HomeMy WebLinkAbout1000-57.-1-20 MIATOWN OF SOUTHOLD
ae
Rental Permit
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a
Permit No. 0223
Owner Gary DeLuca
Occupied as Cottage
Located at 435 Albacore Drive Greenport 57-1-20
Village S/13/1-
Maximum
/B/LMaximum Permitted Occupancy 7
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 Mate Fire Prevention and Building Code Council. Expiration is
two 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
/Nr�do.
N
Town Hall Annex )11 rb, Telephone(631)765-1802
54375 Main Road d
r Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 U�
BUILDING DEPARTMENT
TOWN OF SO HOLD
RENTAL PERMIT APPLICATION
Rental Permit Fee$200(Application must be renewed every two years)
OCT 1 8 2019
Section A.
Property Information: "
Rental PropertAddre � e2k,,o o r
_
Tax Map Number: 1000 SECTION -BLOCK -LOT U
SECTION B.
OWNER INFORMATION:
Property Owner Name: Lk
Property Owner Legal Address: Property Owner Mailing Address:
fly S-3 yss �.
Telephone Number(s): Daytime C/ Evening, Sa "` Emergency f5/4/Y9/ y16 3
Property Owner Email Address: 0�— ��,��' �ac� CSM
c qn-R ,
Page i of 5
u
Town Hall Annex Telephone(631)765-1802
54375 Main Road '' Fax(631)765-9502
Y.O.Box 1 179 4
Southold,NY 1 1971-0959
r" y4��14J���'ff1.0
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, 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."
g C'ZWl V� /
Rental Dwelling Unit Identifier: )�
Requested Maximum number of persons allowed to occupy Dwelling Uni
Number of rooms in Rental Dwelling Unit: a '
Use and Dimensions of each room in Rental Dwelling Unit:
Page 3 of 5
Town Hall Annex y` Telephone(631)765-1802
54375 Main Road r Fax(631)765-9502
Y.O.Box 1 179 r
Southold,NY 11971-0959
� .
'1 �� j�
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)
1 yll tyL certify under penalty of perjury,the following:
1. I 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 Roads f Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
w �
BUILDING DEPARTMENT
TOWN OF SO' OLD
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: 1.N te a
Property Owner's Signature: ✓J
Sworn to before me thiJ t day of 201
Official Notary Public Signature and Original Notary Stamp
Page 5 of 5
A /
Town Hal l Annex '^" Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box ]179
Southold,NY 11971-0959
BUILDING DEPARTMENT 1110V 1 2 2019
TOWN OF SOUTHOLD
RENTAL PROPERTY CERTIFICATION r
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
Erg es°sionat seal re uired or Architect or Engineer, licensed HoMK Inspector must proyi4e
co c)f valid current certification
Rental Property SCTM Number: �O� 57 • ( ��
Rental Property Address: S�0C3-'A"01c�
Owner/Name:
Rental Dwelling Unit Identifier:
Number&Square footage of each bedroom as depicted in the attached floor plan:
(i.e. Bedroom#1 —a OOsq.�Bedroom#2- sq. etc.)
r.
1. y -±1
Property Description (Include all improvements indicated on survey)
1
,,. of
paAa i
1 certify that I have done a physical inspection of the subject rental dwelling unit and find tha l
fully complies with all the provisions of the Code of the Town of Southold,the Residential Code e .
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, q-t °�6 1 l -(t
Print Name and Title rl Signature
Please place professional seal• } . .
'a
m:( � a S '',
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAU KING
[ ] FRAMING t STRAPPING [ ] AL
L ] -FIREPLACE & CHIMNEY ��FIRES FETY INSP'EC ION
[ ' ]. FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ' ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
Date: 11/01 05
No: Z-31250
THIS CERTIFIES that the building NEW DDWELL N
GREENPORT
Location of Property:
43
Location -pa — (HAMLET)
(HOUSE NO.) (STREET)
No. 473889 Section 57 Block 1 Lot 20
County Tax Map _..,---...—.
Subdivision �...�...�
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
( 2P
filed in this office dated 04 pursuant to which_ TULY 2...�
Building Permit No. 30573-Z dated A,UU'SI�16., 2004
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 SI'NGLwS FAMILY U" LLI1 G WITH Vii,T'rACII "T� GARAGE & DCCI mAS 7�.PP9.r_ FOR,
The certificate is issued to J&C HOLDINGS LP
of the aforesaid building.
