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Home My WebLink About1000-87.-1-11 of TOWN OF SOUTHOLD Rental Permit 0424 Owner Harbor 13 Rty Ltd Occupied as Single Family Dwelling Located at 4845 S. Harbor Road Southold 87.4-11 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. 5/10/2023 This Notice must be posted by the main entrance at all times e 2m fficial May 22, 2023 Town Hall Annex � � Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 to 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 Rro essicrrlal seal re aired car rcl ltect or Ftl Itleer llcerzsed forrle iris actor rrlust r avid coov of valid current cerci lcation Rental Property SCTM Number: Rental Property Address: 4845 S Harbor Rd., Southold NY 11071 Owner/Name: Allem Say 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.) Jaedroom &1 190 scift Bedrooml#��3 1 f Bedroom #2 205 saft Property Description (Include ail 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 *i ' gnatu Please place professional seal: Town Hall Annex; Telephone(631)765-1802 54375 Main Road w �> Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 Af, -coo BUILDING DEPARTMENT TOWN OF SOUT OLD 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 _,,,,._-BLOCK I -LOT I I - SECTION B. OWNER INFORMATION: Property Owner Name: µ Property Owner Legal Address: Property Owner Mailing Address: qq ,� � " S � , C ,, Telephone Number(s): Daytim i - vening _Emergency Property Owner Email Address: Pagel of S Telephone(631)765-1802 Town Hall Annex 54375 Main Road Fax(631)765-9502 as P.O.Box 1179 Southold,NY 11971-0959 cou BUILDING DEPARTMENT TOWN OF SO"IM.TTHOLD Section C. Authorized Agent In rmation: Name of Authorized Agent dwelling unit,if any: Address of Authorized Agent( o P.O. Boxes): Mailing Address of Authorized A nt: Telephone Number(s): laytime Evening Emergency Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit,i ny: Address of Authorized Agent(no P.O. Boxes): Mailing Address of Authorized Agent: -- -- - Telephone Number(s): Daytime Eve ing Emergency Email Address: SECTION E. SITE MANAGER INFORMATION:(required for rental pro erties containing 8 or more rental units) Name of Managing Agent of dwelling unit,if any: Address of Managing Agent (no P.O. Boxes):, Page 2 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road �� l Fax(631)765-9502 P.O.Box 1 179 Vim" Southold,NY 11971-0959 ^r BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: 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, 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: Requested Maximum number of persons allowed to occupy Dwelling U " Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit:-KA I_....1L l L Page 3 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road rea» Fax(631)765-9502 P.O.Box 1 179 @� 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, ❑ 1 am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold lam 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) 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 Town Hall Annex `«� Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 4 � 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. p Property Owner's Name: � Property Owner's Signature: Sworn to before me thls L�day of 20—j Z� Official Nota ublic Signature n Original Notary Stamp TRACEY L. ER eW YORK NOTARY p IC,ITA � I .tli QUA W*D IN SUFE CWIV EVIWS AME Page 5 of 5 Town Hall Annex @� Telephone(631)765-1802 Fax(631)765-9502 54375 Main RoadAc P.O.Box 1 179 Southold,NY 1 197 1-0959 p` BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: t Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: ti so 'f0cpWN OF S; UTHOLD BUILDING DEPT. , uw. 631.765-1802 V-— I — [ [ INSPECTION FOUNDATION 