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HomeMy WebLinkAbout1000-53.-5-2 Vt TOWN OF SOUTHOLD Rental Permit 0554 Owner Karol & Marzenna Filipkowski Occupied as Single Family Dwelling Located at 65390 Route 25 Greenport 53-5-2 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. 10/29/2021 DAk ode nfo em nt official This Notice must be posted by the main entrance at all times V W i VW y Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O_Box 1179it r Southold,NY 11971-0959 A AUG ..... 2021 BUILDING DEPARTMENT TOUN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: r 7� Tax Map Number: 1000 SECTION -BLOCK � -LOT Z - SECTION B. OWNER INFORMATION: Property Owner Name: 'a,f v ��' ��� �' �rp11 c,J 11-S Property Owner Legal Address: Property Owner Mailing Address: S;70 Po Bcl� Telephone Number(s):Oaytimeo�J/`739-(:P/ ning e3J-,3 lemerg+ency 6.5j_ CPJ/-30 ` 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 1 1971-0959 ' `t' 0 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 identifie (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 Unit* Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: to 172a Gr s rtU c� -17 X d' sus . � o x 1 3 S Page 3 of 5 a a h: y Town Hall Annex Telephone(631)765-1802 54375 Main Road I �I 0 Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 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. V 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) r� � _ ri "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 owners legal address set forth in "Section B"of this application is my legal address and 1 understand the Town will use the address for service pursuant to all Page 4 of 5 1 i�r,t uuimio Town Hall Annex Telephone(631)765-1802 �Vl 54375 Main Road �� �1 Fax(631)765-9502 P.O.Box 1179 T Southold,NY 11971-0959 BUILDING DEPARTMENT TOVI T OF SOUTHOLD applicable laws and rules. I further acknowledge that 1 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: Property Owner's Signature: �J Sworn to before me this3 day of XVu d , 20; Official Notaryb'lic Signatur dOn final Notary Stamp JONATHAN D. FOGARTY Notary Public•State of New York NO, 01 FOO2 1421 ualded in Su1foR Caunly CJiy Co nimissi n Expires May 2' ,203 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 �` y BUILDING DEPARTMENT S E P 3 2021 TOWN OFOO't"H011AD RENTAL PROPERTY CERTIFICATION Form is to be completed by a license architect,licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit proessi+onal,seal re ulrerd or Architect or En beer,I eased Home Inspector must provide copy of valid current certi� tign Rental Property SCTM Number: C2 —,:T —2 • Rental Property Address: Uzi rve,n / 9 y m Owner/Name: L, Rental Dwelling Unit Identifier: Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1-100 sq., Bedroom#2-90 sq., etc.) — R. ]e- / x l3 — ,Zc9P 13 m X -� '� 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 Plumbing Code of New York State, the Fuel Gas Code of New York State,and the Energy Conservation Construction Code of New York State. ---- , Print Name and Title Original Srl`1 Please place professional seal: �.. .� u u u u u u u OO r m a0 O O p mm m D c c M n � � � z z < --Im ao L O o N _� a � Z m N O O s� Z z ellp M n 0 � Z C z_ p O -o Z — _ m m 0 O z u u u u u u u r M � � Z Q M M m 0 "' 31 O x _ cn na MR O oro 0 r Z � .. 0 TI -v z a m D X 0 0 0 Z SZENK ATELIER LLC 92 Lancia Dr. Architectural design East Norwich, MY, 11732 516 343 5928 � • -. r B T o J Mpi mE � B w�...l� "4 V u,_�.mw.w��.a� ... � � ,.�•m�.�,^^'" 4 DINI 16 GREAT OM a" ... <TCHIEN 11 15 wY _ TN Cp +� B p ! t 41T1L.}"C'g" m..� C7Y" .R B Map L _ p i C1.06H t. p STAIRµ -, �v 6u PORCH A k92 N7 V a. . . 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Town of Southold Annex 9/2/2013 P.O.Box 1179 r 54375 Main Road Southold,New York 11971 CERTIFICATE F OCCUPANCY No: 36481 Date: 9/3/2013 THIS CERTIFIES that the building SINGLE FAMILY DWELLING Location of Property: 65390 Route 25, Greenport, SCTM #: 473889 Sec/Block/Lot: 53.-5-2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 5/25/2010 pursuant to which Building Permit No. 37907 dated 4/3/2013 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 l"amily Llwellin&Y with unfinished bas men , front,and rear covered decks and attachedtr carj),aLa The certificate is issued to Karol&Marzenna Flipkowski (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-04-0186 6/5/13 ELECTRICAL CERTIFICATE NO. 37907 4/1/13 PLUMBERS CERTIFICATION DATED 8/13/13 Karol Flipkowski c .. .a...... . Aut o zed Sig' ture