HomeMy WebLinkAbout1000-88.-5-40 r TOWN OF SOUTHOLD
Rental Permit
0630
IG
Owner Sean & Diane Rainey
Occupied as Single Family Dwelling
Located at 1195 Rambler Rd Southold 88.-5-40
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.
5/10/2024
Code i= for ent Offici
This Notice must be posted by the main entrance at all times
SO
r 631 E85-1802
INSPEC ION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION TND [ ] INSULATION/CAI
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] TIRE SAFETY IN!
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL {TIN
[ ] CODE VIOLATION [ ] PRE CIO [ 41
Town Hall Annex
Town of Southold 54375 Main Road
G�� o Rental Inspection Report PO Box 1179
Southold, NY 11971-1179
Tel: 631-765-1802
Date
SCTM# .2
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Phone
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Address: �" � ���
Inspector
Hamlet .�.._. ,...,._.. ...,M.. . ..... . .-.m _ .._..... .. ... _..,..... ..... _. .. _._ .._.u.._.. __mm.. ...._
Floor Level Quantities
Sub 1 2 3
.w...� . .. .....a. _ �m .. k .� ..
Smoke Detectors not located in bedrooms
Carbon Monoxide Detectors
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roe._
. ExitsExtinguishers Firem
. �........�.. �.._ _._.. ._._ _.... _- ..w,._.�....�..�.. ..._. „m _ �_ a�., ..� _...., _.
Bedrooms 1.. 2a . 3 / 4 1 5 6
� Smoke Detectors
Egress ....
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�.. Occupant � ... .�. _ ..... .. .. _.. _. , .� ..�„.,.
p Count
Building Systems Maintained &Operational Condition of Property
Heating Building interior
Hot water Building exterior
ElectricalProperty clean, maintained & safe j
Mechanical Handrails&guards installed & secure w.
Pool _... ...... w.....�........_.� ..rc Pool Safety r alarm �Date of CO�ssuan 1
Surface water Date p.. .___y is
suance r
Door alarms.u..._. ....�..a. .e.,..�_�., ....�s.�.... .w�..... .. _ ..._ .... ,
Pool comp
letely enclosed
,.Self closing ._... _ ... _ . _..
/ latching gates Pool fence to code requirements
CO's for all items present Prior Rental a� m
Comments
TOWN OF SOUTHOLD
g" Rental Permit
0630
Owner Sean & Diane Rainey
Occupied as Single Family Dwelling
Located at 1195 Rambler Road Southold 88-5-40
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.
5/2/2022
odeNEnrc t (ficial
This Notice must be posted by the main entrance at all times
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
BUILDING DEPARTMENT r � ��
TOWN OF SOUTHOLD i
E 'T L PERMIT APPLICATION
J
Rental Permit Fee $200(Applicotion must be renewed every two years)
iJ
Section A. FEB A' 12 f"I)
Property Information:
N, !
Rental Property Address:
Tax Map Number: 1000 SECTION C7�� ..-BLOCK US•t7 U -LOT Qq0 - C)r v
SECTION B.
OWNER INFORMATION:
� r\\
Property Owner Name: � �
Property Owner Legal Address: Property Owner Mailing Address:
o n. . . av 117 3Z
Telephone Number(s): Daytime Tq 61')IVAUvening-51 637114_'Emergency
Property Owner Email Address:___Qa� sr , at,,4 q e ca
/J
Page 1 of 5
Town Hall Annex Telephone(631)765-1$02
54375 C toad
P.O.Boxox 11179
Fax(631)765-9502
Southold,NY 11971-0959
ya
W
13UILDING 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: . „ w
Telephone Number(s): Daytime mmm 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):uµ„v„w . w
Mailing Address of Authorized Agent:
Telephone Number (s): Daytime--- Evening Emergency
Email Address:
SECTION E. J k-7
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.C. Boxes):.,-,,_,
Page 2 of 5
TO W n Hall Annex
Telephone(631)765-1802
54:175 Main Road Fax(631)765-9502
P.O. Box 1 179
Southold,NY If 971-0959 4�
,.
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent: . µ„ �) !
14
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: p...
Number of rooms in Rental Dwelling Unit:_ `4h t 3 r U(A �r
r �
Use and Dimensions of each room in Rental Dwelling Unit k '
,;, , y ( 1" 10
Page 3 of 5
Town Hall Annex Box 1179
(631)765-1802
P.O.
