HomeMy WebLinkAbout1000-25.-1-21 t3
OWN OF SOUTHOLD
To" WV
f
Rental Permit
_. ' 0506
em�
Owner DL & LS Shaw Family Trust
Occupied as Single Family Dwelling
Located at 220 Skippers Lane Orient 25.4-21
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.
6/20/2023
Code 61forc ent Official
This Notice must be posted by the main entrance at all times
r4f soti,
TOWN OF SOUTHOLD BUILDING DEPT.
631-765-1802
INSPECTION
I FOUNDATION 1ST ROUGH PL13G.
FOUNDATION 2ND INSULATIOWCAULKING
FRAMING /STRAPPING FINAL
FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION
FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION
ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
CODE VIOLATION I PRE C/O [ ,e4,'4ENTAL
REMARKS:
111)
5 rakz S.
t4 L 74
...........
DATE 114SPECTOR
!° Town Hall Annex
H LD TON 54375 Main Road
�� PO Box 1179 Southold,
Re
�tal��p gLi.o, , NY 11971 1179
Tel 631-765-1802
Fax 631-765-9502
..
..Date
SC'TM # _._._ .. _. �...... _...�.. __ . . .... .
._._
_- __... _..ww_.. .... Phone
Owner
_. ..._. . Zlp
Address ^
Inspector
City
_.....
LEVELS
�� _'SUB .._..� .... ...
Smoke Detectors (# bedroom detectors excluded)
__. .
Carbon Monoxide Detectors (#)
Eire Extinguishers (#) ..
_._
35
4
DROOMS ....
B Smck Detecto .. �®
o r Alarms (#)
1
Carbon Monoxide Ararms �# �„ � � � �
Egress (windowsl tY/�l;
iL.+, 6i11y �7 rte; i rlN%n'us . __..,.° . ,w.._..u,
CONDITION OF P
BUILDING SYSTEMS Yl N
Oa
. � R.
_._
r ieati system r~aintained/ope a'iona �u..�d,n Vn,eras ;s ciea
Iden Exterioris c1 ar ma ntaineo mmµ
Hot wafer s"�`°^,,em maintained/o ra+,orae 9
.. > safe maontained
Electrical Mechanical
naintai Handrails � clean
Bands resent
Propertyrs
sq star maintarnedloPerationa & guards
g P
H
... ..,mm�- ...... ..,.
„ V
Rent ai 1.1spectior
� 4
a � °
? � �'� � Vl
� �
�, � �, i
*�' I .' "'""� � � v
�,,,�
�"�� ,� � ,
�, �, ,� � �
�`�
a
�1
o- �°
n �
' ,� ,�, i �r . �7� fi�� r
��i�l���
i �,
�;
�grid;;
�.� m
r
r
+
1
, it /✓rf%�'�/i fii�r/�ji�l/��i/�i///'�%i
r r!! raid�/ii/i/ ,r f ri/ rl/ /i e/ ✓�/irr
rr f/�r//r%//i i//f�✓/ri/''f//�,�//�%%i/�/r l��,�r/,rf�ir.
f /�y��N`T lr err/�/i�jl�oj�//'r�%✓/��i/�//'�'r/'/%ill i..�r//%%%iii fr'�+:;%%r%/r��fi��/�,/��G�%r,
� WI%/�%rrrlif !//�r/� /i/%rr/�Ir ///fir/✓�rl r�%,%/4 i�%����%moi/rf �//�F,��'%rr%%r%/�/F%/%1��.
�� . �.(l N /i6/��rj//,/fii/�/lii//i r //r///�i//a✓i r/rl/f///��/r ti//i�%1���/fJr��al(1/Ir//�r1�i�r G�/i
���',�///'��ir����r r/r//i///%/j//l//�jr r/;iri/�/irf�r/l��/�i✓�/,/r/>�jiJ/f��/r/��'r�%/,
�,��/v,/// oJ�!�i / !/,/ /i��i J��r�/�/i rjii//��,//�/��r(r`i i/N�/,/n✓j!�//r�jr�,�,�'d/�io�pr;.
�����r////�✓d(%/�'��i'�i lr/li'/i r ai ,�r//f�j�///f/,!//��/rf1jOJ�r</j����i��.j��i��%/✓���(�����...
��r//r / ��r � r r //r /r , /��%/iir�r/r/�r�Jr/�j��l��✓'j/��l��ji�//.
