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Home My WebLink About1000-75.-1-16 M4V' � TOWN OF SOUTHOLD Rental Permit R _a 0568 e� Owner Baltic Place Inc. Occupied as Single Family Dwelling Located at 43385 Route 25 Peconic 75.-1-16 Maximum Permitted Occupancy 4 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. 12/15/2023 Code fo ce ent Offic` This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD BUILDING D 831 765-1882 ` INSPEC ION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION TND [ ] INSUEATION/CA1 [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN! [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F11 [ ] CODE VIOLATION [ ] PRE C/O [ U e DATE , ' - ? INSPECTOR *, Town Hall Annex TOWN Of Southold54375 Main Road PO Box 1179 Rental Inspection Report Southold, NY 11971-1179 Tel: 631-765-1802 Dat SCTM # - . � � ., ,�_�� ' Date Owner Phone Visible Address Hamlet Inspector Su Floor Level Quantities 2 3 Sub 1 Smoke Detectorsnot located in bedrooms) . .( Carbon Monoxide Detectors Fire Extinguishers Exits xtin uishersExits 2 34 Bedrooms 5 6 1 ,� Smoke Detectors Egress Occupant Count Building Systems Maintained & Operational Condition of Property Heating Building inter-.or Hot water Building exterior Electrical ro� ert clean, maintained safe I Mechanical Handrails& guards installed & secure Pool Safety Pool on Site __. . ... Surface water alarm Date of CO issuance Door alarms Pool com11 pleter rwclo d Self closing/ latching gates Pool fence to code requirements COs for all items emspre sentr Rent Comments: � f TOWN OF SOUTHOLD Rental Permit 0568 Owner Baltic Place Inc. Occupied as Single Family Dwelling Located at 43385 Route 25 Peconic 75-1-16 Maximum Permitted Occupancy 4 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. 12/14/2021 Code of rc e t Official This Notice must be posted by the main entrance at all times *®f SUUpy� Town Hall Annex , ;Telephone(631)765-1802 54375 Main Roadfr-(631)765-9502 P.O.Box 1179 • O J f �"t Southold,NY 11971-0959 qN 2 BUILDING DEPARTMENT TOWN OF SOUTHOLD y °'r'ti .� RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: 43 3 5 �''�,�I N `�� (q I C � i Tax Map Number: 1000 SECTION ��rJ -BLOCK -. -LOT - SECTION B. n OWNER INFORMATION: Property Owner Name: -6ALr i C SL t C - Property Owner Legal Address: Property Owner Mailing Address: J qA- nC "PLA b6 1 N e - rao 1`12 JbI N. a- zoM ETL I f�' _14VR°o Telephone Number(s): Daytime Evening Emergency Property Owner Email Address: Ursa' Q 01ro)VGY1b9 0 • nes' j 1k JAN 2.6 2021 Page 1 of 5 a SOUIy® Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 O Southold,NY 11971-0959 IoDU0 z BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION INSTRUCTIONS Rental Permit Fee $200 (Application must be renewed every two years) The items listed below are required to be submitted with the completed application. ❑ Floor Plans: Floor plans of each Rental Dwelling Unit, please show location of all smoke &carbon monoxide detectors. ❑ Certificates of Occupancy and Pre-Certificates of Occupancy: Certificates of occupancy or Pre-Certificates of Occupancy for each rental dwelling unit. ❑ Certification of Code Compliance(form enclosed): Must be submitted by a license architect or engineer or license home inspector if an inspection by Town of Southold Inspector is declined. ❑ Rental Permit Fee: $200.00 �pF Oft YX Town Hall Annex A 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: N oAl Address of Authorized Agent(no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number(s): Daytime Even in Emergency Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: NDN E Address of Authorized Agent(no P.O. Bo s): Mailing Address of Authorized Agent: Telephone Number(s): Daytime ening 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: N6 Address of Managing Agent (no P.O. Boxes): Page 2 of 5 r�"Of s®ot).." Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 CA P.O.Box 1 179 Southold,NY 11971-0959 OUO, _ BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime Eve 'ng 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: u�sr � s � �TME Requested Maximum number of persons allowed to occupy Dwelling Unit: 4 Number of rooms in Rental Dwelling Unit: 5 PLUS �5AT44 FNZ�72 Use and Dimensions of each room in Rental Dwelling Unit: !_iy l I.) G RM 1.3 (P�x 1'7'60 15E TD ice' f�`D`'�C 12�(r �; tBe 'i . I��TG+-F!✓yl 13 CP X 13-b " � I Cxr"Z) l Z' & e 7e)M F"jrm Rt�-f I D�b�'X Page 3 of 5 I i �oF:s01/��0. . �® fo Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 G Southold,NY 11971-0959 �C®UM`I,�� :. 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 PdeN'1feM h LOTZ 11"t-4 n-- COUNTY OF&WWQ PALM (3 SAe—I+ 1 J 06,4_ under penalty of perjury,the following: 1. 1 am the of ttie'p"roperty°•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 SOUTyo Town Hall Annex ~® l0 Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 �O Southold,NY 11971-0959 O U0,� 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: I& /' � T a ac.Tsc. l� 4 Er -TA . Property Owner's Signature: Ll Sworn to befQ[e me thQ day of v 20 Com` Official Notary Public Signature and Origi otary Stamp STATE OF FLORIDA,COUNTY OF a foregoing Mltd t w��O Belo M, means of hyviCal praim,M or["[online notaftiew this•O� day of r bh -1 who islare personally.. known to me or produord idem o G2 Ty mon — Printed Name:Christine Lewis Page 5 of 5 OF SO//T�o �l�3�s� hT. �# TOWN OF SOUTHOLD BUILDING DEPT. .t,O • a0 Nyco , '' 765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG- [ ] FOUNDATION 2ND : [ ` ] .INSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] INAL�gvv y PV,,K,T- [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: tE> civ 1 11 M JA DATE INSPECTOR 73ui1din�De�arfinetit Aii�lieatiiin AUTHORIZATION (Wh4re the Applicant is not the Owner) residing at__-2OeTlGl - � (Print property owner's name) (Mailing Address) do hereby authorize (Agent) to apply on my behalf to the Southold Building Department_ V V V (Owner's Signature) (Date) (Print Owner's Name) t� +�1 AlC-16 ! ......41 i ° I r1� � I Jo CAI JW 1 0�7J i , o 0 d. ? 1 a C7 Q I I � ! I Ob o c7 � ca ° m A n I Z I I N A • RU- • f -UTHOLM, -ORD, Z '10 STREET Q/ VILLAGE DIST. SUB. LOT J re" 14-D C 0:11 red FORMER 0 N N E ACR. G!' ;q kk S W TYPE OF BUILDING -tA RES. SEAS. VL. FARM OM CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS ko o ';72" 0 0 /0/ 00 S ) A-LmqL0 0-s DOE' q 6-0 3-700 s-ADo 0 IS -T I 6� 72,jig4,o2__ ' 6kk-,q6j ;o /i) AgMj 'e ZeW 2-1 44�� LII-75`71)5K - T_ AGE BUILDING,CONDITIONKao k(o - Bp 0? .53 f?" - Rp-VID va.:�p Fx is:�q Re-ta; Z J. NEW NORMAL BELOW,, ABOVE 176- eq ns-�. pora'k p-e"tkZ1 �_+o Ao_dla L Q 3 G.,4,.1 FARM Acre Value Per Value Acre ,3 qS-jq, j( , q& _�5 Tillable I a 7tog—L 12 777"bW hhU&K '7D 15a Ele, ff, Tillable 2a ap* SH Tillable 3 Tavat 0 SOUTHOLD _S 6a'( -fb .5 6004L 'Y_,)� v Woodland SP-* :S2342 U4_Z09q0 Swampland MAK FRONTAGE ON WATER Brushland I FRONTAGE ON ROAD House Plot DEPTH BULKHEAD K(-1 I bill 1'/d�L')--a ------- Total DOCK WIND pig. _ . ._ , i MINI■■■■ MINI■■■■■ ■■■■■■■■■■■ Y , i , , �I4r 3 • • ■NOON■■ MEMMEMME ■■■■NI1■ ■■■■■■■■■■■ �_ r�: ■■NIr gar ■ 02■■■■■■■�■r�R■ . .. a � ■■■Ni ■ ■I1Ji'iiii��J1J■■ ■■� NI�■i ■■MINI■M■ i■■■i■if M■■ ■■[SGL til■E. ■■■■i'i` i iia■■NI■■■�■■■■■■fJif, �J > F r1 -pr; ■MINI■■■H ii■■ ■■� o■■■roti■i■ y ■■■■iL i■■■■■■ >i■■i■NIi� ►MINI■► ■i■■■EM I!i■■■■UN■■■II■iS` MIN . , :., . . ■■■■■■iR�iii�9�J■i■\\� iii■�!