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HomeMy WebLinkAbout1000-53.-4-10 TOWN OF S p Rental Permit �d n 0608 Owner Brandvold MK Irr Liv Trt Occupied as Single Family Dwelling Located at 1955 Bay Shore Road Greenport 53-4-10 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. 3/21/2022 ode Enforcement Official This Notice must be pasted by the main entrance at all times Y > 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 PERMIT APPLICATION - Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address:_ q Tax Map Number: 1000 SECTION 13 -BLOCK -LOT © - SECTION B. OWNER INFORMATION: M+0_i e,u 13 RQ-uD ra�.e Property Owner Name: klmrl"O Property Owner Legal Address: Property Owner Mailing Address: �6 Glm«Q &TT'� 1� km1 _ 911 Telephone Number(s): Daytime 4"9-1 It Evening1►13211 Emergency it- 7_11 Property Owner Email Address: el I �i ������ � , a Page 1 of ( ' 5 Town Hall Annex = Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 CC P.O.Box 1 179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Age Telephone Number(s): Daytime Evening EmergenC 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: Useer and Dimensions of each room in Rental Dwelling Unit: A4 t� Page 3 of 5 V e-U Town Hall Annex Telephone(631)765-1802 54375 Main Road �� � Fax(631)765-9502 P.O.Box 1 179 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 ❑ 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. STATE OF NEW YORK) ) COUN TY OF SUFFOLK) 1 �— 6 ��I� 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 1179 Southold,NY 11971-0959 s 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 this ay of f' Ck4vt, , 202-1 Official Notary Public ` nature and Original Notary Stamp Kathryn A.Brandvold NOTARY PUBLIC,STATE OF NEW YORK Regisnation No.OIBR6410075 Qualified in Nassau Coumy Commission Expires 10113120',9, Page 5 of 5 tlf t7T, TOWN OF SOUTHOLD BUILDING DEPT. INSPECTION 1 PENETRATIONI FOUNDATION 1ST ROUGH PLEIG. FOUNDATION 2ND INSULATIOWCAULKING FRAMING/STRAPPING FINAL FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION FIRE RESISTANT CONSTRUCTION FIRE RESISTANT ELECTRICAL (ROUGH) ELECTRICAL (FINAL) CODE VIOLATION PRE C/O REMARKS: a � c DATE l ilk lett- Pow x Z) rjJ Q '�A �- Tol-M rl �,a. (2k� ykar� I t s fl c ,►� s � tv A4 t TOWN OF SOUTHO D PROPERTY REC( OWNER %d� " STREET VILLAGE m ,. ,�� j ... . �.� _..... .u.LU_F . _......... .. FORMER UWNER N E ACR, ......---- S TYPE OF.._B.._UI.L.D...I,.NGW RES SEASVL. FARM COMM. CB. MISC. . ...�_ ._,,,. ...�. ..a_ Mkt. Value �� �.._ �__w. ,..., _..m.. ... ,.___.._.www._ _.....p_. __m_..., _..._._...._...M_MM.....__......__,_....... _ ,_ ........ ;........r _. _._._.,_...._, . ...._..__... LAND IMP, TOTAL DATE REMARKS 1 � v e — t 19 7 rr pN ✓ a �, „v n � � � Gs"ti��C� ✓ � 117 �'#.7 �,��� t !(i^�v^� �� "�^ r,, � % N ..�,:�.�. � i ?,�. �"� ,� 0 ,��.. ' °"d�°. �,:._.��.. ' ., ..._� ,,.�.,,..�... _jk5 12r AGE BUILDING CONDITION N,EW._....__._„�.._.. ._...N-ORMAL BELOW ABOVE.._.. 7.,� ,. j _ FARM.... .........__._ Acremm_._aa..., Value Per q 59 AcreValue,,. Tillable 1 Tillable 2 1 _. _. ,...._..._ .,....._ M.._.. . m,........ _ ...w .... _._. .._ _. Tillable 3 Woodland w. Swampland _...,_..,. GE.ON WATER � ✓ � ��,J .w . .:.FRONTAGE ._.._ .....; _..,.... :,_....... ._.,_,,._. __.,._. .... m,.,......._.,_ .. _. ,...... _._..,_. _ .. Brushland FRONTAGE ON ROAD House Plot DEPTH �..t ..