//��/1r%�//�/' ��'r�`/ill%���'✓i�/
r
//r r
q
r a,
' �f�//��//o rry✓/1//
iY� log II�Y{�r�i'i' ��'•'+Il
v
y e-
f
i
Yr�
///�Q�li�lll'�� �✓(Ai y
i �ii/FF�di lr���y 1d� �i t" (
/��/r r%�ll Gl�� ��//�f// � ��ll� ��
fi�lei f�T����rtt/��i�/��^F,� i��y�fJ� �y� j� � r r o
FiF/FN ii i � (9/lye/r�i /%y r�� ��l � 1 y d �
� � i
�i,Y�. ir/�/�ii�����r�f��f��u���rd������1� �IPy�,���w'����" � y � �;� p4/ i(vl
I i( /i a II y 1 it Gig i
ul 1 � i r� � �?fr � ,
1 , �'�i� rel��, � .y
�y�r�,r�h,�ar
,r�/ � ,,
� F �� m
1 � V� �
+ � � f � ��i er� 1 uu I u� i�lil�'
I � U ��1 f���f�d,��d ���� � ��
1 i 9� l r i"°"°
��i ��
��� iif//��'/jig /� -
i���' � �� ;,i��;j���� �� Illllllllilili
�I� y IJ °' �� ���!�t0 �'�,
��y�`'y" � �� � ��
��
s
��� �
� ,.
���� � ;�.
��<
��,
��; ,
�' ��y'��I � w
i �I� Y'
�14FN����( y i rye(i/
i
���
� ��'
�1 ;t
y
�/F,
�,y
',jr ;y
,i '� ;�
r
, � f
t3
OWN OF SOUTHOLD
To" WV
f
Rental Permit
_. ' 0506
em�
Owner DL & LS Shaw Family Trust
Occupied as Single Family Dwelling
Located at 220 Skippers Lane Orient 25.4-21
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.
6/20/2023
Code 61forc ent Official
This Notice must be posted by the main entrance at all times
r4f soti,
TOWN OF SOUTHOLD BUILDING DEPT.
631-765-1802
INSPECTION
I FOUNDATION 1ST ROUGH PL13G.
FOUNDATION 2ND INSULATIOWCAULKING
FRAMING /STRAPPING FINAL
FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION
FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION
ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
CODE VIOLATION I PRE C/O [ ,e4,'4ENTAL
REMARKS:
111)
5 rakz S.
t4 L 74
...........
DATE 114SPECTOR
!° Town Hall Annex
H LD TON 54375 Main Road
�� PO Box 1179 Southold,
Re
�tal��p gLi.o, , NY 11971 1179
Tel 631-765-1802
Fax 631-765-9502
..
..Date
SC'TM # _._._ .. _. �...... _...�.. __ . . .... .
._._
_- __... _..ww_.. .... Phone
Owner
_. ..._. . Zlp
Address ^
Inspector
City
_.....
LEVELS
�� _'SUB .._..� .... ...
Smoke Detectors (# bedroom detectors excluded)
__. .
Carbon Monoxide Detectors (#)
Eire Extinguishers (#) ..
_._
35
4
DROOMS ....
B Smck Detecto .. �®
o r Alarms (#)
1
Carbon Monoxide Ararms �# �„ � � � �
Egress (windowsl tY/�l;
iL.+, 6i11y �7 rte; i rlN%n'us . __..,.° . ,w.._..u,
CONDITION OF P
BUILDING SYSTEMS Yl N
Oa
. � R.
_._
r ieati system r~aintained/ope a'iona �u..�d,n Vn,eras ;s ciea
Iden Exterioris c1 ar ma ntaineo mmµ
Hot wafer s"�`°^,,em maintained/o ra+,orae 9
.. > safe maontained
Electrical Mechanical
naintai Handrails � clean
Bands resent
Propertyrs
sq star maintarnedloPerationa & guards
g P
H
... ..,mm�- ...... ..,.