5/10 21/0
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL � jT0-02 0021__ _
908 09/1( 05
ELECTRICAL CERTIFICATE NO. 0 8
PLUMBERS CERTIFICATION DATED
05 25 05 AULzCHNik,_� -�.. �-
,o zed S gn�uture
A C ure
Rev. 1/81
-3,
SCOHS Ref. # Rf0-02-0021
ANY ALTE'RATON OR.A=rXW F0 TMS SURVEY IS A VIOLATION
'SECTION 7l P5'Of THE tN'7W YORK'STATE EOLaC"A TFQN'LAW. m, '
CIXLEPr AS P61 SECTION 7RO9^SLOOtVISION 2.ALL CER 11FICArMS
1
AO ARE W".NP..dCi'F t? T Cf7E COPIES
THE CIkP wM� � ,w..m,... ,. .._.. . ......__ .. .... � H �alCr
IF
SAO WAP C19 COPWS BE-At? H AEON,S
WHOSE..w�"a+'dA7UREV APPEARS FARE
AtTTSd USE rO C ANY
A MtFL AdP'LAW TS TXZ AL r,P<'aRaP BY' 6
MrJS�tlSECa,9Y ANY ANLT ALL SRJwr7�M''EYC�R•5 Grdt.L'dYw'G A COPY
OF ANOTHER SLpWSyOR"S MAP TERMS$UCH AS'WSPEC'TF'P'AND I
6RC+t aHr. To-PATE'ARE NOT IN COWUAN:E 7Wa W THE LANW C K f.) 4i L7
T,re docctrons of wrstls and
N r L wsperol's �r
sJ#Oswn hroreun area Irom rind Cbserwrolions J'
cnrF or trorn dnlo o;atarned farm ollmrs.
I aJVAL
AND CONSTRUCTION OF Sk)8SdJHFAC EWA GE
m A¢TrvaatEar with STria^TGar'4R0' ° EStDE.NLE�s
DIS
EM.5 FOR
and Puwi abldaYrayr 8 cotodilionsNg6t 1000 hretn and an the _.
permit to construct.
SEP r,C MEA URS M,-�N FS <p
y.. �G
NOTE"
LOT NUMBERS ARE REFCJ�ENCED TO
MAP OF SOLITHOLO SHORES "FILED
IN THE SLJFF"OLdK COUNTY C'LE'RKS OFF"IC"E.
ON AUG, 29, t96J AS MAP NO. J85847 �
X00 r .
5`
P
Lor < / • .,� ,..
U F F E R,
Y�.�.. LINE OF HA VR.pia LI 5,raRv..r
,� Gr^>lalb+a^s
AM,
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TESTHOLE .
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• � �' ( e to coarse 54
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LOT COVERAGE t5% C Lor ze Lor z�
ell
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CERTIFIED "�, a"
ELJt R
,.. ��-."""sa^ ruv W ,r, r�&7PGSED WAC."P�'".aL
JEC HOLDINGS, L.P. J ` X
STATE TITLE AGENCY, INC. xa "° N res BAR
STATE BANK OF L.L urv+ I pp' Gr �CoA=rr ry
^.... a,+rcrtai.asrrw ' ' BOTTOM Of LEAti
cLenw,xwsd7 ''
a tA"nsi °,p a `rW r-9WV ,TCR A fJ9 `
C LH JSP SEL-TION
SURVEY OF PROPERTY "'trYEM-
AT ARSHAMOMAQUE
NO TES
""TEM OE°SISN ..
TOWN OF SOUTHOLD SUBSURFACE SEWAGE DISP SAd
SUFFOLK COUNTY, N.Y. R OOSEPI t F lSCH TTI, P E.
1000 - 57 — 01 — 20 HOPa R r ROAD
SCALE, YW : 30" s6JI)�765 Y �tBrl �� oF Erw,, �d
NOV.28, 2001 c�
MAY 29, 2C)02 f cross section TH.) rk
40(",' cD 2002 rcerflficujAv ) ;A I 1e tt
EPT 3Cr 2002 t raWf tontr)
Ada t t 3, 200 lr av foes a C^?� 'J'� �u J,s•
w'rtT ?00 PECONtC at.1Ra/EYOf� ��
J.4ra a, . rr^r "s �•,I, ��r.. sS�ti 7E5 _ 5020 AA
7
P. O, BOX 909
d=" 12JO TRAVELER STREET
v
AREA '18,812 sq ft F��• JB# 2OOC°dcstllfdroM rr:k SOUTHOLD, XY, 11971
01 - 275