HomeMy WebLinkAbout1000-63.2-1-2 y TOWN OF SOUTHOLD
-`
Rental Permit
0159
Owner Richard & Karen King (Unit 5B)
Occupied as Single Family Dwelling
Located at 2555 Youngs Avenue Southold 63.2-1-2
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.
9/15/2022
Code meat Official
This Notice must be posted by the main entrance at all times
SOUTHOLD TOWN Town Hall Annex
54375 Main Road
' PO Box 1179 Southold,
`4.
Rental Inspection NY 11971-1179
Tel: 631-765-1802
Fax 631-765-9502
SCTM # Date
Owner Phone 3'IL,
2-5' W -�
Address W/ Zip
Hamlet .o. Inspector �......
Address visible from street?
LEVELS SUB 1 3
Smoke Detectors (#-bedroom detectors excluded)
Carbon Monoxide Detectors (#)
Fire Extinguishers(#)
Exits(#)
BEDROOMS 4 5
Smoke Detector Alarms (#)
Carbon Monoxide Alarms (#)
Egress(windows) (Y/N)
BUILDING SYSTEMS (* N 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 present
POOLS Y/N 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 proof when unattended
COMMENTS:
X TOWN OF SOUTHOL
F Rental Permit
Permit No. 0159
Owner Richard & Karen King (unit- 5B)
Occupied as Single Family Dwelling
Located at 2555 Youngs Ave. Southold 63.2-1-2
Address 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
q qy0,3
Town Hail Annex Telephone(631)765-1802
54375 Main Road IF
P.O.Box 1 179
Southold,NY 11971-0959 /
Ulm
JUL 5 2019
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
' 'a
RENTAL PERMIT APPLICATION
Rental Permit Fee $200(Application must be renewed every two years)
Section A. s �S
Property Information:
Rental Property Address:
Tax Map Number: 1000 SECTION -BLOC -LOT
SECTION B.
OWNER INFORMATION:
Property Owner Name:—____K
Property Owner Legal Address: Property Owner Mailing Address:
10
Lsi w s .. .... � �
Telephone Number (s): Daytime t - 9 Evening SG-rx'p- Emergency. SIG a33—�S a
Property Owner Email Address: .,
r I car t 4. � - / lYl
Pagel of S
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Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax (631)765-9502
P.O.Box 1 179
Southold,IVY l 1971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent: W. ..
Telephone Number (s): Daytime Evenin 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:
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:
f lei
Page 3 of 5
s
Telephone(631)765-1802
Town Hall Annex
v Fax(631)765-9502
54375 Main Road
P.O.Box 1 179a �
Southold NY 11971-0959
u
U � �.,r
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
professlonal 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
❑ 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 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
Town Hall Annex � Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1 179
Southold,NY 11971-0959„war la
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: ” 'j
Property Owner's Signature: _ ..
,
Sworn to before me this day of ....,IT20,-10a
-"4) L—e N,
Official Notary Public Signature and Original Notary Stamp
CONNE C.'i Ui CF'
Notary Public,'Mate of Now York
New.016 618550
Qualified in cuff lk Country
Commis ls�n xoires Aoril t .—
Page 5 of 5
TOWN OF S L BUILDING DEPT.765®1802
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLEIG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [✓j FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
IIS '; IIE VIOLATION [ ] CAULKING
REMARKS:
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' FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z17930 Date APRIL 6, 1989
THIS CERTIFIES that the building MULTIPLE DWELLING
Location of Property 2555 YOUNGS AVENUE SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 063.2 Block 01 Lot 02
Subdivision FOUNDERS VILLAGE Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 1 1987 -----Pursuant to which
Building Permit No. 15839Z dated APRIL2, 1987
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 BUILDING #5 UNIT B IN MULTIPLE DWELLING.
The certificate is issued to LIZDA REALTY LTD.
(owner, )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL S-54 FEB. 1 1989
UNDERWRITERS CERTIFICATE NO. PENDING SLIP 4 6 89
PLUMBERS CERTIFICATION DATED MICHAEL, DUFF 153-P 1/30/89
VILLAGE OF GREENPORT WATER DEPT. APPROVAL 1/19/89
ti
Building Inspector
Rev. 1/81