„ V
Rent ai 1.1spectior
� 4
a � °
? � �'� � Vl
� �
�, � �, i
*�' I .' "'""� � � v
�,,,�
�"�� ,� � ,
�, �, ,� � �
�`�
a
�1
o- �°
n �
' ,� ,�, i �r . �7� fi�� r
��i�l���
i �,
�;
�grid;;
�.� m
r
r
+
1
, it /✓rf%�'�/i fii�r/�ji�l/��i/�i///'�%i
r r!! raid�/ii/i/ ,r f ri/ rl/ /i e/ ✓�/irr
rr f/�r//r%//i i//f�✓/ri/''f//�,�//�%%i/�/r l��,�r/,rf�ir.
f /�y��N`T lr err/�/i�jl�oj�//'r�%✓/��i/�//'�'r/'/%ill i..�r//%%%iii fr'�+:;%%r%/r��fi��/�,/��G�%r,
� WI%/�%rrrlif !//�r/� /i/%rr/�Ir ///fir/✓�rl r�%,%/4 i�%����%moi/rf �//�F,��'%rr%%r%/�/F%/%1��.
�� . �.(l N /i6/��rj//,/fii/�/lii//i r //r///�i//a✓i r/rl/f///��/r ti//i�%1���/fJr��al(1/Ir//�r1�i�r G�/i
���',�///'��ir����r r/r//i///%/j//l//�jr r/;iri/�/irf�r/l��/�i✓�/,/r/>�jiJ/f��/r/��'r�%/,
�,��/v,/// oJ�!�i / !/,/ /i��i J��r�/�/i rjii//��,//�/��r(r`i i/N�/,/n✓j!�//r�jr�,�,�'d/�io�pr;.
�����r////�✓d(%/�'��i'�i lr/li'/i r ai ,�r//f�j�///f/,!//��/rf1jOJ�r</j����i��.j��i��%/✓���(�����...
��r//r / ��r � r r //r /r , /��%/iir�r/r/�r�Jr/�j��l��✓'j/��l��ji�//.
//��/1r%�//�/' ��'r�`/ill%���'✓i�/
r
//r r
q
r a,
' �f�//��//o rry✓/1//
iY� log II�Y{�r�i'i' ��'•'+Il
v
y e-
f
i
Yr�
///�Q�li�lll'�� �✓(Ai y
i �ii/FF�di lr���y 1d� �i t" (
/��/r r%�ll Gl�� ��//�f// � ��ll� ��
fi�lei f�T����rtt/��i�/��^F,� i��y�fJ� �y� j� � r r o
FiF/FN ii i � (9/lye/r�i /%y r�� ��l � 1 y d �
� � i
�i,Y�. ir/�/�ii�����r�f��f��u���rd������1� �IPy�,���w'����" � y � �;� p4/ i(vl
I i( /i a II y 1 it Gig i
ul 1 � i r� � �?fr � ,
1 , �'�i� rel��, � .y
�y�r�,r�h,�ar
,r�/ � ,,
� F �� m
1 � V� �
+ � � f � ��i er� 1 uu I u� i�lil�'
I � U ��1 f���f�d,��d ���� � ��
1 i 9� l r i"°"°
��i ��
��� iif//��'/jig /� -
i���' � �� ;,i��;j���� �� Illllllllilili
�I� y IJ °' �� ���!�t0 �'�,
��y�`'y" � �� � ��
��
s
��� �
� ,.
���� � ;�.
��<
��,
��; ,
�' ��y'��I � w
i �I� Y'
�14FN����( y i rye(i/
i
���
� ��'
�1 ;t
y
�/F,
�,y
',jr ;y
,i '� ;�
r
, � f
rsmf�'G&t TOWN OF SOUTHOLD
C* r
Rental Permit
0506
Owner Shaw D L & L S Family Trust
Occupied as Single Family Dwelling
Located at 220 Skippers Lane Orient 25-1-21
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.
7/20/2021 %In VA
C e E ore e t Official
This Notice must be posted by the main entrance at all times
so
Town Hall Annex :_ Telephone(631)765-1802
54375 Main Road
+ Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
cou
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
X
RENTAL.PERM ITAPPLICATION ;
Rental Permit Fee$200 (Application must be renewed every oK,9,rs7
Section A. ' A
Property Information: `
Rental Propert Address:
I YJ )
L
Tax Map Number: 1000 SECTION%_BLOCK / LOT^
SECTION B.
