HomeMy WebLinkAbout1000-66.-2-42 $§ TOWN OF SOUTHOLD
Rental Permit
0392
Owner Edward Graham
Occupied as Single Family Dwelling
Located at 695 Rogers Road Southold 66.-2-42
Maximum Permitted Occupancy 10
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.
11/20/2024
od ref rc t Official
This Notice must be posted by the main entrance at all times
eel-
TOW O S0►t THO!L.D BUILDING DEPT.
�
631-765-1802
INSPECTION
[ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI
[ ] CODE VIOLATION [ ] PRE C/O [ RENTAL
RE'7�RKS:p
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DATE INSPECTOR
1�1
TOWN OF SOUTHOLD
Rental Permit
- $g 0392
Owner Edward Graham
Occupied as Single Family Dwelling
Located at 695 Rogers Road Southold 66.-2-42
Maximum Permitted Occupancy 10
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.
4/7/2023
Code IT
force �Official
This Notice must be posted by the main entrance at all times
* 'TOWN OF SOUTHOLD BUILDING DEPT.
631-765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PL G.
[ ] FOUNDATION 2ND [ ] IULTIN/CULIN
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ]
ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ]
CODE VIOLATION [ ] PR C/O ENTAL
c °
4
TOWN OF SOUTHOLD
Rental Permit
Permit No. 0392
Owner Edward Graham
Occupied as Single Family Dwelling
Located at 695 Rogers Road Southold 66-2-42
Village
Maximum Permitted Occupancy 5
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.
2/26/2021 John Jarski
Date of Issue Code Enforcement Officer
This Notice must be posted by the main entrance at all times
,r
SO
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 G ,�
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION
Rental Permit Fee$200 (Application must be renewed every two years) i
i
MAR - 6 2020
Section A.
Property Information:
Rental Property Address-
6 yrs
Tax Map Number: 1000 SECTION -BLOCK -LOT "2F -
l0 40 � � c}•
SECTION B.
OWNER INFORMATION:
Property Owner Name: - EdI/ a-r& /4, G i-Gt.I,cLm
Property Owner Legal Address: Property Owner Mailing Address:
s erg kaQ f U
3l_ y
Telephone Number (s): Daytime �679 c - 431-51 -201
Evening Emergency
Property Owner Email Address: e r&-�0-M @-0
�C)
Page 1 of 5
so
Town Hall Annex ®z,t Telephone(631)765-1802
54375 Main Road ` Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
c®U ,� ,
ZZZZZ,�-,
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Section C. �-
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any:
�J
Address of Authorized Agent (no P.O. Boxes):,'
Mailing Address of Authorized Agent:•''
Telephone Number(s): Daytime Evening Emergency
Email Address: rJ
Section D.
Managing Agent Information:
Name of Authorized Agent of dwelling unit, if a�1
Address of Authorized Agent(no P.O.J,Bo ex s):
Mailing Address of Authorize gent:
Telephone Number(s)aytime Evening Emerge y
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:
Z'
I-11
Address of Managing Agent (no P.O. Boxes):
Page 2 of 5
�rr��pF SOU ,
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax (631)765-9502
P.O.Box 1179 ® 19--
Southold,NY 11971-0959
zrrr
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent:
Telephone Number(s): Daytime Evegirlg- Emergency
Email Address: /
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on property: (rY1-�- �'l Ott5e— �[�rt C��'Y�-�/y�
For each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier (for exampled&Le-6/i
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: P
c
Requested Maximum number of persons allowed to occu y Dwelling Unit:
Number of rooms in Rental Dwelling Unit:
Use and Dimensions of each room in Rental Dwelling Uit: _
LZ
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Page 3 of 5
so
Town Hall Annex r� �A a i A, Telephone(631)765-1802
54375 Main Road �s' Fax(631)765-9502
P.O.Box 1179 ,
Southold,NY 11971-0959 'Q
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
❑ 1 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 Ed IIJXrd- a 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
{ 1
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
c®UN�'a,�a
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: Edo(A-r � /-) 1byM&"q11
Property Owner's Signature:X 0—
sworn
Sworn to before me thisCg qday of ��' , 20,Q U
Officia otary Public Signature and Original Notary Stamp
SABRINA M BORN
{Votary Public,State of New York
No.01806317038,Suffolk County-
Commission Expires Dec.22,20
Page 5 of 5
�®f S0�/rMay 16, 2020
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 d
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
Professional seal r egulred for Architect,or Encineer, licensed Home Inspector muss*pr oy de
copy of valid-current certification
Rental Property SCTM Number:
Rental Property Address: 695 Rogers Lane., Southold NY 11971
Owner/Name: Edward Graham
Rental Dwelling Unit Identifier:
Number&Square footage of each bedroom as depicted in the attached floor plan:
(i.e. Bedroom #1 -100 sq., Bedroom#2-90 sq., etc.)
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 Cornelius III CEO Inspector
Print Name and Title ceo# 1216-0283 bAginal Signature
Please place professional seal:
�a0E50U1y� VM� �toqw� S�• SuAol&
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# * TOWN OF SOUTHOLD BUILDING DEPT.
