HomeMy WebLinkAbout1000-9.-7-8.6 TOWN OF SOUTHOLD
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Rental emit
Permit No. 0053
Owner Peter Coolidge
Occupied as Single Family Dwelling
Located at Midlothian Avenue Fishers Island 9.-7-8.6
Village
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.
5/21/2021
Code Enforcement Official
This Notice must be posted by the main entrance at all times
TOWN OF SOUTHOLD BUILDING DEPT.
IRS
785-1802
INSPECTION
[ ] FOUNDATION 1STROUGH PLBG-
FOUNDATION [ ] -INSULATION/CAULKING
[ ] F I /STRAPPING [ FI L
[ ] FI I [ ] FI SAFETY INSPECTION
[ ]
FIRE RESISTANTCONSTRUCTION [ ] :FIRE RESISTANT PENETRATION
[ ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODEVIOLATION [ ] PRE C/
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34Town Hall Annex Telephone(631)765-1802
54375 Main Road „ Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
Vii` "
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION M AR 5 2019 1,
Rental Permit Fee $200 (Application must be renewed every two years) 'T.
',.
Section A.
Property Information:
Rental Property Address: e PS
�?
Tax Map Number: 1000 SECTION el I FLOCK � L LOT, ._.
SECTION B.
OWNER INFORMATION:
Property Owner Name: °
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
Cajf CJ Aveaoe— 1") 5 F 6J A ve4
DD
Telephone Number (s): 62-0
. I'll e Aj Ct f 0
Property Owner Email Address. 0c) t q (2
Page 1 of 4
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 Id of persons allowed to occu �Dwellin
Requested Maximum number p pY g Unit:
Number of rooms in Rental Dwelling Unit:, _ IT
Use and Dimensions of each room in Rental Dwelling Unit:
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 NYS licensed architect, a NYS 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.
Vr I am requesting a fire safety inspection to be performed by a Code Enforcement Official
from the Town of Southold.
Page 3 of 4
❑ 1 am submitting a completed Town of Southold certification form from a licensed
architect, a licensed professional engineer, or a licensed home inspector who has a valid
New York State Uniform Fire Prevention Building code Certification.
SECTION H.
DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit.
STATE OF NEW YORK)
)
COUNTY OF SUFFOLK)
t'
(00 , 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
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 s to any change to the information
regarding Authorized Agent, Managing Agent, or Site Manager.
K
Property Owner's Name:
Property Owner's Signature:_ ."dW�
A R O N,,�
Sworn to before me this—day of w'" t
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Official N:
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otary Public Si nature and Original Notary Stamp s
O K
Page 4 of 4
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a Town of Southold Annex 8/23/2014
tit54375 Main Road
Southold,New York 11971
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: 37106 Date: 8/25/2014
THIS CERTIFIES that the structure(s)located at: Midlothian Ave,Fishers Island
SCTM#: 473889 Sec/Block/Lot: 9.-7-8.3
Subdivision: Filed Map No. Lot No.
conforms substantially to the requirements for a built prior to
APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 37106
dated 8/25/2014 was issued and conforms to all the requriements of the applicable provisions of the law.
The occupancy for which this certificate is issued is:
wood frame one (anvil -dwell� ir� wig th eta°gin a� tint.*
Note: BP,37„�9 additions,,, o d relli rg -OZ-36M
The certificate is issued to Gordon,Albert
... _ _._._. _ ..
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
At 11 -e Sign/
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
I1OUSINC CODE INSPECTION REPORT
LOCATION: Midlothian Ave,Fishers Island _ .. .........
SUFF.CO.TAX MAP
NO.: 9. 7 8.3 SUBDIVI I
NAME OF OWNER(S): Gordon,Albert
.
OCCUPANCY:
ADMITTED BY: Sarah Gordon
DATE 8
SOURCE OF RE UEST: � /25/2014
Q��
Gordon,Albert . . _
DWELLING:
#STORIES: — 2 it EXITS: 6
FOUNDATION Stone CELLAR: Partial CRAWL SPACE:
3 TOILET R 1/2 UTILITY ROOMS)
BATHROOM(S) �� OOM(S)
--
PORCH TYPE: DECK TYPE:FIREPLACE: PATIO TYPE Stone
BREEZEWAY: GARAGE:
DOMESTIC HOTWATER:# Yes m.
TYPE HEATER.
Electric
A
IR CONDITIONING:
TYPE HEAT: Electric . .WKRCIR H WATER:
BEDROOMS: 5 #KITCHENS: BASEMENT TYPE:
Unfinished
OTHER: -
ACCESSORY STRUCTURES:
GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: _ -- _
SWIMMING POOL: GUEST,TYPE OF CONST:
OTHER:
VIOLATIONS:
REMARKS:
INSPECTED BY: ARY1''° DATE OF INSPECTION: 8/6/2014
_...... _.
TIME START: END:
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. 2. .362& . , w , Date , . . . . . . . . . .pct . . .31. . . . . . . .,
THIS CERTIFIES that the building located at . .jDCe fia. Aye• • • • . • • • • • • . Street
Map No. Block No. . . . . .Lot No. . . • • •Fishers. 1s:L . .14y
conforms substantially to the Application for Building Permit heretofore filed in this office
dated . . . . . . . . .Nod. . . '28• . ., 19.69. pursuant to which Building Permit No. . 37592. -
dated . . . . . . . . . . . .iftwr. . . ., 196,x. ., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is . •Private• -one. •famil1•dwelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . .
The certificate is issued to . .Albert• Gordon• • • • • • • • •Owner• • • • • . • • • • • . • . . • • . . . .
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . . .X-.-R, . • . • •
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE `
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
3` 59 Z Date ..................... ....w.www <.,.. ... .... .,
Permission is hereby granted to:
I
.................... . i .. .
to ..,3u� •• ,x�.. ..� .: ... ti :t .. �r .�i ......................................
.............. .......x.ww ..........,.,.... ................................... ........ ...... ... . ..... . .... ..........
at .premises located at -1j%j0 r0,..A` 0............... .....„............ ........r ........w ......,.., ........ .........,
........................................... .ftsho•rB...x014#A.......U*Y-*............. ................ .................................
pursuant to application dated ..... .....................jjf Vj*...2a................ 19 ...,' and approved by the
Building Inspector.
Fee $1AW.............
6.wxnnw
� .. Building Inpectr