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Home My WebLink About1000-126.-10-4 t TOWN OF SOUTHOLD Rental Permit 0534 Owner Lynn Bohlen Occupied as Single Family Dwelling Located at 2490 Bray Avenue Laurel 126,10-4 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. 7/2/2024 ` e car erg Official This Notice must be posted by the main entrance at all times ;axxxur. ' AVf- - L/fWr0t,," TOWN OF SO VIOL-D BUILDING DEPT. 631-765-1802 j-�,4 , - (d - Lj I NS"' P wm" T 10 N [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI L) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL AAQA l DATE - INSPECTOR __ S % 1J E - Town Hall Annex one(631) 1802 54375 Main Road ,1v s , tklo TelephFax(631)765-9502 P.O. Box 1179 era Southold, NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a licensed architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Professional seal required for Architect or Engineer, Licensed Horne Inspector must provide copy of valid current certification Rental Property SCTM Number: 'I Rental Property Address: Owner/Name: - _ Rental Dwelling Unit Identifier. Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 —100 sgft., Bedroom#2—90 sgft., etc.) Property Descripti n (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 To Southold, the Residential Code of New York State, the Building Code of New York State,ttae ll " New York State,the Fuel Gas Code of New York State, the Fire Code of New York ,, n Code of New York State a the nergy Conservation Construction q� rMp Print Name and Title i u Please place Professional Seal: 4#50 SS100 g TOWN OF SOUTHOLD Rib Rental Permit 0534 Owner Lynn Bohlen Occupied as Single Family Dwelling Located at 2490 Bray Avenue Laurel 126-10-4 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. 9/20/2021 otl� Eta � rare: �o Kcal This Notice must be posted by the main entrance at all times n„ Town Hall Annex Telephone(631)765-1802 Fax 631 54375 Main Road � � t� Fa ( )765-9502 P.O.Box 1179 Southold,NY 11971-0959 , BUILDING DEPARTMENT ' TOWN OF SOUTHOLD JUN RENTAL PERMIT APPLICATION Rental Permit Fee $200 (Application must be renewed every two years pp d Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION -BLOCKm G -LOT SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: Qz� _ 176 �, � o 6 � Emer enc yTele hone Number ts): Da time L-(!�Evenin Property Owner Email Address: L20, b('41)C.vX Page 1 of 5 Town Hall Annex' ;: Telephone(631)765-1802 54375 Main Road d,P Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 m p IpI app yy m''Iy'I ( f 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 3.%v�ning_, ..Emergent' ' ........ Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: _ ww 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 � i �� To. t �wr+� 1 1 rciailaaa 1 t 1! SCJ;` ;44;!73 Mo,,Idp'b v,*91v r FAA(011765-9542 P'0' x 1179 �"�� f Mailing Addre.�s of Managing Wit• ` .o N .,. Tel e1911t]ft@ LIRT f(S}:Z2 1 �� µ + s ierslri 4 Emer e17 , . „ Email SEC'ftON F. PROPERTY DE [ ON: Number of Rental Dwelling,Ut*s on PfOPes tjr. For each Rental Dwelling Unit set'forth the Real pwellilg Unit Identifier(for example, Unit 1.,Unit 2,,Unh 3 or Apt A,E>fi);the us#of each room In the Relttal Dwelling Unit (for example,Kitchen,Bedmrorn 1, Bedroom 2,Uvin m)and tl*dirnenslons of each room, For properties with Multiple ttental oweftk units lyse"Renal Permit Applicat.16n Addendum," On ma, 11 Rental Dwelling Unit IdeollRer, t i n Requ>`sW Maximum number of persons all �arert too icy i �e�il��R l�J1dit � Number of rooms In Rental Owelling .�- Use ar d Nmewilons of e4a room In Rentat Dwelling Unit.,,,', yy w M d Kiri+ I Y Page 3 o7 S Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 � Southold,NY 11971-0959 10 �,,. 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 rCXI 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) 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 V", Town Hall Annex Telephone(631)765-1802 631 54375 Main Road Fax� �� ( )765-9502 P.O.Box 1179 G Southold,NY 11971-0959 r - ru fV o BUILDING DEPARTMENT "SUN 2 TOWN OF SOUT OLD 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: . Property Owner's Signature: Sworn to before me this day of ��.. - Official Notary Public Signature a riginal Notary Stamp MICHAEL M. CAPASSO NOTARY PUBLIC,STATE OF NEW YORK N0.02CA478O44I OLNAVIEO IN SUFFOLK COUNTY CO MMISSION EXPIRES APRIL 30,120 Page 5 of 5 TelphW1 (631)765-1802 y(fin#1)765-9502 Town Hall Annex " 543,73-Main Road P,.0:""B6x 1,179 "" Sold WY 1197 111939 SPARTMENT OF Iw T:n RENTAL PRpPERTY CERTIFICATION Form rs to be ` o 1� ejer or licensed home inspector by wrrri ls` ed� ` etch ib ena tt Qwelbng unit I RLX J opr j blSerCy SC TM I( �finer, U �/�: �/ '� ,,,�±ai ,,,, `s i ";;" % ,c," � �,,,.. � / rel %/%/✓//�, �✓ ��,��. / i �„ �� i ; r �i .