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HomeMy WebLinkAbout1000-17.-6-11 r TOWN OF SOUTHOLD 17 Rental Permit} 0157 Owner 170 Oysterponds LLC Occupied as Single Family Dwelling Located at 170 Oyster Ponds Lane Orient 17.-6-11 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. 8/10/2021 Code Eforc � Official This Notice must be posted by the main entrance at all times SOUTHOLD TOWN Town Hall Annex " mw 54375 Main Road PO Box 1179 Southold, Rental Inspection NY 11971-1179 Tel: 631-765-1802 Fax 631-765-9502 SCTM # — - ` Date Z r Owner 1-7 O 01)dS I/ Phone Ay? Address Zip Hamlet orie. Inspector Address visible from street? LEVELS SUE 3 Smoke Detectors (#- bedroom detectors excluded) Carbon Monoxide Detectors (#) Fire Extinguishers (#) Exits (#) BEDROOMS 1 2 Smoke Detector Alarms (#) Carbon Monoxide Alarms (#) Egress(windows) (Y/N) BUILDING SYSTEMS fflN 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 raintainedloperational Handrails &guards present POOLS POOL BARRIERS / Pool present Pool is completely enclosed Pool surface alarm and/or door alarm Barrier is a min.48" high resent POOL GATES Y/N lAII 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 proof when unattended COMMENTS: -C To Cc eoijf�� g TOWN OF SOUT OL R Rental Permit Permit No. 0157 Owner 170 Oysterponds LLC Occupied as Single Family Dwelling Located at 170 Oyster Ponds Li Orient 17-6-11 Address Village S/B/L 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. 8/16/2019 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 1 179 ` Southold,NY 11971-0959 BUILDING DEPARTME1`'t TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a license architect, licensed engineer or-licensed home inspector Separate form is required for-tach individual Rental!Dwelling Unit m Rr°c essl sea're ]rued. or r h tl ct°ar n neer ll erset `' larrle:Ihs ea a rai s i 1de co oraid carrier ce l atian Rental PropertySCTM Number: Ll Rental Property Address: f,7 0 q s G 9 7 f ner/ a e: 1 -7 0 , Lw.<:� Rental Dwelling Unit Identifier: 1 Number&Square footage of each bedroom as depicted in the attached floor plan: .e ('rBedroom#1-100 sq., Bedroom #2-:90 sq., etc.) _ - '. Property Description (Include all improvements indicated on survey) 9 I certify that I have done a physical inspection of the subject rental dwelling unit and find that it fully complies with all the provisions of the Code of the Town of Southold,the Residential Code of New York State,the Building Code of New York State, the Plumbing Code of New York State, the Fuel Gas Code of New York State, and the Energy Conservation Construction Code of New York State. Cf�R�- c_, RLkT7 s t� a �l r OF NE Print Name and Title r �� �, O ig,inal Signature Please place professional seal: W ctl qtic Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 BUILDING DEPARTMENT TO OF°S6 O. RENTAL PERMIT APPLICATION-, l eo,Aai Permit Fee$200(Application must be renewed every two years) oti 3 Section A. Property Information: Rental Property Address t Number: 1000 SECTION- (51,771 �i�f� � -LOT I Tax Map Nu - SECTION B. OWNER TIO Property Owner Name: 0 © � TFf - '9 S L—L- C-- :k Property Owner Legal Address:, Property Owner Mailing Address: I j °. Telephone Number (s): Daytime Evening Emergency Property Owner Email Address: l�1 : 'z V .. 6 Uf A tin cc al a Page 1 of S i ' + Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 too P.O.Box 1 179 Southold,NY 11971-0959 you 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 Emergen Email Address: Section E.). Managing Agent Inforririationi: 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): Daytimea ' 16 0wehin G Emergen(y .. Email Address: �+" - SECTION E. SITE MANAGFR INFORMATION: (requirgd)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 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 " . . BUILDING DEPARTMENT TOWN OF souTHOLD , Mailling Address of Managing Agent, �. -wep hone Number(s): .......... IEmergenoy' _.. 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, C);the use of each room in the Rental Dwelling Uriit (for example, Kitchen, Bedroom 1, Bedroom 2, Living Room) and the dimensions of each room. 'i For properties with multiple Rental Dwelling Units use."Rental Perm it.Application Addendum." 