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Home My WebLink About1000-79.-1-5 TOWN F SOUTHOLD Rental Permit Ar 0405 Owner Richard & Alice Rubinstein Occupied as Single Family Dwelling Located at 470 Goose Creek Ln Southold 79-1-5 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. 3/18/2023 Code Eforc t Official This Notice must be posted by the main entrance at all times so TOWN OF SOUTHOLD BUILDINO-DEPT.r Ulm, 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PCBG. [ ] 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 VRENTAL DATE ��z� INSPECTOR iso $ TOWN OF SOUTHOLD BUILDINGIDEPT. cou 6311-765- 7�/— INSPECTION [ ] FOUNDATION 1 [ ] ROUGH PLE§G- FOUNDATION [ ] INSULATIOL I FRAMING /STRAPPING FINAL FIREPLACE & CHIMNEY [ ] FIRE SAFETYINSPECTION FIRE RESISTANTI FIRE RESISTANTPENETRATION ELECTRICAL (ROUGH) I (FINAL) LCODE VIOLATION / ] RENTAL /01 1 l T Q NA I ipwilialmiliIiijill 1:11m e z i � % % /� �y /r ////i//1/,yin�/%�✓N�i "d5i ! /�l a✓i i i Vii%f%%/%/i/i�j�//�/ �a�%i'%✓/l /��i/��G/i�/?r'; a x e mw i :y r o b g o � r 7 r A r f 1 s ti io r - ny MAR rr I//// /ii/l/ FIR //r %% r / 6/ r o, rrriii i�Ari % „ r . r , r r � a / r i Ji n 1, , i / I f y F: i ;J i f 1 r�i �-y I ,ALJ Do TOWN OF SOUTHOLD Rental Permit y, Permit No. 0405 Owner Richard & Alice Rubinstein Occupied as Single Family Dwelling Located at 470 Goose Creek Dr Southold 79-1-6 Village 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. 3/18/2021 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times Town Hall Annex Telephone(631)765-1802 54375 Main Road N Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 O BUILDING DEPARTMENT D ILS�\VIE TOWN OF SOUTHOL D JUL 1 6 2020 RENTAL PERMIT APPLICATION - _ JllV18.PIN DEP l0 Rental Permit Fee $200 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: 1 Y7a 660-se, >� "d, �l�' Tax Map Number: 1000 SECTION BLOCK _ -Lt�T--_ SECTION R. OWNER INFORMATION: w-M �D I , Property Owner Namekr(G1�__-___-_ Property Owner Legal Address: Property Owner Mailing Address:, (Cannot be the same as Rental Property Address) Telephone Number(s): -;>24o- VQ3- 0-00 oL _ Property Owner Email Address:._ _ Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: om Address of Authorized Agent (no P.O. Boxes): q9 Mailing Address of Authorized Agent: Telephone Number(s): 0�� J �(�✓�' Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if Address of Authorized Agent (no P.O oxes): Mailing Address of Author! Agent: Telephone Numbe s Email Ad ss: - SECTION E. SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units) Name of Managing Agent of dwelling unit, if any: X Address of Managing Agent (no P.O. Boxes) Mailing Address of Managin gent: - Telephone Number(s • _ Email Address: Page 2 of 4 Y 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: O&C�� L/� Q.11 Requested Maximum number of persons allowed to occupy Dwelling Unit Number of rooms in Rental Dwelling Unit: , -- Use and Dimensions of each room in Rental Dwelling Unit: #V/5 ly'x�3 d M �/-�' 'b x I a ' X 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. a� l am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold. - Page 3 of 4 ❑ I am submitting a completed Town of Southold certification form from a licensed architect, a licensed professional engineer, or a 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) ZrtifY 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. �t G�GZ rc-( tyl St 1!`1 PropertyOwner'sName: Property Owner's Signature: Sworn to before m ay of 20- Official Notary Public Sign u e andriga otary Stamp nHoMns J.MxarTHnr NOWY PubGc,State of New York Page 4 of 4 com SUffkonte. ��mb�sr2 D a- 3- .., - ' - - --• ..�� . ...------ • -- _; -�1 ill I'.- __ _.._...--- - ---•_.------ -_ ; I r ` . � I�'I,�bY �I• ate" s• I I �a e(,h 6(2-r *ef �-1qj Cc.*•. ud � ' .�I 0 I 't� ��/a ;�qr G►S Lf-14"N44 c�c I =1 1 Cn�.K.. scnd� ,� m 1 �— _•Cal lu,'.w_e=.r...�—_ �r � I '�ia+a� � I s l j ID 1 I •.i R a 111- �•^'� t'Mite�i..wy � ' � i ;+ tel• i i, �' ,1�� ;�� .0 4, � , r M1 N� .MKrE>Z 2---^o.=N g G46T BF�tiGrs'� r N - � �sPS.ffi•IM=ii6c.