2ND [ ] INSULATION/CAULKING FRAMING r STRAPPING [ ] FINAL RESISTANTFIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION FIRE RESISTANT ELECTRICALI CODE VIOLATION / RE A7S-. �. DATE c� � - ti_ ._ = TRIM � � INN 07� � u i 87.4-11 10/2016 M Bldg Extension - Extension Extension Foundation Bath Porch =Basement - ?l hors lC. Porch Ext. Walls `Interior Finish LR. Breezeway 'Fire Place Heat DRI. -- -�- Garage Type Roof I Rooms I St Floor BR. Patio =Recreation boort' 'Rooms 2nd Floor P f O. B. _ l - <Dormer l � 'Driveway Total 3 } TOWN OF SOUTHOLD R EQ CARD OWNER :STREET VILLAGE DIST! SUB. LOT no-i La !, . FORMER OWNER E ACR E S W TYPE OF BUILDING e I •{ RES. _ SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS vl n n �c - E f a E � , x � s a ,. Z C-0 _ s . _ AGE BUILDING CONDITION -� z X0085 NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH House Plot BULKHEAD F , Total DOCK 3 1 g Town of Southold 2/6/201'7 53095 MaiR Rd Southold,New York 11971 PRE EXISTING CERTIFICATE TE GF OCCUPANCY No: 38818 Date: 2/6/2017 THIS CERTIFIES that the structure(s)Iocated at: 4845 S Harbor Rd,Southold SCTM#: 473889 Sec/Block/Lot: 87.4-11 Subdivision: Filed Map No. Lot No. conforms substantially to the requiremertts for a built prior to APRIL 9, 1957 pursuant to whichCXfF,OF OCCUPANCY NUMBER Z- 38818 dated 2/6/2017 was issued and conforms to all the requriements of the applicable provisions of the law. The occupancy for which this certificate is issued is: d ftame gge AM&dwelling "th co d accessory wood frame Marage.!, Note:BP 413011 00a o service The certificate is issued to Clark, Susan Hansen,Janice (OWNER) of the afbresaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACBM INSPECTION REPORT. A rized,Si aature BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 4845 S Harbor Rd, Southold ....... .. _... ....._ .w.._ _._ . .. WW SUFE.CO.TAX MAP NO.: 87-1-11 SUBDIVISION: NAME OF OWNER(S): Clark, Susan&Hansen,Janice .. ..._...... .... OCCUPANCY: ADMITTED BY: Melvin H, ...�-...---�.,.._._._._...-�...�..____..._..k�w__ ansen . www.___ ... ______�.....�....__.�...._..�__.._...___._.. .. __a.. ... ....... .. ... ......�. SOURCE OF REQUEST: Clark, Susan&Hansen Janice DATE: 2/6/2017 DWELLING: #STORIES: 1.5 #EXITS: 2 _..� _mm..w.........................._.__... FOUNDATION: concrete piers CELLAR: partial CRAWL SPACE: BATHROOM(S): 1 TOILET ROO _......... _.._.._....__....I w_ __._........ .. _.... _ w M(S). UTILITY ROOM(S): yes PORCH TYPE: wood frame DECK TYPE: PATIO TYPE: BREEZEWAY: FIREPLACE: yesGARAGE: DOMESTIC HO'I WAT es TYPE HEATER: oil^^^^^^^^^XµMµMµMµµ AIR CONDITIONING:_. . �--M y �. TYPE HEAT: �` µ~WARM AIR: HOT WATER: baseboard u #BEDROOMS: 7 J #KITCHENS:.— 1 BASEMENT TYPE: - ~~ -m unfinished........... _._..... .__ OTHER: ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: wood frame STORAGE,TYPE OF CONST: __.__._._.. .. _. ....._. ._. _.m...... ___.. ...m. SWIMMING POOL: GUEST,TYPE OF CONST: OTHER: VIOLATIONS: REMARKS: INSPECTED BY: JOHNJ DATE OF INSPECTION: 1/20/2017 TEWE START: 11:20am END: 11:50am Town of Southold 12/7/2018 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE E Off" OCCUPANCY No: 40085 Date: 12/7/2018 THIS CERTIFIES that the building ELECTRICAL Location of Property: 4845 S Harbor Rd,Southold SCTM#: 473,889 Sec/Block/Lot: 87.-1-11 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore fled in this office dated 12/4/2018 pursuant to which Building Permit No. 43272 dated 12/4/2018 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: ELECTRIC SERVICE UPGRAPE TO 200 AMP, The certificate is issued to Harbor 13 Rty Ltd of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43272 11-30-2018 PLUMBERS CERTIFICATION DATED Authorized Signature Town of Southold 2/6/2017 P.O.Boz 1179 ' 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 38817 Date: 2/6/2017 THIS CERTIFIES that the building ELECTRICAL Location of Property: 4845 S Harbor Rd, Southold _m..........ww _. __w.w.