HomeMy WebLinkAbout1000-86.-5-5 - $ TOWN OF SOUTHOLD
Rental Permit
0288
Owner Edward Capobianco & Ors.
Occupied as Single Family Dwelling
Located at 400 Spring Lane Peconic 86.-5-5
Maximum Permitted Occupancy 3
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.
2/7/2020 John Jarski
Code Enforcement Official
This Notice must be posted by the main entrance at all times
so�ir
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
RENTAL PERMIT APPLICATION-
JAN
PPLICATIONJAN 7 2020
Rental Permit Fee$200(Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address: ,
e,Gont C_
Tax Map Number: 1000 SECTION - - B,L`Q,CK.- -LOT
SECTION B.
OWNER INFORMATION:
Property Owner Name:_
a
Property Owner Legal Address: Property Owner Mailing Address:
I IA
Telephone Number(s): Daytime Evening Emerge9b
Property Owner Email Address:
Page 1 of 5
Town Nall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
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BUILDING DEPARTMENT
TOWN OF SOLTTHOLD
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RENTAL PERMIT APPLICATION INSTRUCTIONS
Rental Permit Fee $200 (Application must be renewed every two years) ,
The items listed below are required to be submitted with the completed
application.
❑ Floor Plans: Floor plans of each Rental Dwelling Unit, please show location of
all smoke &carbon monoxide detectors.
❑ Certificates of Occupancy and Pre-Certificates of Occupancy: Certificates of
occupancy or Pre-Certificates of Occupancy for each rental dwelling unit.
❑ Certification of Code Compliance(form enclosed): Must be submitted by a
license architect or engineer or license home inspector if an inspection by Town of
Southold Inspector is declined.
❑ Rental Permit Fee: $200.00
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Town Hall Annex l Telephone(631)765-1802
.54375 Main Road Fax(631)765-9502
P.O.Box 1 179 ,
Southold,NY 11971-0959
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent:
Telephone Number(s): Daytime- _.Evening Emergency _.
Email Address:
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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, Q the use of each room in the Rental Dwelling Unit i E
`E
(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:
Requested Maximum number of persons allowed to occupy Dwelling Uni
_
Number of rooms in Rental Dwelling Unit: 5 -
Use and Dimensions of each room in Rental Dwelling Unit: �U( -r\ Y-C UB, 5 Y, o-��
List t` nc, fay i I k I�� `► �i � �,l
room- 1 d v� °� �1� ► '—� • I� ��
-robes- 2L y� �4 I
Page 3 of 5
so
Town Hall Annex y Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 t
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
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 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)
Name of Managing Agent of dwelling unit, if any:
Address of Managing Agent (no P.O. Boxes)'
Page 2 of 5
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 iN
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
SECTION G.
INSPECTION:
1
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 `'
❑ 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 NEW YORK)
COUNTY OF SUFFOLK)
1 EA,-Pad, OA �Iancu
_ , 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
Page 4 of 5
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Town Hall Annex > Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 ' *`
Southold,NY 11971-0959 Qr ,
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
applicable laws and rules. I further acknowledge that I will notify the Town of Southold
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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 as to any change to the information
,i
regarding Authorized Agent, Managing Agent,, or Site Manager.
Property Owner's Name:
Property Owner's Signatur+—&&,e!:f-�. -,
f
y
Sworn to before me thiL��day of(11 , 20x0
Lam
Official Notary Public Signature and Original Notary Stamp
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Page 5 of 5
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# # TOWN OF SOUTHOLD BUILDING "DEPT:
coum, 765-1802
INSPECTION ,
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ " ] INSULATION/CAUL ING
[ ] 'FRAMING /STRAPPING [ NAL��N�
[ ] FIREPLACE & CHIMNEY [ ],/FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ]
ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:
CIO
DATE 70?,D INSPECTOR
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TOWN OF SOUTHOLD PROPI ARD CARD
OWNER STREET VILLAGE DIST. SUB. LOT
fOYS,
FORMER OWNER N_ E AC
Owd,
S W TYPE OF BUILDING
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RES.
✓RES. X70 SEAS. VL. FARM COMM. CB. MISC. Mkt. Value
LAND IMP. TOTAL DATE REMARKS A
11) 141Z
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c/ Q � � � :J 7 � Cl 3 1'b �3 .iA� Z.�S � /A�t+�L✓C�a- 10— y O h� �.��P ��4� ud A
AGE BUILDING CONDITION 7 a;
rr to CGhbf�A�;CyW'F�— �BCtO
NEW NORMAL BELOW ABOVE FARM Acre Value Per Value r
Acre - P Q8 q— U SSW4 C47Tillable 1
Tillable 2
Tillable 3
Woodland
Swampland FRO�4TAGE ON WATER
FRONTAGE ON ROAD
Brushlond _.cot•
House Plot DEPTH
BULKHEAD
Total DOCK
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MEMNON
MEN
fir . iil� MEMENE
NONE
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. Z!P.+8) . . . . . . Date . . . . . . . . . . .
THIS CERTIFIES that the building located at . 514. S.PT#JK .L". . . Street
Map No. . ?UC. . . . . . . Block No.3PL. . . . . . . .Lot No. XX. . . Pl Cq9 is . . R.-Y.
conforms substantially to the Application for Building Permit heretofore filed in this office
dated . . . . . . . .Qqt. . 24. . . . 1, 19.72 pursuant to which Building Permit No.61.9% . .
dated . . . . . . . . . .Oct - .24. . . . .. 19. .72, 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 . Privateone family dwe113n
The certificate is issued to .Mable.W.QQd. . . . . . . �#er. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .4A17. . 2.7. . 19.7.3 . .�y .R.. villa
UNDERWRITFRS CERTIFICATE No. . 586L5a,apkl TeIDp 5/9/73
HOUSE NUMBER. . . . . . . . .Street. . . 37UIX .tel. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
J
Bu11ding Inspector
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28649
Date: 08/06/02
THIS CERTIFIES that the building ACCESSORY
Location of Property: 400 SPRING LA PECONIC
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 86 Block 5 Lot 5
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 16, 2002 pursuant to which
Building Permit No. 28569-Z dated JULY 17, 2002
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 16' X 10' ACCESSORY STORAGE SHED AS APPLIED FOR. "AS BUILT"
The certificate is issued to EDWARD J CAPOBIANCO
of the aforesaid building. (OWNER)
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO_ N/A
PLUMBERS CERTIFICATION DATED N/A
r
ut rized Signature
Rev. 1/81