HomeMy WebLinkAbout1000-54.-7-8 �A �4Qt't�a TOWN OF SOUTHOLD
c X f Rental Permit
0513
Owner Freddie & Ruth Diaz
Occupied as Single Family Dwelling
Located at 12250 Soundview Ave Southold 54-7-8
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.
7/28/2021
Code EnforceOfficial
This Notice must be posted by the main entrance at all times
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i
SOUTHOLD TOWN Town Hall Annex
�� Gy 54375 Main Road
wa NY Rental Inspection PO Box 1 Southold,
+s� NY 11971-1179
dy • �'�
Tel: 631-765-1802
Fax 631-765-9502
SCTM # �( .— �- O Date 2 7/Z
Owner `�G� p�'Z Phone 7 sc13 SZ9Z
Address .SoUncWCIA/ Zip j �7
Hamlet I Sos O linspector
Address visible from street?
LEVELS SUB 1 2 3
Smoke Detectors (#-bedroom detectors excluded)
Carbon Monoxide Detectors (#)
Fire Extinguishers (#)
Exits (#)
BEDROOMS 12 3 4 5
Smoke Detector Alarms (#)
"'
Carbon Monoxide Alarms (#)
Egress (windows) (Y/N)
BUILDING SYSTEMS /N CONDITION OF PROPERTY N
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 Yd 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:
l b
SO
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765:-9502
P.O.Box 1179
Southold,NY 11971-0959
BUILDING DEPARTMENT DD
TOWN OF SOUTHOLD JUN - 7 2019
RENTAL PERMIT APPLICATION
Rental Permit Fee$200(Application must be renewed every two ye )VN 01?SOUTHOU
Section A.
Property Information:
Rental Property Address:
Tax Map Number: 1000 SECTION -BLOCK -LOT -
SECTION R.
OWNER INFORMATION:
Property Owner Name: F� --
Property Owner Legal Address: Property Owner Mailing Address:
Telephone Number(s): Daytime Evening -V32-k Emergency
Property Owner Email Address: 'ri1,4L-2-72-4- (�A6°^ r1/�. -
Page 1 ofS
q q 11--I 4
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
BUILDING
1971-0959BUILDING 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: Y
Address of Authorized Agent(no P.O. Boxes):
Mailing Address of Authorized Agent:.. .-
Telephone Number(s): Daytime . Evening Emergency
.r.
Email Address:
_ 4
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i
SECTION E.
SITE MANAGER INFORMATION:(required for rental properties con ining 8 or more rental.units)
Name of Managing Agent of dwelling unit;if any:
i
Address of Managing Agent (no P.O. Boxes):
Page 2 of 5
p�F;i�
Town Hall Annex 1 Telephone(631)765-4802
54375 Main Road Fax(631)765-9502
P.O.Box 1 179 G.
Southold,N.Y 11971-0959 � OUfY 1►1
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: '� l'L-Y
Requested Maximum number of persons allowed to occupy Dwelling Unit:-
Number of rooms in Rental Dwelling Unit:
Use and Dimensions of each room in Rental Dwelling Unit:
Page 3 of 5
i
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
TONIN OF SOUTHO.L...D
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
❑ 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 dwellings unit.
STATE OF NEW YORK)
COUNTY OF SUFFOLK)
014 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 ?.
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,1.
1 .,
Town Ball Annex Telephone(631)765-1.802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 "
BUILDING DEPARTMENT
TOWN OF SOUMOLLD
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.
1 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, M.an .a.ging Agent, or Site Manager.
Property Owner's Name: - . ®f 'J 14
Property Owner's Signature:..
Sworn to before me this day ofy �(�Q ,:20j_q
a-ad {
Official No ry Public Signature ae Original Notary Stamp
TRACEY L. DWYER
NOTARY PUBLIC,STATE OF NEW YORK
NO.01 DW6306900 r
QUALIFIED IN SUFFOLK COUNTY
COMMISSION EXPIRES JUNE 30,21AA—a
r
Page 5 of 5
�O�aOE SOUTyOIo `
* TOWN OF SOUTHOLD BUILDING DEPT.
°`ycourm�E`' 765-1802
INSPECTION '
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
( ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] INAL6"kp.",*
[ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION ( ] CAULKING
REMARKS:
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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. .�.i5.545. . . . . . . . . Date . . . . . . . . .March 25 ,. 198.7 . . . . .
THIS CERTIFIES that the building . . . . . .0 n e f am i l.y ,d w e 11 in g
Location of Property .1.2250 Soundview Ave.., & Booth Rd . Southold
House No. Street Nam/er
County Tax Map No. 1000 Section . .0.5 4 . . . . . . .Block 7. . . . . . . . . . . .Lot . . 8 . . . . . . . . . . . . .
Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
. Jan 2 8 , ] 9 8 6 pursuant to which Building Permit No. .1458 7 z
dated March 2 ; 1 9 8 6. . . . . . , . . . 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, one car garage and decks .
The certificate is issued to . . . BERTANI BUILDER, INC .
(owner,�/� I'tldr��a76�t
of the aforesaid building.
Suffolk County Department of Health Approval . . 8$-SO.—.208
UNDERWRITERS CERTIFICATE NO. . . . . . . . . . IN 7 9 3.8.3 1 , . . . . _ . . _ _ . .
