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Home My WebLink About1000-97.-5-5 TOWN OF SOUTHOLD Rental Permit 0178 Owner Michael Doroski & Ors. Occupied as Single Family Dwelling Located at 32345 Route 25 Cutchogue 97-5-5 Maximum Permitted Occupancy 8 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. - 9/15/2021 g6 Code Enforceie�Official This Notice must be posted by the main entrance at all times �dw Town Hall Annex r SOUTHOLD TOWN 54375 Main Road .° PO Box 1179 Southold, am Rental Inspection NY 11971-1179 Tel: 631-765-1802 Fax 631-765-9502 SCTM # 7 r� S�— Date1z) l ' " Owner 1 C. e O Ir0 1 Phone ",f66 -72,6b Address l Zip Hamlet co U Inspector .Address visible from street? LEVELS SUBZ., 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) BUILDING SYSTEMS MN ICONDITION 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 No d . Y& POOL BARRIERSt Pool present % Pool is completely enclosed Pool surface alarm and/or door alarm Barrier is a min.48" high resent POOL GATES Y 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 I 11proof when unattended COMMENTS: r TOWN OF SOUTHOLD ZRental Permit Ar Permit No. 0178 Owner Michael Doroski & Ors. Occupied as Single Family Dwelling Located at 32345 Route 25 Cutchogue 97-5-5 Village s/B/L Maximum Permitted Occupancy 8 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. 9/9/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times Va "U, c. Town Hall Annex Telephone(631)765-1802 54375 Main Road 3 -�02 'P.O.Box 1179 � 00r Southold,NY 11971-0959 JUL 1 6 2019 BU1LD1N ,DEA TWW TOWN OFA; " T RENTAL. PERMIT APPLICATION. Rental ?;e�rm'it Fee. 200.-( ,p �lcai ars a us e; x awedever t r:r years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION 22 - BLOCK SECTION B.. OWNER INFORMATION: Property Owner Name•",, Property Owner Legal Address: Prpperty Owner Mailing Address:- (Cannot be the same,as Rental Property,Address) Telephone Number(s): �� Property Owner Email Address:— - o 4 c)S'<-/'' Page 1 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental-Dwelling Units on property: For each Rental Dwelling Unit set forth the Rental Dw,elling.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 a room. For properties-with-multiple Rental Dwelling Units use "Rental Permit Application. Addendum." r l r wll� Rental Dwelling Unit Identifier.:, Requested Maximum number of persons allowed to occupy Dwelling Unit a Number of rooms in Rental Dwelling Unit:, ____ _ ...._. .., Use and Dimensions of each room m Rental Dwelling Unit. A - - g'' f ys s t � SECTION G. INSPECTION`: Pursuant to-the Town Code of the Town of Southold Chapter 207 (RentalProperties), a safety inspection by Code Enforcement Official is required. If the owner chooses not to have said inspection performed by the Town, a certification fror'n`a NYS licensed 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 ofthe",provisions°of the-tdde 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) a COUNTY OF SUFFOLK) d '� lam"". � ® certify_under penalty ofaperjury,the following: 1. 1amthe owner oproperty ofidentified in Section A" of this application. ; N 2. The prope"rty owner's legal-address set forth in "Section B"of-this application is-my legal address and-I-understand-the Town-will use.te.are.ss for service pursuant to-all--.-- applicable laws and rules. I further acknowledge that I will notify the Town of Southold Building Department of any changes of address within five(&).�days of,anyehanges + thereto. 3. 1 have read and received a copy of Chapter 207 of theCode of the Town of'5outhold and r C 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. . PropertyOwner s Name: Property Owner's Signature:_j Sw rn to before me this day of ., a 20 4 Official N Public Signature a Original Notary Stamp TRACEY L. DWYER Page 4 of 4 NOTARY PUBLIC,STATE OF NEW YORK NO.01 D W6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2_0A91, t �ai 765-1802 INSPECTION , [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]' INSULATION [ ] FRAMING /STRAPPING [ ] INAL � ,,,4,t/ -'aw t [ ] FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING , REMARKS: zm Pouv -liiluA I� DATE c INSPECTOR m 11111111111111-111 ........ � ,_,,..... e � m... �... ,,........... 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Z D c m v_ ^ prny n _ z p m m r �.. , O Z W rnrn 1 Ol Cal m r� L/�` k Q m 17C� �� • 0 00 iYo- Z LA �W 91 X I O O X T X I 0 { W Y O 0 n CD m 0 tm l N S T � N fD CD N yG �I I' W ON. .M � I , I i -I 21 a) - � O \ O O G o -o 3 a o 3 �, '* _ _ A g N� 64 G' T VT `< fl S s CD N O N O Oma' f i ... e FORM NO. S TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 7.$023. . . . . . Date . . . . . . . . . .N(>V' . .29. . . . . . . . .,, 19. 77 THIS CERTIFIES that the building located at . . K/S. Mains. Rd . . . . . . . . . . . Street Map No. .xx. . . . . .. , , . Block No. I . . . . . Lot No. .= . . . Cutehogue. . . .N,Y... . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . Sept; M. .76 pursuant to which Building Permit No. . . .$871Z dated . . . . Sept 20 , 19,76,, was issued, and conforms to all of the require- .. -ments of the applicable provisions of the law. The occupancy for which this certificate is �`--- —issued is private accessory. .gp�$� . . . . . . . The certificate is issued to Theodore. & .Elizabeth .Doroski. . . . . . .0=9rs• . • • . • . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N.R. . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE No. . 1N 3450.'}.4. . June. .30 . . 1.97' . . . . . . . . . . . . . . . . HOUSE NUMBER . 3231+5 . . . . Street . . .Ma.n.Road. . Cute hogue. . . . . . . . . . . Building Inspecto 1 , tt Town of Southold 9/7/2019 P.O.Box 1179 53095 Main Rd + Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40676 Date: 9/5/2019 TRIS CERTIFIES that the building AS BUILT ALTERATION Location of Property: 32345 Route 25, Cutchogue SCTM#: 473889 Sec/Block/Lot: 97.-5-5 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 8/15/2019 pursuant to which Building Permit No. 44102 dated 8/27/2019 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: '"as built"AC unit and..furnacehas conversion)to exi tir sin le-£ aril dwelling,as a )lied for. The certificate is issued to Doroski,Michael&Ors. of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 40676 8/30/2019 .... PLUMBERS CERTIFICATION DATED r �Authorized 3Signature