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Home My WebLink About1000-62.-3-26 s,- - TOWN OF SOUTHOLD Rental Permit AV ,£ Permit No. 0197 Owner Timothy Wood & Mira Dougherty-Johnson Occupied as Single Family Dwelling Located at 340 Locust Lane Southold 62-3-26 Address Village S/13/1- Maximum /B/LMaximum 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. 10/17/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times Town Hall Annex Telephone(631)765-1802 54375 Main Road " Fax(631)765-9502 P.O.Box 1179 ' Southold,NY 11971-0959 " 4* BUILDING DEPARTMENT TOWN OF s0 , RENTAL PERMIT APPLICATION, Rental Permit Fee$200(Application cation must be renewed every two years) Section A. Property Information: Rental Property Address: �(R Tax Map Number.1000 SECTION, 10 U -BI-O , SECTION B. OWNER INFORMATION: Property Owner Name:, WOM- f.-hr-A A Property Owner Legal Address: Property Owner Mailing Address: 71 w ..d Telephone Number(s): Daytime_ ., venina Emergency Property Owner Email,Address: 0 0 VVI VV I+Q, A M,14,4 01A Pagel of 5 6, Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 117 " Southold,NY 11971-0959 t BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if Address of Authorized Agent(no P.O. Boxes: Mailing Address of Authorized Agent: Telephone Number(s): Daytime EveningEmergen Email Address: - . m Section D. Managing Agent Information: �i Name of Authorized Agent of dwelling unit,If any:= '� ` � Vic, Address of Authorized Agent(no P.O, Boxes) Mailing Address of Authorized A,gent:,? I0� ��Z (Ai -71P5too 1V ^��Telephone Number(s):Daytime. ning ergenCy oe i !;mail Addressn. _ , :a SECTION E. SITE MANAGER INFORMATION:(required far rental properties containing g or more rental units) a Name of Managing Agent of dwelling unit, if any: Address of Managing Agent(no P.O. Boxes); 0 e .o Page 2 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 , Southold.NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent:. Telephone Number(s): Daytime - Evening Ernergetxcy 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 Renta!Dwelling Units use"Rental Permit Application Addendum." r Rental Dwelling Unit identifier: Requested.Maximum number of persons allowed to ccupy Dwelling Unit: J Number of rooms in Rental Dwelling Unit: �-. Use and Dimensions of each room in Rental Dwelling Unit- -plan Page 3 of S µF M 30- Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(63I)765-9502 P.O.Box 1179 , Southold,NY 11971-0959 BUILDING DEPARTMENT TONW OF SOUTHO 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. ❑ 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. e STATE OF NEW YORK) 1 a COUNTY OF SUFFOLK) a r g l °certify under penalty of perjury,the following: a 1. 1 am the owner of the property identified in "Section A"of this application. ,6 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 S 8e Town Hall Annex Telephone(631)765-1802 54375 Maine Road � Fax(631)765-9502 P.O.Box 1179 Soathold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD applicable laws and rules. I further acknowledge that I will notify the Town of Southold a; Building Department of any changes of address within five(5) days of any changes thereto. 3. i 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 w regarding Authorized Agent, Managing Agent,or Site Manager. Property Owner's Name:. /� c �' �i✓O� �L Property Owner's Signature: . Sworn to before me this day of 20 Official Notary Publi Signature at Or( final Notary Stamp M, MARY JENNI'roE"�1V''l DROWER NoNq publo,StMe of Now York 11ollfled in Sufttk county wlsel �1� rvn Page 5 of 5 ,l pB 1 4 I ko" ' + TOWN OF SOUTHOLD BUILDINGT. ; 765-1802 INSPECTION [ .] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] INAL C2N'►�!1 [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: TE - INSPECTOR GTOWN OFSOUTHOLD BUILD,ING DEPT. 765-1802 I NSPEC7 [ ] FOUNDATION 1ST [ j ROUGH PLBG. [ ] FOUNDATION 2 D [ ] INSULATION/CAULKING ] FRAMING /STRAPPING [ ] FIREPLACE & CHIMNEY " ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE, VIOLATION [ ] PRE C/O Q-J DATE INSPECTOR 061- •r•;d: rl d OIY�fes.....,-+rM-�• q w Y" Tar. 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CERTIFICATE OF OCCUPANCY No: Z-33954 Date: 0,9/15/09 THIS CERTIFIES that the building NEW DWELLING Location of Property: 340 LOCUST LA SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) ) county Tax Map No. 473889 Section 62 Block 3 Lot 26 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 11, 2009 pursuant to which Building Permit No. 34513-Z dated MARCH 12009 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 FAMILYDWCLI'NG WITH COVERED PORCH AS APPLIED FOR PER ZBA #6244 ' DATED 3/5/09. The certificate is issued to TIMOTHY D WOOD & ANO (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-06-0108 09/03/09 ELECTRICAL CERTIFICATE NO. 4027445 07/13/09 pLUMERS CERTIFICATION DATED 08/09/'09 K & K PLUMBING & HEATING A horAedSJ— ature Rev. 1/81