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Home My WebLink About1000-88.-4-25 w TOWN OF SOUTHOLD Rental Permit 0463 Owner John Kupcha III & Meghan Lamar Occupied as Single Family Dwelling Located at 250 Bay Haven Lane Southold 88.4-25 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. 6/15/2023 1h111— Code Enforcement Official This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD BUILDING D1 631-765-1802 c� + INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAI [ ] TRADING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] TIRE SAFETY INS [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL {TII [ ] CODE VIOLATION [ ] PRE C/O [ 1 REMARKS: INSPECTORok R z \��` �� gip, � \�� \� ��\� �w \~ \� � ��\ \ � ��\ ��` �� \ Town Hall Annex SOUTHOLD TOWN 54375 Main Road PO Box 1179 Southold Rental InsRection NY 11971-1179 Te; 631-765-1802 Fax 631-765-9502 s - _ CQ 3 Date P SCTNI # ;Phone Owner Address _ — r _ Z�P - 'Inspector City _. 3 S U B 'LEVELS Smoke Detectors (#- bedroom detectors exc uded> _ Carbon Monoxide Detectors (# ------- Fire Fire Extinguishers (#) — Exits # y .a�N _BEDROOMS Smoke Detector Alar-:7s `=arbor Monoxide Alarms Egress (windows 0"N" _. �._ _�� . BUILDING SYSTEMS Y'�1 `CONDlTlON OF PROPERTY Y BL,IIc ng Irate,-,o' c lea^ a ^ta zd Heatin siste r' F"atai^ed a r.,a ne e�at�ona� Bui;drng Ex'e'io� 's ciea- a _ o: wager s esteQintainearoo _ _ rty s c ear safe rnain, n a� ec -Electrica; s=ste^ ma,ntaire fooera:iona Nana rails & guaros presen �liechanical s��tem maintaine �rationa 4coMMEr�Ts �� `�� - _C21 TOWN OF SOUTHOLD Rental Permit 0463 Owner John Kupcha III & Meghan Lamar Occupied as Single Family Dwelling Located at 250 Bay Haven Ln Southold 88-4-25 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. l 6/14/2021 C de En rc m nt fficial This Notice must be posted by the main entrance at all times �T F a R Town Hall Annex Telephone(631)765-1802 54375 Main Road N Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee$200 (Application must be renewed every two years) I . or Section A. 2020 Property Information: Rental Property Address: abs kti �� Ha► (� . ��ai (M7I TaxMapNumber: 1000 SECTION O��00 -BLOCK Dy A -LOT�f_-� J�l�� 3 h� 1e 55 6y, � CW. .1 15 K-,4 10,5 K a-do(t SECTION B. OWNER INFORMATION: Property Owner Name: 3-ohn S Veda , Property Owner Legal Address: Property Owner Mailing Address: a.sV &4 �wven �4rlx- ass &hLi t4n.� SOv►�p�cQ WY "1117f SoyN,a��(� illy �l /71 Telephone Number (s): Daytime (WI-361- WEvening Emergency 31H-3'7q- 33 N S-(w'�e) Property Owner Email Address: I 0 kn' kw(' ICf ilA ` - cw Pagel of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road cni Fax(631)765-9502 P.O.Box 1179 z 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 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 Zf SO Town Hall Annex8 [ .fes Telephone(631)765-1802 54375 Main Road" Fax(631)765-9502 P.O.Box 1 179 G` Southold,NY 1]971-0959 `l�Co 4.1 ma 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: I 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 1 Number of rooms in Rental Dwelling Unit: (ocw�5 '�a l�c,Nln�oo►nS ,Fc,ln��', (;v�� VA Use and Dimensions of each room in Rental Dwelling Unit: ge�raooi �I�I� SCA-4 1 J o Irv; Ivilm &g4 (3$4ji ►Jk �- -- d10F �vl t ted' f ihG IIti �b Cez,9V LO Page 3 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road r� C Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 O •�y r UNT►� rs 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. VI 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 (/\ l c/ 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 SQ Town Hall Annex Telephone(631)765-1802 54375 Main Road cos Fax(631)765-9502 