HomeMy WebLinkAbout1000-77-2-17 TOWN OF SO T -OLD
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Rental Permit
Permit No. 0213
Owner Brian Reiss & Mariya Kemper-Reiss
Occupied as Single Family Dwelling
Located at 675 Birch Ave Southold 77-2-17
Address S/B/L
Maximum Permitted Occupancy 10
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.
10/30/2019 John Jarski
Date of Issue Code Enforcement officer
This Notice must be posted by the main entrance at all times
17,
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Town Hall Annex Telephone(63 )765-1802
54375 Main Road _ p Fax(631),765-9502
P.O.Box 1179
Southold,NY 11971-0959
BUILDING DEPARTMENT �,9
TOWN OF SOUTHOL
RENTAL PERMIT APPLICATION w
Rental Permit Fee$200(Application must be renewed every two years)
Section A.
Property Information:
Rental Property Addre s: n 1 ,f /� fir/
J ct � Ar Ay
Tax Map Number: 1000 SECTION 1 -BLOCK 2, -LOT _-
17 q
SECTION B.
OWNER INFORMATION:
Property Owner Name:
ss
Property Owner Legal Address: Property Owner Mailing Address:
Telephone Number (s): Daytime 1 -37a-� �g � Emergency. ,
p � ) y ,.
• f.
Property Owner Email Address: Gi✓'/ q r CO
Pagel of S
NO G r N� �� e
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1 179 a,'Nh ;�� a �ir ✓ .W
Southold,NY 11971-0959 � ��,II ,fpi�Ig4p�wof
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing gent:. ._..
Telephone Number (s): Da lme Evening m, . . ... 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: � 1 .
Requested Maximum number of persons allowe to occupy Dwelling Unit
r �.
Number of rooms in Rental Dwelling Unit:
.n__ �.
Us[244e n Dimensions of ea�l o in Rental Dwellin Unit:
c. C I,A"�,j
6 ,
w W 2 7, X
" ) „ � 1 0 X 9
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"J�i'Af�", P�xxv�y JIfJ
Town Hall Annex """ "` "' Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
1,
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any:
Address of Authorized Agent (no P.O. Boxe/Fvoning
Mailing Address of Authorized Agent:Telephone Number(s): Daytime„ .. Emergency
Email Address:
Section D.
Managing Agent Information:
Name of Authorized Agent of dwellin snit, if any: — ,_.____ -.._............
Address of Authorized Agent (no�.0. Boxes)„
Mailing Address of Authorized Xg�ent
Telephone Number (s): Da he Evening_Emergency
Email Address: mm
SECTION E.
SITE MANAGER INFORMATION: (re ired for rental properties containing 8 or more rental units)
Name of Managing Agent of dwelling nit, if any:
Address of Managing Agent (no P.
Page 2 of 5
ate„
Town Hall Annex ,.. Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 l � �
01
Southold,NY 11971-0959 ryu�� wN .
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 la s 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
❑ I 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)
JI Q 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
q 0Vim$A
Town Hall Annex �u Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
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:
Property Owner's Signature:
f-�
Sworn to before me this day of U 2011
C7"1
Official tart' Public S g atu�nVm _.. _......�.�
and Original Notary Stamp
TRACEY L ' P-
NOIAR PUBLIC,0-rArC CW ISI (,)I
NO.01 d3W63C)690 l
QUALIFIED IN SUFFOLK COMMISSION "IFIES Ji NLS - Il,Z,
Page 5 of 5
SOUTHOLD
` 765-1802
INSPEC."llriON
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND j ] INSULATION/CAULKING
[ ]
FRAMING /STR PPING [ ] INAL
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[ ] FIRE' LACE CHINEY [ FIRE SAFETY INSPECTION
[ ] FIRE-RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
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ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
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5nan Re ss d Minya K—pG-Ra DRAWING .,.FIRST FLOOR PL4N
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50UTHOLD,NEW YORY. 1 1971 NEW HOUSE soVend”"" ''' — _
DESIGN CONSULTING, INC. PR P R e Av
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NEW HOU5E 5 .hdd,N w Yore DATE 3 16 2010
631-765-8667
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FORM NO. 4
TOWN OF SO HOLD
BUILDING DEPARTMENT
Office of the Building Inspector
To Hall
Southold® N.Y.
CERTIFICATE OF OCCUPANCY
o® Z-34495 Date: 08/12/10
THIS CERTIFIES that the building NEW DWELLING
...........
Location of Property. 675 BIRCH AVE SOUTHOLD
...........
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No- 473889 Section 77 Block 2 Lot -17
Subdivision ... ............... Filed Map No- Lot No-
conforms substantially to the Application for Building Permit heretofore
filed in this office to MARCH 25, 2010 pu-rs to which
Building Permit No- 35458-Z dated APRIL 9, 2010
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 FAMILY DWELLING WITH COVERED PORCH, SCREENED PORCH, FIRST AND SECOND
..........
FLOOR DECKS AND ONE CAR GARAGE UNDER AS APPLIED FOR.
The certificate is issued to PE LOPE J MCC THY
...........
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF ffl?ALTH APPROVAL R10-08-0087 08/03/10
ELECTRICAL CERTIFICATE NO- 35458
PLUMBERS CERTIFTCATION' DATED 07/15/10 HURTS RELIABLE INC
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