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Home My WebLink About1000-104.-5-3.3 NDV Town Hall Annex . Telephone 631 r; P ( )765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 �� ,') ,a tic Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOILD RENTAL PERMIT APPLICATION Rental Permit Fe (Application ust be renewed every two 9- Section A. Information:Property Tt r erty A dress. Tax Map Number: 1000 SECTION : " ....._—.-BLOCK -1 OT SECTION B. OWNER INFORMATION: Property ner —]�Name: I C C � Property ner I ress: Property Owner Mailing Address: d 441 21- tl '" Telephone r (s): i - - v in r cy� , PropertyOwner Email r All vJo- �7�3A Page 1 of 5 .y}'Y � Town Hall Annex Telephone(631)765-1802 54375 Main Road1 p Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 G r, BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorizedof dwellingunit, if any: Address of Authorized Agent (no P.O. Mailing Address of Authorized Agent: Telephone Number(s): a i e Evening_,,,,_ Emergency-_-..-.,___ Email Address: Section D. Managing Agent Information: Name of Authorizedn Ili unit, if any: Address of Authorizede o P.O. Boxes):-,- Mailing Address of Authorized Agent: Telephone Number(s): Daytime--..—____Evening Emergency____.__,__ EmailAddress: SECTION E. SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units) Name of ManagingAgent of dwellingunit, if any: r Address of Managing Agent (no P.O. oxes). 0„�"� Page 2 of 5 do Town Hall Annex Telephone(631)765 1802 54375 Main Road 1:ax (631)765-9502 P.O.Box 1 179 a Southold,NY 11971-0959 �� 01 ��% T, BUILDING T ENT TOWN OF SOUTHOLD Mailing Address of Managing Agent:__ .1.4 (/trb Telephone Number (s): Daytime � w � •. � Eveninn " Emergency P; Email Address: SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on rope For each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier(for example, Unit 1, Unit 2, Unit 3 or Apt A, B, );the use of each room in the Rental Dwelling Unit (for example, Kitchen, BedroomBedroom , Living Room) and the dimensions of each room. For properties with multipleental Dwelling Units use "Rental Permit licaion Addendum." h Rental Dwelling Unit Identifier: Requested Maximum number of persons allowed to occupy Dwelling Unit: ' Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: Z- 16 15 Page 3 of r Gv�t� Town Pull Annexr Telephone(631)'765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 UN ✓ Ira c i ��r,h BUILDING DEPARTMENT TOWN OF SOUTHOLD SECTION G. Pursuant to the Town Codeof the Town of Southoldter 207 (Rental Properties), a safety inspection by Coe Enforcement Official is required. If the owner chooses not to havesaid inspection performedcertification r licensed architect, a license professional in r or a home inspector who has a validYork State Uniform Fire Prevention Building Certification is required stating that the propertyis is the subject oft e rental permit application is in compliance wi all of the provisions of the code of the Town of Southold,the laws and sanitary sin regulations oft County of ! by e laws adopted by the New YorkState Fire Prevention and Buildings Council. I am requesting fire safetyinspection to be perfor e Enforcement Official from the Town of Southold ❑ 1 am submittingcompleted of certification form froma license architect r a licensed professional engineer. SECTION H. Signature ized and MUST be the owner of the dwelling unit. S ) COUNTY OF ) SUFFOLK) certify ner penalty of perjury,the following: 1. 1 am the owner of the property identified in "Section A" of this application. . The property owner's legal aress set fort in "Section " of this application is my legal address and I understand the Town will uset ress for service pursuant to all Pae 4 of 1 Town Hall Annex �� Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 r� co,"' Southold,NY 11971-0959 gyro- BUILDING TOWN OF SOUTHOLD applicable s and rules. I further acknowledge thatill notify the Town of Southold Building Department of any changes of address within five ( ) days of any changes thereto. . 