____.__M.M....... ww._........... ..... ._._._._w... _.....w.............._.__�- SCTM#: 473889 Sec/Block/Lot: 87.4-11 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/20/2017 pursuant to which Building Permit No. 41301 dated 1/20/2017..........ww _ww...._. . 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: 100a o af tric pr%1- The certificate is issued to Clark,Susan&Hansen,Janice of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 41301 2/2/2017 PLUMBERS CERTIFICATION DATED Authorized�`8Ignature TOWN OF SOUTHOLD £ Rental Permit 0424 Owner Harbor 13 Realty Ltd Occupied as Single Family Dwelling Located at 4845 S. Harbor Road Southold 87-1-11 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. 4/29/2021 cede o n Official 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 Southold,NY 11971-0959 D a Coy BUILDING DEPARTMENT ItJ TOWN OF SOUTHOLD JAN 2 2 202' RENTAL PERMIT APPLICATION D'Y ; X. Rental Permit Fee$200 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION -BLOCK L -LOT [_- SECTION B. OWNER INFORMATION: Property Owner Name-UA?,509- I-a L l�?, IKL-A 5," �h&L� Property Owner Legal Address: Property Owner Mailing Address: . 4715 WWI - /-:>o L2T4 o�'Q WY �l 021 f Telephone Number(s): Daytime 9.11 141-&�Vtvening -�ZNv-16 Emergency 2L-"0- Property Owner Email Address: Page 1 of S O'So(jr Town Hail Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 • Southold,NY 11971-0959 Ulm BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent:. ^O�6. Telephone Number(s): Daytime Evening Emergency Email Address: SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: _ For each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier (for example, Unit 1, Unit 2, Unit 3 or Apt A, B, C); the use of each room in the Rental Dwelling Unit (for example, Kitchen, Bedroom 1, Bedroom 2, Living Room) and the dimensions of each room. For properties with multiple Rental Dwelling Units use "Rental Permit Application Addendum." Rental Dwelling Unit Identifier: 17 Requested Maximum number of persons allowed to occupy Dwelling Unit Lw Number of rooms in Rental Dwelling Unit: _ 6 _ Use and Dimensions of each room in Rental Dwelling Unit- ('T C 0 6,V4 nit:(tG0LV4 rar'Co`tk 81, n7tc Vi0A0Q EM 1 It X, t0 `` C _- Page 3 of 5 -V'$ Town Hall Annex Telephone(631)765-1802 54375 Main Road °"' ^_ Fax(631)765-9502 P.O.Box 1179 . Southold,NY 11971-0959 t �OIIM'I 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. ❑ f am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold C� 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 H LUE,10 I$A j ;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 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 �• Southold,NY 11971-0959 Q 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:. 1AM2,50C�c.G*� `"i i� 9, �- 1?,P� Property Owner's Signature: Sworn to befo a me this2 d of .20� i • i Official Not ublic Signature and Original Notary Stamp 7Public EN RUBINSTEIN State of New YorkU6261722uffolkCo mypires 2.oZ 'i Page 5 of 5 :; Y 0 ® Jan 16, 2021 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 (j • l��'QUI�'4� • , 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 Enaineer,licensed Home Inspector must provide copy of valid current certification Rental Property SCTIVI Number: 87 — t - 11 3�g� Rental Property Address: 4845 S. Harbor Rd. Southold NY 11971 Owner/Name: Harbor 13 Realty 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.) Bedroom#1 225 soft Bedroom #3 130 Bedroom #2 160 sgft 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 Print Name and Title ceo# 1216-0283 Orig na Signat re Please place p.rpfessional seal: pF SObTyO qs 7 <- s• A4rL/ lwlsa/` w * TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 f INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATIOWCAULKI G [ ] FRAMING /STRAPPING [ ],,FfNAL ] FIREPLACE`& CHIMNEY FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] "FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: 6*vw elvm i Iok DATE q �3 '� INSPECTOR L-.