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Home My WebLink About1000-25.-2-17.3 n TOWN OF SOUTHOLD 1Y � . Rachel Permit 0589 Owner Jeffrey & Karen Shayne Occupied as Single Family Dwelling Located at 845 Orchard Street Orient 25-2-17.3 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. 2/1/2022 Co e E forc m rpt Official This Notice must be posted by the main entrance at all times 0,97 tf s ' t Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 � � Southold,NY 1 197 1-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD M A R 2 4 2021 RENTAL PERMIT APPLICATION Rental Permit Fee $200(Application must be renewed every two years) Section A. Property Information: Rental Property Address, S `j" 6 R /E N�S Oi?� �A � o S rr�� Tax Map Number: 1000 SECTION o�� -BLOCK LOT l SECTION B. OWNER INFORMATION: Property Owner Name: JEFF " "`P KAI?EN S1 ytj E- Property Owner Legal Address: Property Owner Mailing Address: P. 0, /3ox 33 G "7 Telephone Number (s): Daytime -=o== Property Owner Email Address-. s ati e- 40 Calr^ 1:1 CO's' �rr� iw "M317 Page 1 of 5 r „1" Town Hall Annex �' �;„ Telephone(631)765-1802 54375 Main Road KFax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD w . 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 Evening Emergency Email 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: Address of Managing Agent (no P.O. Boxes): Page 2 of 5 Town Hall Annexa Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 f Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: P-P g'X 334; Dy-le4 5M 241 _ f274� S/* b Telephone Number (s): Daytime venin Emergency f Email Address: V gaYtwe ��"��'1.• CvM SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: O N C 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 Dwelling U it Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: (f 11 4- 191K JO/N Zx 14. Page 3 of 5 Soup Town Hall Annexe Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 w Southold,NY 11971-0959 z .; r 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 ❑ 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. FIxZV A STATE OFN COU NTY.,OF&W,ML ) iN S�' ��• certify under penalty of perjury, the following: 1. 1 am the We caner 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 f{ Telephone(631)765-1802 54375 Main Road " a� Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 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: "j, Property Owner's Signature: S rn to f me thil day of MA*4Ak , 207- 1 . BRYAN J.YARCHAN Notary PubjNc-State of Florida Official Not a lic Signature and Original Notary Stamp , ` Cammf%sion scc 282591 MY Comm.Expires Dec 29,2022 Page 5 of 5 �� ,��n p,✓� �� Ori 765-180211 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL'BG. [ ] FOUNDATION 2ND INSULATIOWCAULKING [ ] FRAMING / STRAPPING [ ] FINALP,,k,, FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O IN P DATE INSPECTOR , y� f r a Ir _ 0 40 a ._ _ t a — . — I Ilk, 1,2 LEa _ v S Ip- ,411 - it 3 iCl s t } T1 ; WE 33 �"� �• � ' �� .tom- � �f { Town of Southold 3/17/2020 53095 Main Rd CM Southold,New York 11971 4' ................... PRE EXISTING CERTIFICATE OF OCCUPANCY No: 41150 Date: 3/17/2020 THIS CERTIFIES that the structure(s)located at: 845 Orchard St, Orient SCTM#: 473889 See/Block/Lot: 25.-2-17.3 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- 41150 dated 3/17/2020 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 Pray pane famfly_ llin_g..witfont covered Qjch and ac Notes:BP 6502 shed QQ 70,BEP 9 _ad4 Ljoja lteratt1j1dingQQZ-l030jL.BP 18659..fire"rCP'1irq to veli n Q( "44777 jssue�L-3/10/202Q _ �')Z: )pgn 131 aq iLigLound sE:i The certificate is issued to Wysocki Jr,William ........--.......... ..... ..... (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT, itho z d Signature BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION RE PORT LOCATION: 845 Orchard St,Orient _ SUFF.CO.TAX MAP NO.. 25.-2-17.3... SUBDIVISION: .w..�.. m _._ .. SION: NAME OF OWNER(S): W ysocki Jr,William OCCUPANCY: ADMITTEDBYE...........��................ ��... �_,,.n u.,-.......... ....��..._ SOURCE OF REQUEST: Wysocki Jr,William D... ��-...._ ATE: 3/17/2020 DWELLING: #STORIES: 2 #E" I"t"ITS*"\ 3 O c � � OCELLAR:� full CRAWL SPACE FOUNDATION: �" cement block BAT 1 TOILET ROOMS 1 UTILITY ROOM(S): PORICIRHOO ES : ... ------ ......�. .. 6 eoeeporch DECK TYPE: PATIO TYPE: BREEZEWAY: .................._r,,, _..- .�,.._m _a`....I...�.-...,.__..