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HomeMy WebLinkAbout1000-50.-3-2 4
£ TOWN OF SOUTHOLD
Rental Permit
z
# 0603
Owner Spencer Weinmann
Occupied as Single Family Dwelling
Located at 3075 Lighthouse Road Southold 50.-3-2
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.
4/21/2023 / %
cue fog official
This Notice must be posted by the main entrance at all times
9 �4
Yq�mr'ot'�&
ow OU46N
ILD BUILDING DEPT.
631-765-1802
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INSPECTION ,
FOUNDATION 1ST ROUGH PL13G.
FOUNDATION 2ND INSULATION/CAULKING
FRAMING / STRAPPING FINAL
FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION
FIRE RESISTANT CONSTRUCTION
FIRE RESISTANT PENETRATION
ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
CODE VIOLATION PRE C/O RENTAL
REMA S:
V
DATE
Cad i ► ss
u
Town Hall Annexa Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
r. _^u
BUILDING DEPARTMENTAN
TOWN OF SOUTHOLD
a« „l'k GN"" ik�l l n
RENTAL PERMIT APPLICATION
Rental Permit Fee $200 (Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
. 1 ,
Tax Map Number: 1000 SECTION 0S 12 -BLOCK 0 -LOT 07—
SECTION
ZSECTION B.
OWNER INFORMATION:
Property Owner Name: '�7,> � ' ,.
Property Owner Legal Address: Property Owner Mailing Address:
Telephone Number (s): Daytime_ 'ning Emergency
Property Owner Email Address: WIA 2 L-
Page 1 of 5
Town Hall Annex Telephone(631)765-1802
54375 Main Road � Fax(631)765-9502
P.O.Box 1179 w R5 �y
Southold,NY 11971-0959
0
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
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 Hail Annex Telephone(631)765-1802
54375 Main Road Fax (631)765-9502
P.O.Box 1179 a
Southold,NY 11971-0959
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, Q 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 Unit:
Number of rooms in Rental Dwelling Unit: 6
Use and Dimensions ofeach room in Rental Dwelling Unit:
L4, " ., � , SAIF
Page 3 of 5
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 a
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
/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)
l 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 ��, Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179a
Southold,NY 11971-0959 '��
z amAl f,
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:
Property Owner's Signature: ."
Sworn to before me thiA day of �� . " m , 200
Official Notary Public Signature and Original Notary Stamp
c NNI c . l tr i i
iotat'� 'ubti „State of 5C1
�,��'"Fork
No.�Dliwra1551
iiti d inI tsr J4t2y,C
commission Exp r���,
Page 5 of 5
Town Nall Annex 631 Tele 765-1802
� Telephone( )
54375 Main Road Fax(631)765-9502
P.O.Box 11791
Southold,NY 11971-0959 e2
S
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
i ro essioncrt seal required for architect or Irl ginset licensed theme lns ector must Provide
copy of valid current certi catiron
Rental Property SCTM Number: C. " -2,
Rental Property Address: � Lv - i
Owner/Name: 4
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.)
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 Construc ` Code of New
York State.
Print Name and Title Original Signature
0
Please place profession of�,
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5075 LIGHTHOUSE ROAD
DANIEL J KELLEY AIA , " �
SOUTHOLD NY 11971 ARCHITECT ......✓ D atan B JS
NY 023925 SC SC106 4 FLA AR161237 ......
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390 North Broadway SAO 100 Jarictrra Fu( 16)� � 329
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Phone(518)390,4300
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()RMA,TI0 SERVICE
CERTIFICATE OF OCCUPANCY REPORT
DATE: 3116/2023
TITLE NUMBER: E300-02000769531
PREMISES: 3075 LIGHTHOUSE RD, SOUTHOLD
TAX CLASS: 210
MUNICIPALITY: TOWN OF SOUTHOLD
STATE: NEW YORK
COUNTY: SUFFOLK
DIST: 1000 SECT:050.00
BLOCK: 03.00 LOTS}: 002.000
THE FOLLOWING INFORMATION IS ON FILE WITH THE DEPARTMENT OF BUILDINGS:
CERTIFICATE OF OCCUPANCY FOR NON CONFORMING PREMISES#Z-16197
ISSUED:9/22/1987
PERMIT'#N/1.
