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HomeMy WebLinkAbout1000-10.-9-14 TOWN OF SOUTHOLD Rental Permit Permit No. 0292 Owner Brian & Karen Debroff Occupied as v Single Family Dwelling Located at Private Road Fishers Island 10-9-14 Village S/B/L l 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. r ' 2/11/2020 Mike Verity Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times rif S 0 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 SOUTHOILD RENTAL PERMIT APPLICATION Rental Permit Fee $200(Application must be renewed every ears) "j , APR 1 2019 Section nj,­-Property Information: % Rental Property Address: 7_31 Tax Map Number: 1000 SECTION to —BLOCK— 1 LOT SECTION B. OWNER INFORMATION: Property Owner Name: CLVX- Q4 k�ojtvt Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) -Z-no -T-ry)-ulk -EA- owo'l \ Telephone Number(s): Vk'qM'(_ u Z-0 3 Property Owner Email Address:. _b'/1 CQ_Vv = � ` 0,ok vn_�) UT (� ow Go vvn Page 1 of 4 cr3%f SO Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 �CQU BUILDING DEPARTMENT TOWN OF SOUTHOLD ;RENTAL PERMIT APPLICATION INSTRUCTIONS Rental Permit Fee $200 (Application must be renewed eve wo years).,.,_, I L� e 1 i-- The items listed below are required to be submitted with the complete 201 application. W T.. Floor Plans: Detailed floor plans of each Rental Dwelling Unit, please show location of all smoke & carbon monoxide detectors Certificates of Occupancy and Pre-Certificates of Occupancy: Provide copies of Certificates of Occupancy or Pre-Certificates of Occupancy for each rental dwelling unit ❑ Certification of Code Compliance(form enclosed):Applicant has the option of having a rental dwelling unit inspected by the Town of Southold or by an architect, engineer or home inspector of their choosing. If the Applicant elects not to have the rental dwelling unit inspected by the Town,the Applicant must submit a Certification of Code Compliance completed by a NYS licensed architect or NYS licensed engineer or a licensed home inspector who has a valid New York State Uniform Fire Prevention Building Code Certification. Rental Permit Fee: $200.00 (Please Note:The Building Department does not accept cash. Payment must be in the form of a Check,Credit Card or Money Order.) 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: V T Requested Maximum number of persons allowed to occupy Dwelling Unit: E Number of rooms in Rental Dwelling Unit: vc) Use and Dimensions of each room in Rental Dwelling Unit: •,(-j foDM , tq 13� i �OOVIA ,"e) OVVn 5f �,� ��v�, ` o o `K ' off° Z l 2x l 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 NYS licensed architect, a NYS 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. Page 3 of 4 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): 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): 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): Mailing Address of Managing Agent: Telephone Number (s): Email Address: Page 2 of 4 ❑ 1 am submitting a completed Town of Southold certification form from a licensed architect, a licensed professional engineer, or a licensed home inspector who has a valid New York State Uniform Fire Prevention Building code Certification. SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) } COUNTY OF SUFFOLK) I 1",1✓ti P��,� 'ZV►��►/���C , 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 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. 