HomeMy WebLinkAbout1000-63.-3-18.1 TOWN OF SOUTHOLD
Rental Permit
0530
Owner Grange Rouge LLC
Occupied as Single Family Dwelling
Located at 56995 Route 25 Southold 63-3-18.1
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.
t
9/13/2021
ode En orc m t fficial
This Notice must be posted by the main entrance at all times
Town Hall Annex Telephone(631)765-1802
54375 Main Road "' Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 DQ�
nil,
AUG 2620Z1
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
TOWN O so DEPT.
RENTAL PERMIT APPLICATION.
Rental Permit Fee$200 (Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
Tax Map Number: 1000 SECTION - -6
SECTION B.
OWNER INFORMATION:
Property Owner Name:. ZOUQ6l L C
Property Owner legal Address: Property Owner Mailing Address:
C7�� L' �ov � L�,� -C r�•�e �vg t ��
5� Id NY 111-7 1
Telephone Number(s): Daytime.06797 1VO Evening-_ Emergency
}� x1 16
Property Owner Email Address:
Page 1 of 5
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: Pog e
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:,
Address of Managing Agent (no P.O. Boxes):..
Page 2 of 5
Town Hall Annex g Telephone(631)765-1802
54375 Main Road '° Fax(631)765-9502
11.0.Box 1179
Southold,NY 1 1 971-0959
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: U
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: A66 n J.S
Requested Maximum number of persons allowed to cupy Dwelling Unit:
Number of rooms in Rental Dwelling Unit: __
Use and Dimensions of each room in Rental Dwelling Unit:;.
+ ( v
"PIS � � � �� � �� ` )< 6 ) q " 6141
J
®CK�T�.'1A�.+ �. i Ka 5 i � ; x L
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 IQ, ^
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.
❑ 1 am requesting a fire safety inspection to be performed by a Code Enforcement Official
from the Town of Southold
I 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)
L: _ _�oad► -T� certifV 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 ,. Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 C_Zz'
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:;.. —Yat
Property Owner's Signature:
`13
Sworn to before me this v day of . v1 v l S- y,20 2 f
AF
ffi al Notary Public Signature and iginal Notary Stamp
JAIME H. GAYNOR
NOTARY PUBLIC-STATE OF NEW YORK
No.01 GA6151068
Qualified in Nassau County
My Commission Expires 08-07-2022
Page 5 of 5
Town Hall Annex , Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P:O.Box 1179
Southold,NY 11971-0959
I
BUILDING DEPARTMENT
TOWN OF SOXYMOLD
RENTAL PROPERTY CERTIFICATION.
Form is to be completed by a license architect,licensed engineer or licensed home inspector
Separate form4s requlred for each individual Rental Dwelling Unit
Prof essloval;seai.r,eaukadJf7rAtehitect.or. Engineer,licensed Home:-Inspector must provide
s
ccrpir ot`valid current:certlfkation;,
Rental.Property SCTM Number: 1000=61.03-18.1
Rental Property Address:,: 56995„Main,Rd S.outhold.NY',1.9.71_
Owner/Name: Glenn Heidtmann
Rental Dwelling.Unit,ldenti.fier:..._ W
Number&:S.quare-footage.of each.bedroom;_as depicted;in1he-attached floor;plan:
(i.e. Bedroom#1-100.sq., Bedroom#2-90;sq:,,etc.)
Bedroom #1 ?41.,sq.
Bedroom #4: 1:43.,s
Bedroom #2: 1:86 sq Bedroom`#5 9'11:sq ,
5edroo.m..#3: 257 sq
Property Description,.(Includ`e,,all:imp rouements.indicated on=survey).
2 story"frame dwelling
1 certify.that l,have do"ne.a.physicalinspectio.n,of the subject--rental dwolling-pnit andsfind.that it
fully,complies with_all the provisions.of the:Code of the Town of Southold;the.Residential-Code
of New York-State,the.Bull ding.Code of-New York'State:the Plumbing.Code of New York State,
the.Fuel Gas Code,"of New.;York;State, and the�Energy.Conservatiori Co tr on Code.of New
York State.
Anthony 1po.rtillo,.:R.A
Print Name and Title . = : R rfi;.�af`4 Originai Si . ature
-Please'placeaprofessional:seal:
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af souryo �� -b� �� t'�0A ,,e lc�
# TOWN OF SOUTHOLD -BUILDING DEPT.
765-1802
INSPECTION
[ :] FOUNDATION 1ST [ ] ROUGH PLEIG.
] FOUNDATION 2ND- _ - [ ] INSULATION/CAULKING
[ ]
FRAMING/STRAPPING [ ]URINAL
[ ] FIREPLACE & CHIMNEY [�] FIRE SA ETY INSPECTION
[ ]
-FIRE RESISTANT CONSTRUCTION. [ ]' FIRE-RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL'(FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:
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DATE. 13 x INSPECTOR
a oo�g�8�
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HEIDTMANN
ESIDENCE
56995 MAIN ROAD
SOUTHOLD, NY 11971
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ARCHITECTURE ANTHONY PORTILLO, R.A.,-LEED AP W Z z
1075 FRANKLINVILLE ROAD 204 25TH STREET,SUITE 203 W N o
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FORM NO. 4-
i
I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
! Town.Hall
I
Southold, N.Y.
