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Home My WebLink About1000-9.-7-3 es-�,Ff0 TOWN OF SOUTHOLD CO Rental Permit Permit No. 0376 Owner Deborah Carroll & Ors. Occupied as Single Family Dwelling Located at Equestrian Avenue Fishers Island 9-7-3 Village s/13/1. Maximum Permitted Occupancy 14 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. 1/22/2021 Mike Verity Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times SO��® Town Hall Annex Telephone(631)765-1802 54375 Main Road � Fax(631)765-9502 P.O.Box 1179 G Southold,NY 11971-09591. BUILDING DEPARTMENT TOWN OF SOIJTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: 1 I-4 C.uluGg}vi4v� AV r- P51'L4v5 i Tax Map Number: 1000 SECTION BLOCK LOT 3 SECTION B. OWNER INFORMATION: Property Owner Name:�� QGboval� �Q Ju ;� 6- Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) SCA-" G lagav&c, c Pr.w,o= 02,10 flt-57toi Po /3ox r? 7;�,,y50" , 04 11 2-0y FK feses I51-#+,0 , NV 0600 Telephone Number(s): yN3'(A9s-3YzS Property Owner Email Address: 38i�• Co - Page 1 of 4 Section C. Authorized Agent Information: Ce�-h�vy 21 Name of Authorized Agent of dwelling unit, if any: LCLUr i f_ Fin= - SUR-e.rs 0-YJ SOAS Address of Authorized Agent(no P.O. Boxes): (Aa EQ U e SM an Ave . 84e-vs Island Mailing Address of Authorized Agent: G y 3 U'e i' Ny 0(n390 31 ' � n� 390 Telephone Number'(s): Email Address: I AUY ie, G�5�n�1��f_rSQV1C�SCIi S G0YV1 Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: LPLAVJ-e SVlan- Sy1laT YS + (S Address of Authorized Agent (no P.O. Boxes): (D q 3 4LA U tS�lr 1 QUI 1au2 FIl wy Mailing Address of Authorized Agent: so-wi_. Telephone Number(s): Email Address: `nu tr I e S1l lA' &VYL>a S. V✓l 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): Mailing Address of Managing Agent: Telephone Number(s): c Email Address: Page 2 of 4 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: " �1t UkUAWiy1A PJaCe, �I Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: A YOOrns +010. �htdV00y-riS) Use and Dimensions of each,room in Rental Dwelling Unit: ►�-c�r�,yj = I43.� badvm,n� 3� r �c�,s: 5� �� ba lYOGM ► °� d►Y%,ha Y� ►9� 5y hedYnom "1-9- own sA 4 1sa move"2 32 �tc1 Croom = 1376 Si '4-4 bed Yoow►, (o 10, as' �- b Y00M *2- i s�,s sg P+ bed v0dye► 1= o s 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. C7' I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold. Page 3 of 4 ❑ 1 am submitting a completed Town of Southold certification form from a licensed architect,a licensed professional engineer, ora 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 50%j C*0, o L-, 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: !SCC-V\ CW YI)11 Property Owner's Signature: Sworn to before me this day of tb�Ka , 2QLI KAtA-- Official Notary Publ Signature and Original Notary Stamp DEIRDRE KIYONAGA JOHNSON Notary Public City of Baltimore Maryland Page 4 of 4 IMY Commission Expires November 21,2021 1 fq so//lyo� 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: DATE INSPECTOR R � � oF soup, # * TOWN OF SOUTHOLD- BUILDING DEPT. courm N�'' 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ IRE SAFETY INSPECTION a _ [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE Q'v l3 / INSPECTOR - .