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Home My WebLink About1000-128.-6-7 �Iaf FOL TOWN OF SOUT OL Rental Permit Permit No. 0184 Owner Carll & Susan Austin Occupied as Single Family Dwelling Located at 3300 Peconic Bay Blvd Laurel 128-6-7 Address Village S/13/1- Maximum /B/LMaximum Permitted Occupancy 2 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. 9/17/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times Town Hall Annex r" Telephone(631)765-1802 54375 Main Road , Fax(631)765-9502 P.O.Box 1179u r Southold,NY 1 197 1-0959 " BUILDING DEPARTMENT „ W TOWN OF SOUTHOLD �. RENTAL PERMIT APPLICATION Rental P rmit Pee$200,(Applkatlon must be renewed every two years) Section A. Property Information: Renta Property Addre Prop Aly- Tax Tax Map Number: 1000 SECTION �o� -BLOCK -LOT SECTION B. OWNER INFORMATION: Property Owner Name: '4/j 'S ujwn'l Property Owner Legal Address: Property Owner Mailing Address: L Ric 4p, _�l a, // I Telephone Number(s): Daytime Evening Emergency _ Property Owner Email Address: ''' ago Page 1 of 5 Town Hail Annex '�� 'Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 pi Southold,NY 11971-0959 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, 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 room. For properties with multiple Rental Dwelling Units use "Rental Permit Application Addendum." Rental Dwelling Unit Identifier. IIµW Requested Maximum number of persons allowed to occupy Dwelling Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: Page 3 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road { , Fax(631)765-9502 P.O.Box 1179 �� ' Southold,NY 11971-0959 „u BUILDING DEPARTMENT TOWN OF SO` OLD 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 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 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 ga Telephone(631)765-1802 54375 Main Road r Fax(631)765-9502 P.O.Box 1179 �K 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 flaws adopted by the New York State Fire Prevention and Building Code Council. Wd' 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) Dolores M.Peterson Nohry Public,State of Now York NO:OIFFA216321 COUNTY OF SUFFOLK QVIIIIIAWIN Suffolk County Commission Exp 00/2&20 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 U urd�� Town Hall Annex Telephone(631)765-1802 54375 Main Road ��, Fax(631)765-9502 P.O.Box 1179 W, r Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SO OLD 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: ,��Ul) � 14 Property Owner's Signature: Sworn to before me thi day of , 20 Official Notary Pl1blic ignature and Original Notary Stamp Dolores Peterson N tg 'Publk,Stsft Of Now York NO:01PFA216321 Qualified'in Suffolk Ooamnty C w��wwr iq,;ion Expires 0,1125/2;1 Page 5 of 5 01Town Hall Annex Telephone(631)765-1802 54375 Main Road J� Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOOLD 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 aPro sessional seal're Aired or.Architect or En trweer licensed Home fns ector must provide copy gf valid current cern cation Rental Property SCTM Number: Rental Property Addr'e : I Owner/Name: 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.) ° J S-6 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 Yo k State. N"4' - ga �. Print Name and Title COO'-1241—0 LX-7 Original Signature Please place p ofessional seal: ' TOWN OF SOUTHOLD BUILDING 765®1842 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOL TION [ ] CAULKING REMARKS: Wk fA�JL L o DATE Ns ,AV k - A a. a � � � s a� x. 10, w S Ln O p Ill D m r 700 Ln o a a NJ' m' it Ln rD J .�44 ol � (D (� r ,j z Ln Z w � I ��. G rIr W y , r w m m QQ Co 4 11, In rm r � O O e IM 03 u e O m m in n Z ry � m r , Ln O + p._ rr, f m W r , � 1 w x x cp 0 0 v=i 'o I L .. ......... IN, :;' i Q) So 3 CD CD I ly 7Z— mo o 4 21 Fn G2 i Ild I I I CD cl p to D z m m m ..... _w. m cp O ) x :. CCDW M, C7 h N r' r+ r•a T � N O m ID _ rnL ua.y m s i �m u i r� Q`t`y 21 M m -n O o M 0) c IM o' 3 a rC n d 7 K C H I r1 Q' zr I r � n 3 3 ° N Q T r. O O S I O O � 1 D h m Go * rn fi ; o (a rD CD CD 0 0 Ln ro0 � 3 y 1 �Yr ryr a r' I��IUI mi b r f , o t rt O I m t � 1 r � p� _.. 3 -4 Ln 0 - - f ' a ,..�. __ .W..w .... ._...� v } I� y 4 ' I TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, NEW YORK CERTIFICATE OF OCCUPANCY NONCONFORMING PREMISES THIS IS TO CERTIFY that the Pre- C.0.Z 13118 _ Date Jan.9,1985 /X/ Land / X/ Building(s) /—X/ Use(s) located at 3340 Great Peconic Bay Blvd. Laurel Street - Hamlet shown on County tax map as District ,1000, Section 128 , Block 06 Lot 007 does(not)conform to the present Building Zone Code of the Town of Sfn ahold for the following reasons: Lot issulficient in Area. Two Story Dwelling has insufficient side yard- Three Accessory Buildings are located in the front yard, one contains an apartment as second living unit. 4 On the basis of information presented to the Building Inspector's Office, it has been determined that the above nonconforming /�/Land /�/Building(s) /X/Use(s) existed on the effective date the present Building Zone Code of the Town of Southold, and may be continued pursuant to and subject to the appli- cable provisions of said Code. IT IS FURTHER CERTIFIED that, based upon information presented to the Building Inspector's Office, the occupancy and use for which this Certifi- cate is issued is as follows: One Family Dwelling with two Non-Comforming second living unit & storage shed- Accessory Buildings have Non- Conforming Locations. The Certificate is issued to FLORENCE F. BATTENFELD (owner, N�iTX of the aforesaid building. ' Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO. N/A NOTICE IS HEREBY GIVEN that the owner of the above premises I-1AS NOT CONSENTED TO AN INSPECTION of the premises by the Building Inspec- tor to determine if the premises comply with all applicable codes and ordin- ances, other than the Building Zone Code, and therefore, no such inspection has been conducted. This Certificate, therefore, does not, and is not intended to certify that the premises comply with all other applicable codes and regula- tions. 4-_B41d ng Lns cctor 11 ml IN „ee�iioeo 1/� JS ��%//✓iii �%/ 'rj a„ j��/�''//1 �i j