Loading...
HomeMy WebLinkAbout1000-54.-9-1 TOWN OF SOUTHOLD Rental Permit 0476 Owner 775 Hickory LLC Occupied as Single Family Dwelling Located at 775 Hickory Road Southold 54.-9-1 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. 5/12/2023 Code r�force�� t Official This Notice must be posted by the main entrance at all times f4f,Soup, TOWN OF SOUTHOLD BUILDINd DEPT. u , 631-765-1802 ��� INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND INSULATIOWCAULKING FRAMING ®STRAPPING FINAL CONSTRUCTIONFIREPLACE & CHIMNEY FIRE SAFETY INSPECTION FIRE RESISTANT IRESISTANT ELECTRICAL (ROUGH) ] ELECTRICAL (FINAL) CODE VIOLATIONI ] PRE C/O I ° REMARKS: � " �m ADATE � Town Hall Annex ®UTHOLD WN 54375 Main Road % G M iii/ PO Box 1179 Southold, Rentalgdl Wp§ Gc ' dNY 11971-1179 ��, Tel: 631-765-1802 Fax 631-765-9502 SCTM # .� ._ Date Owner Phone Address ....__ Zip City Inspector LEVELS_ SUB 1 2 3 Smoke Detectors (#_ bedroom detectors excluded)_ Carbon Monoxide Detectors (#) Exits # . Fire Extinguishers ligii III MEMO BEDROOMS 1 3 4 5 Smoke Detector Alarms (#) _ �...,. .,..,..w__.rv.n _...w_.._ ..... _. _. _ .. Carbon Monoxide Alarms �..... srrdows Y/N ✓ ...._ ..._...w_.. gress ERTY YIN BUILDING SYSTEMS Y/N CONDITION OF PROP Interior is clean /maintained Heatinc s stern maintained/operational _ ., water system maintained/operational Building Exterior is clean /maintained Hot Electricals stern maintainer tional Property is clean safe safe/ maintained Mechanical s steal maintained/o erational Handrails & guards present COMMENTS: �.. .... ..�. M_ ..._. _µ.. Rental Inspection Form 4/7/2021 TOWN OF SOUTHOLD x , Rental Permit 0476 Owner 775 Hickory LLC Occupied as Single Family Dwelling Located at 775 Hickory Road Southold 54-9-1 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. 6/17/2021 ?odeE or m nt Official This Notice must be posted by the main entrance at all times *pf SOUTH, Town Hall Annex Telephone(63 1)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 . Southold,NY 11971-0959 Q �� BUILDING DEPARTMENT TOWN'OF SO OLD RENTAL PERMIT APPLICATION Rental Permit Fee$200 (Application must be renewed every two years) Section A. � '�s MAY - 4 2020 Property Information: Renta! Property Address: - i »`s T y DELT-is r-� /J 1��f ^, ,',t Tax Map Number: 1.000 SECTION BLOCK LOT SECTION B. OWNER INFORMATION: Property Owner Name: "�/ ��• � �G.X 66Z Y tbc� Yo 5ritF:-6o/y-FPV F. ✓�/E�« Property Owner Legal Address: Property Owner Mailin_ g Address: (Cannot be the same as Rental Property Address) ��z Li iJpS'zw s-T. U J'ew YDkz ov If Telephone Number (s): Property Owner Email Address: 5?T�✓ �� L� 88 �/n'� �L C D� U, Page'1 of I c Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: .Address of Authorized Agent (no P.O. Boxes): Lch" aw'- 9V na j Mailing Address of Authorized Agent: Telephone Number (s): ('0u - Email Address: '5I-gyic-8lei- cL 46-14AJL • 6,* Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: S ;E P/(gw 1�' /(/-IF Address of Authorized Agent (no P'.0. Boxes): 40 14V19SO4 6 T. —w a 1 Mailing Address of Authorized Agent: a S .c 60 va-) Telephone Number (s): EO q to —2 �?Cv Email Address: l -i• f3 6 G MA 2- Com SECTION E. SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units) Name of Managing Agent of dwelling unit, if any: �T>�nll�� - � -C Address of Managing Agent (no P.O. Boxes): fIVOSbal 6 T. f i!v roti/ rode Mailing Address of Managing Agent: (SAL^.4— A-s ti466y---) Telephone Number (s): to f!, — Z 6 (P — 71 Email Address: 5 r6vc,-'31"aAtL-C 8f; fio Page 2 of 4 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: UW Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: `S �"� A-- Use and Dimensions of each room in Rental Dwelling.Unit: /32 / to X/Z. 2 9.S X jS-"o,!' N7Eb14 /0 1)e L VIA,16 2aOrr' /7 'x 2 3 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 NYS licensed architect, a NYS 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. Page.3 of 4 I am submitting a completed Town of Southold certification form from a licensed architect, a licensed professional engineer, or a licensed home inspector-who has a valid New York State Uniform Fire Prevention Building code Certification. SECTION H. DECLARATION: Signature must be