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Home My WebLink About1000-59.-6-25.1 TOWN OF SOUTHOLD Rental Permit �� Et 0619 Owner Joan Griffin Occupied as Seasonal Single Family Dwelling Located at 3075 Kenneys Road Southold 59-6-25.1 Maximum Permitted Occupancy 3 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 C01-nty 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. 4i 12/2022 - ode Official This Notice must be posted by the main entrance at all times 0 rce r Town Hall AnnexU' k 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 6 Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: 3075 1 en11e s R ad outhold Tax Map Number: 1000 SECTION 59 -BLOCK 6 -LOT 25Toan SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: oll "" " - aGriffin oand' p rv1 o ! n � ., �,° Telephone Number(s): Daytime 917-922-2919 Evening917-9?.7-291 gmergency 917-922-2919 Property Owner Email Address: Pagel of 5 Town Flan Annex `+ �'' Telephone(631)765-1802 54375 Main Road �� 4� Fax(631)765-9502 P.O.Box 1179 �� Southold,NY 11971-0959 �' l i BUILDING DEPARTMENT TOWN OF SO THOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: N/A 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: N/A 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) Nalne of Managing Agent of dwelling unit, if any:----NLA-. Address of Managing Agent (no P.O. Boxes): Page 2 of 5 Town Hall Annex ��i �. Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 Y BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: N A Telephone Number(s): Daytime Evening Emergency Email Address: SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: One 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: 3Dj5jKCn " Requested Maximum number of persons allowed to occupy Dwelling Unit: 5 * " Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: Tuning Room 11x1 5,Living Page 3 of 5 Town Hall Annex �, Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 „ rq P.O.Box 1 179 Southold,NY 11971-0959 00 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 M 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 loan Griffin , 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 � W BUILDING DEPARTMENT TOWN OF SOU OLD 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: loan Griffin tr Property Owner's Signature-7Z)4 Sworn to before me this-97 day of Of l Pigtial otary Publict 're a d Original Notary Stamp LORF:`INE KLOPFEP, II ..,Puei x;,5t .r of New York No 113::3270' Qualified in Suffolk County Commission Expires Nov.30, a?OdtS Page 5 of 5 ��auesoury� �O�J 6QVI„`� f� S o� 1 �0✓"VYo�� TOWN OF SOUTIiOLD BUILDING D +cvwnre� 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCA [ ] FRAMING / STRAPPING [ ] FINAL p�,��Kt [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PI [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI [ ] CODE VIOLATION [ ] PRE GO REMARKS: cQ•t� "- 9cAioi A w- Co4 Spa� ..9o.A44, AAoto-1. Ao C, qtt)o,l,o o, A--- (1) 'k-fooeo". omovv DATE N1 INSPECTOR Town Hall Annex Telephone (631)765-1802 54375 Main Road Fax(63 1)765-9502 P.O.Box 1179 Southold,NY 11971-0959 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 Rentol Dwelling Unit Professional seal required,Uo Architect or Engineer ne ln��lpoeggcttogfrrMnyus�tLProvide , licensed Her cop o v�qlldcu�rrentc�ertllc�adon Rental Property SCTIVI Number: I Poo - Rental Property Address: lo-7 Ir 6'1 S EPAD. .5 01- Owner/Name: '-:S!VAA/ 1-19111ali4 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.) ;&e19J-&0.AA t4o, 1 - 1-5-0 4,A '-MV,g4om r4o'S = /00 V'J 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. ° ?.11 0 Print Name and Title Origin S, iture VIA-, a Please place professlona 'Al SG SG i t v a ` O r �Q°rn FP __ \0 U = Srrtake �p - 511"��N� G/ash �oo� (p s Smok elco C.*P%bo Ro0.j F,« PI-twe q110113 AD STI BEET - ' VILLA SUB. LOT GE DISTRICT ee FORMER OWN11- N E ACREAGE iW TYPE OF BUILDING o RES i SEAS. VL. FARM comm. IND. CB, misc. Est. Mkt. Value LAND IMP. TOTAL DATE REMARKS n CD 1i V ij S AGE ILDING CON D!TiQN Ra-ITA9 NEW NORMAL BELOW ABO" 'ef/30 Form i Acre Value Per Acre Value FRONTAGE ON ROAD Tillable 1 1 r,13 U K ij EAA Tillable 2 DOCK Tillable 3 1 Woodland Swampland Brushlar�'cl House Plot Total a o- T c _ E M. Bld g cr ,' Foundation Both .r v a Extension ,y - Basement Floors Extension Ext Walls r Interior Finish ace Pl ` Heat- t,- peat Extension Fire � = a - f a 3 2 Roof Type -- s Porch z Porch Rooms 1st Floor Breezeway ` Patio Rooms 2nd Floor Garage Driveway Dormer o. B. f t 2-A6 APR 20;� MIMI NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Date ..............—........ x......12........, 19,42. THIS CERTIFIES that the building located jtat -W/ e l.. ....... ....... ......., Street Map No. �=............. Block No. .....X=......... Lot No. ---a=........ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....I...................lkrah............ 0.............. 1961— pursuant to which Building Permit No. A13.A.. dated ....."'ar rb.......3,()........ 19..&L., was issued, and conforms to all of the requirements of the applicable provisions of the [ow. The occupancy for which this certificate is issued is ..........................»..................,......».......... This certificate is issued to . .................owner..................... ............................ (owner, lessee or tenant) of the aforesaid building, Building Inspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 4. 3861 . . . . . Date . . . . . . . . . . . . 1.5. . . , ., 19. 10 THIS CERTIFIES that the building located at . .W/3 -Denny -Road • • • • • • • . Street Map No. XX . . . . . . . . . Block No. .= . . . . . .Lot No. .= . . . . . . Bouthold. . . .N.Y.. . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . .1*Y . . . - 11 ., 19. 7.4 pursuant to which Building Permit No.1+744Z . . dated . . . . . . . . .Nay. . . . . 1.1. . . -, 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 . . .Private. one .family. dwelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . .Edwar( . Y*idel. . . . . . . . . .O=er. . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . ,`.R` . . . , „ . . . . . . . . . . . . . . . . . . . Building Inspector w ,w House # 3075 FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4744 Z Dote .................... .........it............., 19...70 Permission is hereby granted to: ...................;j.04.a;WV.. ... ............................S=tvho ................................ to ............ .. ..atm.t1w..w.. .. st1mg' u ........................................... ................................................ ..................................................................... .,.........................I........ at premises located at ..................... ..... ........................................................... .............................................................g Guth o U. ........ .R-44*.......-........................................ . pursuant to application dated .................................... ........�;. ., 19...7(L, and approved by the v Building Inspector. Fee $... Ypp........... Building"inspector " FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23626 Date MAY 11, 1995 THIS CERTIFIES that the building ACCESSORY Location of Property 3075 ILIUMS ROAD SOUTHOLD NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 59 Block 6 Lot 25 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 20, 1973 pursuant to which Building Permit No. 6677—Z dated JUNE 20 1973 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 STORAGE BUILDING AS APPLIED FOR. The certificate is issued to EDWARD & JACQUELINE MAIDEL (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Buil in Inspector Rev. 1/81