HomeMy WebLinkAbout1000-77.-3-1 TOWN OF SOUTHOLD
} Rental Permit
=` 0160
Owner Penelope McCarthy
Occupied as Single Family Dwelling
Located at 1100 Pine Avenue Southold 77.-3-1
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.
9/25/2023
:.., a ti
This Notice must be posted by the main entrance at all times En rc� e
TOWN OF SOUTHOLD BUILDING DEPT.
d631-765-1802 ql—.3—t
I N S P Fm A C" 'r I A0# N
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTAN/(FIAL)RATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL
CODE VIOLATION [ P E C/ [ RENTAL
REMARKS:
t7 Y LJ •
DATElINSPECTOYR .4
Town Hall AnnexTelephone(631)765-1802
54375 Main Roads Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
.1ae�
BUILDING DEPARTMENT
TOWN OF S030LD
RENTAL PROPERTY CERTIFICATION
Form is to be completed by a license architect, licensed engineer or licensed home inspector
Separate form is required for each individual Rental Dwelling Unit
,Pro essionai seal re uireAineer JBn dad
copy of valid current cerci ication
Rental Property SCTM Number: "�1
Rental Property ddress: hoo `W4 N1- 112 71
Owner/Name: " .0•c.. 1 `c- ` '
Rental Dwelling Unit Identifier:
Number & Square footage of each bedroom as depicted in the attached floor plan:
(i.e. Bedroom #1 -100 sq., Bedroom#2-90 sq., etc.)
Property Description Include all improvements indicated on survey)
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.
Print Name and Title Ori Inial Signature
NYS CEO Certificate No0822-0345
Home Inspection License#16000129107
Please place professional seal:
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IR xFRp,ypCHI-CERTIFIED
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STATE OF NEW YORK
Be it known that
Kyle Matheson
lhas successfully completed the requirements of a Basic Code Enforcement
Training Program established by the Minimum Standards for Code
Enforcement Personnel(19 NYCRR Part 1208)in the State of New York as a:
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CODE ENFORCEMENT OFFICIAL
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46520 COUNTY ROAD 48
SOUTHOLD, NY 11971
DATE
(631) 765-5815 FAX (631) 765-5816 err; ,.,�,,..,.,.,,�,, ._ ..._.__................................�...�w�w.....[J.0 No. w............�.. m
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WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via...--- _....._ww....................._the following items:
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❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications
❑ Copy of letter ❑ Change order ED ._.......................�_.
�• � , e s
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THESE ARE TRANSMITTED as checked below:
❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval
❑ For your use ❑ Approved as noted ❑ Submit copies for distribution
❑ As requested ❑ Returned for corrections ❑ Return corrected prints
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❑ For review and comment ................ ............ .... .
❑ FOR BIDS DUE ............ ............. .................................. ❑ PRINTS RETURNED AFTER LOAN TO US
_..
..................� _........ .......
REMARKS
..,........................................._..........................................w......._.._............,.......... ..................,................,
........................................_.........,,,,,,,,,,,,,,,,,,,,,,,,,,,..,.,,,,......_..........
.............
COPYTO ..M ................... ............ _..,_....v...
SIGNED: _ ............._......................................................_—--------.. ...,,............... ......
If enclosures are not as noted,kindly notify us at once.
Thomas J. McCarthy Real Estate, Inc.
www.thomasjmccarthy.com
9-6-23
Town Of Southold
Town Hall Annex
54375 Main Rd
POBOX 1179
Southold NY 11971
To Whom It May Concern:
As an authorized agent of Penelope McCarthy,we would like to renew the current Rental Permit which
expires on 9-15-23 (Rental Permit#160)for the following property:
1100 Pine Ave Southold
Owner: Penelope McCarthy
Enclosed please find a check for$200.00 made payable to the Town Of Southold and a Rental Property
Certification.
Please feel free to contact our office with any questions.
Thank you.
Best Regards,
e
THMAS T Y-
46520 Route 48 Tel. 631.765.5815
Southold, NY 11971 Fax.631.765.5816
office@ thomasjmccarthy.com
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&0 Rental Permit
0160
Owner Penelope McCarthy
Occupied as Single Family Dwelling
Located at 1100 Pine Avenue Southold 77-3-1
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 cidopted 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.
