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Home My WebLink About1000-26.-1-1.1 TOWN F SOUTHOLD Al---b Rental Permit 0923 Owner Frost & Minichini F am20 Ir. Tr. Occupied as Seasonal Single Family Dwelling Located at 2190 Village Lane Orient 26.4-1.1 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. 6/2/2023 Code fog&ent Official This Notice must be posted by the main entrance at all times Town Hall Annex AL Telephone(631)765-1802 54375 Main Road ir Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT Rr TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200(Application must be renewed every two years) Section A. Property Information: Rental Pro erty Add ess: �— j cc Tax Map Number: 1000 SECTION SECTION B. OWNER INFORMATION: Property Owner Name: ,-- a Property Owner Legal Address: Property Owner Mailing Address: C c Telephone Number(s): Daytime ekefI5 ng�Ee y �b 0 Property Owner Email Address: �-o Page 1 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Roadir Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 �w 'fr rV BUILDING DEPARTMENT TOWN OF SOCTTHOLD Section C. Authorized Age ormation: Name f,"'uthorized 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: SectionD. Managing A t Information: Na 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 E. SITE MAN INFORMATION:(required for rental properties containing 8 or more rental units) e of Managing Agent of dwelling unit, if any: Address of Managing Agent (no P.O. Boxes): Page 2of5 so 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 Tl HOLD Mailing Address of Man I gg Agent: Telephone Nu er(s): Daytime Evening Emergency Emal ddress: 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: Requested Maximum number of persons allowed t occupy Dwelling Unit: 4-004 Number of rooms in Rental Dwelling Unit: � room In Rental Dwelling Unit: Use e and Dimensions o �c� Ren� w-5. �.. 06. Page 3 of 5 qso Town Hall Annex �„ �� Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 Y.O.Box 1179 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. 9 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 , "; ,scertify 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 r Town Hall AnnexTelephone(631)765-1802 qr 5437.5 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD 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 Owne s Sign Sworn to before me this day of 20 1, Ile Official ary P c Signature an r g nal NotaryStamp JI"Art!44KRIF 0t:10N Nota y Public,State of New York Nu.0101ro31238 'aur�rH�ed In Suffol'k couldy Coned„ `i Expifes Novei!,ber 14,202 Page 5 of 5 ,Q s004,; 631-76S-1 802 �-0al@"^✓kW.Y:W.k'. a/pry INSPECTION 1 wwp [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND INSULATIOWCAULKING FRAMING l STRAPPING FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) ELECTRICAL FI CODE VIOLATION E C I" " -Lk i c2 4—.,A 9—w—Lo-Lc—4— �I 60 DATE INSPECTOR JOB.- COO MATRIX DEVELOPMENT CORP. SHEET NO, 11 WOODED LANE/P.O. BOX 1033 HAMPTON BAYS, NEW YORK 11946 CALCULATED BY_...................... DATE ..........._............._ _..._..:_:_:_:_:.: .:.:.:.:....�... (631)728-1777 CHECKED BY.... DATE.M.—..............m_......... _, _.._ SCALE......:...........................w_..w.......w r.. ..._ _. ...._....._.............. _..:.:.:.,,,...., 170 „4..k (... IN e v „..y im er 5 f ^� f i u ........ PIWIMM 0 YU9,r,4c Sh,,itsj r7„bd Pfl V,11! Mn. JOB,........._. .... �_...�. _�.�.._�.�...... ......�....�.�.�.�...�.�.�....._.... ,. SHEET SSC),.vv ..�.. .. �.�... MATRIX DEVELOPMENT CORP. ,,, „ 11 WOODED LANE/P.O. BOX 1033 _.._ _ w...w .....w.w............_._ HAMPTON BAYS,NEW YORK 11946 CALCULATED B . ..v..._..w_..... .._................ DATE..............._..................._.�._.w_. (631)728-1777 CHECKEDBY._______ .........................�_ DATE_ww...w..�.�.................................................._... .. SCALE_.ww. ......w_w_____........ �.�....�.�.....�.................,...�............. �..._.�.�..w..�..�_�_.....�... .._............ ........�w..... w.__....._, w.....,.... �„ f i rt, � E i ,r I o 1 PROMI oll f Nirip[t f?Ugrl N15 i(NJCIOd JOB, .. . � ` MATRIX DEVELOPMENT CORP. SHEET No K' . ...�- 11 WOODED LANE/P.O. BOX 1033 _. , HAMPTON BAYS, NEW YORK 11946 CALCULATED BY..._ ........ DATE _..._.. (631)728-1777 CHECKED BY., DATE .,,... ,,... .�...........,... .,, �.,...... SCALE_ _ww._.... d e� t e a Vdysc. r........... e 4 � MATRIX DEVELOPMENT CORP. 11WOODED LANE/PO. BOX 1UO3 HAMPTON BAYS, NEWYORK1194O CALCULATED BY mns (631)720-177T o^rs CHECKED BY scms FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. . . . .?9955. . . . , . . Date . . . . . . . . . . . . . . . . . . . . . . . . .. 19 .80 THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . « . . . . . . . . , . . , . . . . . . . . . . Location of Property2190 Village Lane Oriento N.Y. House No. Street Ham*lei County Tax Map No. 1000 Section . . . . . 26. . . .Block . . . . . . . . . . . . . .Lot Subdivision . . . . . . Baye ide . . . . _ , . .Filed Map No. . . .Lot No. . . . . . . . . . . . . . requirements for a two-family dwelling built prior to conforms substantially to the Certificate of Occupancy 29955 April. 23 . . . . . . . . . . . 19 57. pursuant to which VM. . . . . . . . . . . . . . . . . . . . . . dated . . . . . *Y. 27 . . . . . . . . . . . . . . . 19 80 , 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 . . . . . . . .. .. A, p µ'Vi" !�" �'' d '�° �« "' : n ,A_ Zone,DistlrxAt . . . . . , . . , . a . . .. Re ante International Corp. The certificate is issued to . . . , . . « . . ,$. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (owner,. . . . X . . • XXX of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . . . . . « , . "��✓, . . + /a rte'7 „ . . . . . .. Building Inspector Rev M79 711 7� BUILDING DEPARTMENT " TOI'N OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT Location-e " c1 ' 1 number r�>et Pivaac ,pai"y - Subdi'vision tap No.: Name of Owner(s) Occupancy otimer en • e " A : 'Admitted by:, �cco�mpanie " Key available Suffolk Co. Tax No--"--I--L Date` `� Source of rec�iaes'� _ " - L OP ,LQ'fGco ._._.� `. Type -reaction stories F dation +'"" � Cellar Crawl space --= Total rooms,:.lst. �. 2nd.: rd« Fl" Bathrooms) Toilet room(s)------ � Porch; type beck, type Patio, type BreezewayGarage Utility room A ... .` �. Type "Heat "Warm Air fjobtater Fireplace(s) No. Pxit Aircondtioxiaa�_ Domestic hotwater 'i`ype heater " Other A(.C�50RY STRUCTURES: . Garaoe, type Storage, type const_ Guest, type const. Swimming pool " Other VIOLATIONS: Housing Code, Chapter 52 Location D scr3. t3.on Art. Sec. all, Remarks: Inspected bY.:Z�i r end, Time start