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HomeMy WebLinkAbout1000-9.-7-1 TOWN OF SOUTHOLD Rental Permit 0462 Owner Brian & Sarah Carroll Occupied as Single Family Dwelling Located at Equestrian Avenue Fishers Island 9.-7-1 Maximum Permitted Occupancy 8 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. e 6/11/20212if ,/ . Code Enforcement Offi ial This Notice must be posted by the main entrance at all times so Town Hall Annex `- 2phone(631)765-180254375 Main Road ax(631)765-9502 P.O.Box 1179 c y• �� Southold,NY 11971-0959 � � -�, # JUL 20 202 BUIL-DING-DEPARTM UII,L�ING DEPT. TOWN OF SOUTH �' n, �'J" .V�I?'�HOLD RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: �ishtK IGICLVA N, OU310 a 61, 111 t* Tax Map Number: 1000 SECTION i -BLOCK _-LOT _-� SECTION B. OWNER INFORMATION: Property Owner Name: %V1. (I IA-d S&Mk Ca-kIra Property Owner Legal Address: 1$0 1Ma(VI Siy?'C+ Property Owner Mailing Address: 1010 1%8 ma,iIn Sfiv� Telephone Number(s): Daytime 2,40115 1 Vvening Emergency C_R,L1 Property Owner Email Address: IDmxr S�'OVs C�1�©l I i l . G�'I f _ J cls �(�U• �(��� Page 1 of 5 �� ('l�, 'IZ4�2 . Town Hall Annex AL Telephone(631)765-1802 54375 Main Road T Fax(631)765-9502 R.O.Box 1179 Southold,NY 11971-0959 Q C®UNI�I, 1� BUILDING-DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit; if any:- C )V1hW 2,1 Address of Authorized Agent (no P.O. Boxes): U43- n,Ui,C.�S V o'A_V1 -� % Mailing Address of Authorized Agent:D&1/ V- 06 a'66 "-- °�2-1 Telephone Number(s): Daytime 01 28 g Evening Emergency Email Address: ivIP 0 G 2-15 kU--H aVt.Gl S a� Is . C 6 M 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 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 of Managing Agent (no P.O. Boxes): Page 2 of 5 SO Town Hall Annex i�t Telephone(631)765-1802 .54375 Main Road Fax(631)765-9502 P.O.Box 1 179 G Southold,NY 11971-0959 lrtx�qac 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: 1 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: �e�e Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: I Use and Dimensions of ach room in Rental Dwelling Unit: r 1( ,I�°�x ( i Seo ® 1 . �� ] ® 5, 16" s " J II nli r � 11VIA - ,� i�l X 5 1 �f vki l�g of 5 q x t Town Hall Annex tj Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 . Southold,NY 11971-0959 C' Ph U 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) pp1 I v. oma- C c) l ` , 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 d 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: 2S Property Owner's Signature: Sworn to before me this.30 day of LAilf Official Notary Pu&9c Signature and Original Notary Stamp Page 5 of 5 r ho��OF SOUTyo� # f TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] 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 (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: DATE INSPECTOR Bathroom Laundry Bedroom 11'2"'x 2'x, Ground Floor Approx.1428.8 sq.fe6t Kitchen Family S � 11'9"x 13'5" ROOM O0 O 00 � Dining . Room 17'x 10'3° Living Room Porch Total area: approx. 1428.8 sq.feet All measurements are approximate and not intended for official use. Plan produced using PlanUp. Upper Level Bedroom 11 off Approx. 576.4 sq. feet x 11 3 O CI ° CI o BathroomHall ---- ---- o o Bedroom 13'10" x 10'4" 0 Pedroom 9'1" x 12' Cl MMF- Total area: approx. '576.4 sq. feet All measurements are approximate and not intended for of ficial use. Plan produced using PianUp.