is:
wood frame one family d renin r with €:essor arage.*
Note:131143916 cicctrical siMQQ40622
The certificate is issued to Sepenosld Jr, John
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
LL. Au lao " d Signature
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 37430 CR 48,Peconic
..............
SUFF.CO.TAX MAP NO.:..... _ _._ . .....................................�..._..........
_.........�.
O.: 69.-4-9.1 SUBDIVISION:
NAME OF OWNER(S): Sepenoski Jr,John
OCCUPANCY:
ADMITTED BY:
SOURCE OF REQUEST: Sepenoski Jr,John � DATE: 8/15/2019
DWELLING:
#STORIES: 1 #EXITS: 2
.
FOUNDATION: cement block CELLAR: CRAWL SPACE:
BATHROOM(S): 1 TOILET ROOM(S): UTILITY ROOM(S):
PORCH TYPE: DECK TYPE: PATIO TYPE:
BREEZEWAY: FIREPLACE: GARAGE:
DOMESTIC HOTWATER: yes TYPE BEATER: g...—
as AIR CONDITIONING:
TYPE HEAT. gas WARM AIR: _HOT WATER: baseboard
_.....
#BEDROOMS: 1. #KITCHENS: 1 BASEMENT TYPE:
OTHER:
ACCESSORY STRUCTURES:
GARAGE,TYPE OF CONST: wood frame STORAGE,TYPE OF CONST:
SWIMMING POOL: GUEST,TYPE OF CONST:
OTHER:
VIOLATIONS:
REMARKS:
INSPECTED BY: JOHN) DATE OF INSPECTION: 6/27/2019
TIME START: 11:12am END: 11:25am
tt " Town of Southold 8/15/2019
P.O.Box 1179
53095 Main Rd
Iry
4° Southold,New York 11971
" »:cr;rerrt
CERTIFICATE OCCUPANCY
,ANCY
No: 40622 Date: 8/15/2019
TMS CERTIFIES that the budding ELECTRICAL
Location of Property: 37430 CR 48,Peconic
SCTM#: 473889 Sec/Block/Lot: 69.4-9.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
6/28/2019 pursuant to which Building Permit No. 43916 dated 6/28/2019
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:
electrical sure and 100a overhead electric service..
The certificate is issued to Sepenoski Jr,John
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 43916 7/16/2019
PLUMBERS CERTIFICATION DATED
ut o ',.e Signature