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Home My WebLink About1000-63.-7-24 TOWN OF SOUTHOLD Rental Permit a 0361 Owner Thomas Punch Occupied as Single Family Dwelling Located at 475 Midfarm Road Southold 63.-7-24 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. 5/10/2023 5 Code Eniorcement Official This Notice must be posted by the main entrance at all tiro , dc"m TO y SOUTHOLD BUILDING DEPT. C � 631-765-1802 INSPECTION FOUNDATION 1ST ROUGH�µg 1 y w FOUNDATION 2ND INSULATIOWCAULKING FRAMING / STRAPPING FINAL FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) ELECTRICAL (FINAL) CODE VIOLATION PRE C/O RENTAL REMARK b �-C DATE INSPECTOR Kyr TCtWN OF SOUTHOLD BUILDING DEPT. 631-765-1802INSPECTION [ ] FOUNDATION 2ND INSUL.ATIOWCAIUL.KING FRAMING /STRAPPING FINAL FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) ELECTRICAL (FINAL) CODE VIOLATION PRE C/O A:VRENTAL _93__Q) DATE '�� TOWN OF SOUTHOLD Rental Permit Permit No. 0361 Owner Thomas Punch Occupied as Single Family Dwelling Located at 475 Midfarm Road Southold 63-7-24 Village S/13/1- Maximum /B/LMaximum 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. 11/19/2020 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times 0 v SO Town Hail Annex Telephone(631)765-1802 54375 Main Road `. „_,,� � Fax(631)765-9502 P.O.Box 1179 _ l Southold,NY 11971-0959 P'L v 2 BUILDING DEPARTMENT DDD)� TOWN OF SOUTHOLD JUL 3 0 2020 RENTAL PERMIT APPLICATION BUID 0 DEPT. Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: 475 Mid Farm Road, Southold, NY Tax Map Number: 1000 SECTION 63 -BLOCK 7 -LOT 24 - SECTION R. OWNER INFORMATION: Property Owner Name: Thomas Punch Property Owner Legal Address: Property Owner Mailing Address: Thomas Punch Thomas Punch 475 Mid Farm Road Southold NY 475 Mid Farm Road, Southold, NY Telephone Number(s): Daytime 917-930.9091 Evening Emergency 631-678-2964 Property Owner Email Address: thomaspunch@gmail.com �-C- q 3�1 Page 1 of 5 \0 Town Hall Annex Telephone(631)765-1802 54375 Main Road at Fax(631)765-9502 P.O.Box 1179 9-1 Southold,NY 11971-0959 No on t4 zrz BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: N/A 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: N/A 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: N/A Address of Managing Agent (no P.O. Boxes): Page 2 of 5 i p SOUr�,� Town Hail Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 COO P.O.Box 1 179 Southold,NY 11971-0959 COUlm,�� BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: P!. 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, 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 Permit Application Addendum." Rental Dwelling Unit Identifier: �� -F2M �' �►'10 Requested Maximum number of persons allowed to occupy Dwelling U it: Number of rooms in Rental Dwelling Unit: LJO ID `1 Use and Dimensions of each room in Rental Dwelling Unit: Page 3 of 5 i Y �{m 1 ' � Town Hall Annex �w� ,ate��° Telephone 631 765-1802 54375 Main Road Fax(63 I)765-9502 P.O.Box 1179 Southold,NY 11971-0959 PA 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. ❑ 1 am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold [A 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) I Thomas Punch 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 p; i� Town Hall Annex ° e Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 �,I 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: Thomas Punch_ Property Owner's Signature: t� Sworn to befo e m his°?day of 20!40 Officia No ry ublic Signature 36 Original Notary Stamp LINDA S. WILSON Notary No. OI' state of CA6137178 w York qualified in Suffolk y 14,20�� Commission Exp iresPage 5 of 5 Town Hall Annex Telephone(631)765-11102 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF 6SOUTHOLD Mailing Address of Managing Agent: N R. Telephone Number(s):Daytime Evening Emergency Email Address: SECTION F. PROPERTY DESCRIPTION: p 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. S� KA� "F�M �I�p...� Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: 3 &�QAO1A.& Use and Dimensions of each room In Rental Dwelling Unit: tK- --t� Il` Sll k q,g(� Page 3 of 5 jk:b Loo!