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Home My WebLink About1000-143.-1-6 .� TOWN OF SOUTHOLD Rental Permit 0207 Owner IPPC, Inc. Occupied as Single Family Dwelling Located at 420 Sigsbee Road Laurel 143.4-6 Maximum Permitted Occupancy 3 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. 11/29/2023 tide EnftrrAm fficial This Notice must be posted by the main entrance at all times q)AD TOWN ' SOUTHOLD BUILDING DI 631 7651802 .... ,� INSPEC ION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAI [ ] FRAMING I STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN; [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICA (FII [ ] CODE VIOLATION [ ] PRE C " MA a So 1A VXANVt( LO * ,# a �. RR INSPECTO s Town Hall AnnexTelephone(631)765-1802 „w°� Fax(631)765-9502 54375 Main Road P_O.Box 1179 Southold, NY 11971-0959 ZI Q BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a licensed architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Professional seal r iuired for Architect or En ineer Licensed Nome In actor nrwust provide cop r of valid current certification Rental Property SCTM Number Rental Property Address: �l iii Owner/Name: w Rental Dwelling Unit Identifier: 4L t I Number&Square footage of each bedroom as depicted in the attached floor plan (i.e. Bedroom#1 —100 sgft., Bedroom#2—90 sgft., etc.) Property Description (Include all improvements indicated on survey) a 044/ 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 Plume of New York State,the Fuel Gas Code of New York State, the Fire Code of New York State,theCodMaintenance Code of New York State and the Energy Conservation Construction Code of New�r"tate. zs .� Print Name and Title I`�'IF Original Signator Please place Professional Se Flµ 0;,2", TOWN OF SOUTHOL. 2C20 Rental Permit Permit No. 0207 Owner IPPC, Inc Occupied as Single Family Dwelling Located at 420 Sigsbee Road Laurel 143-1-6 Address Village S/B/L Maximum Permitted Occupancy 3 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. 10/28/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times V0 & q 5-35 4x Town Hall Annex a Telephone(631)765-1802 54375 Main Road Fax(631)765--9502 tt ill P.O.Box 1 179 Southold,NY 11971-0959 BUILDING DEPARTMENT OCT 2 5 2019 TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION _ r (Rental fleirmiit Fee$200 (Application must be renewed every two years) Section A. Property Information: Rental p7,opertv Addre : Tax Map Number: 1000 SECTION -BLOCK � �� -LOT SECTION B. OWNER INFORMATION: Property Owner Name: he Property Owner Legal Address: Property Owner Mailing Address: Telephone Number (s): Daytime -"13130Evening 057-IIRI Emergency—To :: Property Owner Email Address:- n " c 14� LC 0 in Page 1 of 5 I�w � rykp. Town Hall Annex d; Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 � + 16, coy BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: ef Name of Authorized Agent of dwelling unit, if any: 10, Address of Authorized Agent (no P.O. Boxes): �= n Mailing Address of Authorized Agent: - Sa�, ove– Telephone Number(s): Daytimell _Evening Emergency Email Address: ' i : 10 &C D cc 0 io 0 ,co Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: c— 5 Address of Authorized Agent (no P.O. Boxes): ,/ Mailing Address of Authorized Agent, 6A±�� 11LO M� 3l Telephone Number(s): Daytimea*-- `&3t,? Evening '90 a e Emergency ` ., Email Address: el 1_ °."e ¢ 'ct o 0 C)6t , CVt-Y r 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 i� 4 Telephone(631)765-1802 'own Hall Annex 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 southold,NY 11971-0959 ^ , ( BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: ... Telephone Number(s): Daytime Evening Emergency_ Email Address: m. - 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 1 room. For properties with multiple Rental Dwelling Units use "Rental Permit Application Addendum." Rental Dwelling Unit Identifier: � C� � Y�'lNl " e ✓" ✓ ��; 2XI) ,, 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: -v � rc ✓/ ,.. ,'fid ✓ii rPage 3 of 5 'l,ra t,11/ fi✓io , �ro m f �� ryas Town Hall Annex " Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O_Box 1179 )1I Southold,NY 11971-0959 f//}$ 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. ❑ I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold Ill 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) COUNTY OF SUFFOLK) 1rcr-9 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 Y Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 4"L Southold, Southold,NY 11971-0959 p' i � 1V BUILDING DEPARTMENT TOWN OF SOUTHOLD 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: docz,io dai 01 Property Owner's Signature: Sworn to ore me this day of _ 20 ,„ Official Notary Public Signature and Original Notary Stamp ; vv °•,, Deborah Orlowski NOTARYNotary Public,State of New York v° wsuc = No.01OR6280392 Qualified in Suffolk Ooonty yo?"""o Commission Expires 05/13/200 1 1100"10, Page 5 of 5 'Nov- and � Town Hall Annex a ; Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 CIP P.O.Box 1 179 � �d Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit ldentifiert .�� edc' ' �' I4�d J- ej,1 °- Requested maximum number of persons allowed to occupy each dwelling unit:,. Number of Rooms in Rental Dwelling Unit: ' , Use and Dimension of each room: —ro 4- ee -v 'SIC nAl a�j"- Chirz Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: j, Rental Dwelling Unit Identifier: ` ,11A Requested maximum number of persons allowed to occupy each dwelling unit: ��r%'� Number of Rooms in Rental Dwelling Unit: �t Use and Dimension of each room: �i r Town Hall Annex da Telephone(631)765-1802 54375 Main Road Z Fax(631)765-9502 P.O.Box 1179a Southold,NY 11971-0959 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 Pro essi nal seal re u1re9oQ rch tect or Engineer, l eased;i ome Inspector m Ls povid cop,v,of valid current cert/ acotian Rental Property SCTM Number: 4� - Rental Property Address: z9a j Owner/Name: < m r7 r Rental Dwelling Unit Identifier: J. Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1-100 sq., Bedroom #2-90 sq., etc.) ry 10 oln Property I Orhall improvements indicated on survey) Description �Include.::. "` C lµ is � -�i4pClir' .1 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 Cor tion Construction Code of New York State. Print Name al Original atu of NEw r ,$DQ, Pleas e I e%l 0?251a 4 I I I � b II ....... 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Z � _._....... _ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR, TOWN HALL SOUTIOLD, NEW YORK CERTIFICATE OF OCCUPANCY NONCONFORMING PREMISES THIS IS TO CERTIFY that the )X/ Land Pre C.O. #- Z14360 Building(s) Date- April 28, 1986 Use(s), located at 420 Sigsbee Road Mattituck Street Hamlet shown on County tax map as District 1000, Section 143 . Block 1 , Lot 6 , does(not)conform to the present Building Zone Code of the Town of Southold for the following reasons: Insufficient total area. Insufficient rear set-back on accessory building. On the basis of information presented to the Building Inspector's Office, it has been determined that the above nonconforming /X7d Land $X/CJauilding(s) /s/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- Property contains a one atony, one family, tate is issued is as follows: dwellinw with an outside shower stall and utilitv shed. Fro2erty situated in the A Residential Agricultural ;;ane milb ss to Si bee Road: a town maintained road. The Certificate is issued to AMJAD ASSOCIATES (owner,X1�6J672�Xd�3Cb� 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 HAS 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. ,ski d:c7r Inspector _. m s TOW' OF, SOUTHOO Buuxaw , soudwK IL Y. . . ........ .. . Daw ....... ..� 1 74 j -...E shest . . .. ...«.. .. ............ ..... ._ AppU, "m fwBWhHu9POf=lt dided 197Y. -4& daW . MAI ., raents of . . . .. �.. ... .., ..,... . Vii. �• r Of the afamsidd buUdlxq�, " ..... i.... ...... .. .. .. ..... _..... .... .... ......M.... . .....-.f . ...+... ........., .. YORK » s TO'WH Of SOUTH" aFP T ' . SSUMLID, . Y. 111VI 1T (THIS PERMIT MUST BE KEPT ON THE "REMISES UNTIL FULL I OF: THE WORK 'UTHOI IZ I ) Date . ......... .. .. ...... ......... .....:: °19 ... Perrntis!on is hetsby granted to: JON ! \j � 0 ' .,.. .... ............ ... ......... ........ ... .............. .. ... ... A NN :B v0 `' �s :......... . ........ . ... .. .. .......:. . ..................................... ....x, ......................... to ... . ?..� ........Ex.(sr..........:�1. !!:4:. ....:...F.r'!."�'� 'C. .. .... :,ID ": w ..... .................. ..... .:.... ........... .................................................................................................................................................................. of premisas located at ............................S I.6-S..j�".. :.........:.._.O A �..:....: ....................:....................................................... ........................................................ pursuantI .................................2.9.. P-I.ATt , 1�. ..., and approved by the Building- Inspsoor, ..... . �11 ....,. ..,.......I.............. 66AJ TOWN OF SOUTHOLD BUILDINGDEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2N r III' IIID UI,,,, 'II"ION/CAULKING [ ] FRAMING/STRAPPING [ ] INAL9, [ J -FIREPLACE & CHIMNEY [ FIRE AFETY IN PECTI N [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION, [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION PRE C/O 1( DATE JQvf,,(cqq INSPECTOR, ��r��'jell �'�i�� ,luu _,,;; ��f l ,� � f, `�;��e�� ,�� °'%��+� ; � F� � , 4 n��p,a�°o"u �� '�' �i� �� G �� i�, � °r� ++� J� �sc:'�ut � i ,F1� �� h �, �. li �' � r� �rr�G�/,� � l J�f��i J%�,, �, /J/�f�n1V�l�r�V �i;J b, ` Yu s J s /r ;i m�wn�rr�� ✓j��' sdY'�;6;ii �; � J JJ� �� Yr„% � , ti- rl I Jijrily".,.i d �„ y i!(i f � �� ;.< � / i ,, s �� r�iG�l'i''°' ,� 5 �- V r%� �� , /� 9� a Y-; 1 rJ��t i i ;i, y A ir'"lid„-iJ ��'db � �r 1 h 1 %'r- ,��- t f�/ ,�% �r a ;; �R i it ,� J 6 r � � ti � J,ziv J'r i (a�lJrr��r(��/M �/f�, k1r�lV s nOP,�l< g/�=F ��ks�;,, � �d��,�% M 9m I i f J / r uriM?Ipl lob r i Yvdf� i i it i P.I � r' 4VMIE1I�MI�u�l � wwwr� II ivY i i�l pu l l� i �l u J� � '!n iii ��✓�„ r I11, a i l l 1 Irdr ��1' r ✓i ' �'i%r ,� ,N`f�%m' ��d t��,ori, � 1 I � � « � �I10� �, e > /i wowaiW�rifil4l°wvNV%a�ro�oioi^� DiNiw�IVI � h yv PfID r ,�, mU1Pi�DYf �I�rfs�a,�b! r is iiia a IiPlydi «HArtY^�f a; l�,a,, ,, t iivvri i ii ilii - [ r ",,,„ ;G ��Rropoi�;oiNpf^ii lMlhkwww:w*rm' in�Nlll I it ..... �� ;,.% 'iP�P��NNititlYlFrrwPrlrtaua!utwrwrwrrur«w+lrrrllr�rlq�,«u�rr�ln�f1(flri, � Niii;,y/�////// „ �„ ,. ,j; ��hw'i�'W�,�W;��NN��if�'S4ti4S8'W1W'�'��'NWN1Wif0f�NNNNNub��il➢!Diwp'�^�9i � ivK4(f6�j;7 `�,, nl��;�l� !//1�Illlllllftf�,K %//��/iii///�i////// //%t' %%(%//r/%%/////////%//..v//%////%,,,%%,%/, ..: „.,�i, � i, ;< � � yJ %IIlF/(�avvSru��lG`l5 `°�dW✓f,��(af�''I,wH�r�lr((�fi� J+��G iylr, � l foN��>'i ��i��%✓�i�1«�!��bsY"1N�rw�`�v�i�l,W��J�rrNr�l;iF4�V�h�f��9 . � i. �� 1^ q r, J r i t � ot, 4� ............... 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