notarized'and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFOLK) I STCif" 4 T /3 /e# 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'ownee'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 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 s to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager. Property Owner's Name: f Property Owner's Signature: 1t' Sworn to before me this day of ?iY[�� , 20-2-0 JONES WING ON CHAN NOTARY PUBLIC-STATE OF NEW YORK No.01CH6324921 Qualified in Queens County Official Nota ublic Signature and Original Notary Stamp My Commission Expires 06-24.2023 Page 4 of 4 '*pf S011T�,Ol Town Hall Annex ~O O Telephone(631)765-1802 54375A lv7ain Road Fax(631)765-9502 P.O.Box 1179 G Nc� Southold.NY 11971-0959 � COUH1'I, BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION Form to be completed by a NYS licensed architect, NYS 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 a copy of a volid'New York State Uniform Fire Prevention Building Code Certification. Rental Property SCTM Number: Rental Property Address: -7-7S 9/z-Koat y go. 6DU o[.0 ,!U Owner/Name: -7115 #1e-KDQ Y L,/c Clo 5Tt IaNcw ,l�! I�LF Rental Dwelling Unit Identifier: u&�V / Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1-100 sq., Bedroom #2-90 sq., etc.) Z S S,—" /3t d roO y, # 2 - /s'o S{' MG —., w r 7 t 3o S;4' Property Description (Include all improvements indicated on survey) r _I Ct 70W �'+'t i 1 .7 r'&H eA A1.0 V .ice 1".' �n• P � V N /vk adv P'LA.1 A f-i0 I certify that I have done a physical inspection of the subject rental dwelling unit and find that the unit 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 a d by the laws adopted by the New York State Fire Prevention and Building Code Council. Print Name and Title Ori ina nature �p Altcryt � �W►FFFF F� Please place professional seal: W s% Ole gTEOFN� ag SOUIy # # TOWN OF SOUTHOLD BUILDING DEPT. couto, 765-1802 16(,x,--a— NSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING [ ] FRAMING /STRAPPING [ ] INAL [ ]--FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIO TION [ ] PRE C/O REMARKS: - Pn1'uVl c ar (Kj '-FAAl rup, . n Vi' 64 4p mA -6 G" - R04 '&441r�t n� GAb-9w4&,,,, S DATE flb-40)0 INSPECTOR ItF SOUIyo A ��� (G�'I� K►LO # # TOWN OF SOU HOLD BUILDING DEPT. y�nn 765-1802j�' --I INSPECTION [ ] FOUNDATION IST r [ ] -ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING- [ ] FRAMING/STRAPPING [ �FINALP.44[FIREPLACE & CHIMNEY ] FIRE SAFETY INSPECTION. [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT=PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: DATE -INSPECTOR �l�rl�yr 775 HICKORY 775 HICKORY ROAD SOUTHHOLD.MY 11971 n�serne�o �� • �_ VIAARCHIT[CTUR[ tl IIr—.1r�,v—SII REAR PATIO 7-6" u MEDIA ROOM ENIRY e FO -77 1 7 KITCHEN 0 0 03 I K FO-6-1 C 02 I I I ac� I I I �S-0~-r' 5-37—. 05 � I I I BEDROOM 2 .c.0 La B. ATI-12 I ` r 04 I I § LIVINl Li VV IF8' I FRONT PATIO ( EN7Rr •SCMD SMOKE & CARBON a04°E MONOXIDE DECTORS RENTAL 1. CARBON MONOXIDE ALARMS AND SURVEY SMOKE DETECTORS SHALL BE PROVIDED PLAN AND INSTALLED ACCORDING WITH DRA W IN(;1111F SECTIONS BC 908.7.1 THROUGH 908.7.3. SEAL L S-TURF e�ooeomE woRnaai�a AS NOTED RENTAL SURVEY PLAN AO 1 SCALE: 1 /8"=1 '-0" PAGE I of I DWG No. A-1 . 1 LOR11 D %`` TRIM F j_. -4�`*+,�_;fir. .,. - ++R•-. �_=....,,,, 1 — - -- y 5 ry 54.-9-1 01/26/2017 M. Bldg. �'f 0 j 3 i - i- Extension r Extension ILL - - I i Extension Foundation (Bath f I Dinette Porch (pTBasement --_ ------Floors 'v ' K. Z7c ycJe�- ,a I d g .Ext. Walls Interior Finish i LR. Breezeway Fire Place Heat 'J `DR. -- - - Garage —{- !Type Roof ": Rooms 1 st Floor I i BR. I Patio Recreation Room Rooms 2nd Floor ! FIN. B O. ' B. , > r-Dormer �� o'L� IDriveway Total i �. Town of Southold 1/5/2016 ' 53095 Main Rd ' Southold,New York 11971 PRE EXISTING CERTIFICATE OF OCCUPANCY No: 38019 Date: 1/5/2016 THIS CERTIFIES that the structure(s)located at: 775 Hickory Rd, Southold SCTM#: 473889 See/Block/Lot: 54.-9-1 Subdivision: Filed Map No. Lot No. conforms substantially to the requirements for a built prior to. APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 38019 dated 1/5/2016 was issued and conforms to.all the requriements of the applicable provisions of the law. The occupancy for which this certificate is issued is: one family dwelling with concrete patio and accessory storage shed.