��✓, ,��,.� ,,," ., i ilii %/; i✓�/�� ✓�✓%��%.. <,/"- i� i Via, ;{ 1L, ;n ,, l" �y�..'.�,�,��..��r��dT''�„ s,T"„i"",,,,,;; /i�i�,,, " ,;,< .,,,,,,:� /�/ i „i i��✓�✓�lir: �,/,,,� /o ,,, ,/// ��.. �$1 �1`ie'��S �Ff/ i��i, r„ �,,,, ;,, ,� iii i��✓iii � ,,,, �� //; /%✓ �✓��✓/��/✓� /,,; ,,, ,,,. //iii l/,i iiiiiG/,,,,a c%//;, i i o"; �,,. ,,,,,ii ��a3 ,,, �. „r � � ; /l ✓/ ✓D//,�� „, „%„ i i/ i,,,irk /. i i, ,i ",,,,< ,;,"� ,:. 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[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] FINAL9Allwt,--- FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMA S-0 T01-1�DATE 1161014 INSPECTOR NEW Y — . „. k F 1,0-00 y w .. ..�t .. �.. -T0,H. M.. a r Lh US 9 µ mm w I ° 6 Z oc`5 I_ a v m. i a �' �_. . f,4(b a o O o ° o CD m m ? LL a Ln D `� CD Ln. Arm CD fb �3 v v V — h d i f or �� z d " _ W " lk Dq CD , 0 4 :r m T lk, �^ m re m Q O n r T� Z Z Z �p D -C 0 { } m m o 70 1 Q W r Ll o " n r " I( r -— O G� m m p x x "' t w.� L L In 0 O O C6 w 19i W 14 10, r 6j'r� N Qlk 41, co 71 cl i d � b 1 6 i M �( fG Q p (D N Np ... .... ..... ,.,.. ,,,, .. m r. o °o 0° o °o 3M. -(n m o CD m Ln • �R" " Town of Southold 4/11/2019 & F 53095 Main Rd Southold,New York 11971 � f PRE EXISTING CERTIFICATE OF OCCUPANCY No: 40309 Date: 4/11/2019 THIS CERTIFIES that the structure(s)located at: 2490 Bray Ave,Laurel SCTM#: 473889 Sec/Block/Lot: 126.40-4 Subdivision: Filed ...Map No. Lot No. conforms substantially to the requirements for a built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 40309 dated 4/11/2019 was issued and conforms to all the requriements of the applicable provisions of the law. The occupancy for which this certificate is issued is: wood [r me one family dwelling with enclosed orclr.* Note:BP 2680 addition to dwelling COZ-3085 The certificate is issued to Vickary,Margaret&Vickary, Sarah (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. t �..... . _ � cr laor• ,,e S ignature BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 2490 Bray Ave,Laurel SUFF.CO.TAX MAP NO.: 126.-10-4 _. SUBDIVISION: NAME OF OWNER(S): Vickary Margaret&Vicka� ........ ..�� g ry, Sarah OCCUPANCY: ADMITTED BY: SOURCE OF REQUEST: Vickary,Margaret DATE: 4/11/2019 DWELLING: #STORIES: 1 #EXITS: 2 FOUNDATION: cement CELLAR: partial CRAWL SPACE: x ... _... o ............... BATHROOM(S): 1. TOILET ROOM(S): UTILITY ROOM(S): _ _... � PORCH TYPE: enclosed porch DECK TYPE: PATIO TYPE: BREEZEWAY: FIREPLACE: 1 GARAGE: ................... __ ............. .... _ . DOMESTIC HOTWATER: yes TYPE HEATER: electric AIR CONDITIONING TYPE HEAT: gas WARM AIR: wall furnace HOT WATER: #BEDROOMS 3 #KITCHENS ... 1 BASEMENT TYPE: unfinished OTHER: ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: .............. SWIMMING POOL: GUEST,TYPE OF CONST: OTHER: VIOLATIONS: REMARKS: INSPECTED BY: JOHNJ DATE OF INSPECTION: 4/4/2019 TIME START: 10:10am END: 10:35am FORM NO. 4 TOWN OF SOUTHOILD BUILDING DEPARTMENT TOWN CL'ERK'S OFFICE SOUTHOLD. N. Y. wo ��ns CERTIFICATE OF OCCUPANCY No. . . Z .25.86. . Date . . . . . . . . . . . . . . . . ., 19. .65 THIS CERTIFIES that the building located at PAY.AYt'4'M0. . . . . . . . . . . . . . . Street Map No. . .)=. . . . . . Block No. X=. . . . .. .Lot No. .fit* tt1 C r. .�`i.,'9P.. . . . . . . I . conforms substantially to the Application for Building Permit heretofore filed in this -office dated . . . . . ..5*Tt0M"Q0X . . . ., 19.6 pursuant to which Building Permit No. . .28.60Z. dated .. . . . ► �p�".k'A1 � „�,�.. . . ., 19.6,5., 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 t;*. -P0. -94M41y-C�MX *t'91 . . , . . , .. ... . . . . . . . . . The certificate is issued to . . . . . I+ l3 8ir•VA'A)Ax. .. . . .. . . . .. . . I . ...... ._ , , , , . . . (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval . . . . . .. . . . .. . . .. , . . , . . , , . . . . . . . . , . Building Inspec r Town of Southold 10/20/2020 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CEIITIFICATE OF OCCUPANCY No: 41543 Date: 10/20/2020 THIS CERTIFIES that the building ALTERATION Location of Property: 2490 Bray Ave, Laurel SCTM#: 473889 Sec/Block/Lot: 126.-10-4 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/23/2019 pursuant to which Building Permit No. 43822 dated 5/31/2019 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: inferior alterations including bathrooms and kitchen to an existing e-f milt' welling s applied for. The certificate is issued to Bohlen,Lynn of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43822 8/27/2020 PLUMBERS CERTIFICATION DATED 8/13/2020 R ohien Au 0r" e Signature