HomeMy WebLinkAbout1000-64.-5-22 TOWN OF SOUTHOLD
Rental Permit
0382
Owner Charles & Isabel Barkley
Occupied as Single Family Dwelling
Located at 1055 Old Shipyard Ln 64.-5-22
Maximum Permitted Occupancy 4
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.
11/8/2024
C e En rce 0 idaI
This Notice must be posted by the main entrance at all times
TOWN OF SOUTH BUILDING INEPT.
6 1-? 5-1 302
1 N ZASk P E C;k T 10 N
[ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICALYF AL)
[ ] CODE VIOLATION [ ] PRE C/O [ RENTAL
REMARKS: Q-`- co,141-w.... m� all,r
DATE INSPECTOR
Town Hall Annex Telephone(631)765-1802
54375 Main Road a�(( )765-9502
,
P.O.Box 1179
Southold NY 11971-0959 � Ya
I NOV 4
1
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
o�ess oa al seal re aired or architect or n i ...licensed L1gg1t Inspector n l-qj rovi4
LoAy o valid"current certi ication
Rental Property SCTM Number:
Rental Property Address: 1055 Q d Sh yirc° L n w &outhd �ro.
Owner/Name: �— isabe ... i iey
Rental Dwelling Unit Identifier: _w....._._ � .
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
Bedroom #2 135 sqft
Property Description (Include all improvements indicated on survey)
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.
Victor orne�iLJS ]1111: CE0 Inspector
Print Name and Title c o . 1216-0283 Original Signature
Please place professional seal:
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TOWN OF SO U'TH 1►1LD BUILDING DEPT.
631-765-1802
�- N SPEC'1” I O N
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F,NAL)
[ ] CODE VIOLATION [ ] PRE C/O [ RENTAL
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DATE INSPECTOR "r"
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� Efol � TOWN OF SOUTHOLD
Rental Permit
Permit No. 0382
Owner Charles & Isabel Barkley
Occupied as Single Family Dwelling
Located at 1055 Old Shipyard Lane Southold 64-5-22
Village
Maximum Permitted Occupancy 4
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.
1/30/2021 John Jarski
Date of Issue Code Enforcement Officer
This Notice must be posted by the main entrance at all times
t� so
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 r7
N T,
BUILDING DEPARTMENT DEQ 4 2020
TOWN OF SOUTHO11,D
RENTAL PERMIT APPLICATION
Rental Permit Fee $200 (Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
Tax Map Number: 1000 SECTION -BL0,CK- -LOT
SECTION B.
OWNER INFORMATION:
Property Owner Name:
Property Owner Legal Address: Property Owner Mailing Address:
OLVa' 10,55 OU, Sk"
�O 5 5 S��' PALn ivqooct Ln
J
h 01,6- Pr PM
Telephone Number (s): Daytime(�LAA)M D6FA Evening (3�)3jqiS-1%mergentV (qtj) 2q; .3qe1
Property Owner Email Address: N� k QM oil 00 n�
p�
QQ,o,
� -a0b o 0
Pagel of
'Xlof.so(/pa
Town Hall Annex p Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
coulmi
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any: )l Q°' _ __-
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
oxes):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
Address of Managing Agent (no P.O. Boxes):
Page 2 of 5
F_SOUryo
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1 179 G
Southold,NY 11971-0959 Yo
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent: ni Com.,
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 Unit: t _C� 1 CA1�11
Number of rooms in Rental Dwelling Unit: � __ _ _ � °^��.� �yv�
Use and Dimensions of each room in Rental Dwelling Unit:;
kvt, = .mi6 ®m tied 4brl6mtL3
�eAvuom
1 yo 0_r - - 5 - io 562p,
9, 10-Ircli 13'X ` Wr Wo -fbf Car
Page 3 of 5
4konz'(�. Ib $ ��ed-+o COOK aj J' ►�� ,
pv SOUT�ol
o '
Town Hall Annex .A; _§ .{'+ Telephone(631)765-1802
54375 Main Road q ;. Fax(631)765-9502
P.O.Box 1 179 s
Southold,NY 11971-0959Qd
Y
e0uml a
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)
5 C
twbar k W ,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
So
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 G
Southold,NY 11971-0959 Q
r
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:
t7
TRACEY L. DWYER
NOTARY PUBLIC,STATE OF NEW YORK
NO.01 D W6306900
QUALIFIED IN SUFFOLK COUNTY
COMMISSION EXPIRES JUNE 30,2
Sworn to before me this�f day of '(� 20 _C)
14 AV
Official Notbty
Public Signature Original Notary Stamp
Page 5 of 5
if S®(/TNov 14, 2020
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 Q
r�c®UM'1,�
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
Professional seal required for Architect,or Engineer,licensed Home Inspector must provide
copy of valid current certification -
Rental Property SCTM Number: "1 — 1 0� o,
Rental Property Address: 1055 Old Shipyard Lane., Southold NY
Owner/Name: Isabel Barkley
Rental Dwelling Unit Identifier:
Number'&Square fo6tage of each bedroom as depicted in the attached floor plan:
(i.e. Bedroom#1 -100 sq., Bedroom #2-90 sq., etc.)
Bedroom #1 140 soft
Bedroom #2 160 sqft
Property Description (Include all improvements indicated on survey)
single family home
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.
Victor Cornelius III CEO Inspector alp&
Print Name and_Ti#leceo# 1216-0283 Ori inal Signature
Please plcP�r��fessi�rSal seal: -
thPYiO14V 56�o[e
# # TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
K
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PL13G.
