HomeMy WebLinkAbout1000-87.-2-30 TOWN OF SOUTHOLD
Rental emt
0520
Owner 82 Cypress Ave LLC
Occupied as Single Family Dwelling
Located at 240 Wampum Way Southold 87.-2-30
Maximum Permitted Occupancy 5
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.
8/22/2023
e t:qmrce Official
This Notice must be posted by the main entrance at all times
� 5f s4 )A�o WA)-AgUVvy\ VA VV
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631 -765-1802
INSPEC ION
[ ] FOUNDATION 1ST [ ] ROUGH PTBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAI
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN!
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (T
[ ] CODE VIOLATION [ ] PRE C/ [
REMA a
o
INSPECTOR............
---------
Town lull Annex Telephone(631)765-1802
54375 Main/,goad �� ilax(631)76.5-9507
P.D.Box 1 l/9 "
Southold,NY 11971-0959 rl r W
Yw�n lY
BUILDING DEPARTMENT
TOWN OF SOUTH01,0
RENTAL PROPERTY CERTIFICATION
Form is to be completed by a license architect, licensed engineer or licensed home inspector
Separate form is regaired far each individual Rental Dwelling Unit
fro sis�awl>crl seal re eaired +ar I rchitect or Fn ineer titensed ionre lns ec arr a provide
cop
y o valid current certification
Rental Property SCTM Number: lid
Rental Property Address: NO WA
Owner/Name: ANN a I '
Rental Dwelling Unit Identifier: -
Number &Square footage of each bedroom as depicted in the attached floor plan:
(i.e. Bedroom#1—IGO sq., Bedroom#2-90 sq., etc.)
Property Description (Include all improvements indicated on survey)
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 Plum Ing Code of New York State,
the Fuel Gas Code of New York State, and the Energy Conservati n Construct"er► Code of New
York State,
� .
Print Nam and Title final S" tore
Please place professional seal:
4 s�FEI>�lk���
TOWN OF SOUTHOLD
o Rental Permit
0520
Owner John F. de Reeder & Anne McDonald
Occupied as Single Family Dwelling
Located at 240 Wampum Way Southold 87-2-30
Maximum Permitted Occupancy 5
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.
8/13/2021
de fo a en Official
This Notice must be posted by the main entrance at all times
'eJ0�r1�.
Town Hall Annex r, 'l Telephone(631)765-1802
54375 Main Road , Fax(631)765-9502
Gn
P.O.Box 1179 :. -
Southold,NY 11971-0959
r. BUILDING DEPARTMENT
TOWN OF 90VM61b
APR 2 6 2021
RENTAL PERMIT APPLICATION
Rental Permit Fee$200(Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
240 Wampum Way Southold,New York 11971
Tax Map Number: 1000 SECTION 087 -BLOCK 02 -LOT 030-000
SECTION B.
OWNER INFORMATION:
Property Owner Name: John F. de Reeder and Anne de Reeder Mc Donald
Property Owner Legal Address: Property Owner Mailing Address:
525 New Suffolk Avenue Post Office Box 1322
Mattituck,New York 11952. Mattituck,New York 11952
Telephone Number(s): Daytime 631 298 6161 Eveningi31 298 4445Emergency
Property Owner Email Address:_jdereede(agmail.com
Page 1 of 5
Town Hall Annex .Fi Telephone(631)765-1802
54375 Main Road t " Fax(631)765=9502
P.O.Box 1179 ii -"� � �+
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SIMOLD
OU"
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit,if any:NONE
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: NONE
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 or more rental units)
Name of Managing Agent of dwelling unit, if any: NONE
Address of Managing Agent(no P.O. Boxes):
Page 2 of 5
Town Hail Annex '
4Telephone(631)765-1802
,.
54375 Main Road } Fax(631)765-9502
P.O.Box 1179 '-� G• �`
Southold,NY 11971=0959 ® is
BUILDING DEPARTMENT
TOWN OF SOUMOLD
Mailing Address of Managing Agent: n/a. .
Telephone Number(s): Daytime Evening Emergency
Email Address:.
