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HomeMy WebLinkAbout1000-31.-13-7.2 TOWN OF SOUTHOLD Rental Permit Jk 0248 g Owner Papson Vicky Revoc Trust Occupied as Single Family Dwelling Located at 11120 Route 25 East Marion 31-13-7.2 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 A Code Enfgoeent official This Notice must be posted by the main entrance at all times OUTHOLD T N Town Hall Annex 54375 Main Road PO Box 1179 Southold, Rental Inspection NY 11971-1179 � �. Tel: 631-765-1802 Fax 631-765-9502 a SCTM # . Date Owner -Svh Phone 63 t cf q d OJ(/ Address Zipci Hamlet Inspector Address visible from street? LEVELS SUB 1 2 3 Smoke Detectors (#- bedroom detectors excluded) Carbon Monoxide Detectors (#) Fire Extinguishers (#) Exits (#) BEDROOMS 1 2 3 4 Smoke Detector Alarms Carbon Monoxide Alarms (#) Egress(windows) (Y/N) BUILDING SYSTEMS CONDITION OF PROPERTY N 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&wards present. POOLS Y/N ' POOL BARRIERS Pool present Pool is completely enclosed Pool surface alarm and/or door alarm Barrier is a min.48" high resent POOL GATES Y/Ntax. pening in barrier less than 4" e.. Self-closing, self-latching 2"clearance @ bottom of barrier Latch on pool side of gate, meets height Barrier capable of being locked &child- requirements proof when unattended COMMENTS: TOWN OF SOUTHOLD Rental Permit Permit No. 0248 Owner Papson Vicky Revco Trust Occupied as Single Family Dwelling Located at 11120 Route 25 East Marion 31-13-7.2 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. 12/9/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times Town Hall Annex " " ;; =.Telephon (631 765,-1802 54375 Main Road �Fak`(61 '765-9502 P.O.Box 1179, Southold,NY 11971-0959 ',� OCT 1 6 2019 � , BUILDING DEPARTMENT '= -"- `` TOWN OF SOUTHOLD "RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION , -BLQCK.t-_- 1 �- -LOT _ - �– SECTION B. OWNER INFORMATION: Property Owner Name:,-- Property ame:,_Property Owner Legal Address: Property Owner Mailing Address: Telephone Number(s): Daytime - 4M F— Evening S69M�- Emergenty 3 3 -1382- Property Owner Email Address: I-cK �► <r Page 1 of 5 jo 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 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any. VV�� _. �ti c Address of Authorized Agent (no P.O. Boxes): l o9 I aka r\ a QcA�fu Mailing Address of Authorized Agent: 5/T°Kl Telephone Number(s): Daytimeu�l 9 I �Eveni gY� Seff))(Emerge nc-y ✓1'1 Email Address: v - e +VG`-w io ns• C- ` Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: ® w Address of Authorized Agent(no P.O. Boxes):, Mailing Address of Authorized Agent:, Telephone Number(s): Daytime _ :Evening Emergency' Email Address: SECTION E. SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units) Name of Managing Agent of dwelling unit, if any: - Address of Managing Agent (no P.O. Boxes): _ Page 2 of S X, yi l� f Town Hall Annex : Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 1 1 971-0959 �Vu BUILDING DEPARTMENT a TOWN qF SOUTHOLD t n qV.-X e^-V c/o —T—o WtN . cr/L v Mailing Address of Managing Agent: eF-o= � � I o r Telephone Number(s): Daytim _ �: EveningS _ Emergency, Email Address: 1 _I__ � � �S c.C--ry" SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property.-' - For roperty: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: 1 Requested Maximum number of persons allowed to occupy Dwelling Unit: >04e e-efel Number of rooms in Rental Dwelling Unit: - cl om s - , � Use and Dimensions of each room in Rental Dwelling Unit:'77_fb / to* Y:- ®1L° e-e_ Cd K_1 n '� Flo mac// ��'�XII `° sJard, �3XI2' Page 3 of 5 E� Town Hall Annex " �� Telephone(631)765-1802 54375 Main Road ', Fax(631)765-9502 ; P.O.Box 1179 to "max Southold,NY 11971-0959 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. I 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 ftj K COUNTY OF SCK) �s I � certify under penalty of perjury,the following: 1. 