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HomeMy WebLinkAbout1000-4.-5-17.2 t TOWN OF SOUTHOLD Rental Permit 0219 Owner Stephen & Cynthia Cook Occupied as Cottage Located at Private Road Fishers Island 4.-5-17.2 Maximum 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. 4/19/2024 Code Enfo went offi�ia This Notice must be posted by the main entrance at all times ell Telephonc(631)765-1802 Town Hal I Annex 54375 Wain Rtwd Fpx(f�i1)7b4 9502 P,Q.Box 1179 F. " Sautlwld,NY 11971•i] 9 JN r0 BUILDING; UEPARTMEW 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 iPro ssi an al al re tri ed ► chitect tame�rlg nee^r ll ens or1 _msp—entorm ast ror ' cqy a lrali�l c �a �r crtl rya Rental Property SCTM Number: oop." Rental Property Address: Owner/Name:..... Rental Dwelling Unit Identifier: Number&Square footage of each bedroom as depicted in the attached floor plan: i.e. Bedroom#1-100sq., Bedroom#2-90 sq., etc.) rope Description(Include all irnroverne is 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 Conservatl Con5tructio Code of New York State. Pot "7 �,rint Name and Title •kW; f r1a ure P Or a Please place professional seal: ,� TOWN OF SOUTHOLDRental Permit Permit No. 0219 Owner Stephen & Cynthia Cook Occupied as Cottage Located at Private Road Fishers Island 4-5-17.2 Village S/B/L Maximum 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. 11/13/2019 Mike Verity Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times Iu. C 'd' 10 -:3, ppmI 0th Town Hall Annex ;a �, Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 �� " Southold,NY 1 t971-0959 �ff Cry BUILDING DEPARTMENT TOWN OF SOUTHOLD 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 -LOT cuak ouT T x 8 ILL 7"Ax )44p 7 7j . "T— 17 SECTION B. OWNERINFORMATION: Property Owner Name: 5'6P P . cote( Cy'j7"*g P, cook Property Owner Legal Address: Property Owner Mailing Address: _ ...... .. .�. w _ sola N yap k N�t rvl Telephone Number(s): Daytime 117-7°1?,/013Evening _SPrML ---Emergency Property Owner Email Address: �'� t ' t1o�/7)Q��, COln . •., .. ._ ......... .......................... Page 1 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road �, 1d� Fax(631)765-9502 P.O.Box 1179 ' Southold,NY 11971-0959 ;' lei BUILDING DEPARTMENT SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent (no P.O. 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 Emergen �_m,_,__ 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 / F Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 � a Southold,NY 11971-0959 � 101 / m BUILDING DEPARTMENT TOWN OF SUTL Mailing Address of Managing Agent: . 1i 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: - UNIT Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: w_IT Use and Dimensions of each room in Rental Dwelling Unit: Pimm M ' "� ly'� KiTCI�>r�l (8' '' q'8 Page 3 of 5 �I 4 01P Town Hall Annexilii r' Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959y, C',V 0 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. ❑ 1 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) S?'tiPM / R • co 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 I Town Hall Annex1Telephone(631)765-1802 loo54375 Main Road Fax(631)765-9502 P.O.Box 117915 e 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. p Property Owner's Name: ��� r - Cook CZ7 �P nl Cook R�'� Y n� �� Property Owner's Signature: Sworn to b fore me this,, day of p 20fl ZZ Official Mary lic Signature and Original Notary Stamp Page 5 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 SOLFMOILD 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 ssional seal required for,Architect or Enineer, licensed Horne Itis ector must provide c_ooy o valid current certif ftcation Rental Property SCTM Number: Rental Property Address: Owner/Name: Rental Dwelling Unit Identifier: UN IT t Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1-100 sq., Bedroom#2-90 sq., etc.) 