� ho��,oe soulyolo # TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE &CHIMNEY [ IRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) , [ ] CODE VIOLATION [ ] CAULKING 0 REMARKS: a• DATE 0 -3//X / INSPECTOR a souryolo # TOWN OF SOUTHOLD BUILDING DEPT. `ycourm��'' 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: ' ri�•�:v� C.,�P DATEO� INSPECTOR f I 41 t 1 I r I i _ I Ali-1 it i I T - Fronf P -I - - - -------- - - ----- - I I I i -- - -- � -L -�--- -�- L-'--- -- - -Il---� I '- - -! ! - ---- �i I i I _LJ 1 1 � - - -- ---- - /J - - - --- - I -JL --- - - - - --- ---�- -- - - � ' I I - I I FAIN ' I 1 I q � 1 �---,- --�---, --;---,--- --- ,-- ---- IGF I -� I � I I 1 Y5 C-1� , �,- now , i a � I i 4astrLCI _ Lf -t- Ali�- o I I 26+lflodr I L Ti1L r F 4 o� Town of Southold 1/22/8021 o• Gyp 53095 Main Rd C* Southold,New York 11971 PRE EXISTING CERTIFICATE OF OCCUPANCY No: 41752 Date: 1/21/2021 THIS CERTIFIES that the structure(s)located at: Equestrian Ave,Fishers Island SCTM#: 473889 Sec/Block/Lot: 9.-7-3 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- 41752 dated 1/21/2021 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 covered front and rear porches.* Notes:BP 43564 alterations COZ-41751:BP 43933 repairs COZ-41750 The certificate is issued to Carroll,Deborah&Ors. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. Autho ed Signatu BUILDING DEPARTMENT • TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: Equestrian Ave,Fishers Island SUFF.CO.TAX MAP NO.: 9.-7-3 SUBDIVISION: NAME OF OWNER(S): Carroll,Deborah&Ors. OCCUPANCY: ADMITTED BY: Tom Ahlgren SOURCE OF REQUEST: Carroll,Deborah DATE: 1/21/2021 DWELLING: #STORIES: 3 #EXITS: 3 FOUNDATION: block and poured CELLAR: yes CRAWL SPACE: BATHROOM(S): 2 TOILET ROOM(S): UTILITY ROOM(S): PORCH TYPE: covered porches DECK TYPE: PATIO TYPE: BREEZEWAY: FIREPLACE: 2 GARAGE: DOMESTIC HOTWATER: yes TYPE HEATER: electric AIR CONDITIONING: TYPE HEAT: oil WARM AIR: HOT WATER: #BEDROOMS: 7 #KITCHENS: BASEMENT TYPE: unfinished OTHER: ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: SWIMMING POOL: GUEST,TYPE OF CONST: OTHER: VIOLATIONS: REMARKS: INSPECTED BY: MIKEV DATE OF INSPECTION: 2/28/2019 TIME START: 1:45pm END: 2:30pm �4�Ogt1FF0(KcoGy Town of Southold 1/21/2021 a P.O.Box 1179 53095 Main Rd py�01 �a � Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41750 Date: 1/21/2021 THIS CERTIFIES that the building ALTERATION Location of Property: Equestrian Ave.,Fishers Island SCTM#: 473889 Sec/Block/Lot: 9.-7-3 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore Sited in this office dated 5/8/1992 pursuant to which Building Permit No. 43933 dated 7/8/2019 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: repairs to an existing one family dwelling as applied for. I The certificate is issued to Carroll,Deborah&Ors. of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Autho W ed Signat re guFFD4C Town of Southold O� oG 1/21/2021 P.O.Box 1179 o - o _ 53095 Main Rd y?jo! �ao4 Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41751 Date: 1/21/2021 THIS CERTIFIES that the building ALTERATION Location of Property: Equestrian Ave,Fishers Island SCTM#: 473889 Sec/Block/Lot: 9.-7-3 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/8/2019 pursuant to which Building Permit No. 43564 dated 3/18/2019 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: alterations to existing one family dwelling as applied for. The certificate is issued to Carroll,Deborah&Ors. of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43564 11/23/2020 PLUMBERS CERTIFICATION DATED 12/21/2020 Joel Fulton Autho ed Signat re