O STORY ONE.FAMILY DWELLING, ACCESSORY GARAGE, CONCRETE DRIVEWAY,
HEDGES COMPLETELY AROUND PROPERTY LINES,WOOD GATE
CERTIFICATE OF OCCUPANCY#Z-22528
ISSUED:8117/1993
PERMIT#21465-Z
DECK ADDITION
CERTIFICATE OF OCCUPANCY#Z-22694
ISSUED: 11/4/1993
PERMIT#16881-Z
REPAIRS AND ALTERATIONS
CERTIFICATE OF OCCUPANCY#43918
ISSUED:3/11/2023
PERMIT#45978
NNGROUND SWIMMING POOL FENCED TO CODE
THE pURPO&E Ad- PP*K;,'15 70 PROTIom MAE LEOCCUPANCY INFY E GAL
( LEGAL OCCLp,NCA NOT EEN DETERWNED THIS 416�.SUBMIMED FOR INFORMA'naN PURPOSES�OFINL'„
.,;. DEPARTMENT,
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OrrICE OF BUILDING INSPECTOR
TOWN IIA.L.L
SOUTHOLD, NEW YORK
CERTIFICATE,OP OCCUp�1.NCY
NONCONFORMLNG PREMISES
'`�/✓/ T2US IS TO CrItTIFY that the
'Land1di�Q(s),, Pre
Date- SSeptember 22., 1987
2-1b 197
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F1 usefs)
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1 located 3t 3075 i�hthoase Roed ark
� �..�..� ,.....��� ,,.. 3a.'�tho8ri, New 2 J
„ of et
°- 6�wa'crtlet
1 t n sbcIIvn an County tax map as District l000, section 150 Block 03
i
f,/i
Lot 02does(110t%eanform to the present Building Zone Code of the
Town of Southold for the following reasons:
x
_. Insuffici.ent total area; front *ard set hack; aidard set-back on
Accessary garage
On the basis of information,presented to the Building Inspector's Office
U
it has been determined that the above nonconforming l XJ Land 1 XJ Building(s)
1 Useis) existed on the effective date the.present Building Zbae Cale of the
Tonin of Southold, and may be continued pursuant to and subject to'he 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 Certif'i-
nate is issued is as foLo�vs: t`ropettl c-O tains 7, yt"L one Mall sroun 6 ra ad
framed dweliiu ; Accessory tafv Cea tAtA drive;,hedges tootiletelf axpta�+mray
gg
lines; wood.'gat e;'All: ait ted to 'A" id,�nmt.,w.#1 AST"iiiu,tA�-+,x,',a�.ca�»awm„rr,I„,. C, ,cam-co '.
Gti �huge Rood; a Iwn saintai.ned goad
nW .
ROBERT R.R. REILLY
The Certificate is issue � '
y (otvner.
' of the aforesaid building.'
Suffolk Caanty Department aE Iiealt]a APP-91-11
UAA
EP,WRITERS,CERTI ICATE NO.
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pfll 0 Iu �C"4 Irl 1*1IQ1 tot tla leis' Iitiensta xct��
tot to f3etercne 't ae pt niisas oo"ply ri �l'app"
raodeinspection �✓� y
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awbtb all of �apliceble
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Tole,OF SOMOLD
Off ice BUUILDING DEPARTWM
the Buildinginspector
Town HaIZ
"Southold
N.Y.
i
�'ICAM
OF OCCUPAI^iCY
" Date AUGUST 17 1993
CERTIF E5 that the
building �I»�
ON
; Locatian of p "
0rty . 3075 IrMTHOUSE 96ADL NEW ?�
Bouse No. Street,
U
/ amlet
County Tax Map ,No_ 1000
Section 50 Block 3 Ir�t 2
—__--,
Subdivision T � Iap"No. Lot NO.
conforms,`substantially to the Application for Bctilding Permit heretofore
t
f404 in thiZ
Office dated JUNE 1 3993 pL ,ant to which
Budding Permi.t`No , X1465- cher JUNE 7 399
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was issued,, and' confo=s to all of the requirements of the applicable/
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provisions of the'law. The occupancy for which this certificate is
1S9ue�d lx 4/J:kC^. WDI-IMON 1v KUSTM ylil S13ilLl[1 JJ[ILLLaLlylltS
AS APPLM FOR
The "certificate is issued"to JAMS D. CLAM L. GREE F-=
, & Cof
(owners)
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of the aforesaid building
SUFFOLK COUNTY DEPARTMENT N/A
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e
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, --Pursuant to wh�.ch
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dated" 1988
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svaslissued, and conforms'tn a3_1 of the-requirements of the applicable
provjsi.ons of the asv. ,The oacupancy, for which this certtfzcate 15
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, issued ss ALTERATIONS' ' 0 EXISTINGFSI y DW=MG AS,
' FON.
'eke C04af1Cate 1s Issued to �
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