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HomeMy WebLinkAbout1000-88.-5-28 TOWN OF SOUTHOLD Rental Permit { 0646 Owner Karras Upstate LLC Occupied as Single Family Dwelling Located at 11920 Main Bayview Rd Southold 88-5-28 Maximum Permitted Occupancy 5 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. r 5/16/2022 e *nOfficial This Notice must be posted by the main entrance at all times f 2,60 Town Hall Annexe �°� Telephone(631)765-1802 54375 Main Road „ Fax(631)765-9502 �r P.O.Box 1179 Southold,NY 11971-0959r 0I BUILDING w .t BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200 (Application must be renewed every two years) Section A. Property Information: Rental Pro erty Address: I Tax Map Number: 1000 SECTION6' 0 —, BLOCK ,f ' LOT-S-0 0 - Zro C) SECTION R. OWNER INFORMATION: Property Owner Name: rr �+s .s �< L,L .._ . Property Owner Legal Address: Property Owner Mailing Address: Telephone Number (s): Daytime " '1"' ( Evening, " 1 -Emergen' t Property Owner Email Address: - i fZ� H uy) T .. Page 1 of S Town Hall Annex ` Telephone(631)765-1802 r l� 9�11���� j 54375 Main Road a4 Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SO1 TTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: . Address of Authorized Agent (no P.O. Boxes): -S Vel u r h �2 Mailing Address of Authorized Agent:.­—­­ Telephone gent:. — vTelephone Number (s): Daytime___.__._..__._,, Evening Emergency_ Email Address Section D. Managing Agent Inforrn' tion: Name of Authorized Agent of delling unit, if any: Address of Authorized Agent(no '0. Boxes):_, Mailing Address of Authorized Agents Telephone Number (s): Daytime IN, � 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`'(po P.O. Boxes): Page 2 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road �l� ' Fax (631)765-9502 P.O.Box 1 t79 °w Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number (s): Daytime Evening_,_Emergency__._. Email Address:­w____......_....ww_._....._.w_...�_ SECTION E. 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: Number of rooms in Rental Dwelling Unit: .,,--.- Use nit: . __Use and Dimensions of each room in Rental Dwelling Unit: Page 3 of 5 A y Town Hall Annex p Telephone(631)765-1802 54375 Main Road h Fax(631)765-9502 P.O.Box 1 179 f� 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. ❑ 1 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) __, certify under penalty of perjury,the following: 1. lam th:e.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 N" Telephone(631)765-1802 Town Hall Annex a/ / 54375 Main Road ' ' Fax(631)765-9502 «a rA P.O.Box 1179 Southold,NY 11971-0959 F� � I�- 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: ... __ Property Owner's Signature:_,, Sworn to before me this day of SCJ 1 20 ZO STr��A�Mr MILANO Official Notary Public Signature and Original Notary Stamp Not.ryr P.bft.St Official Ne Park hi0.01MI637307'5, Qual ied in Naassaau Caawnty My Csamm'ss&e�r ExPa",Apr 2, 207 2 *° Page 5 of 5 7 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 5 P.O.Box 1 179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling uni Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: 0 �L IJ 0. 10 (3 J/ Rental Dw Iling Unit Identifier: Requested aximum number of persons allowed to occupy each dwelling unit: Number of R ms in Rental Dwelling Unit: Use and Dimen ion of each room: Rental Dw Ning Unit Identifier: Requested aximum number of persons allowed to occupy each dwelling unit: Number of Rom in Rental Dwelling Unit: Use and Dimen ion of each room: ,* r6a 011LD BUILDING DEPT. TOWN OF SOUT I - 1802 INSPECTION [ I FOUNDATION 1STROUGH PLEIG. [ FOUNDATION 2ND INSULATIOWCAULKING [ FRAMING /STRAPPING FINAL CONSTRUCTIONFIREPLACE & CHIMNEY FIRE SAFETY INSPECTION FIRE RESISTANT I X(FIL)ATION ELECTRICALELECTRICAL (ROUGH) ...._... May 21, 2020 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 4 1 ,� � BUILDING DEPARTMENT TOWN OF SO `THOLD 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 essiolaal seal re rlred Lor Architect or Ea loserlicer� ed Hoo a Iris actor mastProvide copy of valid current certl cation Rental Property SCTM Number: Rental Property Address: 11920 Main Bo view Rd. Southold NY 11971 Owner/Name: 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.) Property Description (Include all improvements indicated on survey) 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 Print Name and Title cec# 1216-0283 OrN i al Signature Please place professional seal: t _ 12P A A Ail YA CA ILI iva � Y 9 � _ M . ' cr= A ffi n F TOWN OF SOUTHOLD PRO117/E///� :ORD CARD 77 74 OWNER STREET i' V I LLAGE DIST SUB. LOT &JJ.