� 6EDf5yD&I- 3 q �L;L. 4- - - - - - 8 oil, Town Hall Annex v ;, �� Telephone(631)765-1802 5 54375 Main Road Fax(631)765-9502 P.O.Box 1179 1 , �... .sa x Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a license architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Pro essional seal required for Architect or Engineer, licensed Nome inspector must provide cony of'valid current certWatlon Rental Property SCTM Number: 1000-63-7-24 Rental Property Address: 475 Mid Farm Road, Southold, NY Owner/Name: Thomas Punch Rental Dwelling Unit Identifier: 475 Mid Farm Road, Southold, NY Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1-100 sq., Bedroom#2-90 sq., etc.) Bedroom#1-205 sq.ft. Bedroom#2- 136 sq. ft. Bedroom#3-188 sq . ft. Property Description (Include all improvements indicated on survey) Single Family house with in ground swimming pool, outdoor shower and rear deck. I certify that I have done a physical inspection of the subject rental dwelling unit and find that it fully complies with all the provisions of the Code of the Town of Southold,the Residential Code of New York State,the Building Code of New York State,the Plumbing Code of New York State, the Fuel Gas Code of New York State, and the Energy Conservation Construction Code of New York State. Print Name and Title Original Signature Please place professional seal: F NE --------------- - Of SOUIyO� �V 15L # * TOWN OF SOUTHOLD BUILDING DEPT.' courm ' 765-1602Jet,'( INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ' ] FOUNDATION 2ND [ - ] INSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] AL Pe%4v(L.,,,,PovwA. [' ]' FIREPLACE & CHIMNEY [ - - FIRE SAFETY INSPECTION [_ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS:L 9 4-b n Dp nn-- LL DATE 1 51 (/ 11 1011W)0INSPECTOR 21 �a►�E� � �:��.�u"-� .__..I UL j U P s �s3PSRs0 I4 F --`sp i F14 MNT1 PT 4'71 HEP PXd , uCy- � � . `• LG.GUM DJ: -L 1 GM1*SD ° } till- • ° S —Its;_ — n__ .�,Itavi.L3_ — � U 4� _1:c�31W�� •j`'.'�. .F�a `L� s � 1 M3'•x liO i •1, ' � a � I I J DE57DERGE FoD. MR .4 Mab 9 . N EGINSICI ••.- 50UTpOLD N.Y. � 'I�aylr • ttir ug"go or?Nt AMMAN NUMIUM Dl A11CWF== '•" .nrt SERAFIN SOTO, ARCHITECT •�"� 1 • /A NGW orIKST NUMVING"N.NtW YDW .o► SCTM # TOWN OF SOUTHOLD PROPEk OWNER STREET VILLAGE DIST. SUB LOT �-x-n qr Tl 4"C.z, cam_HCl(10113\16 ACR. REMARKS O+ TYPE OF BLD. PROP. CLASS LAND IMP. TOTAL DATE 1 tcoo cc)n �6co i I Poao FRONTAGE ON WATER HOUSE/LOT BULKHEAD E TOTAL .r TOWN OF SOUTHOLD PROPERTY RECORD Q0 OWNER �� STREET ,./ �i'�•7 VILLAGE DIST. SUB. LOT Ad FO RM ER O N E R, 0-�r11 YIN E ACR. � Ltl � I 1 d►rn� t'60 --446 •r le S A W 1 TYPE OF BUILDING RES. /O SEAS_ i VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS /2 7 � �J �°-s o _ �7v - C 4n/?FSa�dJ6 -to o 7y� e /i � / OG i-s� /r/✓^/li � f lf.�! sS f�12�I� 69/y��S.l'v'.°.1� - !r`• /P.FC?e'rell--\1 tl — � I�' �i�,//i/' �tSy" ./ � -3 -3 r/7 /� G r�a " . a o '� `�/3 F/ ✓ f `1 �_ 6= (l C�Y��SU_T �L �r�(�o,5 6 6 ""' - o Y» a tie mac,-S- 1 r rc O o / ®0" " ��50� �� 11/90 1' l�l��- I�'G�� ' �-- �, Dec��. ��1-t:�.'� Ri r�.ec�.e. " / 1(ooc� 7 oc on 0IfL BUM O�VDIIf /.b63//2- SG / )f (2(�(?� NEW N( fL E �V� `z I 1 A OCVi E 2 110�151'�� 1 �FARM� eUValue Per Value r Tillable FRONTAGE ON WATER h t n C�3 L Woodland i FRONTAGE ON ROAD Meadowland DEPTH House Plot BULKHEAD ihol1q-Wx�- n lOG_-�'i.�\�r� er.!-a�� P�•d G��n�l�?i7it7, `ems ,,-a zl.i D 31 d ®,in Total v i DOCK 3�7I�, r/:3t�� 7- %�� 0/AUlarl-j 1' �. y1 f / 1 � q / ■ l�i:NN■■■m■■■>MN■■■■ ■■■■■■■■■■■■■■■■■■■■■0 ME ■ �' .nom..,, „- `",I; y1y_ ■ ■ ■■■■■■■ ■■ ■ N {.eYr■i�i.a t -.- • RNii MEN M■■M■■M■MwNMMMMMM■E r.M., ■■■ ■■■■■■■[!i7■�i�■■■■■■■■■■■� MEN Mrr, �A ��m®i'�■■■■f:�■■■■■ MEMO ■■■■M■mME WHIM■■IM■■■■VE■■■■=i■■ ■■L UNION=EWEVE■E■■■MEE■■■ ■■rl ELS■■■!■■■■■■■■EEE■■■■AMEMEN■ ■E■■M■■■■■■■M■■■M■■■�■■ME - �■■.■■■■■Eli■■■E■■MM MMEE We ` ,�� ■NN■■■NE ■MNEME ( MME■ __ • ire Place . . .. Type '.• ••. •• i' i + • �s-=' t•L ! • ' • • Floor— Dormer • • , Wires • u i 6: t FORM NO.4 TOWN OF SOUTHOLD BUrLDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No.$ g;4% Date . . Jfl>tly 3 • ' 19 67. THIS CERTIFIES that the building located at D/$ XWaft pftd . Street Map No. $yt7.Z ODA Block No. .f3t . Lot No. .= . amtI x1$8, XvIrs .•..... conforms substantially to the Application for Building Permit heretofore filed in this office dated Nor .