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HomeMy WebLinkAbout1000-79.-4-54 fat TOWN OF SOUTHOLD �C* Rental Permit - 0600 Owner Stephen & Rosalie Clements Occupied as Single Family Dwelling Located at 1265 Brigantine Drive Southold 79.4-54 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. 3/11/2024 de E or e t Official This Notice must be posted by the main entrance at all times � i1E s(PCrrq� l �" BUILDING DEPT. TOWN 631-765-1802 1 0' 0 S ww'h �CT I o" N N VE [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING / STRAPPING [ KINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F AL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: k4lC� DATE � INSPECTO g � � TOWN OF SOUTHOLD £ Rental Permit f 0600 Owner Stephen & Rosalie Clements Occupied as Single Family Dwelling Located at 1265 Brigantine Drive Southold 79.-4-54 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. 3/2/2022 C e of c went Official This Notice must be posted by the main entrance at all times Town Hall Annex Telephone(631)765-1802 54375 Main Road � Fax(631)765-9502 P.O.Box 1179 N`r$ Southold,NY 11971-0959 r� BUILDING DEPARTMENT R DEC 2 9 2021 TOWN OF SOUTHOLD BUILDING DEPT. TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: .br r Tax Map Number: 1000 SECTION 0 '7q- XD -BLOCK -LOTOI, - 00 O SECTION B. OWNER INFORMATION: //��.. Property Owner Name: "� ( t..' A Property Owner Legal Address: Property Owner Mailing Address: Telephone Number(s): Daytime Evening Emergency Property Owner Email Address: � . Page 1&5 Town Hall Annexti. Telephone(631)765-1802 54375 Main Road Fax (631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 �qb ti Jd y; OU BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: 6,31- qj!-j,,r- v -7-5-9 Telephone Number (s): Daytime Evening Emergency Email Address: © � G/mMTO-e0IYL- 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 Dwelling Un Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: ihAer) C3 -K 13 /3 ' - ? ` x $ ` 4,11 — �y %'X 3 PAM qW, Page 3 of 5 I e� rh ct S ``K Io 14 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 , �� N � .p Coub 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 3 lephe✓l C me 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 AnnexTelephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 UN 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: � u, (ern Property Owner's Signature: Sworn to before me this -' d y of �ce-,I�j . 20_91— M-P Official Notary Public Signature and Original Notary Stamp t NNIS l •BUNCH Notary public„ ;tate of New York No,01BU6155050 Qualified if!SuffOtk Farll o lt2 cpcX3 (1,0m is";ion Ex Page 5 of 5 TOWN OF SOUTHOLD BUILDING 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] NAL [ ] FIREPLACE & CHIMNEY [ ] FIRESAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: r DATE '149VII INSPECTOR, k 1 µyg f r°C C P V J & i } o� dtWw� e � W -v . r L 0 a me u,P N, F L a r y s SCTM # e. TOWN OF SOUTHOLD PROPERTY RECORD CAR ' OWNER STREET VILLAGE DIST DT 3 ACR. ' REMARKS ` TYPE OF BLD. PROP. CLASS LAND IMP, TOTAL DATE FRONTAGE ON WATER HOUSE/LOT BULKHEAD TOTAL TOWN OFUT HOLD PROPERTY RECON /,f-, WER STREET VILLAGE DIST` SUB. LOT _ DORMER OWNER i' N E i C� E t� S Umii W TYPE OF BUILDING RES SEAS. VL. FARM COMM. CB. MICS. Mkt, Value I LAND IMP. TOTAL DATE REMARKS i A e i i " r 1 - < AGE BUILDING CONDITION -- NEW NORMAL ! BELOW ABOVE FARM Acre Value Per i Value Acre Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD I Meadowland DEPTH House Plot BULKHEAD 1 Toto! DOCK 0 i 9 v� F a .€ s4 € ` ` es a ��k e — — � = € I € 3 3 79.-4-54 1/19/2022 _ _.. . INz a M. Bldg. _ - Extension Extension m o - { Extension t Foundation Bath ` ir,e te f : =Basement ' 'Floors -- K. Porch :Ext. Walls Interior Finish LR. Fire Piace Heat Vin. Garage - x -` Type Roof °Rooms 1st Floor BR. _4 a .Recreation Roomi Rooms 2nd Floor ';' _ 'Dormer Driveway Total j r ri FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office " Southold, N. Y. Certificate Of {occupancy ti i No. Z�7t . . . . . . Date . . . . . . . . . . . . . .J=ArY . . . 7., 19.74. THIS CERTIFIES that the building located at ;Brigant.:W@. PX. . . . . . . . . . . Street Map No11arbor .L1.gh ibck No. . . . . . . . . . .Lot No. Squthold. . N sy*. . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . "aP.t. . 3. . . . ., 19 79 . pursuant to which Building Permit No. 1+939Z. . dated . . . . . . . . .Sept. . . 3 . . . ., 19.7.0., 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 . .PrIYA to. QrIQ. rA1411Y. AVP;.,ling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . ,Samuel . . . .Marca2l Own®r . . . . . . . . , . . , . „ . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval i?e . . .13. . .1!973. . . .by R. Villa UNDERWRITERS CERTIFICATE No. .Pq;14#9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSE NUMBER . . .1.265. . . . . . . Street . . . . Brigantine .Dr . . . . . . . . . . . . . Building Inspector u .......... eq� Town of Southold 7/17/2020 P.O.Box 1179 53095 Main Rd Southold,New York 11971 ........... ................................. CII HFICATE OF OCCUPANCY No: 41259 Date: 7/17/2020 ---------- TIIIS CERTIFIES that the building HVAC ............... ...................... Location of Property: 1265 Brigantine Dr., Southold ..................... ........... ................................. SCTM#: 473889 Sec/Block/Lot: 79.4-54 Subdivision: Filed Map No. Lot No. .. .. . ... ......................................... ........ ........ ........ ... conforms substantially to the Application for Building Permit heretofore filed in this office dated 6/12/2020 pursuant to which Building Permit No. 44908 dated 6/23/2020 .............................. was issued, and conforms to all of the r6quirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: "as built"HVAC a_ s applied forty The certificate is issued to -fhiede,Jeffrey&Kristen of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF]HEALTH APPROVAL ..................... ELECTRICAL CERTIFICATE NO. 44908 7/2/2020 PLUMBERS CERTIFICATION DATED .XA—1i t I i"orii