�` ` s/cp �- „. t !. TM VV TOWN "OF` SOUTH0�-D, PR®PER OWNER STREET, p VILLAGE': DIST SUB LOT -- —- FORMER OWNER a' - E :R:c - ff. Nf;2A_ ., Sys W�,t .` . .. TYPE OF BUILDING. mm' ', �2ES I SEAS. VL FARM- i COMM. CB, MICS. Mkt. Value LAND IMP: ! TOTAL DATE” I REMARKS t sr ua t � a { AGE BUILDING CONDITION. > t I _ �.�1� t � .cr- :'•. "f�iC.�t J� 200rtz NEW NORMAL j BELOW ABOVE FARM: Acre 1 Value Per Value ��^ J� Acre i cJ �f a 40 Tillable FRONTAGE ON WATER' YVoodland, I FRONTAGE ON ROADe Meadowland ! DEPTH 1 House Plot BULKHEAD- Total I 'DOCK 4 � DLOR ' TRIM Y-e'L i&0 s.J f a �, I f —1 1 7- } f 87,141 10/2016 + I Bldg i i 1. M -�— t i O f Extensronss - � , Eictension': 1 ; E i Foundation; Bath Dinette! Porch V 3L VZ, BasementFloors K. ^ Porch >X 3 J I �FXt:Walls. � � � Interior Wsh B'reezewoy /� j iFire Ploce Neat D2. ,Garage „ , — 1�1*6 Roof Rooms 1st-Floor BR. Patfo I ]Recreation Room Rooms 2nd Floor �FIN. B, O. B �L/_ Dormer Driveway — — ------ Toral 33 +� �a ..............�..._��_:�: �.�:�Mv _ o...::� _�. µ".._. okgUFFO(,�coG Town of Southold 2/6/2017 3 y 53095 Main Rd N x Southold,New York 11971 o � PRE EXISTING CERTIFICATE OF OCCUPANCY No: 38818 Date: 2/6/2017 THIS CERTIFIES that the structure(s)located at: 4845 S Harbor Rd, Southold SCTM#: 473889 Sec/Block/Lot: 87.4-11 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- 38818 dated 2/6/2017 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 porch and accessory wood framegarage.* Note:BP 41301 100a overhead electrical service COZ-38817 The certificate is issued to Clark, Susan Hansen, Janice (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. )k , OA t prized Signature BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 4845 S Harbor Rd,Southold SUFF.CO.TAX MAP NO.: 87.-1-11 SUBDIVISION: NAME OF OWNER(S): Clark, Susan&Hansen,Janice OCCUPANCY: ADMITTED BY: Melvin Hansen SOURCE OF REQUEST: Clark,Susan&Hansen,Janice DATE: 2/6/2017 DWELLING: #STORIES: 1.5 #EXITS: 2 FOUNDATION: concrete piers CELLAR: partial CRAWL SPACE: BATHROOM(S): 1 TOILET ROOM(S): UTILITY ROOM(S): yes PORCH TYPE: wood frame DECK TYPE: PATIO TYPE: BREEZEWAY: FIREPLACE: yes GARAGE: DOMESTIC HOTWATER: yes TYPE HEATER: oil AIR CONDITIONING: TYPE HEAT: oil WARM AIR: HOT WATER: baseboard #BEDROOMS: 3 #KITCHENS: 1 BASEMENT TYPE: unf nished OTHER: ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: wood frame STORAGE,TYPE OF CONST: SWEMIING POOL: GUEST,TYPE OF CONST: OTHER: VIOLATIONS: REMARKS: INSPECTED BY: JOHNJ DATE OF INSPECTION: 1/20/2017 TIME START: 11:20am END: 11:50am 'f Town of Southold 12/7/2018 P.O.Box 1179 53095 Main Rd p? Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40085 Date: 12/7/2018 THIS CERTIFIES that the building ELECTRICAL Location of Property: 4845 S Harbor Rd, Southold SCTM#: 473.889 Sec/Block/Lot: 87.-1-11 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 12/4/2018 pursuant to which Building Permit No. 43272 dated 12/4/2018 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: ELECTRIC SERVICE UPGRADE TO 200 AMP The certificate is issued to Harbor 13 Rty Ltd of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43272 11-30-2018 PLUMBERS CERTIFICATION DATED Authorized Signature