54375 Main 1117979 Fax(63 I)765-9502
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 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)
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
Jt-n ILA Artn � �^, Telephone(631)765-1802
Sfa=.n Rit,J Fax(631)755-9502
F'�7_Ria 11's� arta °
�m r
BUILDING DEPARTMENT
TOWN OF SO' L'
applicable laws and rules. 1 further acknowledge that 1 will notify the Town of Southold
Building Department of any changes of address within five (5)days of any changes
thereto.
I 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 ,M]l 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 Ov,ner's Signature=
J &
Z/� 2
Sworn to before me this day of ��
Official Notary Public Sign + ,Pw aid "" w rai U'Jorary Stamp
UALWIED IN
NASSAU COUNTY
comm, EXE.
r
� �OF/Ilu� y�
mage 5 of 5
/STRAPPINGNTOWN OF SOUTHOL BUILDING DEPT.
OUNTM,' 631-765-1802
INSPECTION
FOUNDATION 1ST ROUGH PL13G.
FOUNDATION2ND INSULATION/CAULKING
FRAMING
VIOLATIONFIREPLACE & CHIMNEY FIRE SAFETY INSPECTION
FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION
ELECTRICAL (ROUGH) ELECTRICAL
CODE [urL)RE
REMARKS■
ov4m
DATE - V-� INSPECTOR
TOWN OF SOUTHOLD PROPERTY RECORD
DOWNER STREET VILLAGE i DIST." SUB. w F
F
FORMER OWNER E ACR, i
S
W TYPE OF BUILDING
I
i
RESo : SEAS. VL. FARM COMM. CB. MICS. Mkt. Value
i
LAND IMP. TOTAL DATE REMARKS
3
i
3
f
- -
}
AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE
FARM Acre Value Per Value
Acre
Tillable FRONTAGE ON WATER
Woodland FRONTAGE ON ROAD
Meadowland - DEPTH
House Plot - BULKHEAD
Total `}" t `s F DOCK
l
I
.o
COLOR TRIM
-
t
12,
Imo_
7
M. B Idg.
� 0
Extension l 7 5 S 'V 7
t ,
g.y
Extension -
z? = , �
Extension 1, _
Foundation > Bath
Dinette
Porch _ Basement i Floors a K.
9 �• <
g.
Porch !Ext. Walls Interior Finish LR.
i 1?. r �1I
eezew
Bray Fire Place — ; Heat GR.
,
GarageType Roof Rcoms 1st Floor BR.
Patio Recreation Room' l Rooms 2nd Floor FIN. B
O• B. Dormer Driveway
Total -
s
i
FORM xo. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. Z6o51 . . . . . . Date . . . . . . . . . . . . . A'49. . 9. . . . . .. 197 .
THIS CERTIFIES that the building located at Rambler .Road . . . . . . . . . . . . . Street
Map No.Tarry .Water ock No. . . . . . . . . . .Lot No. . 12 . . . . ,Southold. . .N-!Y.•. . . . rt
conforms substantially to the Application for Building Permit heretofore filed in this office
dated . . . . . . . . . . . .deb19.?'+. pursuant to which Building Permit No.7078Z. . .
dated . . . . . . . . . Feb 13 19.?, 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 ,dwell 1
The certificate is issued to . AO 9911A 4,. . , . . . , . , .Owner, . . . . . . . . . . .
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . . .JA1Y. 19 . .197.4. . p. ,R., TtUA
UNDERWRITERS CERTIFICATE No.417434. . Aug. 19?4
HOUSE NUMBER . . . . . 11.95. . . . Street . . . . bler Road
Building Inspect r
G
',l
7
c11FfpC, Town of Southold 4/30/2022
P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 43033 Date: 4/30/2022
THIS CERTIFIES that the building ADDITION/ALTERATION
Location of Property: 1195 Rambler Rd., Southold
SCTM#: 473889 Sec/Block/Lot: 88.-5-40
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
2/5/2021 pursuant to which Building Permit No. 45828 dated 2/17/2021
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:
alterations and addition,recreaction room in basement and covered boot la9rchtca cx stirs .3 prlro Msin lq-fart�
eiweltitl applied f,
The certificate is issued to Rainey,Sean&Diane
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 4587.9 2/11/2022
PLUMBERS CERTIFICATION DATED
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