___-_.__. _._..._...._...._... .. .. ........_ _....M . _. ........ ... ._ ... .,,_._.__...._ .............. _. ............ __..._.._ ., . BULKHEAD ..,.,. � _..._MM...m..._„ Total COLOR dl T a 7 YWq`M Gf Jl.� Y�fYwi'Y➢" �' 7�F� r TRIM ..Y / F r i ISP Y� iDW dM 1 1 2SU �'.. 53.-4-10 3/13 CjC , 1st 2nd 2, PC 3 _ ....Foundation _ c_ tsca MMM.Bath._ Dinette FULL COMBO Extension BasementGRAwL .�. Floors Kit. SLAB Finished ._......_.. .... _ .. _ In 7i l�S� or Finish L.R. xt4n !on �M ._ _ ...._ � .�_.,.mm__ tenor ___.... _... .._....._. .u. .a Extension Heat D.R. Fire Place "" �,,. .�...�.M_M _ age mss .. �-� Ext. Walls BR. � � � l � ""� , . ,...._,M a_�.. . .--Dormer .. ......,.._ —------------M_._.....MM__ __._. _ _..__. Baths. w_ Dec �� Fam. Rm. 09 �, "... Foyer � A.C. Laundry O.B. Library/ study Dock ¢ t w COU R n� 1 � TRIM r,_��M ,,.... w��m»,;n,niromu Nd// � i � r �� ,"�i,s 7°"'r'M >rt ✓(/°� !�: '�i �� �� f�.wl �i.ed ...,.,.,�� a,r,„�,m Ma ..,«,,„a,,, ,. ,. .,,,,., ., � ., ,. w,... r i �j/erahy.,���� r� ru ��/ev � �rr�a � 1�)i r ✓e�X�w / �r���/jDir"� ,.q � l e ✓r� wrG�ENefi✓� _. f �' _...�:...._�_, ����.».�...,�.'»,..�.�..�. �w:�.„• � ..�;�., AMS„ � _� � .� .�, « � ,� j G M Eld� Foundation /1"”, y Both , . .a_ _... .......,.. m inette� Extension 4 r6 ➢' � �a 'rG'ent N I i�D%rte G Extension ,Ext, Walls �o �� Interior Finish 9� '°� LR l Extension F�rc lila a /Ify � Heat r �YPe Roof Rooms lst Floor ' ..._ R Porch Roos Reams 2nd FI a0 � r�w J E3 '� ® .. . . �... �. _ _. .... . . .... .... . . . ... .. _.. _.. '....,� . _ .�..w ., ..�..__ ..,,..�_.. _.. Porch Dormer Baceyewa ,Driveway Garage �a f e Total r FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33382 Date: 11/10/08 THIS CERTIFIES that the building NEW DWELLING Location of Property: 1955 BAY SHORE RD GREENPORT (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No_ 473889 Section 53 Block 4 Lot 10 Subdivision Filed Map No. Lot No_ conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 21, 2006 pursuant to which Building Permit No_ 32526-Z dated NOVEMBER 29, 2006 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 SCREENED PORCH, DECK, SECOND STORY BALCONIES AND ATTACHED ONE CAR GARAGE AS APPLIED FOR PER ZBA # 5516 DATED 4/4/04 AND ZBA# 5851 DATED 4/13/06. The certificate is issued to _JOHN M & MARION BRANDVOLD (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-04-0145 10/08/08 ELECTRICAL CERTIFICATE NO_ 3042145 10!22/07 PLUMBERS CERTIFICATION DATED 11,'08 `07 J ZEES PLUMBING & HEATING h ized Signature Rev. 1/81 _, tltllt' Town of Southold 6/10/2015 P.O.Box 1179 = 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 37596 Date: 6/10/2015 THIS CERTIFIES that the building AS BUILT ALTERATION Location of Property: 1955 Bay Shore Rd, Greenport SCTM#: 473889 Sec/Block/Lot: 53.4-10 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 6/1/2015 pursuant to which Building Permit No. 39819 dated 6/1/2015 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"MINOR ALTERATION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Brandvold,John&Brandvold,Marion of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 37606 02-07-2013 PLUMBERS CERTIFICATION DATED Aut �# Si ;store