[ ] FOUNDATION 2ND [. ] INSULATION/CAULKING
[ ] FRAMING/STRAPPING [ ] F NAL
[ ] FIREPLACE & CHIMNEY FIRESAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION'
[ ] ELECTRICAL (ROUGH) [ ] -ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:
6velD
DATE / y INSPECTOR" -
F',RS'FLOOR
Isabel 1.Barkley&Charles C.Barkley
1055 Old Shipyard Ln Southold NY 11971
Legend:
Garage Door
A Fire/Carbon Monoxide detector garage
B Fire/Carbon Monoxide detector
C Fire/Carbon Monoxide detector
D Fire/Carbon Monoxide detector
' Daor Locations
Basement n represented by portion of d
footprint highlighted in red bold. stairway to r
6
bedroom yry; , bedroom family room
basemenr C
A
■ hallway
,,ng room
Isabel 1.Barkley&Charles C.Barkley
loss Old Shipyard Ln Southold NY 11971 -
Legend:
Garage Door
Fire/Carbon Monoxide detector garage
Fire/Carbon Monoxide detector
Fire/Carbon Monoxide detector _
D Fire/Carbon Monoxide detector
' Door Locations
Basement is represented by portion of
footprint highlighted in red bold.
bedroom bedroom family room
C hk
, J hallway
living room
i
p� d.
SO�iii i ifiva rrLli
dry •,� � fine, w r q�.
i i ha�fumt,i rai xd PPCN a�i �.
^.hur miti y..
BASEMENT
Isabel J.Barkley&Charles C.Barkley
1055 Old Shipyard Ln Southold ply 11971
Legend:
A Fire/Carbon Monoxide detector
B Fire/Carbon Monoxide detector
C Fire/Carbon Monoxide detector
D Fire/Carbon Monoxide detector
' Door Locations
Basement is represented by portion of
footprint highlighted in red bold.
astrwaT m
storage - basemen[
-Hr door
TOWN OF SOUTHOLD PROPERTY RECnRD
OWNER STREET V d VILLAGE DISTRICT SUB, LOT
er
FORME OWNER N E ACREAGE �-
S W TYPE OF BUILDING
RES. Zvy SEAS. VL. FARM COMM. I IND. I CB. MISC. I Est. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
- 6 6 --
- _3 �. 1..� t ccs
AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE FRONTAGE ON WATER
a
Form Acre Value Per Acre Value FRONTAGE ON ROAD -
,
Tillable 1 BULKHEAD
Tillable 2 DOCK
Tillable. 3
Woodland
Swampland
Brushland
House Plot
Tota
V,
I I �
_..._. i rt
Y
--f........_ r
i I i i 11
M. Bldg. Foundation Bath
Extension ` i Basement Floors
Extension _ D Ext Walls Interior Finish
_ ---- /.L{.-- -` - --- �3 ►2 G �i --... - - --- - --'- -- + Y 0 V-1Z _..i. ---............----
Extension t,� ,�� , Fire Place Heat
Porch Roof Type } '
__—........_ _._................... — _ _ _. __.._.—._.-_....-............ ....... xc�_— _.. - . ----.._
Porch Rooms lst Floor
--.._. - - ---------... -. ._ .. _ __ _...... _....-- -- ---....-._............---........................._._..__....._.-_......... -
Breezeway Patio Rooms 2nd Floor - --
-.... _-- -- . ...... —_........ ---- _�—. _
GarageS f - 3 1. Driveway Dormer
_ .....................__................- f- -4- - -- -..__...._..._.. _- -......
—
O. B.
TOV.. ..)F SOUTHOLD
OFFICE OF BUILDING INSPECTOR
TOWN IIALL
SOUTHOLD, NEW YOPM
CERTIFICATE OF OCCUPANCY
NONCONFORMING PRE;iIISES
TIIIS IS TO CERTIFY that the
/ X/ Land Pre C.O. #- Z-16121
/_/ Building(s) Date- September 2, 1987
/ / Uses)
located at 1055 Old Shipyard Lane Southold, New York
Street Hamlet
shown on County tax map as District 1000, Section 064 , Block 05
Lot 22 , does!.not)conform to the present Building Zone Code of the
Town of Southold for the following reasons:
Insufficient total area; side yard set back;
On the basis of information presented to the Building Inspector's Office,
it has been determined that the above nonconforming /_X/Land /_/Building(s)
/ /Use(s) existed on the effective date the present Building Zone Code of the
Town of Southold, and may be continued pursuant to and subject to the appli-
cable provisions of said Code.
IT IS FURTHER CERTIFIED that, based upon information presented to
the Building Inspector's Office. the occupancy and use for which this Certifi-
cate is issued is as follows: Property contains 1 story, one family wood framed
dwelling with attached garage; open porch; all situated in the 'A' Residential
Agricultural zone with access to Old Shipyard Lane
The Certificate is issued to RICHAMH..:ORGASS, EXEC. ESTATE OF ELIZABETH M. ORGASS
(owner, 11§ ddCM3�tiOXX
o: the aforesaid building.
Suffolk County Department of Ilealth Approval N/A
UNDERR-RITEftS CERTIFICATE NO. N/A
NOTICE IS IIEREBY GIVEN that the owner of the above premises ILLS
NOT CONSENTED TO AN INSPECTION of the premises by the Building Inspec-
tor to determine if the premises comply with all applicable codes and ordin-
ances, other than the Buildinn "Lone Code, and therefore, no such inspection
has been conducted. This Certificate. therefore, does not, and is not intended
to certify that the premises comply with all other applicable codes and regula-
tions. �?
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