HomeMy WebLinkAbout1000-24.-2-22 Fr
TOWN OF SOUTHOLD
t
Rental Permit
0294
Owner Lance Jensen & Lisa Kreiling
Occupied as Single Family Dwelling
Located at 1800 Village Lane Orient 24-2-22
Maximum Permitted Occupancy d
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.
4/27/2022 All
Code Eo°oncef Official
This Notice must be posted by the main entrance at all times
Town Hall Annex
SOUTHOLD TOWN
54375 Main Road
Rental Ins tion PO Box 1179 Southold,
ZL- NY 11971-1179
Tel: 631-765-1802
Fax 631-765-9502
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LEVELS W$
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Smoke Detectors (#- bedroom detectors excluded)
Carbon Monoxide Detectors (#)
Fire Extinguishers(#)
Exits'(#),,,
/BEDROOMS r/ /
ro
Smoke Detector Alarms (#)
Carbon Monoxide Alarms (#)
Egress (windows) ;(Y/N) LZ
BUILDING SYSTEMS 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 maintainedl per tional Handrails &guards present
POOLS YIN POOL BARRIERS Y/N
Pool present;; Pool is completely enclosed
Pool surface'alarm and/or door alarm Barrier is a min. 48" high
resent
POOL GATES Y/N All openings in barrier less than 4"
Self-closing, self-latching Max.2" clearance @ bottom of barrier
Latch on'pool side of gate, meets height Barrier capable of being locked &child-
re"quirements proof when unattended
COMMENTS`:
FOL I( TOWN OF SOUTHOLD
�o Gyp
Rental Perm-it .
Permit No. 0294
1 �+
Owner J Lance Jensen & Lisa Kreiling
Occupied as Single Family Dwelling
Located at 1800 Village Lane Orient 24-2-22
Address S/B/L
Maximum Permitted Occupancy 6
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.
2/14/2020 John Jarski
Date of Issue Code Enforcement Officer
This Notice must be posted by the main entrance at all times
r I
0�SID
Town Hall Annex Telephone(631)765-1802
54375 Main Road ; Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 D �`
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
'RENTAL PERMIT APPLICATION
JAN 1 5 2020
Rental Permit Fee$200(Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
Tax Map Number: 1000 SECTION .-LOT _1_71
SECTION B.
OWNER INFORMATION:
Property Owner Name:--A'PkW_( 41
Property Owner Legal Address: Property Owner Mailing Address:
-- --- --- _---- ------ -- -- ---
Telephone Number(s): Daytime Evening_ _. Emergency
I �d
Property Owner Email Address:
avc)
-l6
,e-0jtj� 1
Pagel of S
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 ;G� ;
Southold,NY 11971-0959 E Q
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent: ZA
-
Telephone Number(s): Daytime. - ___ _ _.Evening Emergency--_ _
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:
Requested Maximum number of persons allowed to occupy Dwelling Uit: - �-
Number of rooms in Rental Dwelling Unit: _ -- oo_ _ ._ -' i .
r
Use and Dimensions of each room in Rental Dwelling Unit:,.-VIVI VIA X P —
1�1 tiQ 1� !Md f r�'X l D' J�(� Y 6 E G7/D
or lax,
Page 3 of 5
-�SO, T�®_
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
CA
P.O.Box 1179
Southold,NY 11971-0959 ( '
C®UNT`I,� --
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
❑ 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.
STATE OF NEW YORK)
COUNTY OF SUFFOLK) /�� �•
,certify under penalty of perjury,the following:
1. I 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
Town Hall Annex Telephone(631)765-1802
54375 Main Road f Fax(631)765-9502
P.O.Box 1179 , t, O" ,
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. 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 Owner's Name:,_ .
Property Owner's Signature:
V L/I -
Sworn to before me this 10 day of _ICA.iya!Q A
Official Notary Public Signature and Original Notary Stamp
�• BRRT DUNN
` Novy PUbli�Caw#"*d MawdKob
My Commission Expires Oct.9.2020
Page 5 of 5
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# # TOWN OF SOUTHOLD BUILDING DEPT.
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'INSPECTION
[ ] FOUNDATION 1ST [ ] ,ROUGH PLBG.
[ ] FOUNDATION 2ND - [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [/IFIRESAF
INAL �FIREPLACE & CHIMNEY [ TY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
RE ARKS:
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DATE INSPECTOR
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TOWN OF SOUTHOLD PROPERTY CARD
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OWNER STREET " CSL 7�VILLAGE DISTRICT SUB. LOT
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Town of Southold 4/28/2016
��o Gyp 53095 Main Rd
N a Southold,New York 11971
�y�pl
mss,
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: 38275 Date: 4/28/2016
THIS CERTIFIES that the structure(s) located at: 1800 Village Ln.,Orient
SCTM#: 473889 Sec/Block/Lot: 24.-2-22
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- 38275
dated 4/28/2016 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 brick patio.*
Note:walk in closet first floor
Note:BP 24038 alt/add inc open entry deck and screened porch and covered porch to dwelling COZ-25615;BP 24987
agcy. garage COZ-25988•BP 28095 enclose existing porch COZ-28831.
