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Home My WebLink About1000-34.-3-36.1 TOWN OF SOUTHOLD Rental Permit 0481 Owner Nancy Foote Occupied as Single Family Dwelling Located at 780 (aka 215) Champlin PI Greenport 34.-3-36.1 Maximum Permitted Occupancy 4 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. 6/23/2023 Codenfo ce n Official This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD co Rental Permit 0481 Owner Nancy Foote Occupied as Single Family Dwelling Located at 780 (aka 215)Champlin Place Greenport 34.-3-36.1 Maximum Permitted Occupancy 4 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. 6/23/2021 ` Code Enfo ent Offic This Notice must be posted by the main entrance at all times V 3f so Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax (631)765-9502 P.O.Box 1179 Southold,NY 11 971-0959 11ou BUILDING DEPARTMENT TOWN OF SOUTHOLD MAY 5 2021 RENTAL PERMIT APPLICATION Rental Permit Fee $200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: V, 4 A 1 - ) Chtiji-ILdO /Akc, Cl' rWO Tax Map Number: 1000 SECTION -BLOCK -LOT SECTION B. OWNER INFORMATION: Property Owner Name: U Property Owner Legal Address: Property Owner Mailing Address: ��5- V\j a Vvk 0 tt Vid o-q I Ro ic-6 Sc-��Avjl'� M&Ahc Ti , Telephone Number (s): Daytime Evening mergency Property Owner Email Address: V 2 q vb2k cc',N1 Page 1 of 5 Telephone(631)765-1902 Town Hall Annex � .� Fax (631)765-950_ 54:175 Main Road 13.0.Box 1 179 Southold,NY 11971-0959 T " 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 Unit: Number of rooms in Rental Dwelling Unit: 1\� � 1 1�� -`> Use and Dimensions of each room in Rental Dwelling Unit: r„N u"n I. ;c �" {�� [ 21 x3'' v Ai `,c a ` L%v t (Loa" L I,' "x `x- 1 Page 3 of 5 Sol Telc hone 631)765-1802 Town Hall Annex P 54375 Main Roady� " Fax(631)765-9502 P.O. Box 1 179 �s"• u r; Southold,NY 11971-0959 frr. ?C� 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. O 1 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 F SUFFOLK) I vt- , 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 = �pF S01N Ty :. Town Hall Annex ¢ '�� '• Telephone(631)765-1802 54375 Main Road ra t1 Fax(631)765-9502 P.O.Box 1 179 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 NaL,:::-g m t�C-00 Property Owner's Signa Sworn to before me this day of r? / 202--( Dawn Johnson '= l°hlic State ofNew York `otar`Official Notary Signat Original Nota NStamp - N(MJJ06349053 Qualified in Suffolk County t'uinn�lssinn Expires ILII I/?02q Page Sof 5 ^{ Z� Sooryo 7 }� •fig �� Telephone 631 765-1802 Town Hall Annex ,° ;z -k P ( ) Fax 631 765-9502 54375 Main Road � � �'-�., ,��:`�' �� t ) P.O. Box 1179 4q , n 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 Professional seal required for Architect or Engineer, licensed Home Inspector must provide copy of valid current certification Rental Property SCTM Number: l 0 0 — ` Rental Property Address: o (,u Owner/Name: +N 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.) 1 , 1 }.k I "X 1. 14 "t llq :2��{' Property Deesscrition (Include all improvements indicated on survey) t+v{ 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. Bradley Sherburne Print Name and Title Original nature ?,ED ARcy SHF Tho Please place professional seal: f ; S'79T 040711 F OF NE�`I� BSF aoser M BSF i aosEf SMOKE/CARBON p}ply MONOXIDE DETECTOR I (j BASEMENT emw+oae t 1 I I I 1 I mBF I 1 I SMOKEICARBON I I MONOXIDE DETECTORII I ---- II i 161 SF 'Q, 1W BF OIYYG FWY IIYNG RGOY ��,rs WOOtl039 WOWtl30 l4 tLt !3194 N010313a 3aixoNow NOGUVDMows ,mon ,9. �� k�� X � 2 — . _ , a �� _-.! L � � � r y � ) �J �� / ��5�� SCTM # TOWN OF SOUTH.OLD PROPERTY RECORD CARD OWNER STREET -VILLAGE DIST. SUB. LOT '"4- Q y_. I ACR. .. . REMARKS . TYPE OF BLD. PROP. CLASS .1 Q LAND IMP, TOTAL DATE9 s -�f 9 19 FRONTAGE ON WATER HOUSE/LOOT BULKHEAD TOTAL V,! TOWNOF SOUTHOLD PARTY° :w --dam STREET / VILLAGE DIST: SUB." ~��Y � .2 ";r °}•� `�� /a� .r.-kt L#.tic">%?",.. �6m. ( �A�°�,5� .,k_; �,: 'w;.:„.v��ir-n. e.,�� .`Lr''�' ,p-'r',w._��.-,, � ,. ... .i FORMER OWNER a��•i tf, �;lr:"� �°a 5� � .N� I i Y3"�'l i�'t 1:�'. 1.� i�w-�'� `i�'5.;e#'�.°" ii�'�'i�,,'';°_,,-�r � -;i:' .•�:•,";Ct�.