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Home My WebLink About1000-9.-9-5 � - TOWN OFSOUTHOLD Rental Permit X . - Permit No. 0309 Owner Charles Carroll Occupied as Single Family Dwelling Located at Reservoir Road Fishers Island 9-9-5 Village S/B/L Maximum Permitted Occupancy 10 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. 6/15/2020 Mike Verity Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times Town Hall Annex k Telephone(631)765-1802 54375 Main Road e "y Pax(631)765-9502 P.O.Box 1179 �,� Southold,NY 11971-0959 �� r' BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200(Application must be renewed every t years) DEC Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION -BLOCK -LOT SECTION B. OWNER INFORMATION: Property Owner Name: L +S �• Property Owner Legal Address: Property Owner Mailing Address: 7` . ," Z— Telephone Number(s): Daytime(2U3)26-7VEvening Emergency L?3 -2!9 -7507 Property Owner Email Address: O-re re c 4 4 ov.e-o m r C� Pagel of 5 Town Hall Annex �,` Telephone(631)765-1802 54375 Main Road " Fax(631)765-9502 a P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUT HOLD 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: N 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:(requlred for rental properties containing 8 or more rental units) Name of Managing Agent of dwelling unit, if any: /V1/1q Address of Managing Agent (no P.O. Boxes):. Page 2 of 5 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 SO JITH01.D 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, 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: U MT- Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: Ial i i Use and Dimensions of each room in Rental Dwelling Unit: 9>'la MSG h1 -- 14 23 S SF 161 23o SF r*ffljL0%f —~ 3*A Par 3 of 5 �Rom § ~ 140 SF 0 jji,1 ow M-- '151 5 r .t r reo, Town Hall Annex Telephone(631)765-1802 f�a 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOLITHOLD 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. ❑ 1 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) ) COUNTY OF SUFFOLK) 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 e4 Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF S+1 U T` SOLD 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 2w1day of � -- r 201 q Official No ary Public Signature and Original Notary Stamp BRADFORDR MCCORMICK Notary Public-State of New York NO.OZMC6214558 Qualified in Bronx County My Commission Expires Apr 7,2022 Page 5 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT 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 Lro esslonal seal required Lor Architect or Engineer,licensed Home Inspector must provide copy of valid current cerci cation Rental Property SCTM Number: lDoo• - 9 Rental Property Address: 1112 s I " Owner/Name: G f• Rental Dwelling Unit Identifier: VPI �. Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1-100 sq., Bedroom#2-90 sq., etc.) l 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. sp 4d• Print Name and Title w ° ' r Original gnature , A" .�� Please place professional seal. "I CN ,IN/ F- a z z 7) ZLI DECK 0 LIVING ROOM (432sqft.) DINING ROOM BEDROOM (145 sq1t) ROOFDECK 7s \) & SCREENED DEN LC-1 COVERED PORCH (180sqft.) KITCHEN BEDROOM 5 (187sqt) (140 sqft.) Uir-i Co CARBON MONOXIDE DETECTOR SECOND LEVEL FLOOR PLAN UNIT 1 SCALE:1/8'=l'-O' SMOKE DETECTOR < zz Ao, E L®! L7}g �3��{ kƒ� V2 � �� \!\A L Y P Z O oN w w Z Z _jQ QZ O F N Z � __... Lu _ li �y J 0, FAMILY ROOM N (376 sqt) BEDROOM 1 co BEDROOM 2 �+w (116 sqft.) (235 sgft.) SD Q GARAGE UTILITY ROOM (253 sgft.) r `g BEDROOM 3 t (120 sgft.) so w GROUND LEVEL FLOOR PLAN -UNIT 1 SCALE:718'=1'-0" CARBON MONOXIDE DETECTOR @ SMOKE DETECTOR51. 