I'.
i
j PRE EXISTING
!
CERTIFICATE OF OCCUPANCY
29990. Date: 02/02/04
'.i THIS CERTIFIES that the: building DWELLING
!
I
Location of Property 56995 MAIN RD SOUTHOLD
(HOUSE NO.) (STREET). (HAMLET)
! County-. Tax Map No_ 473889 Section 063 . P1 - 0003 Lot 018.001
i.
j Subdivision Filed Map No. Lot No.
I
conforms substantially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9; 1957 pursuant to which CERTIFICATE OF
i .
OCCUPANCY NUMBER Z- 29990 dated FEBRUARY 2, 2004
was issued, and conforms to all of the requirements of the applicable
I
! provisions of the law. The occupancy for which this certificate is•
issued is ONE FAMILY DWELLING WITH 3 ACCESSORY STORAGE SHEDS & ONE LARGE
.i . BARN.
f The certificate is issued to PECONIC DESIGN & CONSTRUCTION
(OWNER)
4 of the aforesaid building.
I ! ,
I
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
I ! •
ELECTRICAL CERTIFICATE' No 1192123 01/29/04
I. I
PLUMBERS CERTIFICATION DATED N/A.
f I
.I *PLEASE SEE ATTACHED INSPECTION REPORT.
I
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I '
I Authorized gnature
I
I I
I
Rev. 1/81
i
I. -
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
]GOCATIOI7 56995..MAIN'RD SOUTHOLD
SUBDIVISSOI7: AIAP NO.: IAT (S)
i
^-lwv OF O¢Mki (S.): PECONIC•DESIGN. & CONSTRUCTION
OCCWIW CY: SINGLE FAMILY.DWELLSNG. PECONIC DESIGN & CONSTRUCTION
ADITIT'TED.BY: RAY.DICICOFF ACCOMPANIED BY: SAME
KEY A�IAILABLE: SUFF. CO_ TAX IlAP NO.: 63.-3-1S.1.
SOURCB;OF "QUEST: RAY DICKOFF.1/22/04 DATE: 02/02/04
T'YPE':OF COBISTRUCTION: WOOD # STORIES: 2.0 # EXITS: 4
irOi�aniz;rIORa: S+I'ONE &.BLOCK. CELLAR: YES CRAff+1T SPACE: PART
'T'OTAL Rmis R.: 4 2ND FLR.: 4 3RD FLR.: 0
SATFII2 (S}:
2.0 °COIF ROOM(S).: 0.0 UTILITY ROOM(S)
P012CH TYPE: DECK TYPE: PATIO TYPE:
HRkEZEVtAY: FIREPLACES: GARAGE:
•DOYffiSTIC HOTrrAMTER: XX TYPE HEATER: ELECTRIC AIRCORNDITIONING:
TYPE HEAT: OIL WARM AIR: BOTHATER: XX
i. •
OTHER: *REAR MUD ROOM
i .
ACCESSORY,.STRUCTURES:
I
GARAGE, TYPE,OF CONST.: STORAGE, TYPE CONST_: 3 WOOD STRUCTURES
SWIMING POOL: GUEST, TYPE CONST_:
OTHER: 1 LARGE BARN
i
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION..
I DESCRIPTION ART. SEC.
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REMARKS: BP 6775 0 Z-5434.
II7SPECTED BY: DATE ON INSPECTION: 01/26/04
/OHN H. 'OU
TIME START: 9:45 AM END: 10:25 AM
FORM NO. !
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. . Z5434 . . . . Date . . . . . . . . . . . . . . Sopi. . .10. . . ., 19. 7'3
THIS CERTIFIES that the building located at . $/R. . Naft. Aoad... . . . . . . . . Street
Map No. . .xz . . . . . . . Block No. . aoc. . . . . .Lot No. . . =. . . .Bo o1d .'J10Y.R . . . . . . .
conforms substantially to the Application for Building Permit heretofore filed is this office
dated . . . . . . . . . . Aug. .3. . . ., 19. .93 pursuant to which Building Permit No. .677 01 .
dated . . . . . . . . . . . . . .Atte . .3. ., 19. .73 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 . . .Pr vata .on& tazi1y.dwelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TTh� certificate is issued to mia .ov*zton. . . .Owner. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
... ...........
'� (owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval !R• . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
UNDERWRITERS CERTIFICATE No. . .PeaU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HOUSE NUMBER . . . . . 56"J. . . Street . . . . . .Main.Road. . . . . . . . . . . . . . . . . . . . . . . . .
Building Inspecto
q�o�S�1FF0(,f�OG Town of Southold 7/16/2019
P.O.Box 1179
y 53095 Main Rd j
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 40504 Date: 7/16/2019
THIS CERTIFIES that the building WINDOWS
Location of Property: 56995 Route 25. Southold
SCTM#: 473889 Sec/Block/Lot: 63.-3-18.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
3/19/2019 pursuant to which Building Permit No. 43586 dated 3/27/2019
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:
WINDOW REPLACEMENTS IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to Grange Rouge LLC
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Auto ' e Signature