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Home My WebLink About1000-88.-5-69 TOWN OF SOUTHOLD e Rental Permit 0929 Owner Peter Bujnowski Occupied as Single Family Dwelling Located at 1355 Watersedge Way Southold 88.-5-69 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. 6/8/2023 r cacle Official This Notice must be posted by the main entrance at all times Town Hall Annex 9 Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 " " Southold,NY 11971-0959aRy BUILDING DEPARTMENT TOWN OF SOUTHOLD i Y 2 6 20 RENTAL PERMIT APPLICATION Rental Permit Fee $200 (Application must be renewed every two' rrts Section A. Property Information: Rental Property Address Tax Map Number: 1000 SECTION 473�1)` _-BLOCK -LOT - 7 SECTION B. OWNER INFORMATION:,, ,.. p Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: 121) C T- 06 -75 - Telephone 67.Telephone Number(s). Daytime Evening s/�L Emergency s� Property Owner Email Address: f.�v b v ��, w 5 �� C4 5 h C_ v X 41- tL A `�t Page 1 of 5 Town Hall Annex " Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 M BUILDING 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: .-,...---. Telephone Number (s): Daytime__,__ 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):_, w_ 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 g I4 ;. l, Cou fF. BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Pater:1 13u nc1? ;l i-() ner m E("'7 w, Telephone Number(s). Daytime/Evening/Emergency . 860-782-1077 Email Address: ctcrlatjn�wwsli ezlltlglm, , C "jf2022 -" SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: One 1 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:.1lot sggat 136:6 datcr! dgdge ply l µr i't'J Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Eight 8 Use and Dimension of each room: o Rooms on the second floor wowwwww_.Kitchen.... Town Hall Annex Telephone(631)765-1802 p 631 54375 Main Road �� bP� Fax ( )765-9502 P.O. Box 1 179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTH HOLD Mailing Address of Managing Agent: (?�v ) - 7OZ ?7 Telephone Number (s): Daytime Evening Emergency Email Address: � � wwwwwwww. � ._..... SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: r 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: 13 Requested Maximum number of persons allowed to occupy Dwelling Uni , Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in ppRental Dwelling Unit: eack Page 3 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 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 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) ) CO TY OF UFFOLK) I Tc L '�-' , certify under penalty of perjury, the following: 1. I 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 4 Town Hall Annex e „u, Telephone(631)765-1802 54375 Main Road 3 Fax(631)765-9502 P.O.Box 1179 „ dM Southold,NY 11971-0959 IN'S o 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, M aging Agent, or Site Manager. Property Owner's Name: Property Owner's Signature: Sworn to before me this 126 ay of k - 20 a Official Notary ublic Signature and Original Notary Stamp 4SCHERYL B.PARKER Nohry Pgb11e,Stlte of Connecdcnt My Co®mission Eipim 4!30,7025 Page 5 of 5 I s' uTOWN T SOU , HCOLD UILDINGi 631 -765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLRG. ] FOUNDATION TND [ ] INSUTATIOWCAI Jr C 3 FRAMING / STRAPPING [ INAL [ FIREPLACE & CHIMNEY [ FIRE SAFETY IN% [ FIRE RESISTANT CONSTRUCTION [ FIRE RESIST .NT PT ] ELECTRICAL (ROUGH) [ ELECTRICAL (F CODE VIOLATION [ PRE C I SOX, old A-- r�) r 0 (00,0k2 0U v / lidInyu w DATE INSPECTOR /a-t 7 /r 41 , C/ All IL Jh _� Y.9z - T -D r � t . k ` lox �� TOWN OF L !7 I � :ORD CARD OWNER . STREET VILLAGE DISTRICT SUB. LOT e E FORMER ®WNL , N - [ E1 ACREA } – Y z S OF TYPE BUILDING T s RES. .r / t SEAS. VL FARC COMM. IND. ! CB. MISC, LAND IMP_ TOTAL DATE REMARKS z 7o i rrt� Ie n max' r a G BUILDING ONDITION NE [FORMAL BELOW ABOVEZ 735 i Vr _J - Tillable 1 I s Tillable 2 — Tillable 3 Woodland Swampland Brushland House Plot _.. - __ e I ' I Tota l a -'' ? - 71 oma.: — - �� ' � f M. Bldg, _ _ - Foundation Bath Extension Basement Floors Extension Ext. Walls Interior Finish Extension - — - Fire PlcHeat Porc - Attic Porch Rooms 1st Floor ; Bree e o- Patio Rooms 2nd Floor GY 1 Driveway -- _ - - Garage $ Q. B. J FORM NO Q TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy NoWAO. . . . . . . Date . . . . . . . . . .:FOUTO.ry 4 . , 19.72 THIS CERTIFIES that the building located at Wats- Fid + . W47. . Street Map No. Block No. . X Lot No. . .)=. . . Southold N*Yv conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . .140!r0l . 10, 19. 71 pursuant to which Building Permit No. 52222 dated . . . . . . . . . . X43ro$ A0 , 19. 11, 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 . .priVat9 one-family dWel1-Ing . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to Arthur. S n*veld. • • Owner • • • . . . • • • � • . • . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Jan . $6. . 3.972• • •by• R„ V111a House # 1365 /��" � ( 77 Underwriters 192529 Building Insp ectOr