OWNER INFORMATION:
i I l
Pro perty-Owner--Name: :=.:L1��1�.. °! L�(� -
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
3 0 �-g t- 21
- -
O
Telephone Number (s): : f9 2— ��f
Property Owner Email Address: 1b GV S�1 6 I M
Page 1 of 4
Section C. i
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any: m'
ru7r)
D�� 1 4 e►�y s �fil ��� 1 s
Address of Authorized Agent (no P.O. Boxes),—, jh ;_4D"V6A , lsjY° 119144
Mailing Address of Authorized Agent:-
Telephone Number (s): iN t, .._1!�
Email Address:: o1
I
f
Section D.
Managing Agent Information:
S
Name of Authori d Agent of d <un :.
Address of Authorited A t(nMailing Address of Auth ' ed ATelephone Nu er (s): . _-
R«r-'
Email Address:.. ..
SECTION E.
SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units)
Name of Managing ent of dwelling unit, if any:
Address of Managing Age o P.O. Boxes):..__._--. . ..__ .._. -.._
Mailing Address of Managing Agent:
Telephone Number(s):_ ......_. . _
Email Address:
Page 2 of 4
SECTION F.
PROPERTY DESCRIPTION:
i r
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.
3
For properties with multiple Rental Dwelling Units use"Rental Permit Application
Addendum." s
Rental Dwelling Unit Identifier:. `Z9..
Requested Maximum number of persons allowed to occupy Dwelling Uni
Number of rooms in Rental Dwelling Unit:. ��
'Use and Dim nsions of a ch oom i entaCDwelling Unit:
LAlkO
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
❑ lam 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' I il,(� 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
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: .
Property Owner's Signature:
Sworn to befpre me thisI�day of. .2016:11
f(imberty Swann
Official Notary Pu . Signature and Original Notary Stamp Notary Public,State of New York
Reg.No.01SW6366103
Qualified in Suffolk County
Page 4 of 4 Commission Expires 10/23/2021
Town Hall Annex Telephone(631)765-1802
, .
54375 Main Road �"� � F �;.. Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971=0959
�CuEtf0l,li�`� .
BUILDING DEPARTMENT c5
TOWN OF SOUTHOLD
RENTAL PERMIT.APPLICATION A► D:EN®UM
Rental Dwelling Unit Identifier::
Requested maximum number of persons allow, d to occupy each dwelling unit
Number of Rooms in Rental Dwelling Urnit:I D -_ -
Use and Dimension of each room: (r S
- A -
- I
(J�x+c(tys- n5 ir,E
Rental Dwelling Unit Identifiert _-__-
Requested maximum number of persons allowed to occupy each dwelling unit:
ffumber of Rooms in Rental Dwelling Unit:...
Use and Dimension of each room:
Rental Dwelling Unit Identifier:._—
Requested maximum number of persons allowed to occupy each dwelling unit:
Number of Rooms in Rental Dwelling Unit:
Use and Dimension of each room:
SOUTyO�
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] FINALxe�,vwL(f' '
[ ] FIREPLACE & CHIMNEY [FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
R ARKVQW - oq�gN\Cq n�
S: r-
1
"(c, CeAl &�4� T�/ Qo,�4;01'f
c
orh 6� Q\ A
car � ?
DATEINSPECTOR
,. UF sou Y)eo 51P�i KAA-, W�j 0 in e 1
# TOWN OF SOUTHOLD BUILDING DEPT.
cou765-1802
INSPECTION
[ ] FOUNDATION 1ST '".[ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINA4V
j
] 'FIREPLACE & CHIMNEY [v] FIRE SAFETY INSPECTION '
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:
-
CHI
w✓ �rw
DATE INSPECTOR
mm
MEN
MEMMMMM MOMEN ME ME ME MEMO ME MEMO M 0
SNOOK-swim MENNEN WON MEN
EMMOMMEMMOMMEMEM MONSOON ME
ME M 2
n v�
mmomms MMMMMMMMMMMm%mMw MEMISMOM M
�� ONE Mat' MEMO MEMMM
� CCC CCEMEME
MMMENMOMMOMMOMMMEMEMEME mM:'MMM 0 MENNENM;w7 MEMEMMINEIRMEM M NEMOMMEME IN IMEMEMMEMEMEMEMOM
MMMMMMMMMMM amm mom MOMM ME MOMMMOMMMEN ME
EMEMOMMMMEMmumm M ME MMIMEMMOMMOMMMEM
MMMMMMMMMMMKNMM w MEN ISO MONMEMOMEMMM
MMMMMMMMMMMMIMMMMM MOEN MEMMOMMEMEMMEME
NMMMMMMMMMMMINMMMM NONE MEMOMMMMMOMMME
MEMOMMOMMMERNMEEM ME MOMMOMMOMMEME
MOMMEMMEMMENUMMEM MEMO MOMMMEMMEMMMEM
EMMou■■■■a■■M■■■a■■N MOMEMOMMMMEM0
MMMMOMMOMM ME MIMMMMMMMMM ME MMMMMMMMMMMM
MEMEMEMMOMME MIN ONE ME 0 WE EMMOMMMMMEM ME MOEN
MEMMIUMMOMMEM ME MMEMEN m NOMMEMMEMM MOM NOON
M EMMMINEMOMMOMPNEUVA Im-p-loollm IWE MEMNON
0 a wwoull MONMENIMM
0 MENNEN MOMMEMOMMEME MMMMMMMMMMMMMM
ME EMOMMOMEM
MMEEMMEN MOM
mmmm MEN m
��S ICCCC�C��
r
- aro
-C4 of = ,x
�nna.,o
M .
