HomeMy WebLinkAbout1000-103.-4-40 4�
FF t; TOWN OF SOUTHOLD
N
Rental Permit
. 0550
�a
Owner William & Christine Metzner
Occupied as Single Family Dwelling
Located at 65 Emory Road Cutchogue 103.4-40
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.
10/27/2023
Code En f Fce e yt official
This Notice must be posted by the main entrance at all times
TOWN OF S
831 -785-1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAI
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN!
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FIN
[ ] CODE VIOLATION [ ] PRE C/O [
REMARKS:
T � INSPECTOR
TOWN OF S Tk0_L`DD_BtUDING I
1 7�518tE /
'ClrlON
INS
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSUTATIO WCAL
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INS
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE
[ ]
ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII"
CODE VIOLATION PRE C/O [
REMARKS:
Town Hall Annex
ell
Town of Southold 54375 Main Road
Rental Inspection Report PO Box 1179
Southold, NY 11971-1179
Tel: 631-765-1802
Date
SCTM#
Owner Phone
Address
Visible
; Ins o I r-
Hamlet 0�, t
Floor Level Quantities Sub-- ] 1 2 3
Smoke Detectors (not located in bedrooms)
Carbon Monoxide Detectors
Fire Extinguishers
Exits
Bedrooms 2 3 4 5 6
Smoke Detectors
Egress
Occupant Count 6-91
Building Systems Maintained & Operational 'Condition of Property
Heating Building interior
Hot water Building exterior
Electrical Property clean, maintained &safe
Mechanical Handrails & guards installed &secure
Pool Safety Pool on Site
Surface water alarm Date of CO issuance
Door alarms Pool completely enclosed
Self closing/ latching gates Pool fence lto-code requirements
CO's for all items present Prior Rental
Comments:
TOWN OF SOUTHOLDRental
�.�
0550
Owner William & Christine Metzner
Occupied as Single Family Dwelling
Located at 65 Emery Road Cutchogue 103-4-40
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.
10/14/2021 %ta -'sV Al UV U
cid - Official
This Notice must be posted by the main entrance at all times c tri r
1
�ov o " 1
Town Hall Annex f Telephone(631)765-1802
54375 Main Road 4, Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
cou
n.4
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION
Rental Permit Fee$200 (Application must be renewed every two year
Po w L
6 .,
r
Section A.
Property Information: ,
Rental Property Address:
( S EM o2 y 0 C VTC1+06VC n/ Y
Tax Map Number: 1000 SECTION 103 -BLOCK / -LOT /
SECTION B.
OWNER INFORMATION:
Property Owner Name: C If i21 S r/A/E M E TZNE'2
Property Owner Legal Address: Property Owner Mailing Address:
12 60 M AAO#C Pi< /Z o M A-AMe- D
2ivieR-A L Z,3 RiviekA fefv4 EL M710 If,-
S'61 3,7`l 90,6 Sti 37q Q6 76 56 t 371? 46'76
Telephone Number(s): Daytime Evening Emergency
Property Owner Email Address: Ck f l,S° wee 33 Y 71 e
Page 1 of 5
Town Hall Annex 9� �` Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
�4.
Southold,NY 11971-0959 j�"
Uffi
Urt'D,aa.=
BUILDING DEPARTMENT
TOWN OF SOU OLD
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any: IVA
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:
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: /V A
Address of Managing Agent (no P.O. Boxes):
Page 2 of 5
So�,� w
Town Hall Annex �' � Telephone(631)765-1802
54375 Main Road Fax (631)765-9502
P.O. Box 1 179
Southold,NY 11971-0959
CDUM`I
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:
Requested Maximum number of persons allowed to occupy Dwelling Uni
Number of rooms in Rental Dwelling Unit: 6
n Dimensions X11 hRental
( �..iv I M
Use a
In Rent Dwelling nit:
�,,
Page 3 of 5
S �
Town Hall Annex � � � �'rA, Telephone(631)765-1902
54375 Main Roads Fax(631)765-9502
P.O.Box 1179 �x
Southold,NY 11971-0959
@rnnkrr4 G�pn
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.