1 am the owner of the property identified in "Section A" of this application. 't 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 n Page 4 of 5 .j ' .° 'r 2 4 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 Department of any changes of address within five (5) days of any changes thereto. 3. I have read and received a copy of Chapter 207 of the Code of the Town of Southold and k. agreed to abide by the same, k: 4, 1 will notify the Town within five (5) business days as to any change to the information ,a: regarding Authorized Agent, Managing Agent, or Si anager. ` Property Owner's Name:; Property Owner's Signature. 64 V'� Sworn to before me this day of LE J-20— Official -201Official Notary Public Signature and Original Notary Stamp ,- �f CPB : b1�c 31 2pv Not2�pyres Ma ch �, 0 ►Ss` n C > My Gomm Page 5 of 5 x l I -ko *OF SOI¢�o� / TOWN OF SOUTHOLD BUILDING DEPT. `yca 765-1802 INSPECTION j ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] NAL [ ] xv5v- FIREPLACEA CHIMNEY [V FIRE SAFETY INSPECTION [ ] FIRE.-RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] 'ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: AAW/ V~� o 0 - DATE 'Y WINSPECTOR TOWN OF SOUTHOLD PERTY RECORD "CARD m OWNER STREET r o VILLAGE DISTRICT SUB. LOT ',aY ,e, ILw FORMES�11 IN `�i•��` E � ACREAGE f� S jL�, V,t 1YAE 4F BUILDING L SEAS. VL. FARM COMEM. f MD. I CB. I MISC. �. e r LAND IMP. TOTAL DATE REMARKS 7 - Wk&ItXfe ^ I� -• w cn J .wj` /JJ5f� /� f`l f / / �` /TyJ ...lJ• /L/} \\llr �` f 9I sV [/ " 7 f� { T NTLI fFrGiG I GJ •.'! J,4 FSC •i t ! ! If, �_ o Q £� D m 1 ` ` 1TC4 Avg2w res, la �p{c `t t is ale — f GPh1 T i ? jF1 7( MAL ELow ABOVE ' y �`.� cre �V er � ValueLo Lo miabje m L'orillable 70 LO 'm Tillable,. 3 ziLD n ' Woodland -row% � m lk Swampland 3 e� - 54yo al 3rushlarf6'"ti a� ....5 - � 0(^ a, NHouse Plot m - m y 4 ' :. °. iii■■■■■i�■■■■■■■■■ ■■■■iii■oawaMom EM ■■■■S■#■■1 ■■� �MNOW.Mi�it,MWORM LM mono Fire Place p"Mm, '• • r +� •` .. ti TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, NEW YORK CER'T'IFICATE OF OCCUPANCY NONCONFORMING PREMISES THIS IS TO CERTIFY that the /X/ Land Pre C.O. #- Z-15856 ! / Building(s) Date- June 17, 1987 F/ Use(s) located at 11120 Main Road East Marion, New York Street Hamlet shown on County tax map as District 1000, Section 031 , Block 13 , Lot 07 does{not conform to the present Building Zone Code of the Town of Southold for the following reasons: Insufficient lot width and rear set-back; accessory garage and shed in front yard. On the basis of information presented to the Building Inspector's Office, it has been determined that the above nonconforming CX4Land /_/Building(s) /_/Use(s) existed on the effective date the present Building Zone Code of the Town of Southold, and may be continued pursuant to and subject to the appli- cable provisions of said Code. IT IS FURTHER CERTIFIED that. based upon information presented to the Building Inspector's Office, the occupancy and use for which this Certifi- cate is issued is as follows: Property contains 1 story, one family, wood framed dwelling, accessory garage an shed; concrete bulkheads; Permit 1955-CO Z-1652 addition and alteration, Permit 1178822 CO Z-7396, deck addition, Permit !179062 CO Z-10812 ngroun swimming pool. All situated in A Residential Agricultural zone with Access to Main Road; a State Highway The Certificate is issued to VICKY PAPSON (owner, Xm0sinxWX1Coorwxt1 of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO. N/A NOTICE IS HEREBY GIVEN that the owner of the above premises I-LAS NOT CONSENTED TO AN INSPECTION of the premises by the Building Inspec- tor to determine if the premises comply with all applicable codes and ordin- ances, other than the Building 'Lone Code, and therefore, no such inspection , has been conducted. This Certificate, therefore, does not, and is not intended to certify that the premises comply with all other applicable codes and regula- tions. _uikun- inspector -— FORK NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERIC'S OFFICE SOUTHOLD, W• V. CERTIFICATE OF OCCUPANCY No. .. ........