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HomeMy WebLinkAbout1000-110.-8-13 TOWN OF SOUTHOLD �. MY- Rental Permit 4 0269 Owner Arthur Hughes Occupied as Single Family Dwelling Located at 595 Oak Road New Suffolk 110.-8-13 Maximum Permitted Occupancy 5 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. 1/8/2020 John Jarski Code Enforcement Official 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 SOTJTHOLD 1'"-L NOV 2 O 2019 i J RENTAL PERMIT APPLICATION__ Rental Permit Fee$200 (Application must be renewed every two years)' ?`' ..'_-:'�: 'j Section A. Property Information: l" Rental Property Address: Tax Map Number: 1000 SECTION:—��-^ SECTION B. OWNER INFORMATION: - Property y v�' 0 6-fI� ~ `-as ro N Y Owner Name: Property Owner Legal Address: Property Owner Mailing Address: - ------- - --- - - - -- `� Telephone Number (s): Daytime Evening_ _ - Emergency I� tJ � Property Owner Email Address: C - -&D -0 Page 1 of 5 i T Town Hall Annex .1L Telephone(631)765-1802 54375 Main Road - '! Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 v BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C: Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: , An1g Address of Authorized Agent (no P.O. Boxes):` Mailing Address of Authorized Agent: _ Telephone Number(s): Daytime + __ Evening _Emergency Email Address: -- — Section D. Managing 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 Emergency 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: Address of Managing Agent (no P.O. Boxes):. Page 2 of 5 7 r soUr �- 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): Daytime Evening _ .Emergence _ Email Address: SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property:= N For each Rental'Dwelling Unit set forth the Rental Dwelling Unit identifier(for example, Unit 1, Unit 2, Unit 3 or Apt A, B, Q 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"Perlriit Application Addendum." Rental Dwelling Unit Identifier: Requested Maximum number of persons allowed to occupy Dwelling Unit:- Number of rooms in Rental Dwelling Use and Dimensions of each room in Rental Dwelling Unif. v�"'' "'I /3 X 3 j Page 3 of 5 } Town Hall Annex ' Telephone(631)765-1802 54375 Main Road Fax(631)76.5-9502 P.O.Box 1 179 t ; 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 j inspection performed by the Town, a certification from a licensed architect, a licensed i professional engineer or a home inspectorwho 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 su ffolk and by the laws adopted by the New York State Fire Prevention and Building Code Council." j I am requesting a fire safety inspection to be performed by a Code Enforcement Official >" from the Town of Southold I 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. { 1 STATE OF NEW YORK) COUNTY OF SUFFOLK) 1 u d PJ /!��[/�� ;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 l I Page 4 of 5 j s Town Hall Annex - Telephone(631)765-1802 54375 Main Road r 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 Buildin De artment of an changes of address within five (5) days of any changes g .p Y thereto. I 3. t have read and received a copy of Chapter 207 of the Code of the Town of Southold and l agreed to abide by the same.' 4. 1 will notifythe 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.' _ ___&_ Property Owner's Signature: Sworn to before me thi day of. (�1/PV1(1 _:-201q Official No aY Public Signature Original Notary Stamp TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK -NO.01 DW6306900 QUALIFIED IN SUFFOLK COUN COMMISSION EXPIRES JUNE 30, a • t Page 5 of 5 i a0F SOUjy # # -TOWN, OF SOUTHOLD BUILDING DEPT. �O • �O �yco765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND ="[ ]" INSULATION/CAULKING [ ] FRAMING /STRAPPING [rFIRE INAL/&,4 [ ] FIREPLACE & CHIMNEY [ SAFETY INSPECTION " [ ] FIRE RESISTANT CONSTRUCTION =[ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: pr , DATE th/ INSPECTOR W o E � up 1 5"M0Kd 6 rkqbA CtM oN Mv�dcY sof L,•1 y 1 N tr C3'-x25 o�o,vT ^�'� , F460A .04 for VO ID ,AAAA 124- R _ l w � I A4 TOWN OF SOUTHOLD PROPERTY RECORD OWNER STREET VILLAGE DISTRICT SUB. LOT FORMER T;IR6 EJ) ACREAGE � ! TYPE OF BUILDING -+-�-- L S �d ,� /P6 a of Wp7a //c r RE 21� SEAS. VL. FARM COMM. I IND. I CB. MISC. I Est. Mkt. Value LAND IMP. TOTAL DATE REMARKS 6'0 o ;4 yo o 1 is 7 A�kc ces S b an FC. 12o0 U co v sLe -to t,rj %q:Fk, Apo.