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 s to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager. Property Owner's Name: � ^�`^ Property Owner's Signature: h, Sworn to before me this/ his ay of !1V!cc XiC-4 , 20 - A � 4 �*' Official N y ublic S nature and Original Notary Stamp Page 4 of 4 Town Hall Annex `t Telephone(631)765-1802 54375 Main RoadFax(631)765-9502 P.O.Box 1179 .� Southold,NY 11971-0959 �lCOU `r� �O BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: OF SOUjyO� * TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 -INSPECTION _ ( ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION _ [ ] CAULKING REMARKS: C' D• az -e,- OS o z , DATE INSPECTOR OF SOOT / # # TOWN OF SOUTHOLD BUILDING" DEPT. `ycourm ' 765-1802 INSPECTION [ ] 'FOUNDATION 1ST [ ] ROUGH PLBG. [ =] FOUNDATION 2ND ' [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] �_FAL [ ] "FIREPLACE & CHIMNEY', [ FIRE"SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT"PENETRATION" [ ] ELECTRICAL-(ROUGH) " [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: ©� DATE INSPECTOR - a 7 ` fit, ., • , �,`, d - 1 ro 14 -eGi- APR 1 1 2019 Not low tc" Olv- Ip ID k t.E u27�'t.� � h• an. f L� 1 gr - - -- ------ -- - - - - - - A P R 1 1 2019 - --- -- - --- - -- • -- r��utrv�{Y � 7-- Q,V e4� COP "XI tVt IIl�YfODvvr � i 14 Y wv vas,„ s4-ID _ ob 62 i r � TOWN OF SOUTHOLD P2,OPZ,'1 Y KPM.UKU F.ARD OWNER STREET VILLAGE T DISTRICT SUB. LOT Z" F RMER OWNER\'6 �' N �; / E � _� e ACREAGE eri t_ IZalk )Of y �i <�'r i Lj. X 0 Cl kQVJ sk-I S W TYPE OF BUILDING RES. SEAS. VL. FARM COMM. IND. CE. MISC. LAND IMP. TOTAL DATE REMARKS 3 0o 900 � - - - 7 2r C'-, btu D ; ti✓ , - --- 1 r - r t �33 t�C1 �-c. _ C7© — fit ---= —Z yp 1 3700 3 r3 91 /o Z- 65' _ L 12 _Z (l) kOwS i h, PuAu�k ltl�G t, AGE r, BEY BILI 16P NG CO DI I O i �p IQ 32-'f NEW NORMAL BELOW 1 GZ(#-�,XQ,t►an; "?��Gb� �j�j� � � '�1J J f - _ 1-- ----------- --- ABOV Farm Acre fue Per Acre Value Gw, i � )000 Tillable Tilloble 1 � Tillable 2 ---------=----- Tillable 3 Wccdland ---- — -- --------------- - Swomplond - -- Brushland House Plot ^�7 � .�ivC'�! •1`i r a_.+ 14 WO 1 i Tcta 1 1 ane jaw— M. M. E ition 10:9-14 4107 Exte ent j t; Floors Exte /alls �,, Interior Finish Exte lace t Heat Porch Attic Porch Roorns 1 st Floor Bre .,.:I. ► : Rooms 2nd Floor Got _... �. way i jj O. 10.-9-14 3113 ff t4 14 R i 10:9-14 3/13 - i {— i 10:9-14 4/07 T } M. Bldg. Foundation f A�`� • Bath / Extension G S' Basement Floors � . ExtensionwT Ext. WGIIS U D YA(141 Interior Finish �L 0') 3 V y Extension I Fire Place j Heat 7.ov' k Zoo Porch Attic Porch I Rooms 1st Floor y Patio Rooms 2nd Floor -, 2 Z Driveway Gcrage -I O. B. 474 2y gar w'•-- r ti FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 31965 Date: 10/30/06 THIS CERTIFIES that the building DWELLING Location of Property PVT RD INNER BAY FISHERS"ISLAND (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 010 Block 0009 Lot 014 Subdivision Filed Map No. Lot No. conforms substantially to the Requirements for a ONE FAMILY DWELLING built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 31965 dated OCTOBER 30, 2006 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 ONE FAMILY DWELLING.* The certificate is issued to RICHARD & ELIZABETH DALKOWSKI - - — - (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. Aut oriz d Signature Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: PVT RD INNER BAY FISHERS ISLAND SUBDIVISION: NAP NO.: LOT (S) NAME OF OWNER (S): RICHARD & ELIZABETH DALKOWSKI OCCUPANCY: ONE FAMILY RICHARD & ELIZABETH DALKOWSKI ADMITTED BY: REALTOR ACCOMPANIED BY: REALTOR KEY AVAILABLE: SUFF. CO. TAY MAP NO.: 10.