(A �
�I'�� ISO' I � I I � -__-----•_
r\ 7 a.Qb I
r - �.t
ba
it —
� J Nav vaaa - _
- I
i -
- I
_ y
SUlle Residence
Floor%an-TERNA-3 11110F
Scale:l/G• Sb' 210re lana.Orient
NY 1189]1957
1st.Floforf Plan
A-101
• V 45 ��
1
t , s ,
771-1
,
..
:n
. i
i
3'F t
;
_r....:
F
i
;
r
«�
,
v r,
AfV
VIr Fri
..........:_. .
..
,: ..; :;::,:xts. I I I ,..'Y, � !.°'-,.i:y i"r' rte, _ �•�»,,,,,A'.,:..- ._d:.�`V��i —
1.
_—....... i.... _
..............
M. Bldg. I 3` � ..a f Foundation y-may :. . Bath I
Extension ;_ ��r �,.a ,. Basement
-----...-_...__...- __.-..._..._.._._.______ — —
- r" $
ors
Flo
Extension b� a '
Ext. Walls �V— _� Interior .Finish
' -. - :'
._.. ✓..._ _. -- -=.. _.. ...- .............---._.__._._.._._._._.__. _.._. = --............._ -- ----+_....---- - - -- ----
Extension d� ,- ' �€ Flre Place, ... , .. .' H.eat. t v
" "
r
v
., � Typo
;
Por h Raof
I
c
Porch: .. .. Dooms 1st' Floor , ` 6
_ .
:
- > ^
,
, I
r : Roo s n loon
Breezeway ..: G Patio m .2 d F
Dormer......,
'Garage. 1� ,�. ; - , rAve
:
,
tt ,
,
'
a
a; s
141
-
b�
I
,
„
` ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ • •'
y9n rri :' f !L ne. a eve` ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
ro c aK ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
5F ■■■ !wlliM■■��M®■■■■■■■■■■■■■■■■
,ts ■■■■I■'m', oIJ■■■■■■■■■■■■■■■■■■■
aC
IS 111111.1 ■f�1i/1®■■■■■■■■■■■■■■■■■■■
�
IS ME 0VIMMM■■■■■■■■■■■■■■■■■
0 ORION
■rsit■■!�1■■■■ �!■■■■■■■■■■■■■■■■
; ° �.; ,° ��,nth--` �;"' ;C 8 � � ■■!�+!.�■1■■■Li'1�.�!■■■■■■■■■■■■■■■■■■
Cc
OTHER-
Basement 1: CRAWL PARTIAL
SLAB
Fin-ished B. Interior Fin sh
01
be
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
..
..
®®
a
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-23695 Date JUNE 12, 1995
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 220 SKIPPERS LANE ORIENT, NEW YORK
' House No. Street Hamlet
County Tax Map No. 1000 Section 25 Block 1 Lot 21
Subdivision Filed Map No. Lot No.
conforms substantially to the Requirements for a One Family Dwelling built
Prior to: APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z-23695 dated JUNE 12, 1995
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 ACCESSORY TWO CAR GARAGE
The certificate is issued to FLORENCE W. SMITH
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
Building Inspe or
Rev. 1/81
I
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 220 Skippers Lane Orient, New York
number b street municipality
SUBDIVISION MAP NO. LOT(s)
NAME OF OWNER (s) FLORENCE W. SMITH
OCCUPANCY SINGLE FAMILY
type owner-tenant
ADMITTED BY: INGE FLYNN ACCOMPANIED BY: SAME
KEY AVAILABLE SUFF.CO. TAX MAP NO. 1000-25-J-ZI
SOURCE OF REQUEST: KEVIN J. McLAUGHLIN, ATTY DATE: MAY 23, 1995
DWELLING:
TYPE OF CONSTRUCTION WOOD FRAME STORIES 2 I EXITS '4
FOUNDATION CANT CELLAR FULI' CRAWL SPACE
TOTAL ROOMS: IST FLR. 7 2ND FLR. 3 3RD FLR.