9/15/2021
Enfor a en ficial
This Notice must be posted by the main entrance at all times
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�A TOWN OF SOUT OL
Rental Permit
Permit No. 0160
Owner Penelope McCarthy
Occupied as Single Family Dwelling
Located at 1100 Pine Ave Southold 77-3-1
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
Celephooe,� 31)766-�$02
54375 Main Road 's
(63 r) �
P.O.Box It 79 �J
L
Southold,NY 11971-0959 � �� � °�
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BUILDING DEPARTMENT � � �n'
TOWN OF SOUTHOL I► �a r..'`,,O u'.. .
RENTAL PERMIT APPLICATION
Rental Permit Fee$200(Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address: S
aulf�clo
Tax Map Number: 1000 SECTION -BLOCK -LOT -
SECTION B.
OWNER INFORMATION:
Property Owner Name: 1$A
AT
Property Owner Legal Address: perty wrierit ng d sw
Ir" *Jp 449
rK N\4 beer-
, ll� °
Telephone Number(s): Daytime Eve ng EmergencMAA Ay
Property Owner Email Address:
14
Pagel of S
Town Hall Annex V` Wre Telephone(631)765-1802
54375 Main Road ��, b� Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959k
BUILDING DEPARTMENT
TOWN OF SO JTHOLD
Section C.
Authorized Agent Infor ation:
Name of Authorized Agent of dwe ' g unit, if any:
Address of Authorized Agent (no P.O. B'o s):
Mailing Address of Authorized Agent:
Telephone Number(s): Daytime Evel1rlg, Emergency
Email Address:
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:
SECTION E.
SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental u Its)
Name of Managing Agent of dwelling unit, if any:
Address of Managing Agent (no P.O. Boxes):
Page 2 of 5
,hK
�r
Town Hall Annex Telephone(631)765-1802
� r��,
54375 Main Road Fax(631)765-9502
P.O.Box 1 179
Southold,NY 1 1 971-0959
�u
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: "
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: SEE, ,
Page 3 of 5
�
Town Hall Annex �1 'R, Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1 179
Southold,NY 11971-0959
Cou
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.
❑ 1 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
l 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)
'aiI �, , . �tify 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 m Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 C 4,b°
jrjrj jr
jr
BUILDING DEPARTMENT
TOWN OF SOU T'HOLD
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:
("
Property Owner's Signature:
q
Sworn to before a hi day of 20------------
�l
Official Notary Public Sid re and Origins otary Stamp
THOW J. York
SUffolk .No,6004790
0 M m!S ian t, e rlbar 2 3.
' .
Page 5 of 5
Town Hall Annex �r �� Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11.971-0959
BUILDING DEPARTMENT
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 each individual Rental Dwelling Unit
'rossional seal required for Architect or Engineer, licensed Nome Inspector must Provide
,copy o valld current cerci kation
Rental PropertySCTM Number: 100b- 3 ' I
Rental Property Address: I I Q9 Fgin, u Ave,(�U'C-
Owner/Name: 'PCAP-(o
Rental Dwelling Unit Identifier:
Number&Square footage of each bedroom as depicted in the attached floor plan:
(i.e. Bedroom#1-100 sq., Bedroom#2-90 sq., etc.)
Property Description (Include all improvements indicated on survey)
a
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. II aa
Print Name and Title a P�� iginal Signature
Please place professional seal:
03741" 4
kloo pine<®r'rAve'/ .5144,
TOWN OF SOUTHOLD BUILDING DEPT.,
T.,,
765-11862
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
ISE A. IS:
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRS EXISTING
CERTIFICATE OF OCCUPANCY
No Z-25374 Date NOVEMBER 21, 1997
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 1100 PINE AVENUE SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 77 Block 3 Lot 1
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 -25374 dated NOVEMBER 21 1997
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 ONE FAMILY DWELLING WITH ACCESSORY TWO CAR WOOD GARAGE
The certificate is issued to JANET ODELL
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
I
Building In actor
Rev. 1/81
111111.0 1 NG 1)1-"I'A Rl ti E'14 1'
']'OWN OF SO111,1101.1)
HOUSING COOS INSPECTION REPORT
LOCATION: 1100 PINE AVE- SOUTHOLD, N.Y.