-9-14 SOURCE OF REQUEST: RICHARD & ELIZABETH DALKOWSKI DATE: 10/30/06 DWELLING: TYPE OF CONSTRUCTION: WOOD FRAME Y STORIES: 2.0 # EXITS: 2 FOUNDATION: STONE CSAR: FULL CRAWL SPACE: TOTAL ROOMS: IST FLR.: 5 2ND FLR.: 5 3RD FLR.: 0 BATHROOM(S): 2.0 TOILET ROOM(S): 0.0 UTILITY ROOM(S): PORCH TYPE: DECK TYPE: PATIO TYPE: BREEZEWAY. FIREPLACE: NONE GARAGE: 1/2 BASEMENT DOMESTIC HOTWATER: YES TYPE HEATER: OIL AIRCONDITIONING: TYPE HEAT: OIL FIRED HARM AIR: HOTM&TER: OTHER: ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST.: NONE STORAGE, TYPE CONST.: SKIMMING POOL: GUEST, TYPE CONST.: OTHER: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC _ REMARKS: BP7621 WINDOW COZ31963• BP12541 DECK COZ31962 BP3243 elec / lu b COZ319164 INSPECTED BY: ` DATE ON INSPECTION: 10/30/06 ROBER W TIME START: �= f^ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31962 Date: 10/30/06 THIS CERTIFIES that the building ADDITION Location of Property: PVT RD INNER BAY FISHERS ISLAND (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 10 Block 9 Lot 14 Subdivision Filed Map No. Lot NO. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 8, 1983 pursuant to which Building Permit No. 12541-Z dated AUGUST 4, 1983 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 DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to RICHARD &-ELIZABETH-DALKOWSKI (OWNER) of the aforesaid building. - SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. _ N/A PLUMBERS CERTIFICATION DATED N/A Aut r'zed Sign ure Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31963 Date: 10/30/06 THIS CERTIFIES that the building ADDITION Location of Property: PVT RD INNER BAY FISHERS ISLAND (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 10 Block 9 Lot 14 Subdivision Filed Map No. Lot NO. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 1, 1974 pursuant to which Building Permit No. 7621-Z dated NOVEMBER 5, 1974 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 WINDOW ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued-to- RICHARD & ELIZABETH DALKOWSKI (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A 4-'.1 'g;�� //tri4d S' nature Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31964 Date: 10/30/0 THIS CERTIFIES that the building AS BUILT ALTERATIONS Location of Property: PVT RD INNER BAY FISHERS ISLAND (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 10 Block 9 Lot 14 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 19, 2006` pursuant, to which Building Permit No. 32438-Z dated OCTOBER 19, 2006 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 "AS BUILT" ALTERATIONS (ELECTRIC AND PLUMBING) TO AN EXISTING ONE FAMILY DWELLING AS APPLIED'-FOR. - - - - The certificate is issued to RICHARD & ELIZABETH DALKOWSKI (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 3009686 10/05/06 PLUMBERS CERTIFICATION DATED 10/03/06 EMERY HEMESRAY t oriz d Si ature Rev. 1/81 o\pFfo�.co Town of Southold 2/11/2020 P.O.Box 1179 a 53095 Main Rd sh. Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41056 Date: 2/11/2020 THIS CERTIFIES that the building AS BUILT ALTERATION Location of Property: Pvt Rd Inner Bay,Fishers Island SCTM#: 473889 Sec/Block/Lot: 10.-944 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/23/2019 pursuant to which Building Permit No. 43839 dated 6/10/2019 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: "as built"alterations to an existing singlev dwelling as applied for. The certificate is issued to DeBrA Brian&Karen of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43839 10/29/2019 PLUMBERS CERTIFICATION DATED 2/5/2020 Matthew Kolodnicki Anthodit--d'SignatAre