HomeMy WebLinkAbout1000-34.-3-40 � TOWN OF S UTHOLD
Rental Permit
0402
Owner: Carol-Ann Hoffman
Occupied as: Single Family Dwelling
Located at: 360 Champlin P1 Greenport 34.-3-40
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.
Issued: 02/27/2025P�/ >�at_'V
Expiration: 02/27/2027 CodetnfoJment I
This Notice must be posted by the main entrance at all times
,vxxzwsar,
TOWN OF SOUTHOLD BUILDING DEPT.
w� 631-765-1802 30 3- 5/0
I N � � E��"I � 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) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ j-/R/ENTAL
REMARKS:
O)L 00 oce-C/
00
DATE INSPECTOR
Town Hall Annex
Town Of Southold 54375 Main Road
Rental Inspection Report PO Box 1179
Southold, NY 11971-1179
Tel: 631-765-1802
SCTM# — 3 — Date �2
Owner Phone
Address Visible
Hamlet Inspector
Floor Level Quantities Sub 1 2 3
Smoke Detectors(not located in bedrooms)
Carbon Monoxide Detectors
Fire Extinguishers
Exits
Bedrooms 1 2 3 4 5 6
Smoke Detectors
Egress
Occupant Count
Building Systems Maintained&Operational Condition of Property
Heating Building interior
Hot water Building exterior
Electrical Property clean, maintained&safe
Mechanical Handrails&guards installed&secure
Pool Safety Pool on Site
Surface water alarm (Date of CO issuance
Door alarms Pool completely enclosed
Self closing/latching gates Pool fence to code requirements
CO's for all items present Prior Rental
Comments*
¢ � TOWN OFSOUTHOLD
Rental Permit
0402
Owner Carol-Ann Hoffinan
Occupied as Single Family Dwelling
Located at 360 aka 307 Champlin Place Greenport 34.-340
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.
2/27/2023
Ocde ' �rcement Official
This Notice must be posted by the main entrance at all times
TO N OF SOUTHOLD
631-765-1802 � Aoyl
INSPECTION
FOUNDATION o / r
I l ROUGH PLBG. 30� CX Aml�'
REMARKS:
TOWN OF SOUTHOLD
Rental Permit
Permit No. 0402
Owner Carol-Ann Hoffman
Occupied as Single Family Dwelling
Located at 360 aka 307 Champlin Place Greenport 34-3-40
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.
3/15/2021 John Jarski
Date of Issue Code Enforcement Officer
This Notice must be posted by the main entrance at all times
h
r3DUT�O
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 A \
BUILDING DEPARTMENT D V
TOWN OF SOUTHOLD Gi
RENTAL PERMIT APPLICATION OCT 2 3 2020
Rental Permit fee$200(Application must be renewed every two years) BBDO DEPT,
T0VyT'?OY,8C)UT OLD
Section A.
Property Information:
Rental Pro pe Address:
qq
Tax Map Number: 1000 SECTION_ l 000-13LOCK -
SECTION B.
OWNER INFORMATION:
Property Owner Name: cArox-crane aV_r An
Property Owner Legal Address: Property Owner Mailing Address:
We It
W
V
Telephone Number(s): Daytime 0031-%S3 *3Evening Emergency
Property Owner Email Address: Cines"Aw OG
Page 1 of 5
Town Hall-Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any:
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 Address of Authorized Agent:
Telephone Number(s): Daytime Evening Emergency
�J
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: �( I A
Address of Managing Agent (no P.O. Boxes):_ I �-
Page 2 of 5
O L SDUj�O
Town Hall Annex Telephone(631)765-1802
.54375 Main Road � � Fax(631)765-9502
P.O.Box 1 179
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent:
Telephone Number(s): Daytime E vening Emergency
Email Address: l
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, Bedrpom 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:
2'a!:I
Number of rooms in Rental Dwelling Unit:
Use and Dimensions of each room in Rental Dwelling Unit:
S-ee cIne-A
Page 3 of 5
Q�VpF`SO(/T�,�
Town Hall Annex Telephone(631)765-1802
54375 Main Road • Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
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.
V, 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)
I Co eO\-G-r-Ae. tkt- nn , 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
.O��.p�SD(/j�o,
Town Hall Annex Telephone(631)765-1802
54375 Main Road _ Fax(631)765-9502
P.O.Box 1179
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: CAe0\—ane n
Property Owner's Signature: t� �
Sworn to b ore m this 20 day of 046bAV . 20.2.0
Official Ootarf 0-u/bVslgnat-u-r-e and Original Notary Stamp
DOREEN E.TYBAR111'
NOTARY PUBLIC,STATR OF NEW YORK
Registration No.OITY0274186
Qtudified in Suffolk Courcy
Commission Expires dec.31.2020
Page 5 of 5
�O��OFSOUlyO6 7� ��� C' 1V�
# # TOWN OF-SOUTHOLD BUILDING DEPT.
°`y�ouxn ' 765-1802
r INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND = [ ] INSULATION/CAULKI
[ ] FRAMING /STRAPPING [ ] Al_
[ ] FIREPLACE & CHIMNEY 'FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION j ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) : [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION ( ] PRE C/O
REMARKS:
Or N FcJvc/ �,..�
w�
DATE l tv)011INSPECTOR
DN.
PORCH
16'-0" 16'-0"
UP BEDROOM 2 I CL.
LIVING ROOM
00
N
CL. N
CL.
BATH- DN.
