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Home My WebLink About1000-90.-2-29 TOWN OF SOUTHOLD w � °w Rental Permit 0585 Owner Jesse Clemmens Occupied as Single Family Dwelling Located at 505 Midway Road Southold 90.-2-29 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. 2/27/2024 Code Fero orc r� r��Officio i This Notice must be posted by the main entrance at all times �. 4f so TOWN OF SOUTHOLD BUILDING D' 631 -785-1802 .- INSPEC ION [ ] FOUNDATION 1 ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAt [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN: [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL {FII [ ] CODE VIOLATION [ ] PRE C/O [ REMARKSE DATE 114SPECTOR ~~ } Jan 29, 2024 SU Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION , 9 24 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 Professional seal required Lor Architect or Engineer, licensed tome inspector must Provide copy ofvalid current certification Rental PropertySCTM Number: 1000—g0 -2"Z.4 Rental Property Address: 505 Midway Rd., Southold NY 11971 Owner/Name: Jesse Clemmens 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.) RP(irnc)rn #1 130 soft BpdrooM #R 1,10 Bedroom #2 170 sqft Property Description (Include all improvements indicated on survey) sinale hQme 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. Victor Cornelius III CEO Inspector Print Name and Title ceo# 1216-0283 O"Sinat Please place professional seal: STATE OF NEW YORK Department of State Division of Building Standards and Codes Uniform Fire Prevention and Building Code Educational Program VICTOR CORNELIUS is hereby awarded this Certificate signifying completion of BUILDING CODE OF NEW YORK STATE in the New York State Department of State Code Enforcement Educational Program, totaling 21 hours of instruction, on 2/4/16 John R. Addario, P.E., Director Division of Building Standards and Codes DM t"A I'MEN " This certificate is subject to verification with the BUILDI -(x "rxr'r Department of State Training Record Database STANDARDS ANDC E rri NYS Education Department Sponsor#64 Y o Z TOWN OF SOUTHOLD P, Rental Permit 0585 Owner Jesse Clemmens Occupied as Single Family Dwelling Located at 505 Midway Road Southold 90-2-29 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. 1/27/2022 Enfo cet fficial This Notice must be posted by the main entrance at all times i 1�9 �4�Y0 v4'nA Ilw rv"r Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 d dm�rrtl9��d JV�V �6 fi BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ;� " Rental Permit Fee $200(Application must be renewed every two yrs Section A. Property Information: Rental Property Address: Tax Ma Number: 1000 O 2 --LOT— SECTION LOT - �- Map SECTION � -BLOCK ,.-..__ SECTION B. OWNER INFORMATION: Property Owner Name: �S�F ' Property Owner Legal Address: Property Owner Mailing Address: �� ru�1.�� .� Q_ G4p 3 Telephone Number(s): Daytime �a ° I Evening Emergency S M nr'\ C r\ c l a. Property Owner Email Address: so- Page 1 of 5 /ly Town Hall Annexe Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 518 �t' Southold,NY 11971-0959 pp� BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: w ...._..� o _... ., Address of Authorized Agent (no P.O. Boxes) M. _,. _ ..,. .. . _ . Mailing Address of Authorized Agent: mm,...... Telephone Number (s): Daytime Evening_,...-,-___Emergency,- Email mer erreEmail 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: µ _. Address of Managing Agent (no P.O. Boxes): Page 2 of 5 Town Hali Annex Telephone(631)765-1802 54375 Main Road Fax (631)765-9502 Y.O.Box 1 179 Southold,NY 11971-0959 B� BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent:_ _R-)-h-1 -I - "I — Telephone Number (s): Daytime„ M„ _ 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. Requested Maximum number of persons allowed to occupy Dwellingnit: „yy Number of rooms in Rental Dwelling Unit: . �3� Use and Dimensions of each room in Rental Dwelling Unit:ton, 2— 113 0 S' �11° y 13130 5n 2 -7-114F1 26 Page 3 of 5 I / Town Hall Annexe Telephone(631)765-1802 54375 Main Road v Fax(631)765-9502 P.O.Box 1 179 �a Southold,NY 11971-0959 `e�'i✓r��.,,,.p Biu,,, "", 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 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 NEW YORK) COUNTY OF SUFFOLK) I e sS e d CA (/'3 certify under penalty of perjury, the following: 1. l 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 Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 ...