HomeMy WebLinkAbout1000-78.-9-41 gE TOWN OF SOUTHOLD
Rental Permit
0570
Owner Jeremy Lamande
Occupied as Single Family Dwelling
Located at 480 N Bayview Rd. Ext. Southold 78.-9-41
Maximum Permitted Occupancy 7
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.
2/6/2024
jt4X-�//.e�T7
Code for ent WWI
This Notice must be posted by the main entrance at all times
TOWN OF SOUTHOLD BUILDING DI
631 -765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PL13G.
[ ] FOUNDATION 2ND [ ] INSULATION/CAl
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN;
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL. (FII
[ ] CODE VIOLATION [ ] PRE C/O [ I
REMARKS:
0 -0621,
DATE
, .. �,�- INSPECTOR
Town Hall Annex
Town Of Southold 54375 Main Road
,T Rental Inspection Report PO Box 1179
Southold, NY 11971-1179
� ry Tel: 631-765-1802
ez.
... ........... .... _ .._._. .. .. ............... Date
Owner Phone
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.Hamlet .�_ww.__�.. ,.�ww..._.._........_...�..� _ Inspector
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Floor Level QuantitiesSub 1 2 3
......aw a...w� .,_.. �. ...
Smoke Detectors (not located in bedrooms) f
o . .� m ,� _..._ .. _.... ...... . .........
Carbon Monoxide Detectors
Fire Extinguishers
Exits
Bedrooms 1 2 3 4 5 N 6
Smoke Detectors
Egress w oµ
Occupant Count
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I Condition of Property
�Building S ..,...�. �e.,.� .w.. ..�.v . �� .... .. ....a�.
Systems Maintained &Ope rations
Heating Building interior
Hot water
Building exterior.
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Electrical Property clean, maintained &safe
Mechanical . m . Handrails&guards installed &usecureMM
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Pool Safety Pool on Site
w. ...... ......_.... ..... �w. ... .
Surface water alarm Date of CO issuance
,.�.. . ......... ... .�N.._.��� � ���
Door alarmsPool completely enclosed
Self closing latching gates Pool fence to code requirements
C
O's for all items present � �Prior Rental
Comments .......... ......... ...
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Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
BUILDING DEPARTMENT '� � ;� ; I L
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION SEF, 2 2 2021
Rental Permit Fee$200 (Application must be renewed every two years) iP 1 a.
Section A.
Property Information:
Rental Property Address:
q
Tax Map Number: 1000 SECTION - -BLOCK 1 -LOT-41 _-
SECTION B.
OWNER INFORMATION:
Property Owner Name:
Property Owner Legal Address: Property Owner Mailing Address:
4
i��
p
Tele hone Number(s): Daytime 1 I�Evenin Emergency
Property Owner Email Address: Q '
Page 1 of 5
Town Hall Annex Telephone(631)765-1802
54375 Main Road j� � Fax(631)765-9502
P.O.Box 1179 ;u
Southold,NY 11971-0959 w '
1t IFa
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Section C.
Authorized Agent Information: �r
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 Emergenwcy
Email Address:
Section D.
Managing Agent Information: N�
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) N�
Name of Managing Agent of dwelling unit, if any:
Address of Managing Agent (no P.O. Boxes):
Page 2 of 5
Town Hall Annex 1 °, Telephone(631)765-1802
54375 Main Road 'rJ Fax(631)765-9502
� `
P.O.Box 1 179 '"F � p!
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.
I am requesting a fire safety inspection to be performed by a Code Enforcement Official
from the Town of Southold
❑ Vam 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
Town Hall Annex p 4 Telephone(631)765-1802
54375 Main Roads Fax(631)765-9502
P.O.Box 1179 " 4
Southold,NY 11971-0959 �r
BUILDING DEPARTMENT
TOWN OF SO HOLD
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 a' 4(j 20�
Official Nota r
blic Signature an riginal Notary Stamp
TRACEY L. DWYER
NOTARY PUBLIC,STATE OF NEW YORK
NO.01 DW6306900
QUALIFIED IN SUFFOLK COUNTY
COMMISSION EXPIRES JUNE 30,2-2—Pa
Page 5 of 5
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1 179 fr
Southold,NY 1 1 971-0959 u " p41
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, 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: �UYY1\� wl \
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:
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TOWN AFOUTHOLD
coufffl, 765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] INAL' `
[ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
o�n
DATE 177
1 st Floor
24' 17'
cfl
Kitchen Dining Room
00
77 Bathroom 1
Key
a
Carbon Monoxide Detector Living Room
Bedroom 1
p Smoke Detector ,5•
14' 15'
2nd Floor
14' 11.5' 9.7'
3.4' Closet
_. .� Bathroom 10'
8.4'
Landing �..�
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cV V
Bedroom 3
11' Bedroom 2
Key
Carbon Monoxide Detector
q
3
S
p Smoke Detector
21' 15'
Basement Floor 20.5' 19.5'
Unfinished Basement Family Room
l� Same smoke detector
N as indicated on the 1st Finished Basement iN
floor stairs to the -�
basement _ V
�w
Key
Carbon Monoxide Detector
Mechanicals Den
O Smoke Detector 7' y�
8.5' 24.5'
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�. Town of Southold 3/7/2015
P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 37460 Date: 3/6/2015
THIS CERTIFIES that the building RESIDENTIAL ALTERATION
Location of Property: 480 N Bayview Road Ext, Southold,
SCTM#: 473889 Sec/Block/Lot: 78.-9-41
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
8/1/2014 pursuant to which Building Permit No. 39161 dated 9/9/2014
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:
partially_finishl aanertt berlroom and aal�a rcacm ire an existirr ,ne frail dellaa�ulied for.
