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Home My WebLink About1000-63.-2-11 TOWN OF SOUTHOLD Rental Permit NO 0911 Owner Santacroce Jr., Henry & Ellen Occupied as Single Family Dwelling Located at 1800 Youngs Avenue Southold 63.-2-11 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. 5/22/2023 e E orc Official This Notice must be posted by the main entrance at all times C) Scr TOW4 V 10'UV�THOLD BUILDING DEPT. 631.765-1802 INSPECTION . FOUNDATION 1ST ROUGH PLEIG. FOUNDATION 2ND INSU TIOWCAULKING FRAMING 1 STRAPPING AL FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) ELECTRICAL - CODE VIOLATION PRE C/O RENTAL �- C t7 A✓� Ve p# �3 t 4- co Town Hall Annexi 1}765-1802 ii D/ !� 54375 Main road /��% �; Fax(631)765-950 P.O.Box 1 179 ,r Southold.NY 1 1 97 1-0959 ��/�!��%%/`"� 15 2.-3 ( V06je err BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION INSTRUCTIONS Rental Permit Fee $200 (Appficotion must be renewed every two years) The items listed below are required to be submitted with the completed application. C, Floor Maras: Floor plans of each Rental Dwelling Unit, please show location of all smoke & carbon monoxide detectors. Certificates of Occupancy and Pre-Certificates of Occupancy: Certificate's of occupancy or Pre-Certificates of occupancy for each rental dwelling unit. Certification of Code Compliance (form enclosed): Must be submitted by a license architect or engineer or license Dome inspector if an inspection by Town of Southold Inspector is declined, El Rental Permit Fee: $200.00 Town Hail Annex s 437 Main Road ��i///�/ i/ ��"� l a, ��, �, ? , �.fr 02 P.O.Box 1 179 Southold,NY 1 3971-0959 BUILDING DEPARTIMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200(Appiicotion must be renewed every two years) Section A. Property Information: Rental Property �.'-«:gess ae)0 V�4 0'11 g71 Tax Map Number: 1000 SECTION _ �� , �f ^,.7�:9�� _ � -LOT SECTION B. OWNER INFORMATION: Property Owner Name: _-- ` //—o Property Owner Legal Address Property Owner Mailing Address w i3O ioi�� 7—/-LL Telephone Number (s): Daytime 1/ � 3�0'. Evening___-__ ,_ Emergency Property Owner Email Address: '� /?e Town Hall Annex /��%� %��,/'/ a Telephone(631)765-1802 i /�iI/�G 54375 Main Road �!�/ "%��% Fax(631)765-9502 1'.O.Box 1 179 Southold,IVY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOI.D 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 iaenhgg„„ Emergency Email Address: Section D. Managing Agent Information: rlame of At,ahorised Agent of dweihng urine, if any Addi.ess of g,WIiodlzed Agent. (no P O. Boxes) Mailing Address of Authorized Agent: Telephone Number (s): Daytime____._` Evening w Emergency Email Address: SECTION E. S11 MANAGER R i I�� ION: fro,.„eni.r7G p�"tJptltllieao c oi0llwlli 4114,s or rririR i`^�u;','YlW N.IY'6l'�sw Name of Managing Agent of dwelling unit, if any: Address of Managing Agent (no P.O. Boxes):.___ Page 2 of 5 Town Hall Annex j 5 75 Mein Road �%1 ��%%y'% 4i �/ d ". (t`•.,1 l�, s 4G' 1'.U-Box 117Q Southold,NY 1 1 971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: FQ'lei' ht' ne Number . D7ytir'n �E'P"Itl1"1ir'_ rner�en(�, 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: -- 4, Requested Maximum number of persons allowed to occupy Dwelling Unit Number of rooms in Rental Dwelling Unit: '? ^" 5, V/ Use and Dimensions of[geach room in Rental Dwelling Unit X �J�d �p d7rtz�t a jsrli rOd�sr � �6��g��i Page 3 of 5 1'tnvn Nall Annex Telephone(631)765-1902 /,ri %r t�ax(631)765-9502 54375 Main Road ' V.O. Bos 1 179 Southold,NY 1 1971-0959 ' BUILDING, DEPAR'T'MENT 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. ' 1 am requesting a fire safety inspection to be performed by a Code Enforcernen't Official from the Town of Southold 171, 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 ,01`° SUFFOi , 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 lir Tavel,Hall,annexi/j �e� 1 54375 Main Road �o� / 902 V.O.Box 1179g�� o it Southold,NY 11971-0959 BUILDING DEPARTMENT 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: _ ,'7/7 � - Property Owner's Signature: Sworn to before me this day of P1a, U, JA Official (Votai lic Signature and 71K, ai Notary Stamp TRAC'EY L.DWYER NdTAF3Y PUBLIC,STATE OF NEW YORK NO.OiDW6306900 QUALIFIED IN.SUFFOLK COUNTY COMOSSION EXPIRES JUNE 30, Page 5 of 5 goo /� //od 'jotpaoi ry„ /01�� c3. S � l O s S� 74 ti L y� A --� i r, a a \ � ~ A Bldg Extension - - T. Extension e Extension m Foundation ;Both D inettc Porch Basement „ Floors K s Porch Ext, WallsIn erior�Finish �LR. a I Breezeway Fire Place ; Heat `_ DR. GarageTYPe Roof Rooms lst Floor BR. Patio Recreation Room' Rooms2ndFioor 11ti1. B ------------- O. B. Dormer 'Driveway Total i TOWN OF SOUTHOLD PROPERTY RECC 31,E OWNER STREET f VILLAGE DUD. LOT —7 FORMER OWNER N E ACR. 'go W-, TYPE OF BUILDING _J 'kAS. VL. FARM 1 RE COMA. CB. MICS. Mkt. Value LAND lmp. TOTAL DATE REMARKS J 4 44 AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre I Value Per Value Ac re Tillable FRONTAGE ON WATER i Woodland I FRONTAGE ON ROAD Meadowl,and DEPTH Hc,%LPlot BULKHEAD Total DOCK