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Home My WebLink About1000-55.-6-28 TOWN OF SOUTHOLD A, } Rental Permit 0645 Owner Elaine Mitchell Occupied as Single Family Dwelling Located at 675 Maier Place Southold 55-6-28 Maximum Permitted Occupancy 3 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. S/16/2 022 t e E orc ficial This Notice must be posted by the main entrance at all times y. Town Hall Annex ' 1 fl�� Telephone(631)765-1802 54375 Main Roads �r- tk .( P.O.Box 1179 Southold,NY 11971-0959 duIY1+i BUILD 4G Uizj�rl` BUILDING DEPARTMENT 100/N OF Sot11)1-D TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: y Rental Property Address: l .... .� tj e L 41 Tax Map Number: 1000 SECTION SECTION B. OWNER INFORMATION: �.... Property Owner Name:. Z Property Owner Legal Addre : Property Owner Mailing Address Telephone Number(s): Daytime&u venin _ Emergency _--„ Property Owner Email Address: .� Page 1 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 o „a BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: _w�. ..... __...._.._ ...........__ . _w_.._.... ..._._. �. Telephone Number(s): Daytime Evening Emergency __,. Email Address:-,---—,,,—. SECTION F. PROPERTY DESCRIPTION: 4 mm1 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." <m< a Rental Dwelling Unit Identifier: � ... _., . Req P Requested Maximum number of ersonallowed to occupy Dwelling Un! Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental DwellingUnit: i �...__ .1-160 17 X Page 3 of 5 r r Town Hall Annex �- Telephone(631)765-1802 54375 Main Road a Fax(631)765-9502 Y.O.Box 1179a t` a 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 flaws adopted by the New York State Fire Prevention and Building Code Council. V, I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold �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) 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 Town Hall Annex Telephone(631)765-1802 54375 Main Road t Fax(631)765-9502 i P,o.Box 1 179 „a 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, iv ' Property Owner's Name: ��... ,.�:_.� --�. Property Owners Signature: Sworn to before me this)5 day of I 202-2- Official Notar ublic Signature an iginal Notary Stamp TRACEY L DWYER INOTARY PUBUC,S T ATE OF MW YORK NO,01 IDVV6306y00 QUAD lRrD 00UNI"'Y COMMISSION EXPW&S JUNE 30,2P29, Page 5 of 5 (Nivv Nto, T OF SOUTHOLDE I 631 -765-1802 r�r~ .•-- INSPECTION [ ] FOUNDATION '1 BT [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAL [ ] FRAMING / STRAPPING [ ] FINAL C l FIREPLACE & CHIMNEY [ ] EIRE SAFETY INE' [ FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (Fit [ CODE VIOLATION [ ] PRE C/ [ , REMARKSM DATE 117lW>0000' INSPECTOR , Jan 23, 2022 Town Hall Annex t�f Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 s � Southold,NY 11971-0959 l . BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a license architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit ,Pro ssional seat re uired for Architect or En ineer ticenserl� ins actor ust rovlde co v of valid current cerci fication Rental Property SCTM Number: Rental Property Address: 675, Maier Pl. Southold NY 11071 Owner/Name: Blaine Mitchell Rental Dwelling Unit Identifier: Number &Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 -100 sq., Bedroom #2-90 sq., etc.) Bedroom #1 105 s ft Bedroom #2 150 sqft Property Description (Include all improvements indicated on survey) si I certify that I have done a physical inspection of the subject rental dwelling unit and find that it fully complies with all the provisions of the Code of the Town of Southold,the Residential Code of New York State,the Building Code of New York State, the Plumbing Code of New York State, the Fuel Gas Code of New York State, and the Energy Conservation Construction Code of New York State. Victor Cornelius III CEO Inspector 0 Print Name and Title ceo# 1216-0283 Original Signa u e Please place professional seal: 2�j JAZ . 00 o t � � l 1 6 cc) Doo out. . , } �� TOWN F S UTH L D PROPERTY RECORD OWNER STREET r a VILLAGE DIST SUB. LOT w S z a e z q FORMER OWNER qa E ACR. $ w TYPE OF BUILDING a RES. >��, SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS Oil ? 1 a G z t -.. -. - f '.•c...✓ ....JI F e'f' Ja s � i a ,. m 7 21 Salf u . f r _ r AGE i BUILDING CONDITION __ . - i ` _. .. � n NEW NORMAL BELOW ABOVE - FARM Acre I Value Per Value Acre I a Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD E Meadowland DEPTH r. a House Plot BULKHEAD I Total '`""' �"' _ ?�, �: DOCK r \\ \` �\ — - COLOR ale i I ,�., _ TRIM F IN boom r f E _n 1 . t e E � f m M. Bldg Extension t � Extension Extension Foundation ;Bath = FORM X0.4 TOWN OF SOUTHOLD ; BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ............ Date ...........i.Septr.....3.0,,.......... 19.68.. t THIS CERTIFIES that the building located Street Map No. ...!%*1 ...... Bloat No. ...................... Lot No. ...6,...t•3OLttha14,...Xew--York.............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..W..... ................ .. 19-fila, pursuant to which Building Permit No.1899.2.. I dated .......•.....>!Ay....2A.....................••, 19...&B, 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 ........ prigate.•one..�;��Y..�l��.��altg.»........... ...........».......»..,....,.»..»...».................,.».....,....,...,........ The certificate is issued to ...A41A1t;LQ- QN.CQV1Ch...... ................................................................... (owner, lessee or tenant) of the aforesaid building. Health Dept. Approval, Seotexnber 26, 1966, Robert Villa .:..::.►...:. : , .:: :........... �� Building Inspector FORM No. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24062 Date DECEMBER 61 1995 THIS CERTIFIES that the building ACCESSARY Location of Property 675 MAIBR PLACE SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 55 Black 6 Lot 28 Subdivision Filed Map No. Lot No.� conforms substantially to the Application for Building Permit heretofore filed in this office dated N M2ER 9 1'9'35 ursuant to which Building Permit No. 23143-Z dated N 8'ER 29 1995 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 ACCESSORY STORAGE SHM IN REAR YARD AS APPLIED FOR "AS BUILT"" The certificate is issued to MARIA UGRICICH (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building Inspec ' r Rev. 1/81 Town of Southold Annex 5/3/2012 P.O.Box 1179 54375 Main Road " '► �" � Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 35575 Date: 5/3/2012 THIS CERTIFIES that the building AS BUILT DECK Location of Property: 675 Maier PI, Southold, SCTM#: 473889 Sec/Block/Lot: 55.-6-28 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated pursuant ursuant to which Building Permit No. .w� .37172 _._.w...w dated 4/26/2012 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: Has fau It°°",2 s .. &vk addlnt ao tta a _e iAjng,� <iwc llic�� p�al�r fcaf,. The certificate is issued to Jelenkovic,Bruno&Jelenkovic,Laura (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Au ed S urs