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. . 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: � �. ��" e� 1,• PropertyOwner's Signature: Sworn to before m hi a f 2 Official Notary Pu jJ 1 a Original Notary Stamp b E A FEUERSTEINhlic„State of New York.01FE62831'15d in New York Countyn Expires lay 28,20 Page 5 of TOWN OF SO 'THOLD BUILDING DEPT. 7 541 802 119SPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND :[ ] INSULATIOWCAULKING C ] FRAMING /STRAPPING [ ] FINAL C ] FIREPLACE & CHIMNEY ] FIRE SAFETY INSPECTION [ ] FIRE-RESISTANT CONSTRUCTION [. ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O ., R=S-a............. 1INSPECTOR 6370 Skunk Ln 2 ° 15° Kitchen Living Room 11.5' X5' Bedroom 1 Bedroom 2 Bathroom 11.5'X 10.5' 6 utility 7' 1OU, L-j = Smoke&CO Detectors zLng KLA d G' Q' Q'CD o m rp m "n m � �7 -r W N nl 7J _.. qA m � �J CD 1• n v . Vii C r r � e i " Zm rLnCD Z Oil I• a �N Ds m � G o O CD m O r ' y.. �m m tj ke �, _ CIL', ��° � i (ire Ln � o w � _ ti O w. co Ln�,.m.. ... — LA w; J° oa z r fl c CL m � CL c a) ID O Z z tM f w O C r m r v O O 1 Z 2 p m m e Ln o 7 I Q " 03 . ri , i co V °moo. r - s , 0 G) ; mT TID ID 10 VAI CD Ln tD 1n w in r fi ilNl II l 1 I I I r w .p .� �� "• rD m C h CD 3 C< 3 a O 0 ❑_ fD 0 (D7 -r p I � ? S T 4 Jra � a a m NN rt O o �- N �,... ....._,. _.. N .�.... 1 f a n [ g I f r U I i 3 H u FORM TO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY Z..71K Date ... THIS CERTIFIES that the building located at .Rai ]!avex�Ug� Echo$u8 •, Street �#tt Map No. 4 Ick. No. Lot N��' ,.. .. . .... ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... lay 1 1951a . pursuant to which Building Permit• No. ... Z 34DI.. fated .............. May' 1. 19.58 , was issued, and conforms to al of the requirements $ of the applicable provisions of the law. The occupancy for which this certificate is issued is PRIVATE ONE YAMILY SLIMMER D'� I)93 This certificate is issued to Theodore & Clarice Hurchock„ ownet.a (owner, lessee or tenant) of the aforesaid building. Building Inspecto i f w,s FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-4635 Date: 05/16/72 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 6370 SKUNK LANE ..., _CUTC...HOGU E �._....... (HOUSE (HAMLET) County Tax Map No. 473089 Section 104 Block 5 Lot 2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore .. filed in this office dated MAY 13, 197....1 Pursuant to which Building Permit No. 5294ITZ dated � MAY 13, 1971 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 BUILD AN ADDITION ON EXISTING DWELLING. (CORRECTED TO INCLUDE ALTERATION OF SEASONAL DWELLING TO YEAR ROUND RESIDENCE) , The certificate is issued to CLAIRE MURCHECK & CLAIRE BLAIR (OWNER) .._...,.,_.....—,_ m......._ of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A authorized Signature Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 43722. . . . . . Date . . . . . . . . . . . . . . .R . r. . 31.., 19.69 THIS CERTIFIES that the building located at . . Bay.A.To. . . . . . . . . . . . . . . . . Street Map No. Aamm. . . . . Block No. . =. . . . . .Lot No. Cutcho . N.Y.. . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . .JV4 . . . . . _ . ., 19 69. pursuant to which Building Permit No. X41644. . dated . . . . . . . . .Aug . . . .�.1 . . . ., 19.69., 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 . . . . Rri to • c ory • (Itorag ) - dint . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . Theo. &.Claim Mureback. . . . Owner . . . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval spa . . . . . Building Inspector 6390 Bay Ave