HomeMy WebLinkAbout1000-79.-4-49 TOWN OF SOUTHOLD
Rental Permit
0471
Owner Michael Koke
Occupied as Single Family Dwelling
Located at 755 Brigantine Drive Southold 79.4-49
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.
11/1/2023
Code E00rciJent Offici
This Notice must be posted by the main entrance at all times k
TOWN OF S
631 -765-1802 7
INSPECTION
] FOUNDATION IST [ ] ROUGH PLBG.
FOUNDATION 2ND INSULATION/CAI
[ ] FRAMING I STRAPPING [ FINAL
j ] FIREPLACE & CHIMNEY [ TIRE SAFETY IN!
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (E11
[ CODE VIOLATION [ ] PRE CIO [
RE ES:
o e—
God �t
o - o- , 3
��E� INSPECTOR
TOWN OF SOUTHOLD BUILDING DI
631 -765-1802
INSPEC ION
[ ] FOUNDATION 1ST [ ] ROUGH PL13G.
C l FOUNDATION 2ND [ ] INSULATION/CAl
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN!
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII
C l CODE VIOLATION [ ] PRE C/O [
REMARKS:
DATE INSPECTOR
Town Hall Annex
Town Of Southold 54375 Main Road
Rental Inspection Report PO Box 1179
Ql. Southold, NY 11971-1179
Tel: 631-765-1802
SUM # �Date
pOwner
Phone
Add ress .w � ... > Visible
_..... ...._. .__ .
"Hamlet "�,„� Insp or
i Floor Level Quantities
Smoke Detectors(not located in bedrooms) _ _ Gm �.,,.,..._..m..
Carbon Monoxi d e Detectors
® _... .a. ...... _ .. ..........._.ry., .
Fire Extinguishers
Exits
Bedrooms _Z 2. 3 I 4 5 6
Smoke Detectors
Egress
Occupant Count
Building Systems Maintained &Operational `Condition of Property
_ _ . ....
Heating Building interior
Hot water ! Building exterior
Electrical
�... ..
Property clean, maintained &safe
Mechanical Handrails &guards installed &secure
Pool Safety Pool on Site
Surface water alarm Date of CO issuance
Door alarms Pool°completely enclose
Self closing/latching gates Pool fence to code requirement
s i
CO's for all items present Prior Rental
Comments
ooc�c TOWN OF SOUTHOLD
Rental Permit
0471
Owner Michael Koke
Occupied as Single Family Dwelling
Located at 755 Brigantine Drive Southold 79-4-49
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.
6/15/2021
t ficial
This Notice must be posted by the main entrance at all times e Enf c
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 ^
)j
BUILDING DEPARTMENT FEB 12 2021
TOWN OF SOUTHOLD
R€ ''T L PERMIT APPLICATION
Rental Permit Fee $200 (Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
�r-- - _-Sp Utbd
... :.... .:
Tax Map Number: 1000 SECTION-A-
-71
ECTION, l_
SECTION B.
OWNER INFORMATION:
Property Owner Name:.-._ ,_::,., .....►..�.I.lGY1�e-4......_.....:, . .._..
Property Owner Legal Address: Property Owner Mailing Address:
s�o,,jJ1l ttiJ1fj Ig 7 - _. ..S�,��1-►o"fid..: alp), //9-7 /
la- - y ( 31 1,31
Telephone Number(s): Daytime. 73°3 Evening _87�-SZ`l I Emergency. `�°y-7-1o3
Property Owner Email Address: AIJK (UGOa �a o1/24dl-'7i. cA.�-�,,- -
Pagel of S
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
Mailing Address of Managing Agent:
Telephone Number(s): Daytime," ping Emergence
Email Address: _. .._--
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on property.-L., 3 BeJ✓ua.-zs.
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::".. . . �.-..
Number of rooms in Rental Dwelling Unit: ._
UsQe and Dimensions of each room in Rental Dwelling Unit:;
U Xe
a
GN
Page 3 of 5
Town Hall Annex Telephone(631)765-1802
54375 Main Road " ' Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
C�UIY
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
0 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)
C.Y1Gtrt,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
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:.:.___..... . ...._[..► ILYI_�-� ... IC.�I ... ..
Property Owner's Signature: .. .
Sworn to before me this !oZ day of 20 l
Official Notary Public Signature and Original N Stamp
BARBARA H.TANDY
Notary Public,State Of New York
No. 01 TA6086001
Qualified In Suffolk County
Commission Expires 01/13/20
Page 5 of 5
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INSPECTION
[
]- FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [, ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] INAL
[ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ °] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS: P &%P
AIAl rw
DATE11(ofINSPECTOR C/
a0F SOGTH
f TOWN OF)SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] _FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING
[ ] FRAMING/STRAPPING [ ] FINALA,,.Aj,,,,,-
[ ] FIREPLACE & CHIMNEY [V FIRE SAFETY INSPECTION
FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:
Q 1 e%to
DATE ld INSPECTOR �A"
TOWN OF' SOUTHOLD- PROPERiry RECO
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OWNER STREET "" VILLAGE i DIST.
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FORMER OWNER – — N, -:` E ; ACR' �j.
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S TYPE OF BUILDING
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RES. ;` SEAS. VL. f FARM, COMM. CB,., MICS, Mkt. Value, �
LAND IMP. TOTAL DATE . REMARKS
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Acre
Tillable i FRONTAGE'ON WATER
Woodland I FRONTAGE ON ROAD
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Meadowland DEPTH '
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Total i DOCK-'.
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Type Roof Rooms ist Ficor 6R.
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FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No. . . 9 . . . ., Date . . . . . . . . . . . . .8ept . . . . . ., 19.67,
THIS CERTIVIES that the building located at .Vrlg .fit.: lne. Pm . . . . . . . . . . . Street
Harbor Lightg .sets I
Map No. . . . . . . . . Block No. . . . . . . . . . . . .Lot No. ou hold.A+ays. . . . . . .
conforms substantially to the Application for Building Permit heretofore filed in this office
dated . . . . . . . kpri. . . . .19. . , 19. 67 pursuant to which Building Permit No. .3443..Z
dated . . . . . . . . . .App.il. . .19. . ., 19. 67, was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is . . Pr�vmte:one Xami:.y. dwal3An g. . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . .
The certificate i issued to . .40)t.Fit7emt l'i r. . . . . .0xn(,,r .
(owner, lessee or tenant)
i
of the aforesaid;;building.
Suffolk County 1 Department of Health Approval . . qJP�. _09. A907 . .1 Y. R t N�.Aa.
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Building Inspector
I
�, 1
FORK NO.2
TOWN OF'SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S'OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST-BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N0 3441 Z Date ............................. �....�... ., i 9. ..
Permission is hereby granted to:
': : .. 710 V� ► �
....:. ..... 4.1jawou li'.. .........................
.......:., +ice••+ • 0 •, ............ :' . .
...............................................I............................... ... ................ ........... .... ... .........................
at premises located of .... :�:t..... ...... • v, A8hU
.....................................................I.....................
.................................::...:...:.. ,' :.. ........: .:....................................................
pursuant to application dated .....................::..........x ..:.. . :...., �9f#..., and approved by the
Building Inspector. x. _
.Fee $..... b f ......
.. .. _. '
-Byiiding .Inspector -