`�courm,N�' 765-1802
--
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2NDr f ] INSULATIOWCAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
.[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE,RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:
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DATE INSPECTOR
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PO Box 1083
Southold, New York
11971
April 30, 2020
Town of Southold
Building Department
PO Box 1179
Southold, New York
11971 j
MAY - 1 2020
To Whom It May Concern:
Topic: Rental Permit Inquiry
Last year we began the rental process with our Town — completing the
necessary forms and payment of the $200.00 fee. Our home inspection was
scheduled for March 29-this year but because of Covidl9—that was cancelled.
We have pending renters for June 1st through August 23. We are hoping for
follow-up information as to our home inspection from the Town so the process
could be completed and we may be able to rent. Please advise us about the
inspection reschedule..i.e...how will we be notified?
Sincerely,
�.� a
Edward A. Graham
J
PO Box 1083
695 Rogers Road
Southold, New York
11971
May 23, 2020
Michael J. Verity
Chief Building Inspector
Town Hall Annex Building '
MAY 2 6 2020
54375 Route 25
PO Box 1179
Southold, New York 11971
Dear Sir:
We are requesting a home summer rental permit from the Town. Enclosed are
the necessary completed application form copies.
Our initial inspection from the Town was scheduled for March 30th but because
of Covidl9, the Town government offices were closed. ,We were then able to
hire a State inspector.
The Rental Property Certification inspection was performed on May 16, 2020.
We completed the requirement to have 5/8 fire-rated sheet rock placed above
our boiler and flue as well as the inside completion of the bay window
construction in our living room. We received the Certification in the mail Friday,
May 22, 2020 and it is enclosed in this packet.
Our proposed renters are familiar with the North Fork and come with excellent
recommendations. They are available to come June 1 st and stay throughout the
summer as our only renters. We are hopeful for your approval now and look
forward to hearing from you.
Sincerely,
6'L�
Ed Graham
FORM NO. 4
TOWN OF SOUTHOLD
BUMDING DEPARTMENT
Town Clerk's Office
Southold, Ne Y.
Certificate Of Occupancy
No.r 7���?.. . Date . . . . . . . . . . . . . Mar. . 2 . . . .. . ., 19. .7.7
THIS CERTIFIES that the building located at . . .1�0g1��.r S .coact. . . . . . . . . Street
]3 Mock No. 7. . . . . . .Lot No, g. . . . . wuuthold. , 1�..._t.. . . . . . . . . .
Map No. .8�-���P�'�. �'►S ,
conforms substantially to the Application for Building Permit heretofore filed in this office
dated . . . . . . Tlov • - 17 , 19.7 5- pursuant to which Building Permit No. 83014 .
dated . . . . -h ov. . 17. . ., 19r/5. ., 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 . .P j.vatq. .�x� .1��ra �,v' . �� .17_ xa . tits th. cld f;�on. . . . . . . . . . . . . . . . . . . . .
The certificate is issued toWin. - . . .Omer. . . . . . . . . . . . . . . . . . . . . . . . . . • .
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . -X-E... . . . . . . . . . . . . . . . . . . .
UNDERWRITERS CERTIFICATE No. -111�L '. 23. . :x.976. • . . • • • • • • • • - • • -
HOUSE NUMBER . .695. . . . . . Street . . Rogers. 11mad. . . . . . . . .Southold.. . . . . . . .
Building Inspector
Foci• Town of Southold 2/24/2021
P.O.Box 1179
53095 Main Rd
1 Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 41823 Date: 2/24/2021
THIS CERTIFIES that the building ADDITION/ALTERATION
Location of Property: 695 Rogers Rd, Southold
SCTM#: 473889 Sec/Block/Lot: 66.-242
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
11/18/2020 pursuant to which Building Permit No. 45522 dated 12/2/2020
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, including garage conversion to habitable space and enclosed porch, to an existing one family
dwelling as applied for.
The certificate is issued to Graham,Edward
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 45522 12/9/2020
PLUMBERS CERTIFICATION DATED
ut o ' e Signature
g Town of Southold 2/26/2021
53095 Main Rd
Southold,New York 11971
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: 41825 Date: 2/23/2021
THIS CERTIFIES that the structure(s)located at: 695 Rogers Rd., Southold
SCTM#: 473889 Sec/Block/Lot: 66.-242
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- 41825
dated 2/23/2021 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 attached garage and outdoor shower stall
Notes: BP 8301 addition to dwelling COZ-7543:BP 45522"as built"alterations COZ41823
The certificate is issued to Graham, Edward
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
0-- Uh( d Signature
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 695 Rogers Rd.,Southold
SUFF.CO.TAX MAP NO.: 66.-2-42 SUBDIVISION:
NAME OF OWNER(S): Graham,Edward
OCCUPANCY:
ADMITTED BY:
SOURCE OF REQUEST: Graham,Edward DATE: 2/23/2021
DWELLING:
#STORIES: 2 #EXITS: 2
FOUNDATION: cement block CELLAR: 1/4 CRAWL SPACE:
BATHROOM(S): 1 TOILET ROOM(S): 1 UTILITY ROOM(S):
PORCH TYPE: DECK TYPE: PATIO TYPE:
BREEZEWAY: FIREPLACE: yes GARAGE: attached
DOMESTIC HOTWATER: yes TYPE HEATER: indirect oil AIR CONDITIONING:
TYPE FEAT: oil WARM AIR: - HOT WATER: baseboard
#BEDROOMS: 4 #KITCHENS: 1 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: JOHNJ DATE OF INSPECTION: 6/18/2020
TIME START: 2:30pm END: 3:20pm