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Home My WebLink About1000-78.-6-9.4 f OF SOUTHOLD T"'WN " Rental Permit s 0503 Owner Donna Cook Occupied as Single Family Dwelling Located at 6900 Main Bayview Rd Southold 78.-6-9.4 Maximum Permitted Occupancy 4 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. 6/5/2023 J lbfficial This Notice must be posted by the main entrance at all times ( e le Town Hall Annex " Telephone(631)765-1802 54375 Main Road ^ Fax(631)765-9502 P.O.Box 1179 ; r 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: Tax Map Number: 1000 SECTION � -BLOCK -LOT . SECTION B. OWNER INFORMATION: Property Owner Name: �/� p Y Cq-tl::�' Property Owner Legal Address: Property Owner Mailing Address: Telephone Number(s): Daytim Evening Emergent w. Property Owner Email Address: u " `SDC) L 40 �0 5`a��JO?) Page 1 of5 sy 1 p Telephone 631 765-1802 Town Hall Annex 3�` P ( ) 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959a,60 �'s rou BUILDING DEPARTMENT TO" OF SOUTHOL 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: All" 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) Name of Managing Agent of dwelling unit, if any: Address of Managing Agent (no P.O. Boxes):_,,.__.__ Page 2 of 5 Town Hall Annex off, Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 BUILDINGDEPARTMENT TOWN OF SOUTHOLD m Mailing Address of Managing Agent: Telephone Number(s): Daytime Evening Emergency Email Address: SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: '"w ' y5;C 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." sw . xj Rental Dwelling Unit Identifier. �G " t . pyDwellin .:� Unit: Re ue,� d aximum number of persons allowed to Number of rooms in Rental Dwelling"Unit.- Use and Dimensions of each room in Rental Dwellin Unit 1 ', V1 'z �. Page 3 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 F Southold,NY t 1971-0959 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. 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) If' ° ,'� ' �� 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 Telephone 631 765-1802 Town Hall Annex �'" ''� P ( ) lk ,z 54375 Main Road n Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 ONI BUILDING DEPARTMENT TOWN OF SO HOLD 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. ba ilk .,a 0 Property Owner's Signature: � - Sworn to before me thisday of (" l� ,r . 202-0 ri� �� Official N ry Public Signa , e and Original Notary Stamp TRAC :Y L. DWYER NOTARY PUBLIC,STATE OF NEW YORK NO01 DW6,306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION ISSION EX'l IR S JUNE SU, ,� -- Page 5 of 5 ��, a�satyrOD a)ep'h (�ovtotj To I WN OF SOt ' HOLD BUILDING DEPT. 631-765-1802 INSPECTION I FOUNDATION 1ST ROUGH PL13G. FOUNDATION 2ND INSULATIOWCAULKING FRAMING /STRAPPING C tNAL FIREPLACE & CHIMNEYC ]IFIRE SAFETY INSPECTION FIRE RESISTANT CONSTRUCTION CFIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) M L CODE VIOLATION PRE CIOCRENTAL JAI DATE _.. .ww_ TOWN OF SOU HOLD BUILDING gDEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING I l FRAMING/STRAPPING [ZFIRE INALFIREPLACE CHI NEY [ SAFE Y INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O y DATE INSPECTOR TOWN Olk u OLD BUILDING DEPT. 765-1802 "JQ [ ] INSPECTION - FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND I SULATIOWCAULKING [ ] FRAMING/STRAPPING [ ] NAL �e4k P&vnI_ [ ] FIREPLACE & CHIMNEY ['V: FIRE SAFETY INSPECTION FIR RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION CT IC (ROUGH) [ ] ELECTRICAL (FINAL) CODE VIOLATION." [ ] PRE C/O REMARKS: I Ko vij ?vo % 4, \ M WL c � dd 4o'lipA elms, 14( t - TOWN OF S UTHO D PROPERTY --- - CARD OWN R STREET — - VILLAGE DIST.; SUB. LOT - f � f FORMER OWNER N E AGR.., S I W TYPE OF BUILDING RES. SEAS. rVL. FARM COMM. CB. MISC. Mkt. Value LAND IMP. i TOTAL DATE REMARKS t t ry } E I - AGE BUILDING CONDITION = NEW NORMAL BELOW ABOVE Acre Value Per Value Acre Tillable 1 3 Tillable 2I i Tillable S I Woodland i Swampland !,FRONTAGE ON WATER - Brushland FRONTAGE ON ROAD House Plat DEPTH BULKHEAD I Total DOCK 16 I j 'f"° I s Q°S q �• ��€ aI m u 210 y tf w ` +ems ate+ sok 1 00 � a ;# 1 2-2y32 ,- I Nt� R-S r_ TI---06R L/ 9 /'t / 4 CK: = r i } e y PH fY)OD vis CA '- EXISTG . s' EXIST'6 FO0IING S- ate` gg _ A, E SPACE �' I --- 'ra' .:� 4 � _ � - , ATH �n a` - � S Ji -- _ E40 m-F CL a a Q a' sow 1 3 f -_ 1 + €€ LOW yY 0061R0B2 �s" lr2 ?t.fie€ r T � I- l-4 8 _ .:TS'=b 11�hTX1N `�- '2 0 I 3 HI F�(1A51TN6L ,.. !