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on property: 1
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: ?40 Wampum Way, Southold
Requested Maximum number of persons allowed to occupy Dwelling Un i 12
Number of rooms In Rental Dwelling Unit: 10
Use and Dimensions of each room in Rental Dwelling Unit: 1. Living room: 14'5"by 16'0"
2. Kitchen: 11'4"by 15'8" 3. Dining room: 11'4"by 11'8" 4. Library/den: 11'4"by 11'8"
5. TV/game room: 11'4"by 11'8" 6. Laundry/utility room: 7'4"by 15'8" 7._ Bedroom 1:
11'4".by 1.67". 8. Bedroom 2: 11'4'.'.by 1452" 9. Bedroom 3: 1097"by 1.1'4''
10. Office: 9'2"by 1056"
Page 3 of 5
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 t
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 1s 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.
IR 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 dwelling unit.
STATE OF NEW YORK)
)
COUNTY OF SUFFOLK)
I John F. de Reeder , 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
Town Hall Annex ..��tt,, Telephone(631)765-1802
54375 Main Road (t Fax(631)765-9502
P.O.Box 1179 t, G- 4 r
Southold,NY 11971-0959 V;
BUILDING DEPARTMENT
TOWN OF SOU MOLD
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. I 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: John F Regi oer
Property Owner's Signature:.
Sworn to before me his .6 day of_ I , 20 2 l
Official Notary blic Signatt, d Ori inal Notary Stamp
JONATHAN ®. FOGARTY
Notary Public o State of New York
NO.01F06241421
Qualifed in Suffolk County
My Commission'Expires May 23,20P
Page 5 of 5
pF SOUTdplo 1
# # TOWN OF. 011THOL (BUILDING DEPT.
�ycou765-1802 � /I 3 (�
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PL13G.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL ®�
[ ]" FIREPLACE &CHIMNEY<' [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:
(49 ?w 4A,�ovl
DATE '10 INSPECTOR
240 WAMPUM WAY
,, 5OUTHOLD
Roughly to Scale, meaouremento approximate
- - - - - - - - - - - - - - - -
SD Smoke detector
TV/GAME ROOM LIVING ROOM DINING ROOM sS Combination Smoke/CO detector
11'4"x 11'8" � 14'5"x 160" � 11'4 x 11'8"
Green labels identify detectors
OPEN TO LIVING
shown in composite photo
BEDROOM
ROOM BELOW BEDROOM
11'4"x 14'2" 11'4"x 167"
SD BALCONY SD
LIBRARY/DEN FP KITCHEN so
11'4"x 15'8" 11'4"x 15'8" CL CL CHIMNEY
Jill 1
SD
SD UP-D jil
--DN 2E co a---DOWN DRE55
5° _ING CL
S° LAUNDRY/UTILITY S° MASTER ROOM
ENTRY HALL T4"x 15'8" BEDROOM
�0 10'7"x 11'4" BATH OFFICE -
S° 5'0"x 9'0" 10'6"x 9'2" BATH
-7EDATH CL CL
CL2"
sS5'0"x 14'5"
Smoke detector on
baeement ceiling at
bottom of Stairway
FIRST FLOOR PLAN SECOND FL00R PLAN
GARAGE
J u�l Q 2021
13T7Tj)TN(1 i?FpT.
240 WAMPUM WAY 5OUTHOLD SMOKE AND CO DETECTOR IN5TALLATION LOCAT N5
r
Tm
Basement(B1) Laundry/Utility(1A) Front hallway (113) Library/Den (1C) Balcony(2A)
CJ
I•
4
Fif
.. :
Outside shared bath MBR (2C) L5E BIZ (2D) NE BIZ (2E) Office (2F)
FFOL/r019 Town of Southold 8/13/2021
0
a� y� P.O.Box 1179
0
o • 53095 Main Rd
V Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 42232 Date: 8/13/2021
THIS CERTIFIES that the building SINGLE FAMILY DWELLING
Location of Property: 535 Tepee Trail, Southold
SCTM#: 473889 Sec/Block/Lot: 87.-2-30
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
1/15/1973 pursuant to which Building Permit No. 6418 dated 3/20/1973
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:
single family dwelling with unfinished basement,attached garage "as built"deck and outdoor shower as ap liep d for
The certificate is issued to John de Reeder&Anne McDonald ,
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL S01280 9/11/1975
ELECTRICAL CERTIFICATE NO. 6418 7/14/2021
PLUMBERS CERTIFICATION DATED 6/25/2012 /7NJoIK.de Ree
ri ed ignature