� C � I' S' I�`(�R U (] Mtr4 iJF•M1r 1 i I I t I �( 4 1 I flJ 1 1 I DIN ya i i � I' 1 I•' "' R � � aocr r,enar n om�ww..a{��Q/ ._.._ � RF61110.". • � „I 1t i .r`' �11 11 �� rfltl4r•�.",t(,ql ��`rf}� 'Hn 1 IR T f��I%�P4Mxti1_- � •., 1tR.rlla ' 1 l - F- / t / / I � I / / I , F�.Sw- --------_'� NNSML4s�lA•�3iVK-� � �' '1 1 I � ,9`x',71 i��' ! 1� ♦ ♦ 1 � � ., i��rC/V�fyJv, ♦ X41 r�/ ,lr i� ♦ till Lo ryf • f'• m�a6 c.N6 A9 `� f AZ 6 �af6i94�d� I 1 - CII �tt7`oC4.' �+9a-:4 •,�}k�P��.� f i ��I ra,,,;.••,°.,lana �,� �}ni R.nJ' # � � , Lbl�f"s �is:U �4b I /,nl,-vruul v4 ,1•..a _ f a0F SOUT . # # TOWN OF SOUTHOLD BUILDING DEPT. cou765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] INAL, M" [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: 1 �o &4!(,yo DATE '� ?�0'?a INSPECTOR 1 � l - _ �. TOWN OF SOUTHOLD PROPERTY RECOI OWNER STREET VILLAGE T DIST.' SUB. LOT seem ' FORMER OWNER 4Z, E +�- �+ ACR. S :? W TYPE OF BUILDING RES. Z J SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS pr d U Lr'a ✓ f�' 7 10-Z/41143 a c?oaz� 7-ZLO3-1- Z9S 77 �/�urr? -_ rn lrr h 00 '� �-cJcJ J �-� b ► a� ►-�-� raa4 4 y-�..— *0--0. � e. -- 1 00 -7L� )0 /7 CC) ,o ��- - � o9b --� �ra '' ►v — AGE BUILDING CONDITION NEW NCRMAL BELOW ABOVE FAR1,A Acre Value Per Vclue Acre - Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD -Meadowland DEPTH House Plot j BULKHEAD Total i DCCK d � , I -- — LOR mac- TRIM I i II i i 1 - ! - 5 79.-1-5 2/22/2019 } NI. 4-t �� - v -- -- --- 3'S� 176+ 14, sio t x 3t s t2 �- 290 7 i 'to s on�� r "r2 2X-7 Extension Sxt3 - �5 , �3 2611 • Foundation G+VYE Both Dinette Pov orc '$X Z.5 � � ZS . $r� (per jBasement �,� Floors K. 2-�c�j 2g (� F.xt. Walls Interior Finish u_ �� LR. Breeze.. ` N�l'l y �� S��.�. f o2 Fire Place Heat _ _ DR. 1 Garage Z,.7- X Z5 _ ��j ,5a Z Type Roof Rooms 1st Floor BR. BU Recreation Room Rooms 2nd Flcor FIN. B -�OC Dormer Drivewcv - �' L SGOT 4aU FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24614 Hate SEPTEMBER 11, 1996 THIS CERTIFIES that the building MW DWELLING Location of Property 470 GOOSE CRSSK LAM SOUTHOLD, N.Y. -Location-of =House No. Street Hamlet County Tax Map No. 1000 Section 79 Block 1 Lot 5 subdivision Filed Map No. Lot No. -conforms substantially to the Application for Building Permit heretofore -- - - -- - filed in-this office dated NOVEMBER 17, 1993 pursuant to which - -- - - ---- - -- - -- ---- --- __ Building- Permit_No_._21811-Z dated DECEM 39R 4, 1993 -_-_=_ -- m4 ---_was==issued:--and=conforns to all of the requirements of the applicable - =pzovteions=of=t}ie=law. The occupancy for which this certificate is issued is ONE FAMILY DWELLING WITH ATTACHED GARAGE a DECK AS APPLIED FOR = -i-The -certificate is issued to VIRGINIA L. RUMPLER (owner) of the aforesaid building. -` - -- —_�-SUFFOLK COUNTY,-DEPARTMENx OF HEALTH APPROVAL 92-SO-�99-SEPT. 6, 1996 F --_-- --UNDERWRITERS CERTIFICATE NO. N-329499 - OCTOBER 7, 1994 - - -- - - --- -- - --- -PLUMSERS__CERTIFICATION-DATED DECEMBER 7, 99 PECONIC PLUMB. & HEATING ---- — - _ __ : -=_ ,------ Building Inspec r Rev. 1/81 r L� f 0190 W& Town of Southold 8/29/2020 � P.O.Box 1179 e c" 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41395 Date: 8/29/2020 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 470 Goose Creek Ln, Southold SCTM#: 473889 Sec/Block/Lot: 79:-1-5 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 8/15/2019 pursuant to which Building Permit No. 44126 dated 9/4/2019 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-Around swimming pool fenced to code as applied for. The certificate is issued to Rubinstein,Richard&Alice of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 44126 11/4/2019 PLUMBERS CERTIFICATION DATED Signature o\pg�l�Fnl,�io� Town of Southold 10/25/2018 P.O.Box 1179 y 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39994 Date: 10/25/2018 THIS CERTIFIES that the building GENERATOR Location of Property: 470 Goose Creek Ln, Southold SCTM#: 473889 Sec/Block/Lot: 79.4-5 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/25/2018 pursuant to which Building Permit No. 43096 dated 10/3/2018 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: ACCESSORY GENERATOR AS APPLIED FOR The certificate is issued to Rubinstein,Richard&Alice of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43096 10-18-2018 PLUMBERS CERTIFICATION DATED Authorized Signature