� , 19 66 pursuant to which Building Permit No. 3301 Z. dated 10Y ,19 66,was issued, and conforms to all of the require- ments of the applicable provisions of the law.The occupancy for which this certificate is Issued is PI rata.me fafai.ly.die+sUing....... .... ... . ................... The certificate is issued to Y1*0h1Dxk& 010WO).. ........fir ....... of the aforesaid building. (owner, lessee ortenant) Suffolk County Department of Health Approval 3k r. 229, 3.967 ..bp. uitding Inspec r FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,NX, Certificate of Occupancy No. „Z1g693 ( ........ Date ...... July• 24 .... ...... ........1981. THIS CERTIFIES that the building ...................... .. ............... ........ Location of Property 475,Kid,Farm.Road Southold, New York • ...... County Tax Map No. 1000 Section h►am�e. • ..ab3...,..Block ..0.7,.....,....Lot ...X024.......... 1 Subdivision.. ....... ................ ......Filed Map No. .... .....Lot No. ............. , conforms substantially to the Application for Building Permit heretofore filed in this office dated March 10 ......, 19.8 pursuant to which Building permit No. ...11050 Z ....... dated ,March..i 2................. l g8 1. was issued,and conforms to all of the requirements t Of the applicable provisions of the law.The occupancy for which this certificate is issued is ......... ........n89k,eyrtoA4491i.cq oAa.>r$lq4jy.J)VWAAr1S. ..�. . ....... . The certificate is issued to .......Al;v4¢,R.. ltl �lass .................. Of the aforesaid building. x Suffolk County Department of Health Approval ......11!11................... .............. UNDBRWRITBRS CERTIFICATE NO....N/R.......... ... .... ... ... .. .. .. ...... ....... 61". Building Inspector Rev.Itat FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 2-20086 Date 1UNE 26, 1991 THIS CERTIFIES that the building ADDITION Location of Property 475 WDrux ROAD SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 63 _Block Lot 24 Subdivlsion Filed Hap No..Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 14, 1989 pursuant to which Building Permit No. 1864B-Z dated ROVEmE8 16, 1969 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 PARMIALLY ROOFED OVER AS APPLIED FOR. The certificate is issued to JENNIE CARLSEN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-114466 - FEHRUAI2Y 15, 1990 PLUMBERS CERTIFICATION DATED_ N/A Building Inspector Rev. 1/81 Town of Southold A ` ! P.O.Box 1179 8/3/2018 53095,Main Rd Southold,New York-11971 CERTIFICATE OF OCCUPANCY No: 39824 Date: 8/3/2018 THIS CERTIFIES that the building 'RESIDENTIAL ADDITION Location of Property: 475 Midfarm Rd, Southold SCTM#: 473889 Sec/Block/Lot: 63.-7-24 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 6/28/2018 pursuant to which Building Permit No. 42825 dated 6/28/2018 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: ADDITION INCLUDING A DECK TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The,certificate is issued to Carlson Jenny E I.iv Trust of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 42825 07-10,-2018 PLUMBERS CERTIFICATION DATED 07-10-2018 G rge Be Jr A t ed Signature Town of Southold 1/9/2020 P.O.Box 1179 rs w 53095 Maln Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40986 Date: 1/9/2020 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 475 Midfarm Rd.,Southold SCTriI#: 473889 Sec/Block/Lot: 63.-7-24 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office,dated 3/18/2019 pursuant to which Building Permit No. 43584 dated 3/26/2019' was issued,an&conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: ADDITIONS AND ALTERATIONS INCLUDING COVERED FRONT ENTRY AND REAR DECK TO AN EXISTING ONE FAMILY,DWELLING AS APPLIED fOR The certificate is issued to 475 Midfami LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43584 08-28-2019 PLUMBERS CERTIFICATION DATED 10-15-219 Jorge G i lez J zo 'zed Sibn6ture 5►I QT R caG Town of Southold 2/3/2020 P.O.Box 1179 wo r 53095 Main Rd rr�Ogi,-- yon. Southold,New York 11971 CERTIFICATE OF (OCCUPANCY No: 41031 Date: 2/3/2020 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 475 MidFarm Rd,Southold SCTM 9: 473889 Sac/Block/Lot: 63.-7-24 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/1/2019 pursuant to which Building Permit No. 43537 dated 3/7/2019 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: ACCESSORY IN-GROUND SWIMMING POOL. FENCED TO CODE.AS APPLIED FOR The certificate is issued to 475 Midfarm LLC of the aforesaid building. SUFFOLK COUNT'(DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43537 06-26-2019 PLUMBERS CERTIFICATION DATED Autl )riz gnature