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Home My WebLink About1000-15.-2-16 ¢_ 4 TOWN OF SOUTHOLD Rental Permit x 0464 Owner Martin J. Bancroft, Jr. Occupied as Single Family Dwelling Located at 38099 Route 25 Orient 15.-2-16 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. 5/25/2023 "'-�/4vret Code E for &ent Official This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD BUILDING DEPT. ;4 INSPECTION FOUNDATION 1ST ROUGH PI-136- FOUNDATION TN 2ND INSULATIOWCAULKING FRAMING /STRAPPING [ ] N L [ ] FIREPLACE & CHIMNEY [ N TY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION ] ELECTRICAL ( [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [v]-"RENTAL REMARKS: � c� Town Hall Annex SOUTHOLD TOWN 54375 Main Road Jl PO Box 1179 Southold. /'/ ' its 11 NY 11971-1179 Tel: 631-765-1802 Fax 631-765-9502 '/0 4 SCTM ## .�- to w_ ...... Date a3- a' Owner _ ____ Phone ✓?�09`� Zip Addressh --� City Inspector MENEM LEVELS SUB 1 2 3 Smoke Detectors (# bedroom detectors excluded) Carbon Monoxide Detectors Fire Extinguishers Exits (#) BEDROOMS 1 2 3 4 Carbon Monoxide Alarms BUILDING SYSTEMS YIN CONDITION FPRROPERTY Y/N Building Interior is clean/maintained Hr atuG�sYsterx.l maintained/o�ptratial� ..._,w_.. _. ". w_ _ on.w" Building Exterior is clean /maintained .. " Hot waters stra w maintained/ope�eraticnal '�"'�� Property is clean /safe/maintained Electrical s -tem_ aintainedfo erationaG Mechanical ss stent maintained/o erationai Handrails & guards present COMMENTS: ° .o►C- ...._ _ __www. _. ,_� Rental Inspection Form 4/7/2021 TOWN OF SOUTHOLD Rental Permit 0464 Owner Martin J. Bancroft, Jr. Occupied as Single Family Dwelling Located at 38099 Route 25 Orient 15-2-16 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. 6/11/2021 Code E;force&Official This Notice must be posted by the main entrance at all times �ufF.QL/- �O CO Town Hall Annex 0�0 Gym SOUTHOLD TOWN 54375 Main Road o - PO Box 1179 Southold, CO2 = Rental Inspection W .ri NY 11971-1179 �,j, Tel: 631-765-1802 Fax 631-765-9502 SCTM # Date 6 A(A I Owner GV!o�� Phone 6 113 13 2_3 Address Zip HamletU-I'e��-r Inspector Address visible from street? LEVELS SUB 1 2 3 Smoke Detectors (#-bedroom detectors excluded) Carbon Monoxide Detectors (#) Fire Extinguishers (#) Exits (#) BEDROOMS 1 2 -3 4 5 Smoke Detector Alarms (#) Carbon Monoxide Alarms (#) Egress (windows) (Y/N) BUILDING SYSTEMS N CONDITION OF PROPERTY Heating system maintained/operational Building Interior is clean/maintained Hot water system maintained/operational Building Exterior is clean/maintained Electrical system maintained/operational Property is clean/safe/maintained . Mechanical system maintained/operational Handrails &guards present ' POOLS N POOL BARRIERS VN Pool present Pool is completely enclosed Pool surface alarm and/or door alarm Barrier is a min.48" high resent POOL GATES Y/, All openings in barrier less than 4 Self-closing, self-latching Max. 2"clearance @ bottom of barrier Latch on pool side of gate, meets height Barrier capable of being locked &child- requirements proof when unattended COMMENTS: Via::.: �,. ,: ::• Town Hall Annex + : <; '` :' Telephone(631)765-1802 54375 Main Road � � � i. Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD* —J) RENTAL PERMIT APPLICATION MAR 232021 Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: . C� ( 19 Tax Map Number: 1000 SECTION, .:..._. _-B:LdK .. ... : .; . .__=LOI' SECTION B. OWNER INFORMATION: Property Owner Name::. i. 1 • Property Owner Legal Address: Property Owner Mailing Address: MAW \ � Telephone Number(s): � Ev�ua�g )3 ' 3 Property Owner Email Address: M P,P11c-'RQ)F"T "Page 1 of S Town Hall Annex Telephone(631)765-1802 54375 Main Road e' �� Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 1 ' 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: 0A Address of Authorized Agent (no P.O. Boxes) Mailing Address of Authorized Agent:. Telephone Number (s): Daytime. Eveningmergenpy 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 Town Hall Annex r = Telephone(631')765-1802 54375 Main Road ">i ,` n '< !' Fax(631)76.5-9502 P.O,'Box 1179 Southold,NY 11971-0959 ` ito 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 D welling Units on property` t��l);, 1 HMII� lt�C 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 Unit: ._ . . .. TKRs) Number of rooms in Rental Dwelling Unit: CP Use and Dimensions of each room in Rental Dwelling Univ: f✓� . _ � . C� `-' �� it Page 3 of 5 Town Hall Annex _ Telephone(631)765-1802 54.375 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. 