�. �_.._ ._.....�..._� ,._ FIREPLACE: 1 GARAGE: DOMESTIC HOTWATER: _..... ...._ _��. -.-..._..��... �..�..-., .._. _ y TYPE HEATER: natural gas AIR CONDITIONING: TYPE HEAT: _ ............... H. r OT WATER: steam #BEDROOMS: """ 4 KITCHENS �, : 1 BASEMENT TYPE: unfinished .Mme........_ ..A.......e.�d ._�,. OTHER: o.,e.., ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: wood frame STORAGE,TYPE OF CONST: ,�... .........W_.�. w�..._._....._ �� . SWIMMING POOL: GUEST,TYPE OF CONST: OTHER: ..�.m ,_ ...... ..��...�_��_...._ VIOLATIONS: l REMARKS: INSPECTED BY: JOHNJ DATE OF INSPECTION: 3/16/202„0 - TIME START: 2:16pm END: 2:30ppa FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z19235 Date JULY 24 1990 THIS CERTIFIES that the building REPAIR Location of Property 845 ORCHARD ST. ORIENT House No. Street Hamlet County Tax Map No. 1000 Section 025 Block 002 Lot 17.3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated-NOV". 15,, 1989 _____.pursuant to which Building Permit No. 18659Z dated NOV. 21, 1989 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 REPAIR EXISTING ONE FAMILY DWELLING DAMAGED BY FIRE. The certificate is issued to WILLIAM L. WYSOCKI JR. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N127779 MAY 10, 1990 PLUMBERS CERTIFICATION DATED KING PLUMBING & HEATING APRIL 9, 1990 Building Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z 7.0 . . , . . Date April . . . 22 19 7� THIS CERTIFIES that the building located at . . .9rchard. .St. . . . . . . . . . . . . Street Map No. .?x . . . . . . . . Block No. . .?x . . . . .Lot No. . . , . . . . .0rient. . N*Y... . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . . .Arir1l. . 17 19.73. pursuant to which Building Permit No. fi p2Z. dated . . . . . . . . April 20 19. ?3, 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 .Acc®s sort'. P3 4. 4P9. . . , . . . . . . . . . . . . . . . . . . „ . . . , .. , The certificate is issued to . .Williams ,Wysocki Sr „ .owner. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval �il, : UNDERWRITERS CERTIFICATE No. I.. . . . . . . . . . HOUSE NUMBER . . . .845. . . . . . Street . . Orchard M5t . . . . . . . Building Inspector FORM NO.4 ;,.0 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. . . . 210301. . . , . . . Date Deodmber, 15, . . . . . . . . 19 80 THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property45 .Orchard Street t . . . . . ... . . Orient. . . . . . House!U'o. . . . . Street Hamlet County Tax Map No. 1000 Section . . .QF.5. . . . . .Block . . . . 02 . . . . , . .Lot .017,.0.03. . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated 3eptember. .15,..15, 19 .75 pursuant to which Building Permit No. . . 8.1.96. L. . . . . . . . . . . . dated . .5 ePUMber. :15.,. . . . . . . . . . . 19 .7.5 ,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 Structure, ,(Addition axed Alteration). . . . , , . The certificate is issued to . .'I:W-5-Ac1M. Wysocki A, J. : . y - . • , a (owner , of the aforesaid building. Suffolk County Department of Health Approval . . VR. . . . . . . . . . . . . . . . . „ „ . , . „ „ , , . . . . . . .. UNDERWRITERS CERTIFICATE NO.N/R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a . .. . . Building Inspector Rev 4/79 t Town of Southold 10/20/2022 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43519 Date: 10/20/2022 THIS CERTIFIES that the building HVAC Location of Property: 845 Orchard St,Orient SCTM#: 473889 Sec/Block/Lot: 25.-2-17.3 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 10/15/2021 pursuant to which Building Permit No. 47044 dated 10/27/2021 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"HVAC as applied for. The certificate is issued to Shayne,Jeffrey&Karen of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 47044 10/3/2022 PLUMBERS CERTIFICATION DATED Ata �z...d gnatur t Town of Southold 2/1/2022 P.O.Box 1179 53095 Main Rd q ar{ Southold,New York 11971 dip * , CERTIFICATE OF OCCUPANCY No: 42731 Date: 2/1/2022 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 845 Orchard St.,Orient SCTM#: 473889 Sec/Block/Lot: 25.-2-173 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/2/2020 pursuant to which Building Permit No. 44777 dated 3/10/2020 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: paq for.,. The certificate is issued to Shayne,Jeffrey&Karen of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 44777 7/21/2021 PLUMBERS CERTIFICATION DATED Aut tit zed ature