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 : I 'r 11 f Lei Page 3 of 5 r Telephone(631)765-1802 Town Hall Annex Fax(631)765-9502 54375 Main Road Y.O.Box 1 179 Southold,NY 11971-0959BUILDING DEPARTMEN'r TOVVN Ota, 1 UT1101M SECTION G. INSPECTION Pursuant tolife Town Code of the Town:of Southold Chapter 207 (Rental Pro:perties-)i 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 Cod e`Certificatiorf 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 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) I - ? ;,.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 I understand the Town will use the address for service pursuant to all Page 4 of 5 X Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 r Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD applicable laws and rules. I further acknowledge that I will notify the Town of Southold Building p an De artment of changes-.of address within five (5)(5) days of any changes; Y g thereto. a , r 3. !.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: t70 0 C— r �ww Property Owner's Signature: )zz °� r / day A �' 2Q_ DENISE A. NAVARRA Sworn to before me this NOTARY PUBLIC STATE OF NEIN YORK -- No: O1 NA6191295 �� 0 Qualified in Suffolk Ounx �� tial Notary Public Signature and Original Notary Stamp My Commission Expires 1 rv' it Page 5 of 5 Y ky oK✓ w/ (-70 1 i l � ' fa j (lip 4 JIL —4 � w�� u pati . � �\ . . . . . . .�, �����.m .� \� � .� , . %� � y� : �\ . <�,�. , / �� � � � \,.� � , ... �� � . . � :.��_ \ � � �� . . d � � � � � � � . \ . \ � . � �. �� } ` ` � � � � \ � � \ ` \ } � � � } :�z: , � . 7�_�__�_�_�����.�.:�. �:�. ���:,..,��..,�...,�{ ,�. .j I a _ir m p O n = — _ U) r' vvi �- 3 a a �,. Z Q o m m FDo Z m o a 3 °" w N m ; �b�", a `a i s y rvi m03 CD L — P V rn 03 C � y Z ,, < � _ 0 3 � w - � mm �3 I C m� 1 a . ; y n N � � I ni "G rn �7 4 I Ln �1 VIII I L, C i 1 1 tv 1 � C .;..,.--,......, �.� m�ataa 0.➢l wea r. dG,'�'SiP�r�aw rr� i �r�w�.msmM1H^,wkri'DNPIW'Ma'm��roMbw'Mlu.".vYmrv'w wowwu anew-,. .,a oXM ro O N (D �• �• �• �- , C) 7 7 3 td I _J I uuu i _t 1 /' wn t E „p ........... ... _ `G (p N rt O ,,,,,,.,,. iii ,,,..... .m............mw, .........�.�a.. ... .. ,,......... ,,.e,. � V w kI w T OJ 3 f1 0 a. L� A , FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. A.13.3 Date ............................W4....9........ ., ]9 9.. THIS CERTIFIES that the building located at....... .......... Street Map No. .....X=........... Block No. .......=.........Lot No.xx..........Orient..........NoXe.................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......L.l.'". . ....Ai t.....P-9.......... J 19.A9., pursuant to which Building Permit No. . �..$f��............... dated ........................ ....... 19.0.,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.............. ....................Px'.lya t o..one..X=�a,y...dxalling...,. ...,,......,. .».,..........---........................ ...,..,. This certificate is issued to ... . .. !& "w; a ...... ........E. .f '}...- ........... ...........,...» (owner, lessee or tenant) of the aforesaid building. ...... ....... ..............». Buiylding ..lnspectorN w FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall i Southold, N.Y. w 1 Certificate Of Occupancy No.:7 2.229. . . . . . . . Date . . . 'A.NUARY .25. . . . . . . . . . . . . . . . i9 F34 THIS CERTIFIES that the building .ACCESSORY. . . • . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property 170. .oysterpond .lane . . . . . , a . . . . . .orient: , . . . . Haase No. S. . .treet Hamlet County Tax Map No. 1000 Section . . .0J..7. . . .Block . . . . .6. . . . . . . . .Lot . . . . . . . .11. . . . . . . Subdivision . . . . . . . . . . . . . . . „ , . . . . . . , . . . , . . .Filed Map No. , . . . . . . ,Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated . . .00TOBERL3 . . . . . . . . 19 8,3 pursuant to which Building Permit No. . .12b.$7Z. . . . . . . . . . . . dated . . .OCTOBER. .13 . . . . „ . . . . . . . . 19 83. ,was issued, and conforms to all of the requirements of the applicably provisions of the law. The occupancy for which this certificate is issued is . . . . . . . . . FOR .AN. AQCFv.SSQRZ'. .$UjT,AING. . . . . . . . . a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . .LVU25 ,LARZECKI „ . . . , , . V . „ . . M . , . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval F/A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . N/A. . , . . . . . . . . . . . , , , k Building Inspector Rov.1/81