* Note:BP 9835 accy structure COZ-9368•BP 8467 addition with porch to dwelling COZ-7959 The certificate is issued to Stephenson, Shawn (OWNER) of the aforesaid building. SUFFOLK:COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. Autho ' Si ature BUILDING DEPARTMENT G TOWN OF'SOUTHOLD J-11 HOUSING CODE INSPECTION REPORT LOCATION: 775 Hickory Rd,Southold SUFF.CO.TAX MAP NO.: 54.-9-1 SUBDIVISION: NAME OF OWNER(S): Stephenson,Shawn OCCUPANCY: ADMITTED BY: SOURCE OF REQUEST: Stephenson,Shawn DATE: 1/5/2016 DWELLING: #STORIES: I #EXIT 2 FOUNDATION: Concrete Block CELLAR: 1/4 CRAWL SPACE: . 3/4 BATHROOM(S): 1 TOILET ROOM(S): UTILITY ROOM(S):, PORCH TYPE: DECK TYPE: PATIO TYPE: Concrete BREEZEWAY: FIREPLACE: Yes GARAGE: DOMESTIC HOTWATER: Yes TYPE.HEATER: Oil AIR CONDITIONING: TYPE HEAT: Oil WARM AIR: HOT WATER: X #BEDROOMS: NV 2 #KITCHENS: 1 BASEMENT TYPE: Unfinished OTHER: ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: Small Shed SWE MING POOL: GUEST,TYPE OF CONST: OTHER: VIOLATIONS: REMARKS: INSPECTED BY: GARYF - DATE OF INSPECTION: 1/4/2016- , � TIME START: END: FOUR NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N Y. Certificate Of Occupancy t • No. .' 7059. . . . . Date . . . . . . . . .Jona . . ... . . . . . ., 19. �b THIS CERTIFIES that the building located at . Saundvi- ew.Ave. A.liiAkory Street Map No. . IX. . . . . . . . Block No, . ,X4. . . . . .Lot No, . . Xx. , . O.QUttIpId . .Ns X• . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . . . April. . .1, 19.76. pursuant to which Building Permit No. . .e4.6.7Z 1 dated . . . . . . . . . . . April . = 19. 716., 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 . . .Private. me .fanill3i.OxellIng.sPrtt4_ addition. . . . . . . . . . . . . . . . . . . . The certificate is issued to . .Remy.0 Aethlei4xi, A?Orer. . . . .Ovmn:i. . . . . . . . , . • . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .NPR*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ; UNDERWRITERS CERTIFICATE No. Ile]RUAg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSE NUMBER . . . 10)600• . . . . Street . . S©madv�Ow. AVS . . . . . . . . . . . . . . . . . . . . . . . . 1 775 hickory Road . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Building Inspecto i is FORM NO. A TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. . . ZR368. . . . Date . . . .December. . ?- . . . . . . . . ., 19. 18 THIS CERTIFIES that the building located at .10,66.00.Son ad. V.i.ev. Ave. . St m Map No. . . . . . . . . . . . . Block No. . . . . . . . . . .Lot No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . 3uno • . • .34) • . • • • • ., 19. 79 pursuant to which Building Permit No. . _ . . .9355z dated . . . .d u -y . . . p.1 . . . . . . . ., 19. . .,78 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 . . . . . . . . .A-WeAW-n" 53 t.M]1C1tVY: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . . . . . . . . . . . . IzCIEW,er. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (owner, 1JeMftpa y of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . . . . . N/R. . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE No. . . . . . . . . . . . . . . . . . . . . . N/R HOUSE NUMBER . . . :1.0 9.600. . . . Street . . . . . . . . . . .Sl aund.. Vie-is. Av.t�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . ��Qu 1;I �.d 11j1 . . . . . . . . ��'''�� if/ •irk Building Inspector County Tac Number 1000-54-9-1 �o�SUF�CpG� Town of Southold 6/17/2020 P.O.Box 1179 y m 53095 Main Rd oy�jo� �ao� SouthoId,New York 11971 CERTIFICATE OF OCCUPANCY No: 41188 Date: 6/17/2020 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 775 Hickory Rd., Southold SCTM#: 473889 See/Block/Lot: 54.-9-1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/22/2020 pursuant to which Building Permit No. 44610 dated 1/22/2020 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: "as built"window and door replacements and new door and new patio addition to an existing one family dwelling as applied for. The certificate is issued to 775 Hickory LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED A d Signature i