-�^,v now DECK - P ( ~J } 01RA _`� -- �"ACe b- € r>Ft DECD nnxs)- `$ 3i € I I , ALLEssPn4 —x E € ;_• .s• ' i ee•a 2' Caw ala+ tt p� IXr 21 2'2ik 1DP '•€ ; EX15TG 3 BRKF5 2 (moil LL VE� - m � 51 £ s t M 140 Ei 6L M t _ +Io kD6E Em DE K I = - r12 '< - 12 — (Mr DEG K PLNKI J FOUNDATION PLAN TAW, \ IV(1) FLI r T' F A g -�. EAG Eli D(M'I.�AL) _ b � 515�3ED.d'OL 77 ALL DIMENSIONS ARE APPROXIMATE I o•px-s)eA*ts 1 m 3 FX15TS EXK7G -ean. BRJCF5T KITCHEN w1eL • EurL.v L.ru rrveaa FAMILY "6 3� 9 F,�18'OL 'RYYG�D (4J 2v 4 PO-iT ROOM i (`. DECK Fl.AIb) ' _ ::_ t'--z 8 F.l-VOL—� 0M `�'=1' IF EX15TS `P a ' 8A5EMENT t--5`DIA LALL" € _ -_ 24 24'zl2'DP g 05257 e PL FM"IIK 11Y9GPU 4 ION r - _ 263 PL 3 TOWN OF SOUTHOLDPROPERTY RECORD OWNER STREET ft VILLAGE DIST.' SUB. LOT NA f-1 FORMER OWNER NI ACR , S W � _ TYPE OF BUILDING v RES, SEAS. V FARM :COMM. CB. MISC. Mkt. Value - LAND IMP, TOTAL DATE REMARKS �. e e y� NE'y I ' F FARM Acre Value Per ' clue Acre Tillable 1 L _ s b s s Tillable E S Tillable 3 Woodland Swampland FRONTAGE ON WATER Brushland FRONTAGE ON ROAD House Plot DEPTH i BULKHEAD i Totak iDOCK =5 OLOR I RIM ! i _ I � a E � T i z 78-6- 27 10/06 M. Bldg. y, _ Foundation Bath Dinette Extension __£, .�. -- B meat Floors K. I r_ 3 � i� Extension U =Ext. Walls —Anterior Finish � � � LR. xtensior _ Fire Place Heat DR. t_e tType Roof =Rooms 1st Floor BR 6£ Porch s recreation Room !Rooms 2nd Floor' I FIN. B = a _ Porch Dormer� ; �eee Driveway Garage Patio - Q. B f E Tctal __ VL FORM NO. 4 TOWN OF SOUTHOW BUILDING DEPARTIONT Office of the Building Inspector Town Hall Southold, N.Y. PRE EX31STIM OF CCCUPARM No—Z-23007 Date Y 23 1994 THIS CERTIFIES that the building OUR FAMM, R I Location of Property 7250 �1' N RO.S 25 LTx 1. '12- House No. Street. Hamlet County Tax Map No. 1000 Section 78 Block-6 Lot 8 Subdivision Filed Map No. Lot No. conforms substantially to the Requirements for a one Family Dwelling built Prior to: APRIL 9 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER 2-23007 dated MM 23 1 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued in ONE WA11ILY DWELLING WITH ACCESSCM The certificate is issued to DAVID S W4VAU8ML (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. H/A PLUMBERS CERTIFICATION DATED Nh :PLR SSE AT711COND INSPRCTION MPOBT. /)16ilding Inspector Rev. 1181 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 7250 BAYVIEW RD. & 25 PRIVATE RD. #12 SOUTHOLD, NEW YORK municipality litY SUBDIVISION LOT(s)__ NAME OF OWNER (a) DAVID & CAROLINE MCCONNELL OCCUPANCY A-] RESIDENTIAL OWNER_ tenant ADMITTED BY: SELF ACCOMPANIED BY: SELF KEY MAP NO. SOURCE OF REQUEST: DAVID XcCONNELL DATE: APRIL 19914 TYPE OF CONSTRUCTION # STORIES ONE I EXXT� SW FOUNDATION CEMENT BL CELLAR FULL CRAWL SPACE—,.-- ONE - B LR NO FLR 3RD FLR. TOTAL ROOMS: ls� F FULTH BATHROOM (s) LET ROOM (s) UTILITY ROOM PORCH TYPE REAR N ED BECK, TYPE PATIO BREEZEWAY——— FIREPLACE _,ONE GARAGE—,---- DOMESTIC HOTWATER YES TYPE HEATER ELECTRIC AIRCONDITIONING TYPE BEAT, OIL WARM AIR HOTWATER OTHER:—,—...-,--,—., ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST. WOOD FRAME STORAGE, TYPE CONST._ SWIMMING POOL GUEST, TYPE CONST._.,,,_ OTHER: VIOLATIONS: CUMTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE L C TrOM DESCRIPTION ART. SEC. ........... ... . ........ REMARKS: BP 122063-Z-COZ-23006 FOR DECK ADDITION 'TED BY APRIL 27, 1994 INSPECTED DATE OF INSPECTION TIME START 9:30 END 9:50 FORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Tull Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31625 D t : 06/21/06 THIS CERTIFIES that the building ADDITIONS ALTERATIONS Location of Property: 25 PRIVATE RD #12 SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 78 Block 6 Lot 9.2 Subdivision Filed Map No. Lot No_ conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 30, 2004 pursuant to which Building Permit No. 30458-Z dated JUNE 302004. 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 ADDITIONS & ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to DONNA M COOK (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO_ 1123201 06/05/06 PLUMBERS CERTIFICATION DATED 04/12/06 H2M LABS INC. //hor/zed'signature Rev. 1/81