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) 1,.N1AR- _i tl t �1�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 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::(, r Property Owner's Signature: Sworn before me this ay of . — RL' l�. ,20A Official Notary Public Signature and Original Notary Stamp KAREN LUNDARI Notary Public,State of NewYork No.01LU6146018 Qualified in Suffolk County Gcommission Expires June 26,20— Page 5 of 5 Town Hall Annex4 r Telephone(631)765-1802 .. 54375 Main Road N$t{ Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-09.59 BUILDING DEPARTMENT TOWN OF SOUTHOLD ` RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier:. Requested maximum number of persons allowed to'occ y each.dwelling unit Number of Rooms in Rental Dwelling Unit: =...... Use and Dimension of each room: ' Rental Dwelling Unit Identifier: . Requested maximum numberof persons allowed to occupy e /hdwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: . Rental Dwelling Unit Identifier: ► v -A Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Town Hall Annex >° Telephone(631)765-1802 6_' 54375 Main Road a\ :. Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 nit 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 l raf s iv al$$Cl/feL7 Jrecl fair:Ar 3 r'tett=or-.Ei�dii�e r�,..Ifcer sed Dome.:Irifs ect,rmu :.:pra�.. copy-of valld current.;�er#i rraE n Rental Property SCTM Number: . _ Rental Property Address: Owner/Name: Rental Dwelling Unit Identifier:. Number &Square footage of each bedroom as depicted in the atta hied floor plan: (i.e. Bedroom#1 -100 sq., Bedroom#2-90 sq., etc.) Property Description (Include all improvements indicate on survey) I certify that I have done a physical inspection of/ e 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 �nergy Conservation Construction.Code of New York State. . . . ............. Print Name and Title Original Signature Please place professional seal: UN G,� 74, ,,.'. v; L� ,� -C F-R - `r •vI:L •=.=ice=�.. �o- , X�1��,. A�� o•�.�_ Aj,a. _ �..' R .4 r — I O of e _fz { o_ 1�( 1 'o } SUTER&'SUTFR OCHITECT$ j � PO.BGXt;OQ . l •i- �o ` 124JESSUPAVE^ O^ i I i r StAd IEV�-Zzk. i Y - � J_ i • Y' SCTM # ---- -'; ...__..... . TOWN OF SOUTHOLD.-PROPERTY REC: OWNER STREET VILLAGE DIST. SUB. LOT' ACR. REMARKS /y+f t (/�/jp y ob qog f y 'X_�..O r^ � M l✓ -✓"'T !'^" i`%a'T' a P TYPE OF BLD.. PROP. CLASS lG ��] LAND IMP. TOTAL DATE �I `' {; , 113'7 _' a - % �1�l rr® CP039/0 3 10 0 GL-1 00 .0 0 3 t 1 l . FRONTAGE ON WATER HOUSE/LOT BULKHEAD TOTAL ( r a , Y , , n T _. UTH L PARTY .: R CAR® i f OWNER STREET ? 'DIST. SUB. ; LOT VILLAGE TORMER OWNER° , , ACR'. N E ..,»,„ w<1 :.�'/ 1 c +....�»° '✓ f &�'1 z3:"s NPt't d fg ,�t�, '""`, � fr4�2 f.`.'C; _ t•+r X ,'`r,. 5'- '`6J','A.�.` itVi?'t :; £yr , :q I r.¢1 i'? , „!f" S. W TYPE OF BUlLDI.NG. RES. SEAS. VL. ~FARM COMM. CB. M]CS. Mkt, Value LAND IMP. ' i TOTAL DATE. REMARK .� r a � te ,; ° {. =w&:.: r�t' .;'" ,s� •`' - ? I.:� %�,. `�, ,�{'»,„a��;r✓ �� . +��P ="f tl1 ':!'s-.°:._'��`.'•; ��,¢.' � �r•,�;t}�' ��:? '�,, � ,w"sus e� , '�''r_°°`,=:�," _._ f V'aa ;d.lCr C�:t�} e1"S' � l d'.''- "�..-.tgi I�'- ___ J 3 s r r:.. �� t `1 t _. ..». •� Vd� A310— \4 '�; v }fit C {f r iorr h:xq.:'�rg�•�+;' r},`�; F` ,;fii ,a P,,; c i ! i '�i<;.�L.''gt'i '�'f`i8 G"t F. §;.,�" °°.�L,-a l+,<• c- „`° •.i, its.«^` [ t �.._.._ ,...._......,.._._..�� ., .. "^.r ,�.�. �'"a„� °`°" M � �.,.(f i•',d�•� '� .�CM�' r�Y��;�, .g i _.i r, ,�l(. ..w.'r r+> Y_ 'l _..�_.._. AGE BUILDING CONDITION ' f NEW NORMAL BELOW ABOVE - FARM Acre Value Per, Value Ac re i TillableI -FRONTAGE.ONWATER'- +_.._ Woodland FRONTAGE ON ROAD Meadowland - DEP' TH � . House Plot BULKHEAD ,� ��;",.rYr Total [70C ,.,,�+,' .yam;,: .....}" a ..r+C:'�•'<++sn;.� .' '.� ., ,.. r , P FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29349 Date: 04/09/03 THIS CERTIFIES that the building NEW DWELLING Location of Property: 38099 MAIN RD ORIENT (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 15 Block 2 Lot 16 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 13, 2001 pursuant to which Building Permit No. 27706-Z dated SEPTEMBER 18, 2001 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 FRONT AND REAR WOOD STOOPS AND ROOF TOP DECK AS APPLIED FOR. The certificate is issued to MARTIN J BANCROFT JR (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-99-0043 03/15/03 ELECTRICAL CERTIFICATE NO. 1057650 03/21/03 PLUMBERS CERTIFICATION DATED 04/01/03 ROBERT VAN ETTEN Au horize i nature Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33005 