-� P.O.Box 1179 Southold,NY 11971-0959 , "tour BUILDING DEPARTMENT TOWN OF SO'UTHOLD 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. � 6'� �1�M NS Property Owner's Name SSS Property Owner's Signature:.. w Sworn to re r t s7 t y of w � 209/ Ictal No ar ... u I Signature and Notary Stamp g m s� LUIS BATISTA Notary Public-State of New York NO.O1 BA4862723 Qualified In New York untY My pMMIssion Expires Page 5 of 5 f so TOWN OF S UTHOLD, WILDING DEPT. 165-1802 INSPECTION [ ] FOUNDATION 1ST ROUGH PLBG! [ ] FOUNDATION 2ND [ ] INSULATIOWCAULK [ ] FRAMING /STRAPPING [ ] FINA �7zt [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O RE,77m, p DATE �� INSPECTOR July 17, 2021 Town Hall Annex, Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 �� Southold,NY 11971-0959n �� BUILDING DEPARTMENT TOWN OF SOUTHOLD 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 Pto essionol seal required for Architect or Engineer licensed Home 1'n ector mustprovide copy 0 bold current cern icatl'an Rental Property SCTM Number: Rental Property Address: 505 Midwgy Rd. Southold NY 11971 Owner/Name: Jesse Clemmens Rental Dwelling Unit Identifier: - -1 Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1•-100 sq., Bedroom #2-90 sq., etc.) Bedroom #3 130 s f Bedroom #2 130 s ft 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. w " Victor Cornelius III CEO Inspector Print Name and Title ceo# 1216-0283 Orlgirlal Sign r Please place professional seal: a or < < m c - " 34, ,r :m �a } cyst'._ -crsr •. -.. . > -: ,- 1.: . .o . so- x �• t < f - - _ _ - 41 - . - - F < _ c.%14 c114 CY14 _ e > i• / ,r t - - > , ' .�uA p•r mac, ��:i _ -" . _ - f < •r . a •. SM.��,� �rl,e•. Mei a�t� eG� � I ` �• 1 � ()ts't.�'bw•.. fit• � _.. . � � - t ,- I° Pwglu.xt�<<Ar"_i�) � ��I�!d�'•Cr.. �� tr � � p <e {3FC.11. a5o► aM�� _ r e ; m� 4® t r # X , SCTM # _ v TOWN OF SOUTHOLD PROPER! 3, OWNER STREET _, VILLAGE DIST SUB, LOT ACR. REMARKS t AL- s 4 TYPE OF BLD- PR P. LD_PROP. CLASS LAND IMP. TOTAL DATE I FRONTAGE ON WATER HOUSE/LOT i I BULKHEAD TOTAL COLOR TRIM 4 — a QQ' E I - I ` i I 3 a F M. Bldg• ' ' r c-, wl = g Extension I i Extension � Foundation Both N4 Dinette � Porch �p a s a Basement 1 +1 Floors K, t Porch = / 0 2- ' Ext. Walls ¢ r'. Interior Finish LR. Breezeway (Fire Place Heat , DR. Garage Type Roof Rooms 1st Floor BR. Patio Recreation Room Rooms 2nd Floor FIN. B O. B. Dormer Driveway E Tcgal i 1 I ' I 3 STATE OF NEW YORK Department of State Division of Building Standards and Codes Uniform Fire Prevention and Building Code Educational Program VICTOR CORNELIUS is hereby awarded this Certificate signifying completion of BUILDING CODE OF NEW YORK STATE in the New York State Department of State Code Enforcement Educational Program, totaling 21 hours of instruction, on 2/4/16 '4 -` John R. Addario, P.E., Director Division of Building Standards and Codes BUILDING i1 z g'N r This certificate is subject to verification with the M] OF ' E Department of State Training Record Database STANDARDS N CODES ISYS Education Department Sponsor#64 FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z- 1 5312March 1987 No. . . . . . . . . — — . . . Date . . . . . . . . . . . . . . . . . . . . . . » . . „ . . . . „ THIS CERTIFIES that the building , , ONE FAMILY DWELLING WITH ATTACHED WOOD DECKS Location of Property 505 Midway Road Southold,' New York House No. Street Hamlet County Tax Map No. 1000 Section . . .9 0 „ . . . .Block . . . .021 1 1 1 1 . Lot . . .�2 9. . . . . , . . . . . Subdivision , . . . Cedar Beach Park Filed Map No. 9 . . . . .Lot No. P °. ,144 conforms substantially to the Application for Building Permit heretofore filed in this office dated February 19 , ] 9 8 5 pursuant to which Building Permit No. 1 3 8 0 5 2 March 28 , 1985 dated . . . . . . . . . . . . . . . „ . . . . . , . . . , . . , 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 FAMILY DWELLING WITH ATTACHED WOOD DECKS The certificate is issued to . . WINDSWAY BUILDING CORP. . w . . . of the aforesaid building. Suffolk County Department of Health Approval , , , , 10-SO-48 „ . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . , . . . N746732. . . . . . . . . . . . . . . . . February 27 , 1987 PLUMBERS CERTIFICATION DATED: a-4-ct_ . . . . . . . . . . . . . . . . Building Inspector Rev.1/81