The certificate is issued to Millis,Walter Millis,Alison
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
-'A� /'
Auth ' ed Si)6iature
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 1800 Village Ln.,Orient
SUFF.CO.TAX MAP NO.: 24.-2-22 SUBDIVISION:
NAME OF OWNER(S): Millis,Walter&Alison
OCCUPANCY:
ADMITTED BY:
SOURCE OF REQUEST: Millis,Walter DATE: 4/28/2016
DWELLING:
#STORIES: 1.5 #EXITS: 4
FOUNDATION: stone&brick CELLAR: CRAWL SPACE: x
BATHROOM(S): 2 TOILET ROOM(S): 1 UTILITY ROOM(S):
PORCH TYPE: DECK TYPE: PATIO TYPE: brick
BREEZEWAY: FIREPLACE: 1 GARAGE:
DOMESTIC HOTWATER: yes TYPE HEATER: electric AIR CONDITIONING:
TYPE HEAT: Nat. Grid Gas WARM AIR: x HOT WATER:
#BEDROOMS: 3 #KITCHENS: 1 BASEMENT TYPE:
OTHER:
ACCESSORY STRUCTURES:
GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST:
SWIMMING POOL: GUEST,TYPE OF CONST:
OTHER:
VIOLATIONS:
REMARKS:
i
INSPECTED BY: ARYF DATE OF INSPECTION: 3/11/2016
TIMESTART: END:
tF
FORM NO.4 a
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold,N.Y.
Certificate Of Occupancy
No. . . . . 2.1.3756 . . . . . Date . . . . . . .August. x.4. . . . . . . . . . . . . .1 1985.
THIS CERTIFIES that the building . . . .accessory.
Location of Property 1 800 Village Dane Orient
House No. Street Ham%r
24 22
County Tax Map No. 1000 Section . . . . . . . . . . .Block . . . . . . . ... . . . . .Lot . . . . . . . . . . . . . . . .
XX
Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . .Lot No. . . . . . . . . . . . . .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
July 29 , , . . . , , 1983. pursuant to which Building Permit No. . . . . , ,124.71 Z
dated . . . August 9 . . . 19'33, ,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, buildin�.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The certificate is issued to . . . . . . . . . . . . . .DOROTHY nDORMAN
of the aforesaid building.
Suffolk County Department of Health Approval . . . . . . . . . . . . . . . . . N/A, , . . . . , . . . . . , . , . . . . . .
UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . . . . . . . WA. . . . . . . . . . . . . . . . . . . . .
Building Inspector
Rev. 1/81
z
r
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.X.
CERTIFICATE OF OCCUPANCY
No: Z-25615 Date: 03/27/98
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property: 1800 VILLAGE LA ORIENT
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 24 Block 2 Lot 22
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 17, 1997 pursuant to which
Building Permit No. 24038--Z dated APRIL 14, 1997
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 ALTERATION & ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to WALTER & ALISON M MILLIS
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N-448507 03/17/98
PLUMBERS CERTIFICATION DATED 03/17/98 KING PLUMBING & HEATING
it ing I Spector
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-25988 Date: 09/28/98
THIS CERTIFIES that the building ACCESSORY
Location of Property: 1800 VILLAGE LA ORIENT
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 24 Block 2 Lot 22
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 30, 1998 pursuant to which
Building Permit No. 24987-Z dated JUNE 30, 1998
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 GARAGE IN REAR YARD AS APPLIED FOR & AS PER ZBA #4571
The certificate is issued to WALTER & ALISON M MILLIS
(OWNER) ,
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. PENDING 09/18/98
PLUMBERS CERTIFICATION DATED N/A
Bui ing inBpqetOr
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
r
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
NO: Z-28831 Date: 08/27/02
THIS CERTIFIES that the building ALTERATION
Location of Property: 1800 VILLAGE LA ORIENT
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 24 Block 2 Lot 22
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 31, 2002 pursuant to which
Building Permit No. 28095-Z dated FEBRUARY 20, 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 ENCLOSE AN EXISTING PORCH ON AN EXISTING ONE FMAILY DWELLING AS
APPLIED FOR.
The certificate is issued to WALTER & ALISON M MILLIS
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO_ N/A
PLUMBERS CERTIFICATION DATED N/A
Authorized Sign ure
Rev. 1/81