Date: 04/29/08 THIS CERTIFIES that the building SUNROOM ADDITION Location of Property: 38099 MAIN RD ORIENT (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 15 Block 2 Lot 16 Subdivision Filed Map No Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 29, 2007 pursuant to which Building Permit No. 32720-Z dated FEBRUARY 12, 2007 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 UNHEATED SUNROOM ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to MARTIN J BANCROFT, JR (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2012001 07/08/04 PLUMBERS CERTIFICATION DATED N/A 9- )Xhori/ed S ature Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector 1 Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33017 Date: 05/05/08 THIS CERTIFIES that the building ACCESSORY Location of Property: 38099 MAIN RD ORIENT (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 15 Block 2 Lot 16 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 14, 2004. pursuant to which Building Permit No. 30256-Z dated APRIL 23, 2004 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 INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR PER ZBA #5484 DATED 4/8/8. The certificate is issued to MARTIN J. BANCROFT, JR. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2012001 07/08/04 PLUMBERS CERTIFICATION DATED N/A *6thcAized Signature Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34635 Date: 10/25/10 THIS CERTIFIES that the building ADDITIONS Location of Property: 36099 MAIN RD ORIENT (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 15 Block 2 Lot 16 Subdivision Filed Map No Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 5, 2009 pursuant to which Building Permit No. 34720-Z dated MAY 28, 2009 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 ADDITIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to MARTIN J BANCROFT, JR. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 12384 04/23/10 PLUMBERS CERTIFICATION DATED N/A t Au horized Signature Rev. 1/81 S ORL'fell Town of Southold 5/16/2019 _..:.n ......... P.O.Box 1179 53095 Main Rd ' Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40390 Date: 5/16/2019 THIS CERTIFIES that the building GENERATOR Location of Property: 38099 Route 25, Orient SCTM#: 473889 Sec/Block/Lot: 15.-2-16 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/30/2019 pursuant to which Building Permit No. 43439 dated 2/4/2019 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 GENERATOR AS APPLIED FOR The certificate is issued to Bancroft Jr,Martin of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43439 05-01-2019 PLUMBERS CERTIFICATION DATED Authorized Signature ` Town of Southold 12/11/2019 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40915 Date: 12/11/2019 THIS CERTIFIES that the building ACCESSORY GARAGE Location of Property: 38099 Route 25, Orient SCTM#:; 473889 Sec/Block/Lot: 15.-2-16 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/28/2018 pursuant to which Building Permit No. 43111 dated 10/9/2018 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 GARAGE PER ZBA DECISION#7194,DATED 09-20-2018 AS APPLIED The certificate is issued to Bancroft Jr,Martin of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43111 11-04-2019 PLUMBERS CERTIFICATION DATED ,` t e Signature F014-019, Town of Southold 12/11/2019 0 0 y ' P.O.Box 1179 53095 Main Rd � Ol Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40916 Date: 12/11/2019 THIS CERTIFIES that the building FIREPLACE Location of Property: 38099 Route 25, Orient SCTM#: 473889 Sec/Block/Lot: 15.-2-16 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 10/12/2018 pursuant to which Building Permit No. 43153 dated 10/19/2018 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: GAS FIREPLACE IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Bancroft Jr,Martin /of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED t o ' e Signature Town of Southold 12/11/2019 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40916 Date: 12/11/2019 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 38099 Route 25, Orient SCTM#: 473889 Sec/Block/Lot: 15.-2-16 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 10/2/2018 pursuant to which Building Permit No. 43113 dated 10/9/2018 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 IN-GROUND SWIMMING POOL,FENCED TO CODE AS APPLIED FOR The certificate is issued to Bancroft Jr,Martin of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43113 11-22-2019 PLUMBERS CERTIFICATION DATED (7r' Signature