■NI■ No MINI■ ■■i■■i■■■\►Ii ■ii®® ME ME ■■■■■■■■■■i �iii®■■■ Rooms Ist Floor Rooms 2nd • a I r TOV ..:F SOUTHOLD OFFICE OF BUILDING I'_\Sl'I;CTOR TOWN I NLL SOUTHOLD, NEW YORK CERTIFICATE OF OCCUPANCY NONCONFORNIIING PFEJUISES TIIIS IS TO CERTIFY that the Land ' Pre C.O. #- Z-15967 / XI Building(s) Date- 'July 2 1, 1987 Use(s) ]ocated at 43385 Main Road Peconic, New York Street Hamlet shown on County tax map as District 1000, Section 075 , Block 01 Lot 16 does�not?conform to the present Building Zone Code of the Town of Southold for the following reasons: Insufficient total area; non conforming vehicle storage garaee: canvas shop; warehouse On the basis of information presented to the Building Inspector's Office, it has been determined that the above nonconforming /X/Land I V Building(s) /Use(s) existed on the effective date the present Building Zone Code of the Town of Southold, and may be continued pursuant to and subject to the appli- cable provisions of said Code. IT IS FURTHER CERTIFIED that, based upon information presented to the Building Inspector's Office, the occupancy and use for which this Certifi- cate is issued is as follows: Property contains 2 story brick and frame_. one family, apartment; canvas store; truck storage building, one story warehouse; all situated in 'A' Residential Agricultural zone with access to Main Road; a State Highway. The Certificate is issued to FRED WIGHTMAN/CONTRACT VENDEE (X� � gXt7CZ�X of the aforesaid building. Suffolk County Department of Health Approval N/A TjNDERl:!RITEftS CERTIFICATE NO. N/A NOTICE IS IIEREBY GIVEN that the owner of the above premises IMS NOT CO'�:SENTID TO AN INSPECTION of the premises by thb Building Inspec- tor to determine if the premises comply with all applicable ccides and ordin- ances, other than the Buildinrr "Zone Code, and therefore, no such inspection has been conducted. This Certificate, therefore, does not, and is not intended to certify that the premises comply with all other applicable codes and regula- tions. _Y, .. — _:ai'-di::' :n-specEor FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24256 Date APRIL 3, 1996 THIS CERTIFIES that the building ALTERATION Location of Property 43385 ROUTE 25 PXCONIC, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 75 Block 1 Lot 16 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in, this office dated MARCH 10, 1996 pursuant to which Building Permit No. 23318-Z dated MARCH 20, 1996 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 RENOVATE EXISTING RETAIL SPACE 'TO BEAUTY SALON AS APPLIED FOR. The certificate is issued to LORRAINE DUNHUBXR (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. H-049205 - MARCH 22, 1996 PLUMBERS CERTIFICATION DATED N/A �G wilding Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office-of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28559 Date: 07/01/02 THIS CERTIFIES that the building REPAIR Location of Property: 43385 MAIN RD PECONIC (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 75 Block 1 Lot 16 Subdivision Filed Map No. Lot NO. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 10, 2002 pursuant to which Building Permit No. 28447-Z dated JUNE 10, 2002 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 PORCH REPAIR TO EXISTING RETAIL STORE AS APPLIED FOR. The certificate is issued to BALTIC PLACE INC. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A tho zed Signature Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-32009 Date: 11/17/06 THIS CERTIFIES that the building ALTERATIONS Location of Property: 43385 MAIN RD PECONIC (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 75 Block 1 Lot 16 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 7, 2006 pursuant to which Building Permit No. 32348-Z dated SEPTEMBER 7, 2006 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 ALTERATIONS (REPAIRS) TO AN EXISTING STORAGE BARN AS APPLIED FOR. The certificate is issued to BALTIC PLACE, INC. (OWNER) of the aforesaid building. SUFFOLK COUDPI'Y DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Authorized Signature Rev. 1/81