PLUMBERS CERTIFICATION DATED: Feb . 24 , 1987
✓r!rw�/. . . . . . . . . . . . . . . . . . . . .
Building Inspector
Rev.1/81
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SUFFOLK COUNTY HEALTH DEPARTME..* � 0 o
SINGLE-FAMILY•QLNEILINQ ONLY
N.D.REF;
�r
•. `• � :3•r ,�' ;fir: '
THE SE'WAIDE 61SPOSAL AND WATER SUPPLY FACILITIES FOR THIS
L00ATI0M-AAVg AEEN INSPECTED BY THIS DEPARTMENT AND
F01fN0.70. „8��11 QTQ
oE, SURVEV OF PROPERTY
.ice:. = ostt*Ai..W'Monagernent Section - SO U T H O L D
.._.,._.__.......... ... F SOUTHOLD
SUFFOLK COUNTY, N.Y
toxo •r A54 - :.07 - 08
S.CA1.E 1 " s 30 ' - -
JUNE 6 , 1986
ROV. 7 , 1986
4 �q
LAN 0,9
A-/ 9G
1 N.Y.S. LIC. NO. 49668
° l~ Prepared in aeoordanee with the minimum
1 oql E Y O R S 9 ENGINEERS , P. C . standards for title surveys as established by
(5 f 6 020 the L.1.A.L'S. and approved and adopted
P.O. 8 OX 909 for.such use by The New York State Lanc.
MAIN ROAD Title Association.
SOUTH OLD, N.Y. 11971
j 8-6 - 15 2 C
4 '
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-29085 Date: 11/18/02
THIS CERTIFIES that the building ACCESSORY-
Location of Property: 12250 SOUNDVIEW AVE SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 54 Block 7 Lot 8
Subdivision Filed Map No. Lot No_
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 6, 2002 pursuant to which
Building Permit No. 28887-Z dated NOVEMBER 6, 2002
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 ACCESSORY TWO CAR GARAGE WITH STORAGE ABOVE AS APPLIED FOR.
The certificate is issued to PATRICK T RYAN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 021017 02/27/02
PLUMBERS CERTIFICATION DATED N/A
Authorize x
Signature
Rev. 1/81
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CERTIFIED TO: e �s �
COMMONWEALTH LAND TITLE c'
INSURANCE COMPANY
TITLE NO.G 628 487 S
EASTERN FEDERAL SAVINGS
.AND LOAN ASSOCIATION
MIGNON T. RYAN
{SURVEY OF PROPERTY
AT SOUTHOLD
TOWN OF SOU THOL D
SUFFOLK COUNTY, N.Y
Prepared In cccordonce with.Ih° minimus, 1000 — .054 — 07 — 08
ttondardi for fill* survey* as edabiirhed by
the 1.1.A.L.S. and approved and odople.i SCALE 1 - 30 '
for such use by The New York State land JUNE 6 , 1986
'fill* Association. NOV. 7 , 1 9 8 6
.Q LANDS'
A.
rIA. 00
N.Y.S. LIC. NO. 49668
P�CONr .\vt ag'r,�a� & ENGINE ERS P. C .
0516) 7C. .
P. BOX 9
�%f'" FFOt�''�t Town of Southold Annex 9/15/2014
P.O.Box 1179
54375 Main Road
k�� • Southold, New York 11971
CERTIFICATE OF OCCUPANCY
No: 37145 Date: 9/12/2014
THIS CERTIFIES that the building ADDITION/ALTERATION
Location of Property: 12250 SOUNDVIEW AVE SOUTHOLD,
SCTM#: 473889 Sec/Block/Lot: 54.-7-8
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
8/11/2004 pursuant to which Building Permit No: 30562 dated 8/12/2004
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:
DORMER ADDITION TO AN EXISTING UNHEATED UNFINISHED NON-HABITABLE ACCESSORY
BUILDING AS APPLIED FOR
The certificate is issued to PATRICK T RYAN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 30562 09-08-2014
PLUMBERS CERTIFICATION DATED
Auth Si ature
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT -
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 30562 Z Date AUGUST 12 , 2004
Permission is hereby granted to:
PATRICK T RYAN
460 BOOTH RD
SOUTHOLD,NY 11971
for
ADDITIONS AND ALTERATIONS TO AN EXISTING NON-HEATED NON-HABITABLE
ACCESSORY BUILDING AS APPLIED FOR
at premises located at 12250 SOUNDVIEW AVE SOUTHOLD
County Tax Map No. 473889 Section 054 Block 0007 Lot No. 008
pursuant to application dated AUGUST 11, 2004 and approved by the
Building Inspector to expire on FEBRUARY 12, 2006.
Fee $ 75 . 00
Au hori ignature
ORIGINAL
Rev. 5/8/02
ggFFtll�- g Town of Southold 3/30/2016
a
P.O.Box 1179
53095 Main Rd
oy S��� Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 38185 Date: 3/30/2016
THIS CERTIFIES that the building AS BUILT ALTERATION
Location of Property: 12250 Soundview Ave., Southold
SCTM#: 473889 Sec/Block/Lot: 54.-7-8
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
pursuant to which Building Permit No. 40496 dated 2/29/2016
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"alterations,includingexisting xisting arage converted to living space and a bathroom in the basement,in an existing
one family dwelling as applied for.
The certificate is issued to Ryan,Patrick
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 40496 3/24/2016
PLUMBERS CERTIFICATION DATED
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