The certificate is issued to Jackson,Christopher&Jackson,Kara
_.................................. .__— .... . .
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 39161 3/4/2015
PLUMBERS CERTIFICATION DATED
r
t 4
FORM No.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
"W
29769 Date November.30 19 79
THIS CERTIFIES that the building . . , . . , . . . . . . . . . . . . . . . . . . • • . . . .
Location of Property 480 NO. B ,YVP wt Fact. w . . . . . . . . . . .Southoldt, N.Y.
Hrau a H , Street Hamlet
County Tax Map No. 1000 Section . . .0Ta. , . . . .Block . • . .9. , . . • • , . . .Lot . . • . • .41. . . .
Subdivision. . . . . . . . . . . . . . . . . » , . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
t' 13'f Z
.'�Eto'�, 2$ . . . . . . . . . 1q7. .pursuant to which Building Permit No. . . . .�. . . . . . . . . . . .
dated . Merch 29, , , , , , , , , , , , , , , , , 1977 ,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 . . . , . .
13
'�vae. Ono. ?-Y Dwellinm. . .
The certificate is issued to . . . . . . . . . . . . . . Nort.e. SUftor. » . . . . . . . . . . . . . . . . . . . .
Owner,�
of the aforesaid building.
Suffolk County Department of Health Approval Vi.11a .
UNDERWRITERS CERTIFICATE NO. . . , . . . . . . . .3569��!
Building Inspector
Rev 4/79
6
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold,N.Y.
Certificate Of Occupancy
No. . . . ,Z-.1.5.2.9 6. Date . . . F.ebrua.ry. 24 '» 19.8.7
. . . » . . .
THIS CERTIFIES that the building . „ . S t a i n l e s s St. . . . el *Chimney & Wood .Stove.
Location of Property 480 North Bayview Road Southold, New York
House%110. Street `amtet
County Tax Map No. 1000 Section . . . . . . .8 . . . .Block . . .9 . . . . , . . , » . .Lot . . . .4.1. . . . . . . . . . .
Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
October 31 , 1986 15460 - Z
. . . . . . . . . . » . . . . . . . . . . , pursuant to which Building Permit No. . . . . . . . . . . . . . . . . . . . . .
dated . . ..
October 3 1 , 19. 6 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 , . . . . . . . .
STAINLESS STEEL CHIMNEY & WOOD STOVE
The certificate is issued to . . . . . . K A RE L & L.A U R I E Z MR Z L I K . » . . . »
r. +� � ',�jie�r3ir�F,�{. , » . . . , . , . .
(owner;
of the aforesaid building.
Suffolk County Department of Health Approval . . . » . . . . . . .N . . . . . I . — . . . . . .. . . . . . . . . . .
UNDERWRITERS CERTIFICATE NO. . .. . . . . . . . . . . . . . . ./. . . . . . . . . . . . . . . . . . . . . . .. . . . . .
PLUMBERS CERTIFICATION DATED: N/A
1
.�. . . . . . . . . . . . . . .
it ing 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-17870 Date MARCH 22 1989
THIS CERTIFIES that the building ACCESSORY
Location of Property480 NORTH BAYVIEW ROAD SOUTHOLD, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section78 Block Lot,
41
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 8 1980 ___pursuant to which
Building Permit No. 10821-Z datedAUGUST 8, 1980
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 ACCESSORY STORAGE BUILDING
The certificate is issued to LAURIE B. & KAREL ZMRZLIK
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NLA
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED NLA
rdl(ig Inspector
Rev. 1/81
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-32013 Date: 11/17/06
THIS CERTIFIES that the building ADDITION
Location of Property: 480 NORTH BAYVIEW RD EXT SOUTHOLD
(HOUSE NO. ) (STREET) (HAMLET)
County Tax flap No. 473889 Section 78 Block 9 Lot 41
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 16, 2006 pursuant to which
g dated OCTOBER 23, 200
Building Permit No. 3'2444-Z
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 "AS BUILT" DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED
FOR,
The certificate is issued to KAREL & LAURIE B ZMRLIK
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. NIPA_,
PLUMBERS CERTIFICATION DATED N A
or" ed ignature
Rev. 1/81
� t Town of Southold Annex 7/11/2012
P.O.Box 1179
54375 Main Road
6 Southold, New York 11971
,o
CERTIFICATE OF OCCUPANCY
No: 35816 Date: 7/11/2012
THIS CERTIFIES that the building AS BUILT ALTERATION
Location of Property: 480 N Bayview Road Ext, Southold,
SCTM#: 473889 Sec/Block/Lot: 78.-9-41
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this otFiced dated
5/30/2012 pursuant to which Building Permit No. 37313 dated 6/20/2012
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:
"as built"bedroom in unfinished basement and"as built" second floor mmalterations in an exis.t.i ag orae 1`a it Agtjin
a 1 or..
The certificate is issued to Hanlon,Robert&Frankel,Jessica
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 37313 6/25/12
PLUMBERS CERTIFICATION DATED
Authc i arc
Town of Southold 3/7/2015
P.O.Box 1179
53095 Main Rd
Southold,New York 11971
SOIL
CERTIFICATE OF OCCUPANCY
No: 37460 Date: 3/6/2015
THIS CERTIFIES that the building RESIDENTIAL ALTERATION
Location of Property: 480 N Bayview Road Ext, Southold,
SCTM#: 473889 Sec/Block/Lot: 78.-9-41
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
8/1/2014 pursuant to which Building Permit No. 39161 dated 9/9/2014
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:
pg1lially.finished basement ria and media room in an existin ogre Tamil dwellinas a laud.for.
The certificate is issued to Jackson,Christopher&Jackson,Kara
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 39161 3/4/2015
PLUMBERS CERTIFICATION DATED
jut 4Si Lure