.BATHROOM (s) 2 TOILET ROOM (s) UTILITY ROOM PANTRY
PORCH TYPE FRONT COVERED & PART SCREENED DECK, TYPE PATIO
SIDS PORCH ENCLOSED FIREPLACE ONE GARAGE
DOMESTIC HOTWATER YES TYPE HEATER LILCO GAS AIRCONDITIONING
TYPE HEAT LILCO GAS WARM AIR YES HOTWATER
OTHER:
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST. 2 CAR WOOD STORAGE, TYPE CONST.
SWIMMING POOL , GUEST, TYPE CONST.
OTHER:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION S BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
REMARKS
INE'PFCTED BY DATE OF INSPECTION MAY 25, 1995
JOHN M. BOUFIS TIME START 9:15 END 9:45
i
a
F014-C19, Town of Southold 3/18/2016
P.O.Box 1179
0
53095 Main Rd
o4!4 �ao�� Southold,New York 11971
ig
CERTIFICATE OF OCCUPANCY
No: 38157 Date: 3/18/2016
THIS CERTIFIES that the building RESIDENTIAL ADDITION
Location of Property: 220 Sldppers Ln;Orient
SCTM#: 473889 Sec/Block/Lot: 25.4-21
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
3/10/2015 pursuant to which Building Permit No. 39592 dated 3/17/2015
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 AND ALTERATIONS INCLUDING A DECK,TO AN EXISTING ONE FAMILY DWELLING AS
APPLIED FOR
The certificate is issued to Shaw D L&L S Family Trust
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 9592 10-05-2015
PLUMBERS CERTIFICATION DATED 03-17-2016 rad I iecuc
Auto ed igna e
i
ops K oG Town of Southold 3/18/2016
P.O.Box 1179
o - ,
o 53095 Main Rd
11 Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 38158 Date: 3/18/2016
THIS CERTIFIES that the building ACCESSORY
Location of Property: 220 Skippers Ln, Orient
SCTM#: 473889 Sec/Block/Lot: 25.4-21
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
3/10/2015 pursuant to which Building Permit No. 39592 dated 3/17/2015
es issued, and 7AS
quirements of the applicable provisions of the law. The occupancy for
' this ce CESSORY TFOR
The certificate is issued to Shaw D L&L S Family Trust
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 39592 10-05-2015
PLUMBERS CERTIFICATION DATED 03-17-2016 Brad Piuch
rriz/d Sign ture
I
I
i azar,
FF0L,y�oGy Town of Southold 3/18/2016
P.O.Box 1179
C 53095 Main Rd
A Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 38157 Date: 3/18/2016
THIS CERTIFIES that the building RESIDENTIAL ADDITION
Location of Property: 220 Skippers Ln, Orient
SCTM#: 473889 Sec/Block/Lot: 25.4-21
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
3/10/2015 pursuant to which Building Permit No. 39592 dated 3/17/2015
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 AND ALTERATIONS INCLUDING A DECK,'TO AN EXISTING ONE FAMILY DWELLING AS
APPLIED FOR
The certificate is issued to Shaw D L&L S Family Trust
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 39592 10-05-2015
PLUMBERS CERTIFICATION DATED 03-17-2016 Brad Piecuc
Auto ed ignat e
APR 2 8 2021
April 291h 2021
To: Southold Building Department
Re: Rental Permit Renewal
Location: 220 Skippers Lane!
Orient, NY 11957 i
I am writing to request a rental permit renewal for my home at 220 Skippers Lane
in Orient. Nothing has changed in my home since I last got my permit, and am
happy to schedule the necessary inspection.
Enclosed please find my check for $200 for the renewal fee.
Sincerely,
Z5;7
Lucy tiIle