14'-0" DINING AREA ROOM
S/C
r. w
6-01,
—4
0-4
BEDROOM 1
00 KITCHEN
N BASEMENT N 00 N
II
n - CL.
C
DW I
UP- N o 0
W/D
HATCH
To 14'-0"
BASEMENT MUD
ROOM 2 SECOND FLOOR
BASEMENT -- 307 CHAMPLIN PLACE
T-6" SYMBOLS GREENPORT, NY 11944
14'-0"
FLOOR PLANS
smoke and carbon
FIRST FLOOR S/C monoxide detector DATE-10/19/20 1 PAGE:1 OF 1
l
Al,
OPERTY :'RECORD,— (^,,
OWNERS* _ STREET VILLAGE - DIST.1' SUB. LOT
art1
16
X;4' PA, e . ..A&
FORMER OWNER N ACR.
SW TYPE OF`BU I LD.I NG
RES. SEAS.' VL. FARM COMM. CB. MICS. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
/1
`7 V 1 +� {-7
ma
/
f ,
AGE BUILDING CONDITIONNEW NORMAL -.BELOW ' ABOVE
FARM Acre Value Per Vclue — ^ —
Acre
Tillable j FRONTAGE ON WATER
Woodland — FRONTAGE W ROAD
Meadowland DEPTH-
House
EPTH House Plot BULKHEAD
- -
DOCK-
Total -----i- ----------- - - - .
—�
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"N'.' 'U-10 Y-
a ns•*� n T6 sn.e � i _
LOR � s TRIM
I
i , I
34.-3-40 1/29/2021 ; I i + r y—(—i i�'r —
,-
M. ,Bldg,
Extension r
3 4'6 o
`.Extension
__ L ;
Extension
Foundation {6M'r 6r g` Seth f ; Dinette j
Porchf'Basement Floors j iOt
Porch { Ext. Walls ` ;Interior Finish " µ LR,
Breezeway _----- —�; Fire Place {NeatDR.
_ r,)a
Garage I 4 (Type Roof ,Rooms 1st Floor i ! BR.
Patio-- � { i
f ! 1 Recreation Room — Rooms 2nd Floor FIN B
O.` B. I Dormer � �Driveway
Total .
_
JV
..........w..a�..x......:... „.".,x.aw.,...�....Q., aeM.e. .x..x.w.w., .•rxF -... .,,,..., ..,ax.,a..,. »..,.., -R. ."..3:�x,;,.*W.4... k:,.Y Y...w.,..a.., ....a...w.a.....,,., '" " - - r_ .,� .. ,. ..
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.X.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 26196 - Date: 12/29/98
THIS CERTIFIES that the building DWELLING
Location of Property 360 aka 307 CHAMPLIN PL GREENPORT
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 034 Block 0003 Lot 040
Subdivision Filed Map No. Lot No.
conforms substantially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z- 26196 dated DECEMBER 29, 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 ONE FAMILY DWELLING WITH ATTACHED PORCH.*
The certificate is issued to JEROME & PATRICIA URBAN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. H4831
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
Building Ina etor
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
aka 307 .
LOCATION: 360 LHAMPLIN PL G)(ERNPORT
SUBDIVISION: MAP NO.s LOT (S)
NAME OF OWNER (S) : JEROME & PATRICIA URBAN
OCCUPANCY: A-1 RESIDENTIAL aEROME & PATRICIA URBAN
ADMITTED BY: JEROME URBAN ACCOMPANIED BYs SME
KEY AVAILABLE: SUFF. CO. TAX MAP NO.: 34.-3-40
SOURCE OF REQUEST: JEROME & PATRICIA URBAN DATE: 12/29/98
DWELLING:
TYPE OF CONSTRUCTION: WOOD FRAME # STORIES: 2.5 # EXITS:
FOUNDATION: CQNCRETE BLOCK & POURED CONCRETE CELLAR: PART CRAWL SPACE:
TOTAL ROOMS: IST FLR.: �} 2ND FLR.: 3RD FLR.: 0
BATHROOM(S) : 1.0 TOILET ROOM(S) s 0.0 UTILITY ROOM(S) :
PORCH TYPE: FRONT ROOF DECK TYPE: PATIO TYPE:
BREEZEWAY: FIREPLACE: GARAGE:
DOMESTIC HOTWATER: X TYPE HEATER: FROM BOILER AIRCONDITIONING:
TYPE HEAT: OIL WARM AIR: HOTWATER: X
OTHER: BASE OF PORCH REMOVED
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.: STORAGE, TYPE CONST.:
SWIMMING POOL: GUEST, TYPE CONST.:
OTHER:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION I DESCRIPTION I AUT ; SEC.
{ I {
{ I {
{ 1 {
1 { j
1 { 1
� 1 {
REMARKS:
INSPECTED BY: DATE ON INSPECTION: 12/03/98
HN M. SOUFIS TIME START: 10:50 END: 11:20
h�o�g�EFO(,fcoGy Town of Southold
3/14/2021
� P.O.Box 1179
o -
o • { 53095 Main Rd
y�Bl �,ao Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 41874 Date: 3/14/2021
THIS CERTIFIES that the building ALTERATION
Location of Property: 360 (aka307)Champlin Pl., Greenport
SCTM#: 473889 Sec/Block/Lot: 34.-3-40
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
5/22/2000 pursuant to which Building Permit No. 44646 dated 1/31/2020
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:
roof alteration and alteration and r�air to an existing dwelling forto an existing single dwellin�pplied for
The certificate is issued to Homan,Carol-Ann
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Au o ' e Si6 ature