P.O.Box 1179 Z- Southold,NY 11971-0959 D a` -&OUN1�,�� , 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: Property Owner's Signature: Sworn to before O day of 20 Z d Official Not 'ry Publi ignature and Original Notary Stamp KAITANA VICTORIA RODRIGUEZ NOTARY PUBLIC,STATE OF NEW YORK Registration No.02RO6377948 Qualified in Kings County Commission Ex ares July 16,2022 Page 5 of 5 II 1 Y DATE.YL,�_Vd B.p,.IJV \�,♦g NOTIM BUIUJIN(,'pE IgmEL. )4RING 1�TO a pM 8=0" I 2'sq.FaoTc ITYv) is runrA,loNnsB.Ernays... . Fpe o--.I-,_•• TM'0 P.tt-i nvEp I 1 R9Uffss vAMrl... ........... FF— I-'�':]U / L L�-J --. Li.•� ..-—� � C OUIRErMEN'}SI CC'PI I Il.ci'. CONSTRUCTION$NEPGY CODR NOT RRIONS BlE FOO f^ � DRIGN OR COrySTRUCpON ERRORS Y � RUNNY U04 or p,f/i6N WALL) /3-o.• `r'- _o„ I Nora „ aFL:..__wry �-� � for water d'rslnhmin aftyp.Ka lolly I Rl .WdLL 6'N/GN v .. \ I I ! ,E'OuGN OPEN/NG FO,2 I 7 III I -Q'CT/✓C..'LOO c� r_A � r¢-WiNOOWS�a'WlpE X 2�,V14,V) - i II , 9Ej WEEN L/dsi ENG r j '/o'JIxRRF. f�o,Z I �G4.C/GE i 1 I I 4(4 _ N jI c u``f/oe UP I2'M X/1 DEEP firCKEI/a Ea.•C,. - ._.... ...... I (6)z/P C.OL 41W✓V5qj (7YP.} �1 ,• ,,l� ::, - e i :E.r.•. A_ - _*�T,y - - _ „+: I SEDT/�OiV':y y'.r WALL-T N/awJ-Jl ..I 1 I (/'- _SQ/ 1 ami •u.�+l _. 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TOTAL DATE REMARKS ,o o -� / ,�> %� �,� s i v��o✓7 x_ 6 o 0-0 nt6r`7`' 3 49 be� 300' 13/1-7 2-0t, �lrd ':AGE BUILDING CONDITIO / ems, , �a fvr , � _ IVIZ .G3.5 �� irs - 2c� CFlCaY SJ b 0 n NORMAL BELOW : . ABOVE - .. . 'FARM Acre Volue:Per Value g n Aire l a i5/�?cr� ;chard J7 6r6 dea s'' �a/iv/oar (dr.:� Ti'Ilable:' ,.T ' —7J 11 L 1-7 7d —.Fj 2tj TO d-nI In a'il d le' ''2 `b-lr G� 1�►-{'� -.� .. h7 �or;,n. _ talc „ Tillable 3 t la1�tG-d ISO A\ tO \<-xor_ „m -i Woodland . I ,-Swampland :' FRONTAGE ON WATER Brushland FRONTAGE ON ROAD House Plot DEPTH 1 �. BULKHEAD Total DOCK ■ ■ SISI■■■■ ■■E■NNE■ss■ • s• SISI■■■■ ONO■■■■■ ■■■■■■■■■ SISI■■ ■■■■■■■■S■■■■SIMM■■■ SEEN■ ■■ ■ ■■N ■■ ■■ ■■ES Y:'r SISI■■E E!�■■5 ■ ■ ■:'NS'■E■SI■■■■■■ # ' . w mom■■■fi ■■EEE■■®E■ENE■■■■■■ ■■E■■EI ■■NNOM NE■®®■■■■■SISI ■■■■EN�31 N'UMOM■ N■■■■■■■■■■■ 11 glillN■ ■� S SISI■■■■ SISI■■® ®■ 'tz �■■■■� ■■�Sli■NNN■■■■®®SISI■■■ x;a, �;. ��'a , x. ��. �� . ., w : ■■■■■■�.lE■■E�1■■MM■■■■®SISI■NE ■mom■■e■■MM■■■■■■■■SIMM■■■S■ ■ SISI■■ ■■■■■■■■■E■■■■■■ ■ �, � w�* L ■NEESI SISI■■■■■MM■■®■■■ ■■■■ ■E ■E■■■S■■E •• y r ■®® orl, Foun8ation ••II • I rBasement Edensign'. Heat Rooms Ist Floor Recrectio Parage �■�■ . _ . FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. . . . . . Date . . . . . . . . . August .5. . . . . . . . . . . . . 198 . THIS CERTIFIES that the building . . . . .nevq,dwelling. , , , , , , , , , , , , , , , , Location of Property 26 . . . . . . . . . . . . . . Bey,Hpvgn,Lane, , , . , , . , , , ,Sou. . . . . . . .. hold House No. Street .Ham%t County Tax Map No. 1000 Section . . .88 . . . . . .Block . . . . . . . . .!l. . . . .Lot . . . . .?5. . . . . . . . . Subdivision . . . . . . . . . . . . . . . . X . . . . . . . . . . . . .Filed Map No. . . . . . . .Lot No. . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore fled in this office dated March 26 84 129842 . . . . . . . . . . . . . . . . . . . . . 19 . . . pursuant to which Building Permit No. . . . . . . . . . . . . . . . . . . . . . dated ARil. 6 . . . . . . . . . . . . 19 4. ,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 . . . . . . . . .. Private one—family dwelling. The certificate is issued to . . . . . . . . . . . . . . . JAMES P. 1`lE0 towner of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . . ..;SO-42 . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . N66091.9 Building Inspector Rev.1/81