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Home My WebLink About1000-63.1-1-8 - '" Falk -tL � 3 RentalOWN OF SOUTHOLD C� Permit Permit No. 0155 Owner M & G Wilson Fm. Mng. Tr. Occupied as Single Family Dwelling Located at 2555 Youngs Ave Unit 2C Southold 63.1-1-8 Village S/B/L Maximum Permitted Occupancy 4 _............... ... 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. 8/16/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times Auk- 01 Town Hall AnnexXr, Telephone(631)765-1802 54375 Main Road tiff Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 mm, BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION,: -BLOCK' �` -LOT SECTION B. OWNER INFORMATION: Property Owner Name:. _4_ L, 4401, a 'r�sf Property Owner Legal Address: Property Owner Mailing Address: D r rb i Aj I 'i.,IP7F �3i - ' 7;;'-- Telephone Number (s): Daytime / Evenin. / 2 Emergency /&_2/ Property Owner Email Address::t-69iA5 "k, ry c, Q5 Page 1 of 5 � 1 � �Y j fla Town Hall Annex Telephone(631)765-1802 54375 Main Road �' Fax(631)765-9502 P.O.Box 1 179 ri �• � Southold,NY 11971-0959 y l ro BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any:V)/d1 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:k M Address of Authorized Agent (no P.O. Boxes)::_ Mailing Address of Authorized Agent: Telephone Number (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:_..... �1 Address of Managing Agent (no P.O. Boxes): Page 2 of 5 Town Hall Annex � ��1 Telephone(631)765-1802 _54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 1nn BUILDING DEPARTMENT TOWN OF SOUTHOLD 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 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: C- Requested Maximum number of persons allowed to occupy Dwelling /IV,116�2— ,J Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: ,-vl dd /l ` ®` 4210 r� Page 3 of 5 Town Hall Annex IV, Telephone(631)765-1802 54375 Main Road { Fax(631)765-9502 Y.O.Box 1 179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD 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. I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ 1 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) certify under penalty of perjury, the following: f4! ` , L 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 w, Town Hall Annex " Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 k� Southold,NY 11971-0959 " UN BUILDING DEPARTMENT TOWN OF SOUTHOLD 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. 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 regarding Authorized Agent, Managing Agent, or Site Manager. Property Owner's Name: 4i Property Owner's Signature: Sworn to before me this�day of d .. , 20� Official Notaryn� �___ Public Signature and Original Notary Stamp CONNIE D.BUNCH Notal Pubti ,State of Now Y06, No.OI OIC 619 Qualified in SuffoW ou Commission Explm5 A.n0 "14 Page 5 of 5 Avg- �/040 a 1 � TOWN OF' SOUTHOLDBUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] INAL ?��td� [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING I REMARKS: ve DATE i 4 t l 1 / n� ye, > AF W pp , PL LULJ ,t O 1 o l cc�. � O ol CC IC 1 00 , 0 dc 4C 11 11C us 0r mom [TJr� ' 1Ca 1 1 1 MM I d �µ LULL y, z o . v Ln I � s m NJ o r � , ro OQ 71 y r � �r< II� e e P. wig u � , , , 1 ........... i Ni sit {I IIry oll,//,)),,l,,,//"ow"','),w FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z.13 4 21. . . . . . . . . . Date . . . . . . . . M a.y .9. . . . . . . . . . 198 5 THIS CERTIFIES that the building . . . , .MULTIPLE D W E L LING Location of Property .25,5.5 _ YOUNGS, AVENUE UE SOUTHOLD House No. Street . . . . . . Ham/et County Tax Map No. 1000 Section , .0 6 3 . . ,Block . _00.1. . . . . I . .Lot . , .?8 & 29 „ Subdivision . . . . F 0,U N D E R S „V I L.L A G E. . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated Nov. . _1.7 . , . . . . . _ . 1 19 8.3 pursuant to which Building Permit No. . . , 1 .8 4 0 Z n dated . . . Jan ; 1 7, , , .. . . . . . . . . . . . . . 19 A4 ,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 , . , . . . . . . BUILELlNG. 4.2 .Ap.t, .2.-.0 .Uni-t .in. Multiple. dwelling. . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . . . . L I Z D A REALTY LTD . (owner, " & tX X. . . . . . . . . . . . . . . . . . . . of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . .S-5.4. . „ . , . „ . UNDERWRITERS CERTIFICATE NO. . . . . . . „ . . , N 6 8 7 31 0 Flumbers Certification April 25 , 1985 ti� oma,. Building Inspector y + Rev.1/91