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HomeMy WebLinkAbout1000-63.-4-7 TOWN OF SOUTHOLD Rental Permit 0259 Owner Nancy Butkus Occupied as Single Family Dwelling Located at 465 Town Harbor Ln Southold 63-4-7 Maximum Permitted Occupancy 8 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. 12/13/2021 Code Enfore t Official This Notice must be posted by the main entrance at all times � Town Hall Annex SOUTHOLD TOWN 54375 Main Road PO Box 1179 Southold, Rental Inspection NY 11971-1179 � Tel: 631-765-1802 Fax 631-765-9502 SCTM # — — Date �. Owner Phone Address 6Ywif-tM / to Zip C1 Hamlet s o u o( Inspector ., Address visible from street? LEVELS SUB 3 Smoke Detectors (#-bedroom detectors excluded) Carbon Monoxide Detectors (#) Fire Extinguishers (#) Exits O L� BEDROOMS 1 2 3 4 5 Smoke Detector Alarms (#) 41-1 Carbon Monoxide Alarms Egress (windows) (Y/N) BUILDING SYSTEMS , i�N CONDITION OF PROPERTY / Heating system maintained/operational Building Interior is clean/maintained Hot water system maintained/operational Building Exterior is clean/maintained Electrical system maintained/operational Property is clean/safe/maintained Mechanical system maintained/operational Handrails&guards present POOLS POOL BARRIERS Pool present Pool is completely enclosed Pool surface alarm and/or door alarm Barrier is a min. 48" high resent POOL GATES All openings in barrier less than 4" Self-closing, self-latching z Max. 2"clearance @ bottom of barrier Latch on pool side of gate, meets height Barrier capable of being locked &child- requirements J.proof when unattended COMMENTS: a € ¢£ TOWN OF SO T OL Rental Permit Permit No. 0259 Owner Nancy Butkus Occupied as Single Family Dwelling Located at 465 Town Harbor Lane Southold 63-4-7 Address Village S/13/1- Maximum /B/LMaximum Permitted Occupancy 8 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. 12/24/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD u x.3 .1 N�` ,RENTAL PERMIT APPLICATION,, Rental Permit Fee$200 (Application must be renewed every two years) Section A: Property Information: Rental Property Address: Tax Map Number: 10.00 S.ECTIONa.r— SECTION B. OWNER INFORMATION: Property Owner Name::. . w � SProperty Owner Legal Address: Proberty Owner Mailing Address: tow 19W Telephone Numbers : I ay time, Evenin _._ _ . E er i G ( ) � '� ° � gee -__. Property Owner Email Address: �.1 N V VS� I� G (PN'l r Page 1 of 5 � ... Z Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD ti Section C. Authorized 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'Y Email Address:. w n _•. .. _., Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any:,T 1 �1r Address of Authorized Agent (no P.O.. Boxes),: Mailing Address of Authorized Agent: Telephone Number (s): Daytime, ,Evening Emergency m Email Address: SECTION E. SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units) I Name of Managing Agent of dwelling unit, if any:w_• Agent ( Boxes)-,, .e, ��....... _ A no P.O. Address of Managing g Page 2 of 5 r Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: } Telephone Number(s): Daytlme Evening.. :Emergend 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: _ mmmm_ m, .. � � Requested Maximum number of persons allowed to occupy D Re p PY welling LIrt:,i( � Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit.:_„ .h.. � .... �m �.� _ L V- "r _ Page 3 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 Um�., 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 ❑ lam submitting a completed Town of Southold certification form from a licensed ' architect or a licensed professional engineer. i t - e SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. i t. STATE OF NEW YORK) COUNTY OF SUF LK) certify under penalty of perjury,the following: identified in "Section A" of this 1. I am the owner of the property application. ' t forth in "Section B" of this application is gal le 2. The property owner's legal address se pp address and I understand the Town will use the address for service pursuant to all i P I Page 4 of 5 4 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 SOUTHOLD applicable laws and rules. I further acknowledge that I will notify the Town of Southold Building De artment of anY changes of address within five (5) days of any changes .p t d thereto. J 4 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 bwner's Name: tie Property Owner's Signature: i Sworn to before me this—day of � Official .�,.� Of Notary Public Signature and Original Notary Stamp E Page 5 of 5 N w * TOWN OF SOUTHOLD BUILDING DEPT:. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL . ( ] FOUNDATION 2ND ( ] INSULATIOCAULING ( ] FRAMING / STRAPPING (/] INAL FI EPLACE C I EY � (. RE SAFETY INSPECTION. 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The occupancy for which this certificate is issued is: _ _ __ ` _ _ 1? RC11 RFAR lel E SND tlF1NlI O "f",� �"S'"1 �L1N �UL�_°i "C"T'I4..t�'' RE1�. ON"l' BASErIIT AS APPI T4 The certificate is issued to MAUREEN SMITH of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-99-0012 07-11-2017 ELECTRICAL CERTIFICATE NO. N498697 08-09-1999 PLUMBERS CERTIFICATION DATED 09-31-2006 Plambiug uthod ed Signature I Town of Southold 12/17/2018 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERT1 IFICAFICATE OF OCCUPANCY No: 40095 Date: 12/17/2018 THIS CERTIFIES that the building ACCESSORY GARAGE Location of Property: 465 Town Harbor Ln., Southold SCTM#: 473889 Sec/Block/Lot: 63.4-7 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/8/2018 pursuant to which Building Permit No. 42481 dated 3/23/2018 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: ACCESSORY(!ARRC El,.AS A13Pl,LLL' )E0–K The certificate is issued to Butkus,Nancy of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED __— Aut 1 zed e.......—