•. Date ..................... .! .... �......... .. 196 .... ., THIS CERTIFIES that the building located at .................................. Street Map No, X=YX......... Block No. .�........... Lot No.�.......�Amt....� ....�p �T � ...... . .... s. :2. conforms substantially to the Application for Building Permit heretofore filed in this office dated I3@�elit��.. .... 19.6 . pursuant to which Building Permit No. 21955 ...... ...................... .., ... dated ...............................DAa.mber-8, 14.69., was issued, and conforms to all of the requirements of the applicable provisions of the low. The occupancy for which this certificate is issued is ........ ...............$ '. ,V r.@...A)Ilii..XaMi17..d>IiEtllin .......... . ... ... .................................... .................... The certificate is issued to 10...Pa,P.> CA........ .. . ......Omer............................................................. (owner, lessee or tenant) of the aforesaid building. ...•. • A"• iii.•.•.'..•.•r 1iY•avi,1.�.`issYa••.••a••....•........... Building Inspector i FOBN NO. 4 TOWN OF SOUTHOLD BUMDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 77396 . . . . . Date . . . . . . . . . . . Doe. . . .; . . . . . .. 19. ..6 THIS CERTIFIES that the building located at A.a.W.u. .$/S• Maita• Rd• • • . . . Street Map No.X.16 . . . . . . . . . Block No. Xx. . . . . Lot No. . xx. -last.Mavi©nr . .N.j o• • • . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . fir. . 2 19.75. pursuant to which Building Permit No. .7.g82Z. . dated . . . . 9 . .?. . 19.75, 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, sae fAmily. Avel.ling.with.addition.(duck). . . . . . . . . . . . . . The certificate is issued to . Vicky Stavro3 k*s. • nwner• • • • • • • • • •• • • •• • • • • • • . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N•R• . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE No.lt204.79 . . . ;Ulr. . .$5. • 1.975• . . . . . . . . . . . . . . ROUSE NUMBER 11120. . Street . . . .Main. Road • • • Ea-st•Marien • • • . • • • . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . r.--� . . . . . .. . . . Building Inspector FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. .;1.0AI?. . . . . . . . . Date . . . . . . . Pggc mb". T1. . . . . . .. . . . .. 19$1. THIS CERTIFIES that the,building .Cpool .&. ,:ance. grlCloAt;ro). . . . . . .. . . . . . . . . . . . 'Location of Property1 1,120. . . . . . . . . . . . . . . . ;44. too. . . . . . . East_ Marion . . . . . . . . . . . . . . . . . Nouse No , Street Hamlet County Tax !flap No 1000 Section . . .Q3 . . . . . Block . . .13. . . . . . . . . . .Lot . . PA.7 . . . . . . . . . . . Subdivision . . . . . . . . X. . . . . . . . . . . . . .. . . . .Filed Niap No. . N. . . : . .Lot No. . .x . . . . . . . . . . conforms substantially to the Application for Building Pernit heretofore filed in this office dated 906 . . . . . . . . . . . 19 75.pursuant to which Building Permit No. . !. . . . . c. . . . . . . . . . . . . dated NAY .9 . . . . . . . . . . . . . . . . 19 . 7-5,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 . Ari . . . . . . . 1zae '.043a 1. use:. . . . . . . . . . . . . . . . . . . . . . . . . . The certificate isissu;,dto . . . . . . . YA(;M AP-SoA .5Wr;o;axes (owner,lease.00 fml;npj of the aforesaid building Suffolk County Department of Health Approval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . 14544 ,91 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �!r Building Inspector Rev 1/61 1 C)Ff t , fir., ..... ,-r.... { � v ' .oC) Z IT - Ro c) M1 r► twoDv L i v i t-� ci o c i-i 1 15 12 -2114 HAL.1..... S�) a 1 I X t t