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 York State. r �w Print Name a �. „ `" Original bignature Please pla fes i al-" M0, (b " ". " s o TOWN OF SOUTHOLD BUILDING DEPT. 765-1802INSPECTION1 ] FOUNDATION IST [ ] ROUGH PLBG. ] FOUNDATION INSULATIOWCAULKING ] FRAMING /STRAPPING [ I L FIREPLACE & CHIMNEY -FIRESAFETY INSPECTION FIRE RESISTANT CONSTRUCTION FIREI T T PENETRATION ELECTRICALI L ( I CODE VIOLATION [ PRE C/O IIII e DATE INSPECTOR i a S,r,cpfwN A - Caw �,v CIA)*4 P. Cook I 0'0 koa I w Woo P �(I rc Hr-IJ CLogE9' gzatf Rawl i I I I U v ,�pudq Y v vi FRONT l3rooict- r T m Z 0 r 0 0 > PI Q- 7J :�-- (D C7 I > Z (D (D > m m 0 m rn 7J .. ..... ........— .............. ................ ............ .. ........(D (In (D X rn m --------- - ------- --—- --- .. +7, -n < a E 0 z < In ................... .......- --------.......... ............. -TI m 0k. 0 0 m 7� Z :7 ,L f r,l C) in m m 0 0 z z m rTl C (D Cl m r$ ? IV fD m T rt O m 70 i D — N r . r p O m _ ..... r v 11'111n -..,•, m n O � O mD D f"'r m :5 Q m m , vii r O O �- Z n Z G`1 i � — N V 3 u, :} m m d co 4 � g C r I f I z�u I ti r O r 1 BTl fTl MOM AMMEW AM m Iowa 6 t �e �o W rc ie I n gym. yi y, d y 9 4 m C9 -- n U3 „u _ _� �...".. ..� r t B u Lit _ T ED— J q v i TOWN OF' SOUT'HOLD BUILDING DEPARTMENI" "rown Cler,k's Office Southold, N.Y. . r Certificate O Occupancy µ January 23, , 1 No. . . . .Z. .1035.9 . . . . a � a �� . �. o . . � o- , . ,� . ,:r THIS CERTIFIES that the building A . . . . . Location f ropy rty Road;. moa a 'i s p �� . ,I e . . . , . . W . Stieet County Tax Map No. 1000 n ection ��. . . . Noc Not A Block 1 . . Subdivision .Fisher s Island. Club Requirements fo:r a Pr'.JLvate One Family Dwelling Bu confornis substantially 't the Prior ° o Certificate cf Occupancy r . ).,. w 1 . 7pumia t t ichild-ink P . • I.- ° . Z.1.0359. . . dated . . . . . January. , . : . . . .,. . . . 19 -81 . was issued. and conforms to all of fine requirements of the applicable provisions oaf the law. The occupancy f6r which i s certificate is issued is r M rsT . 1 E' TRUCTU.E - A ONE FAMILY LI G HOIJSE,�,­ 6 A TOILET, SINK, rrr. ,l. y r r� r r„ ; r� rrr rrr /rr T � a l d . . . yEN �. COOK r, . . of tht tea• I r UNDERWRII ENCSRTIFI ATF., r I �,�w,�*, � " ��a b; m�'�'�.:. i W/O t y/ rr /i r„ In the Matter of AFFIDAVIT Sale of Premises on Fishers Island, ew York, by H. RICHARD DIETRICH, JR. , to STEPHEN A. COOK and CYNTHIA P. COOK - - - - - - - - - - - - - - - - -x TATE OF PENNSYLVANIA) OUNTY OF CHESTER ) I, H. RICHARD DIETRICH, JR. , having been duly sworn, To depose and say: I am over the age of twenty-one (21) years and n-ow reside at Chester Springs, Pennsylvania. The main residence of the above mentioned premises as constructed in or about 1926 and has been used for resi- ential purposes only. The Cottage on said premises was built at the same LLime and contains a small kitchen with cooking facilities, a bathroom, one bedroom and a living room and has been used since .ts construction as a guest house . The garage, which was also built at the same time., contains in addition to car space, a small bathroom with toilet and sink and one bedroom, which has been used as servants quarters since its construction. CHARD ICH, JR Subso bed and S ,orn to before me tit rs � dayof J a y, 981 IOTA AT Pn _..._ I C CO.