HomeMy WebLinkAbout1000-31.-12-16 TOWN OF SOUTHOLD
Rental Permit
0487
Owner Mark Clifford
Occupied as Single Family Dwelling
Located at 820 Trumans Path East Marion 31-12-16
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.
6/29/2021
Code Enforc ent Official
This Notice must be posted by the main entrance at all times
O`oSUFFU(��'QGTown Hall Annex
SOUTHOLD TOWN 54375 Main Road
o - PO Box 1179 Southold,
y Rental Inspection NY 11971-1179
dy • ��
Tel: 631-765-1802
Fax 631-765-9502
SCTM # ( .— 2. �� Date j/'-'z
Owner rn �(� C ( '���� Phone 3y-7- Z/0,38o
Address 0 7r rr&AS o�rk Zip l
HamletlInspector
Address visible from street?
LEVELS SUB 1, 2 3
Smoke Detectors (#-bedroom detectors excluded)
Carbon Monoxide Detectors (#)
Fire Extinguishers (#)
Exits(#)
BEDROOMS 1 2 3 45
Smoke Detector Alarms (#) 7
Carbon Monoxide Alarms (#)
Egress (windows) (Y/N)
BUILDING SYSTEMS CONDITION OF PROPERTY ON
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 Y POOL BARRIERS Y/
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: I O CC v
b t.S KJ c-- tM,
Soul
Town Hall Annex Telephone(631)765-1502
54375 Main Road Fax(631)765-9502
P.O.Box 1179 }
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION -' L
t 1 ,
Rental Permit Fee$200(Application must be renewed every two years) MAY 1 4 2021
r�II!Ts j%"flt'k -
17O
Section A. Y �• �r r
Property Information:
Rental Property Address: 8�"C3
1t y
Tax Map Number: 1000 SECTION 3.� -BLOCK. I Z -LOT
�•l�c 3 8 g9
SECTION B.
OWNER INFORMATION:
Property Owner Name:, " Q Q F�0
Property Owner Legal Address: Property Owner Mailing Address:
%";,C) —mum ANS TaVi4
=j '"S'•d �(3ak a2
c—az-c Mact�a� nr, ,1g39
Telephone Number(s): Daytime EveninEmergency
Property Owner Email Address: �1AR�c, C.LIVrd(tj).1�4 e G MAtO Co 0%_
Page 1 of 5
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(63 l)765-9502
P.O.Box 1179 t
Southold,NY 11971-0959 !
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION INSTRUCTIONS
Rental Permit Fee $200 (Application must be renewed every two years)
1 The.items listed.,below are required to be submitted with the completed
application.
004
C3' Floor Plans: Floor plans of each Rental Dwelling unit, please show location of
all smoke &carbon monoxide detectors.
C' Certificates of Occupancy and Pre-Certificates of Occupancy: Certificates of
occupancy or Pre-Certificates of Occupancy for each rental dwelling uni 1
t, .Q A �i 4 •gni;.t\ ,'�t.,.... � ����'L>
❑ Certification of Code Compliance(form enclosed): Must be submitted by a
license architect or engineer or license home inspector if an inspection by Town of
Southold-inspector i"s'de;dined. ,r
lY Rental Permit Fee: $200.00 r
of S NIP,
$
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
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: r1
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 qr m9re rental units)
Name of Managing Agent of dwelling unit; if any:
Address of Managing Agent (no P.O. Boxes):.
Page 2 of 5
i�
�C �y w* CLX-I-
Ccs 4� h����-
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 .
Southold,NY 11971-0959
Qum�
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, C);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: • C.
Requested Maximum number of persons allowed to occupy Dwelling Unit:.
Number of rooms in Rental Dwelling Unit: rgdrt`s iys
Use and Dimensions of each room in Rental Dwelling Unif
bnL-
Page 3 of 5
14V SO r
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1 179
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.
®'la1 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. 1't - L' � Y(b)i"Oertify 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
i
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: . 1 " 16,yl,t<� L I
Property Owner's Signature: y
Sworn to before me this 1_!_day of ;.202,
�A a�CW_ Ze D-W-Uo A, d .
Official Notary blic Signature an 01riginal Notary Stamp
TRACEY L. DWYER
NOTARY PUBLIC,STATE OF NEW YORK
NO.01 DW6306900
QUALIFIED IN SUFFOLK COUNTY
COMMISSION EXPIRES JUNE 30,2-UR
Page 5 of 5
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z17307 Date SEPTEMBER 15, 1988
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 820 TRUMANS PATH EAST MARION
House No. Street Hamlet
County Tax Map No. 1000 Section 31 Block 12 Lot 16
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 15, 1987 pursuant to which
Building Permit No. 16131Z dated JUNE 24, 1987
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 W/ATTACHED ONE CAR GARAGE, DECKS AND
ROOFED PORCH.
The certificate is issued to EUGENE & BARBARA PERINO
(owner, )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 87-SO-15 7/7/88
UNDERWRITERS CERTIFICATE NO. PENDING
PLUMBERS CERTIFICATION DATED JOSEPH RUSSO AUGUST 26, 1988
Building Inspector
Rev. 1/81
1 ,.
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-26552 Date: 07/09/99
THIS CERTIFIES that the building ACCESSORY SHED
Location of Property: 820 TRUMANS PATH EAST MARION
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 31 Block 12 Lot 16
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 30, 1999 pursuant to which
Building Permit No. 25797-Z dated JUNE 14, 1999
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 12' X 20' ACCESSORY SHED IN THE FRONT YARD AREA AS APPLIED FOR.
The certificate is issued to EUGENE & BARBARA PERINO
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
dw,
Building In ctor
Rev. 1/81