�� ;�'_ �....,,/,�^ � '.<, sd<,;W:�„� �``)v k{`� , j;d. :,. S,•.vi Com:..' lji. l .1=,t`� F: ,• s°1 . „m S W TYPE OF BUILDING §. RES. SEAS.. .VL., FARM COMM. GB... . MICS Mkt. Value j LAND IMP. TOTAL DATE 'RE -KS 'ci "I..p—, ”" ptp ,f/ .11,1 �.'•'V? l 'a. ' G` �'rv' ".zx;� _,• „+,r"i a_____ _ df � f` C`' f'6.:_ ... 7p i /Z",{�•F`M°X, -, f',+'�"S Sz9y 6 .t• 0' ;jP•* ~; f``g..`�...�I.._..._! x�Tf, �` r;_ � ? 00, 0 0 C, id S ! .�•' r7' `i? °•> _°^ , IS.:t r'�# P �.�,,�i,.' !''+.,, '•fa»'- r, "z _ .. :.� Y•.:s: .e :aV- 's' °' -.�- 1:'°'` ?='a�fjJ tr;ars• '' AGE j BUILDING CONDITION, NEW NORMAL —1.1 " BELOW ABOVE ; FARM Acr-eValue Per I Value Acre 1 __—� ,_ _ ,— Tillable F41- G @i �W".tI ER�� '. • ;,, , y.... }� ter'' '£ f .4s,�t t'. FSB ,�a Woodland i i FRONTAGE,ON ROAD... P `,,g,' F"�.: ` I74r��l ,," - �y, ,• Meadowland DEPTH' House .Plot . BULKHEAD: —Total € DOCK � OWNER STREET VIL�fLAGEDIST. SUB. LOT j� rt jQ �- 1rT J) '(� {jy„yy� J �,� � �} {rwh �4�`p/ }��ad.�•.. YT'". j� 1 i{ ,—„r L�`f.��"f'-`��t�/' � / hit��f � � "__ �t� s„�'v� j�ffa•. � [s 'tea .Az"�stagy<�+g, v,•.-`,.�, a�.�Js.d�,.f'� �,�' ae. .'�°"a'. :h FORMER OWNER N ' F E �t ., r ACR. /� f S :W TYPE OF BUILDING _ a` t1" ' 'fir t "r a i, Vi RES. i SEAS. VL. FARM COMM: CB. MICS. Mkt. Value LAND IMP. TOTAL DATE':, REMARKS 141 -• ri a. .��°jd.fl^ FJi % a ..�'; dr �-3lZi' dLPtar' a�6 ttw:F �'a ii / �✓ , l" �� e J 4 l9 ?JX iia if CXf, a 14 I AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM � Ac re Value Per Value Acre Tillable OSE Oir!"W.kTER" +f %. a� ,x t�I> :% �` r � j r tTr a,• Woodland —i-- - --- - FRONTAGE ON'ROAD — . Meadowland DEPTH i 707jff, _ House`Plot. ` k � yy+ Tota! { DOCK FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy leo. . 7-ggj 9. . . . . . . . Date . . . . January.4. . . . . . . . . . : .:. . . .. 19 -80 THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property Qb9LR 1,1---P- lam-,P . . . . . . . . . . . . . .Greernxxt,. X.1r. House No. Street Hamlet County Tax Map No. 1000 Section . . .1 . . . . . . .Block . . . .3. . . . . . . . . .Lot . . . . .36•..1 . . • • • • • Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . .. . . . . . . . . . requirements for a one family dwelling buil • pinto to conforms substantially to th Certifioate of Opoupancy 79818 . . . knr.il. P.3. . . . . . . . 19 a..1: pursuant to which 19Cdd� . . . . . . . . . . . . . dated . !� . . . . . . . . . . . . . . . 1960. ,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 . . . . . . . . . . . . . . . . . . . ..�P': T,=LJy. .])Nmel.incr .wAdditian, 1;Bld.g.. Permit .102-7.1 2 ,. . . . The certificate is issued to . . . . . . .WA-113.am .J.. Mills1Tl• . . . . . . . . . . . . . . . . . • . • . (owner, of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . . .NIP, . . . . . . . . . . . . . . . • . . . . . • . • • UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . =. • N•461`-65. Building Inspector Rey 4ns BUILDING DEPARTMENT TOWN OF SOUTHOLD, Ni Y. HOUSING CODE INSPECTION REPORT Location 78P Champlin Place number & street (Municipality) Subdivision Map No. Lot(s) Name of Owner(s) William J. Mills,III Occupancy. R - 1 unoccunied type owner-tenant Admitted by: Mr. Mills Accompanied by: self Key available Suffolk Co. Tax No. 1000-34-3-36.1 Source of request ' Mr. Mills Date Nov. 29. 1979- DWELLING: Type of construction Wood framed #stories 1 1/2 Foundation Stone & cement block Cellar full Crawl space Total rooms, 1st. Fl 3 2nd. Fl 2 3rd. Fl Bathroom(s) 1 Toilet room(s) Porch, type wood roof/overbeck, type wood Patio, type Breezeway Garage Utility room Type Heat oil- ` darm Air - Hotwater x Fireplaces) s+Anding No. Exits 2 Airconditioning Domestic hotwater yes Type heater tan less Other ACCESSORY STRUCTURES: (small) Garage, type const. Storage, type const. wood- Swimming pool Guest, type const: Other VIOLATIONS: Housing Code, Chapter 52 Location Description Art. Sec. Foundation Foundation needs parching - 1 Stairs to 2nd floor No hand rail on stairway 2-2 Remarks: This dwelling is being completely rebuilt. A new bathroom has just been added. (B1dg.Permit 10271Z) Inspected by: Date of Insp. 12/12(79 Curtis Horton Time start1_45_end 2:15