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 C�f � W-1— MJU nr , 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 S '- Telephone(631)765-1802
54375 Main Road "f Fax(631)765-9502
ol
P.O.Box 1 179 aka", •� �J
Southold,NY 11971-0959
UN
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: C kri3. ,Ale Mj-zj e-j--
Property Owner's Signature.
Sworn o before me
this day of 10- 20%q
Y
OffiKial otar Pu ..�....��... ..�--
,��r CFiR1ST1NAeulAA��klry��.'�d
y Public Sig attire and Original Notary Stamp MYcoMthlss�R 1 F917501
EXPIRES:aplambar 27,2015
r C Bonded Thiu NOWY POW U40M*M
Page 5 of 5
TOWN OF SOUTHOLD BUILDING DEPT.
um" 765-1802
INSPECTION
[ ] FOUNDATION 1ST, [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IULTIN/CULKIN
[ ]
FRAMING / TR PING [ ] IAL
[ ] FI EPL C I NEv [ ] FIRE F T IN S C"TION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/
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INSPECTOR
(oVc �03 q
TOWN OF SOUTHOLD BUILDING DEPT.,
W
765-1802
'INSPECTION
[ ] FOUNDATIO 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ]
FRAMING /STRAPPING [ ] NALAov�44 •
�Pr1lM��
[ ] FIREPLACE & CHI'. NEY [ F E SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
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. .Z 13 217 Date . . . . . . . . . . . Feb: . . . . 5. . . . . . . . . .. 19 8 5
THIS CERTIFIES that the building . .New Dweng . • . , •
2500 Little Neck Rd. Cutchogue
Property r Emory fid'
Location of p y ! N Hamlet'
Hou,�e No. Street
County Tax Map No. 1000 Section . . 1.0 . .. . . . . .BIock . . . . . . „ . . . . .Lot
Subdivision . . . . Bunny Shores • • _ . • • • •Filed Map No. 3231 . . .Lot No. .17. . . . . . . . . .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
July 2 • , 19 •8 4pursuant to which Building Permit No. . . . . . 13 4 21 Z. • • • • • • , •
. .
dated . . . . . .Sept' . • • • • •6. • • • • • • . • 19 •$4,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 . • , . . . . . .
New Private One. Family, Dwelling, . . . • , , • • • . . . . . . . . . . . . . . . . . . . . . .
The certificate is issued to . . . . , . , . , . , . • . • • MIrTZ f P r 0 'PH , . . . , . .. . . . . . . .
(owner, *eR-sWJ
of the aforesaid building.
Suffolk County Department of Health Approval . . . . , • . • . • • , , , . „ „ . . . . „ . . . . . . . . .
UNDERWRITERS CERTIFICATE NO. . . . . . . . ,, • „ N 673681 „ „ „ • . . . . . . . . . . . . . . . . . ..
Building Inspector
Rev.1181
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall t "°
Southold,N.Y. , "
Certificate Of Occupancy
No, .Z 1636.6 * . . . . Date . . , ,November 5 , 1987 . . . . . . ..
THIS CERTIFIES that the building . . . . . . Accessory » » » » » . » » » .
Location of Property
65 E M 0 R Y Road C u t c h o g u e _ » . » » »
House No. Street Hamlet
County Tax Map No. 1000 Section . . 3 . . . . . .Block . . . . `. . . . . . . . . .Lot —49. . . . . . . . . . . . .
Subdivision , ,S u n n y Shores . , . . , , . .Filed Map No. 3?3#i » r rLot No. ..7. . . . , . . . . . .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
June 2 , .1.9.8 7 pursuant to which Building Permit No. . .1.6.1.0 8 Z, , . , , . , , , . _ .
dated . . June 2 2 , .1.9.8.7 , , . . . was issued, and conforms to all of the requirements
of the applicable provisions of the law.The occupancy for which tlus certificate is issued is . . . . . . . . .
Accessory. building as applied for.
The certificate is issued to , ,JOSEPH M ME T Z N E R
{ow�rer, X X.
of the aforesaid building.
Suffolk County Department of Health Approval . . . . N/A . . . . . . . . . . . . . . . . . » . . . . . . . . . . . , .
UNDERWRITERS CERTIFICATE NO. . . . . . ,, , . . N/A
PLUMBERS
. . . . , . .
PLUMBERS CERTIFICATION DATED: N/A
Build' g Inspebtor
Rev. 1181