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Home My WebLink About1000-7.-4-7 'WN OF SOUTHOLD T g - �� 0' C* Rental Permit t 0204 Owner David Johnson Occupied as Single Family Dwelling Located at Off East End Road Fishers Island 7-4-7 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. 11/8/2021 Code Enfor 'mer off s This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD 13UILDING DEPT., o 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH .PLBG. ]: I2ND INSULATIOWCAULKING FRAMING /STRAPPING ] FI I 'FPL OE . CHIMNEY FIRESAFETY INSPECTION FITRUCTION ELECTRICAL ) ELECTRICAL ( I CODEVIOLATION PRE C/O REMARKS: C�w p 1,4. October 2, 2021 221.1 BUILDING 1.,, ,'T Building Department TOWN OF SUl1THOLD Town of Southold S4375 Main Box 1179 Southold,, NY 11971 Renewal of Rental Permit Tax Map 1000-7.-4-7 Off East End Road, Fishers Island, NY Please find enclosed $200 renewal payment for this rental' permit. Since original permit was issued in October,, 201 9,, there have been no changes to the property or to the location of any smoke or fire detection units. Please put me on the schedule for a Town property inspection. My contact information i ; T: - -275 : 203-89S-2614 gLqiLnct@gtnall.com Local representative on Fishers Island is Jim is - - i i si er l com Thank you- ')" "� &� David S. Johnson 1 Lincoln Lane Ridgefield,, 77 00 0 d �r CD ET H-+ n C7 o O O r+ (D N (D p 00 O m CL ; P -, --- 9 CD c O N o �--. CD Q p cr O .< m CD- � - v m o K � m Fn. a) M O �„ o X U) CLCD O z m 0 o m F, O m 3 mCr Q C CL (D cr Do CD z o 0 o CD rn r+ V� Q -G r.f . -n O O 3 _0 `V N m 0 - O c0 � T CrD n 70 m � m (7 d 3 cQ CCDcn M o C �. CD v n 0CL n v m °' CLQ r-r CL �' CD 0 o Z cc r 1 rD m m J -0N O r+ v o O � -P � I in' 0 f e Town Hall Annex Telephone(631)765-1802 54375 Main Road 1,P Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 e s: p BUILDING DEPARTMENT - TOWN OF SOUTHOLD -J U'Irk o 2019 RENTAL PERMIT APPLICATION Rental Permit Fee $200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION BLOCK b LOT L SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) CAJ rv. Telephone Number(s): Property Owner Email Address: Page 1 of 4 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: �? �U Telephone Number Email Address: "� C 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): 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): Mailing Address of Managing Agent: Telephone Number(s): Email Address: ...... Page 2 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: �_ 1 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: � 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: SECTION G. i tij li INSPECTION: _ w �� 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 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 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. Page 3 of 4 ❑ 1 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 a , MUST be the owner of the dwelling unit. STATE OF NEW YORK) ) COUNTY OF SUFFOLK) 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 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 s to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager. Property Owner's Name: C \ a Property Owner's Signature: . Sworn to before me this 3I day of 20J Official Notary Public Signature and Original Notary Stamp CAITLIN BARTOLO Page 4 of 4 r 1" A t 1UHLI:° g MY COMMIS910N EXPIRES FEB,2.8,2021 C W � n n u r 7S FTJ Ma �. . h t •fir,. er WN JMt C -lam a ism- Is\ < Ins . . 40, fµ I Pu!l ti �� «�" '\. ."^�. �✓ $"� n �� "'v.'dry " � - �—p + m,„ " +r V a IF J 177 m N t -F" a *1 w�a '+ U IleIN ae•�_ ro.n. , IR 02, N t k A "W J i " a� " r w �u G If a� F n � 7 � u him al VI Ff` Nit3. n �I P Irl Al :q yN� "F n m. d a . , X! Ile " da" tl � ✓ m14 µ 7 4 ." � w~n TOWN OF S OUTHOLD BUILDING DEPT. 765-1802 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 ,F. REMARKS: �.�. t DATE INSPECTOR -7-4f-7 TOWN OF SOUTHOLD BUILDINQ DEPT. 765-1802 ihPECTIONINS [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] FINAL FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O leiii W DATE INSPECTOR 1 YY III q �o l ...... ........ ° w 71 En , O S d CL 61 IA LIN i N d .M w w, r v S wr 1 D OD O �t w w° l�� } C m 1 m r v 0 Z _ � �i < rri 70 r 0 rest G) p w m r f �a J �n L �F "' rdR 1 f6 �' m L4 j w� m Cov Flu w is y p 1 n W p ® N 7 7 W I fir m : �� rri r r/ri asix ��, r/....; o� . �Jr%ice if C 1 r L o l 3I o. .�.... � . .. ... -C r j 5z r 1 ��N I r� � e ®e�.. o �� 1 FORM NO.4 TOWN OF SOUT14OLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z1242.6x . . . . . .. . M Date . M . . . . . . p.: iI 17 . . . . . . . . . . „ M ., lCy4 . THIS CERTIFIES that the building M knew_dwe13 inr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property Pr-vate Road Fishers Island '' Mouse Jho. street Hamlet County'Tax Map No. 1000 Section . . .007. . . . ..Block . . . .04. . . . . . . . .Lot . .047. . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. X. . .Lot No. . . X . . . . . . . . . conforms substantially to the Application for Building Permit heretofore tiled in this office dated _7ulY. 2.7 . . . . . . . . . . 197 8 pursuant to which Building Permit No. — PM. . . . . . . . . . . ,dated . . . . M »Sjp rq ber .19 _ ' . 1978 ,was issued,and conforms to all of the requirements of the applicable provisions of tho law. The occupancy for which this certificate is issued is . . . . . . . . , . . . . . .Private ons—family dwelling. . M . . . . . . . .. . . . . . . . . .. . . . . . . . . . . . . . . . » , . . The certificate is issued to . . . . . DAVID S; JOHNSON , , . , . , , , . , M M (owner,I' rd"em"t)� of the aforesaid building. Suffolk County Department of Health Approval .$-50-104 ,. .3/2 7/84 ,. Robt;. . . . . . .A. �Ii3la . . . . P.E. UNDERWRITERS CERTIFICATE NO. . . . . . . , .N N. 4.8.6027. M � M . M . .. . . . . . . . . . . . .. . . . . . . . W e ♦ . A r fl x . Y��Mew +N M w 4 M M. � x ♦ . M ». Building Inspector Rev.1181 G Town of Southold 12/26/2019 P.O.Box 1179 53095 Main Rd ' Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40962 Date: 12/26/2019 THIS CERTIFIES that the building ACCESSORY Location of Property: Off East End Rd,Fishers Island SCTM#: 473889 Sec/BIock/Lot: 7.4-7 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/12/2019 pursuant to which Building Permit No. 44183 dated 9/18/2019 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"shed as applied for. The certificate is issued to Johnson,David of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Autl�o ' ecl 5�, ;a�at ,,e Rental Permit Application May 30th, 2019 i- The notes on my floor plans about the locations for some of the smoke and CO detectors pending inspection comes from a conversation today or yesterday with i Verity and our real estate agent on Fishers Island, Jim Reid. We have very ll ceilings on the second floor and were unsure about placement. Thank you — David Johnson