- number JIM a reel.) ( III
91111DI VI SION NAI' NO- LOT
NAME OF OWNER JANET O'DELL
OCCUPANCY SINGLE FAMILY
Type
ypel
owner- eiian
ADMITTED BY: PENELOPE McCARTHY ACCOMPANIED 11Y- SAME
KEY AVAILABLk—' !,l f f F?_J-o T TAX HAI' NO,
SOURCE OF REQUEST. CHARLES CUDDY, ATTY DATEJUNE 6, 1- --._.
997
DWELLING:
TYP U-6Ve WOOD FRAME 1 2
r ONST]tl?C'f]ON I s-roltilss-1--,
1700NDATION WOOD FRAME CELLAR PART- CRAWL SPACE PART
........------ ..........
'roul. ROOMS: IST 2ND 3RD
omwr itoom 11TI1.ITY ROOK11-
PORCII TYPE SIDE ENCLOSED HEATED BECK, TYPE PATIO
1114KEZEWAY F111EPLACK ONE GARAGE
DOMESTIC 110TWATER XX TYPL? JlEA*j'jtR ELETRIC- A111(.0NDITION]"t.
TYPE BEAT OIL WARH AT]t 1101"WATER xx
OT111SR.-
.. .. ...................
ACCESSORY STRUCTURES:
CARAGR, TYPE OF STORACK, -i-Yri: coms-r,
. .........
f;WIHHIN(; POOL mms.r. .1-yi,it cowrr.
OT11KII:
---------------- ---------------
-------------- ----------- ---------- ------ ---
V-101.AnONS: CHAPTER 45 N.Y. STATE UNIFORM F111H PitFVHN'I*ION & 111JILDINC CODE
AIiON DESCRIPTION
A HT SEC.
..................
.................. . .......
......... .......
lkl',HAltKS: BP #37�p,5.-Z-CO Z-3027 (ADDITION)
.......... .......
INSVECTEI) llyN
DATK OF INSPECTION JUNE 10 997- RET FPFCTFD
JOHN M. ROU- TIME START 10:30 X.M. FIND 11-00 AM
FORM NO. 4
TOWN OP SOUTHOL.D
BUILDING DEPARTMENT
."OWN CLERK'S OFFICE.
SOUTHOLD, N. Y.
GE.RTIFiCATE OF OCCUPANCY
No. 2. .30 7 . . , , Date . . . . .AprI1.4.. . . . . . . . . . . . . . . .. 19.68
THIS CERTIFIES that the building located at . .1J01gR10. 1ff_UQ, ... . . . Street
Map No.Qooae.Day. Block No. . . . . . . . . . . . .Lot No. 56. 5.7.SS. . Sow.thold,L.x..s .X.Y.
Ests .
conforms SU�s':al_lially to the Application for Building Permit heretofore filed in this office
dated . . . . June .6. . . . . . . . . . . . .. 19.6. pursuant to which Building Permit No. 019
dated . . . .June. -9. . . . . . . . . . . . .. 19 67., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is . . . . . . . . . .p.Vfvate• one. -family -dwell ing . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .
The certificate is issued to . . . .j.. .E.I.Van .& B 6. .DpW . ,LaW804 . . . . .owner. . . . . . . . . .
(owner, lessee or tenant)
of the aforesaid building.
.Suffolk County Department of Health Approval
Building Inspector
03IMMISMIZEIM
46520 COUNTY ROAD 48
SOUTHOM NY 11971
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( 1) 765-5815 FAX (6 1) 765-5816 _ _... ...
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WE FIIII SII:::]IJMNG YOU F.l Attached I Under sgp)ar �to covou.via ... .tdo following itei'�no�°
1 1 S11 ml:) drawn i o U Priints L p'�`low.ws 11 owvll:mllov I Specifications
I I olp)y of Neuter L_..I Change order ��a . .................................
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11 NIL If:::::AIFIE 1fRANS Il T-Tlf-::::Y:) as cll'im eked below:
Il or appbrovap 17 Approved as submitted UrisullliuuuiU _ _ _.a;cl)„e s pato.ap provrrll
F:or your use I l Approved as noted Sii.wll-miniip -. wu puVm�� prpu°a�ii�rgrwllruwUaip�uuu
As requested I I Returned for corrections I pUehi a cow o ec,u:od 11iuInit:.�
1 oil, Ieviiew wiw'oat vain r u o ur^u It
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