-1v/L 4 0 GC7 plo2 4c� S �r S t0 -la �5- rles ragk,- cc�,�, � Ca10 47 Co J V�> 2� 20 J C)q -1 r�OcJ 5 n Cc ),,a es-4a -71,--�g//C/_ /3 3 — AGE BUILDING CONDITION g k -L 2?g X153 - ilvuJsk� 7`a M ,1P��� 39D, OGS NEW NORMAL BELOW ABOVE FRONTAGE SN WATER Farm Acre Value Per Acre' Value FRONTAGE ON ROAD /r G . /SO ft, 6dK IPasd� Tillable 1 BULKHEAD_7* r 7— B Tillable 2 DOCK Tillable 3- Woodland Swampland Brushland House Plot �- — - i ota I . r x . ' WW -- I All OC Oe — _ ---�-?-- --rte --�--- -�--�- 110.-8-13 10/2014 a Foundation Both jjIdx -- Exten ion ��'� �'!� Basement � 1 Floors Extension Ext. Walls `n, Interior Finish , ExtensionFire Place • ' v Heat- -- -- -- -- - -- -, - - ---- A©� 7 k y Porch Roof Type Porch Rooms 1 st Floor L� Breezeway Patio Rooms 2nd Floor ?j Garage !&O Driveway Dormer O. S. --- J t Z 7 (,oC it►+) } j.r Town of Southold Annex 8/6/2014 54375 Main Road Southold,New York 11971 PRE EXISTING CERTIFICATE OF OCCUPANCY No: 37068 Date: 8/5/2014 THIS CERTIFIES that the structure(s)located at: 595 Oak Rd,New Suffolk SCTM#: 473889 See/Block/Lot: 110.-8-13 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- 37068 dated 8/5/2014 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 family dwelling with accessory garage and accessory shed.* NOTE:BP 16004 accessory shed COZ-15783;BP 39058 issued 7/28/14 for garage demolition. The certificate is issued to Orlowski,Helen (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. t oriz Signature BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 595 Oak Rd,New Suffolk SUFF.CO.TAX MAP NO.: 110.-8-13 SUBDIVISION: NAME OF OWNER(S): Orlowski,Helen OCCUPANCY: LL--- ADMITTED BY: Victoria Germaise SOURCE OF REQUEST: Orlowski,Helen DATE: 8/5/2014 DWELLING: #STORIES: #EXITS: FOUNDATION: cement block CELLAR: CRAWL SPACE: Full BATHROOM(S): 1 TOILET ROOM(S): UTH TI'Y ROOM(S): PORCH TYPE: DECK TYPE: PATIO TYPE: BREEZEWAY: FIREPLACE: GARAGE: DOMESTIC HOTWATER: Yes TYPE HEATER: National Grid AIR CONDITIONING: Yes TYPE HEAT: Natl.Grid WARM AIR: X HOT WATER: #BEDROOMS: 3 #KITCHENS: 1 BASEMENT TYPE: Unfinished OTHER: ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: wood frame 1 car STORAGE,TYPE OF CONST: wood frame shed SWIMMING POOL: GUEST,TYPE OF CONST: OTHER: VIOLATIONS: REMARKS: INSPECTED BY: ARYF DATE OF INSPECTION: 7/18/2014 TIME START: 10:30am END: 10:50am FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate OF Occupancy No .? 15.783 A Date May, 22 , . 19.87. . . . . . . . . THIS CERTIFIES that the building Accessory. . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property 3180 New. Suffolk Road . . Cutchogue , . . AiLse IVo. Street ­ Hamlet County Tax Map No 1000 Section 1.10. .Block . . ..8 . . . . . . . . .Lot , ,13 . . , , . , . . , .. Subdivision . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . .Lot No. . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . .A p r i.1. 3,0 , . .1.9.8 7 pursuant to which Building Permit No. .1.6004 Z dated May ? 1 , 1987 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 building as applied for . The certificate is issued to BENNETT ORLOWSKI . . . . , . . , . (ovvrier,/!f#�36K�k�a7b}¢X% of the aforesaid building Suffolk County Department of Health Approval . . /. . . . . . . . . . . . . . .. . . . UNDERWRITERS CERTIFICATE NO ,N/A. . . . . . . . . . . . . . . . . . . PLUMBERS CERTIFICATION DATED: N/A • udding Inspector Rev 1/81