1 W LL s TOWN OF S UTH LD PROPERTY RECORD CARD " OWNER !STREET VILLAGE DIST.: SL,JB. LOT z , FORMER OWNER = N E s ACR. - - _ S W TYPE OF BUILDING r RES SEAS. VL. FARM - COMM. CB. MICS. Mkt. Value _ ^! LAND IMP. TOTAL DATE REMARKS }. - _. j t . v 3 _ - �.u :=' �-� j4.. -z � - [ �' U d � _ ,- '•- ,Zt#��_ _�� .�a � - �7 _ � � �P ��T�:<6- �-ji`'li6Cf f� -- y = _ F ., a P z p -'r AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Vclue Acre Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowhnd DEPTH i House Plot - - BULKHEAD Total DOCK 1i COLOR -, > TRIM ' �• � I - I . M. Bldg. a ; Extension 3 3 ✓S= Extension Extension l4 $ 1 71 a -2- Foundation =Bath Dinette r " Porch Basement - . Floors K. r Porch 1 s? ! :; 'Ext Walls =Interior Finish LR Breezewa - r Fire Place 'Heat DR. Garage 1 s Tie Roof 1 � I Rooms 1 st Floor BR 'Row01 �,�¢, � �.� ' Recreation Room' :Rooms 2nd Floor FIN. B 0. B. Dormer Driveway Total L � 1, E COLOR f � s slum t TRIM ,rV Ov tkt 9:9-5 04/2015 1 st 2nd M. Bldg. Foundation Bath 3 Dinette a FULL COm8 Extension Basement CRAWL PARTuw Floors Kit_SLAB ,/ Extension Finished B. Interior Finish L,R. Extension Fire Place Heat D.R. {ears aExt. Walls BR I _ Z ,(2- _ Porch Dormer Baths Deck/Patio Fam. Rm. Pool 2otb1 �' er Laundry A.C. Library/ O.B. G�?n �x d N �-' Study Dock 1 I FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. x. .3896. . . . . Date . . . . . . . . . . . .July . . . 24 . . . . .. 19.70 THIS CERTIFIES that the building located at Pert load .( !Aovior .13A). Street Map No. .W*. may. . . . Bloch No. MiMr. Subot No. . - - tvac. area.). . .ritheralsUmd N«Y• conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . .00t . . . 23 . . ., 19. .0$ pursuant to which Building Permit No. 4.532z. . dated . . . . . . . . . . . .0ct. . .30. . .1 19.69., 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 •Privete• one- fa-milt' dwel-1-ing . . . . . . . ° . . - • . . . The certificate is issued to . . .Kent -Rhodes. . . . . .Owner . • . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .pending. Building Inspect r 1FFQt,t Town of Southold Annex 10/10/2014 P.O.Box 1179 54375 Main Road Southold,New York 11971 CERT" FICATE OF OCCUPANCY No: 37185 Date: 10/10/2014 THIS CERTIFIES that the building IN GROUND POOL Location of Property: Reservoir Rd,Fishers Island, SCTM#: 473889 Sec/Block/Lot: 9.-9-5 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 4/1/2014 pursuant to which Building Permit No. 38754 dated 4/1/2014 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 in 2round�swjp nipg pool_with hot tub and concre�atio fenced to cod as applied for. Corrected to ahM Nfijcati�an date from 1/1/1900 to 4/l/2014, The certificate is issued to Carroll, Charles (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED , u o gyred Sipa ure A' Town of Southold Annex 4/1/2014 P.O.Box 1179 54375 Main Road Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 37 834 Date: 4/l/201 4 THIS CERTIFIES that the building DECK.............................................. _...._ _.. - ........... w.._.... _ ....._ Location of Property: RESERVOIR RD FISHERS ISLAND, SCTM#: 473889 See/Block/Lot: 9.-9-5 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 11/27/2006 pursuant to which Building Permit No. 32544 dated 12/5/2006 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: l addition to e istin q family dwellji4ns a &k for. The certificate is issued to CHARLES F CARROLL ,. ._.. ...._....................................._.M.M....w..........._..__.....__.......- ...................._mmmmmm. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED ..... .5i..._. ..--ure._w.Hw wwwwww