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Home My WebLink About1000-103.-13-12 4 fit `SOWN OF SOUTHOLD Rental Permit n 0222 Owner Brooks DJ Dec of Trust Occupied as Single Family Dwelling Located at 985 W. Creek Ave. Cutchogue 103-13-12 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. 7/29/2022 Code Enfo ent Official This Notice must be posted by the main entrance at all times ` _ ,r Town Hall Annex �» SOUTHOLD TOWN 54375 Main Road C= PO Box 1179 Southold, Rental Inspection NY 11971-1179 Tel: 631-765-1802 Fax 631-765-9502 a , „ ,l m ' Y NO r , Rif RI,i NWIN ti 1 -, ,,," -,�I. � ,,.... 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Permit No. 0222 Owner Brooks DJ Dec of Trust Occupied as Single Family Dwelling Located at 985 W Creek Ave Cutchogue 103-13-12 Address S/B/L 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. 11/18/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times pp pp Town Hall Annex 1 Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 a f P.O.Box 1179 a � - Southold,NY 11971-0959 �or Z: BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Propert Address: ),, Tax Map Number: 1000 SECTION -13LO _( . -LOT tZ - SECTION B. OWNER INFORMATION: Property Owner Name: U coo Property Owner Legal Address: Property Owner.Mailing Address: q1 oa Telephone Number(s): Daytime Evening__,,Emergency Property Owner Email Address: .- hly)Q l 4 , Page 1&S k N Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 v v P.O.Box 1 179 u Southold,NY 11971-0959 n � BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent:_.............................. . 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, 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 room. For properties with multiple Rental Dwelling Units use "Rental Permit Application Addendum." Rental Dwelling Unit Identifier: w Requested Maximum number of persons allowed to occupy Dwelling Uni . � Number of rooms in Rental Dwelling Unit:_sITIT _ V Use and Dimensions of each room in Rental 11w ding �l` Unit: L NC25 ° - t a ��.. .��` w,_, a"::� 4-�`►oow Z- � ® `b Page 3 of 5 �Y WU I pF Qd Town Hall Annex Telephone(631)765-1802 54375 Main Road -' Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 f Gay 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 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. STATE OF NEW YORK) COUNTY OF SUFFOLK) I , 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 Town Hall Annex Telephone(631)765-1802 54375 Main Road I Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 � e Clufr�8f�. BUILDING DEPARTMENT TOWN OF SO SOLD 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'sName: )� ..� bo.� Property Owner's Signature: l. orn to before me t day of , 201 S � Official ary Public Signat r and Original Notary Stamp w TRACEY L. DWYER NOTARY PUBLIC,STA-,rC OF NEW YORK U QUALIFIED IN.SIFFOL C 7UN' �" COMMISSION EXPIRES, UNE 30 ,d, Page 5 of 5 Town Hall Annex 141 Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 �r � �� ,y. BUILDING DEPARTMENT TOWN OF SOUTHOM RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: Vs W kJA C Requested maximum number of persons allowed to occupy each dwelling uni : r Number of Rooms in Rental Dwellin µ 10, to g Uni' �� Use and Dimension of each room: 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: 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: .. i rp w IZ CD Ell NO p i ' /r j m 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 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 Fro ssicrraai seal re uirecti[grArchitect or Engineer licensed Home iVas ector must provide copy o valid current cern cq i n Rental Property SCTM Number: 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#1-100 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. Print Name and Title wo- IZI 6 -6-.-P3 Original Signature Please place professional seal: 5 = TOWN OF • r SOUTHOLD BUILDtNG DEPT.765-11802 INSPECTION `] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND: [ ] INSULATION/CAULKING FRAMINGI [/]IFIREAAFETYINSPECTION INA -FIREPLACE [ ] FIRE RESISTANT CONSTRUCTION `[ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH)- [ ]- ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: 15 001407� Si DATE -U Aim- NS M 1( Wim__ .M .d�a '"' •.. �,� �, w � � w s� r i w M r _....... . cn co cn Ol 13 cn 71 � _ m o m CIO O b s. z 1 :3Ll p I,rFl rra ° m .� Q � £ j (/7 ' Z N � 9 � w W p � r C m O Dc m � n r 6 O CD O m a ti, m !F CD OR F -------- .......... maN 07 O n TI C m �o N I , T` S Z m, D m OZ w� (I„„ v> ri Ni r , n I� � r z r B q ' —I 0 v Gl ao v m m m rr r O S] p -D O O X k X CD N n n N N N o ID m 7' � :3In. u3i 7 7 7 4 9� yl iA o f - � /,al/I x ia� N /m✓� CD if m ar W ✓�r//�fF ,lj r9' -.._.__ ...... � ......... ..-.. „,..., .... ...................... QN —- - � � r 0 07 -n - .s¢° 0 a 0 CD CD -v 3 a c on` m _ _ ,.., .., _.— . _....pm_. n. a ._ 1 ._.� °, m _. r fj ... q .,..._ O O O En i ..... CD ° W f t� FORNf N0. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Ii, Y. CEFtT1FICATE OF OCCUPANCY Date . . .... ......................July..21...... .... No, ,,........Z..7.4.�.. Cut0q eStreet tJ,les�i: Cxe Av�s?ue•►.................... building located at ................ .....M, ,....-..... THIS CERTIF]F that the bui g o $lest Eslock No *.,.,...Lot No, .. 200 & .2,�1 .,,.., a �o lic substantially to the App ation for Building PFrmit heretofore filed in this office conforms Permit NO. ......Z...4.99...- 49�P ... 7....... lg $,.• pursuant to which Building dated ..........•-• requirements •late d rh ,...,..^,CC�b�^po2�•......... 1y.��•,, was issued, and conforms to all of the for which this certificate is issued is of the applicable provisions of the law. The occupancy ONE rjRI ...... ............. .... .. 1A e .... .................. ....... .. This certificate is issued to .,•-•--•••.• (Q%Vner, tessee ox tenant) Of the aforesaid building. .................. Building Inspector 1 +I" y Town of Southold 11/18/2019 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40866 Date: 11/18/2019 THIS CERTIFIES that the building AS BUILT ALTERATION Location of Property: 985 W Creek Ave., Cutchogue SCTM#: 473889 Sec/Block/Lot: 103.-13-12 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..._ ._ 11/6/2019 pursuant to which Building Permit No. 44412 dated 11/14/2019 was issued, and conforms to all of the requirements of the applicable provisions of the Iaw. The occupancy for which this certificate is issued is: "AS B"QII_,7 BATHROOM IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Brooks DJ Dec of Trust of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED utl:a Si nater