�o FORMER 0W R N E AC 1 a '- ary S W TYPE OF BUILDING a Z . RES. 7 t © SEAS. VL. I'FARM COMM. CB. MISC. Mkt. Value LAND IMP, TOTAL DATE REMARKS I ;Af i 3 AGE BUILDING CONDITION NEW ? NORMAL BELOW ABOVE FARM -Acre Value Per Value Acre 1 Tillable i s _ Tillable 2 l Tillable 3 Woodland Swampland l FRONTAGE ON WATER Brushland 1 FRONTAGE ON ROAD f House Plot I DEPTH r BULKHEAD Total i DOCK l L ow AL a � �.�, , COLOR f E TRIM — s 3 I 8828 10/2016 r F M. Bldg. o © Foundation Bath !Dinette F �{ Extension ,Basement � l Floors � K. ' Extension - Ext. Walls ' nterior Finish 1 LR. I f. Extension X Fire Place ' Heat I - R . ts 2a-i bb �- - } . �y 1 �"� 'Type Roof �BRA CS� � o Rooms 1 st Floor IReoeotion Roomy Rooms 2nd Floor® FI- - TDarmer E : Breezeway i -1Y D ri vewa Garage - - -- Patio Total PL z1a � '� ' E FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 26813 Date: 12/06/99 THIS CERTIFIES that the building DWELLING Location of Property 11920 MAIN BAYVIEW RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 088 Block 0005 Lot 028 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 Z- 26813 dated DECEMBER 6, 1999 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 ONE FAMILY DWELLING WITH ATTACHED ONE CAR GARAGE The certificate is issued to ROBERT MILLS OLSSON (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION RE 1/7 z If Building ' apector Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD LOCATION: ......www. G!ITT 1Q a7 SUBDIVISION: MAP NO. : LOT (S) NAME OF OWNER (S) : ROBERT MILLS OCCUPANCY: SINGLE FAMILYQ $ � yji Qj ADMITTED BY: Kul vn ACCOMPANIED BY: , KEY AVAILABLE: SUFF. CO. TAX MAP NO.: $Q,_:5_2$ ..... ...... SOURCE OF REQUEST: M L,TwS. 5? Q1„31.1 _ DATE: 12/06/99 DWELLING* TYPE OF CONSTRUCTION: # STORIES: 2.0 # EXITS: 2 FOUNDATION: BET93C CELLAR: PART CRAWL SPACE: TOTAL ROOMS: IST FLR.: —AL 2ND FLR..- _I 3RD FLR.: _I RATHROO24(S) : 2.0 TOILET ROOM(S) : a•0 UTILITY ROOM(S) : YES* PORCH TYPE: _ DECK TYPE: ..... w PATIO TYPE: ,& BREEZEWAY: _ FIREPLACE: _,,, GARAGE: DOMESTIC HOTWATER: YES TYPE HEATER: L.P. GAS AIRCONDITIONING: ,,, ............ TYPE HEAT: L.P. GAS WARM AIR: XX HOTWATER: OTHER: + GARAGE, TYPE OF CONST. : STORAGE, TYPE CONST.: SWIMMING POOL: GUEST, TYPE CONST. : OTHER: ---------------- VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE ffi ffi ffi « w ffi ffi i ffi « ffi N ffi ffi ffi ffi R « B ffi ffi « ffi ” : p a : a « ffi C « ffi ffi ffi ffi S « ffi ffi REMARKS. INSPECTED $Y: DATE ON INSPECTION: 11/30/99 ;oe= . BOUFIS TIME START: 10:15 AM END: 10:45 AM fltC" Town of Southold 11/17/2017 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OIC" OCCUPANCY No: 39345 Date: 11/17/2017 THIS CERTHUS that the budding ADD'1"1"1;C1'N'/ALT'F. A" ION Location of Property: 11920 Main Bayview Rd., Southold SCTM#: 473889 Sec/Block/Lot: 88.-5-28 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 2/24/2016 pursuant to which Building Permit No. 40501 dated 3/2/2016 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 additi �t c iz ,.dc l�v�itl� c�cl house and.alterations to a qga &rc�l arull ter Irl. i t 4 family w lip"g. s applied orppL�ZBA#7(D?�1., aatecl 7/20/2017. The certificate is issued to Kanas Upstate LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 40501 10/17/2017 PLUMBERS CERTIFICATION DATED uJI-0 ed ignat re Town of Southold 11/17/2017 P.O.Boz 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39347 Date: 11/17/2017 THIS CERTIFIES that the building ACCESSORY Location of Property: 11920 Main Bayview Rd., Southold SCTM#: 473889 Sec/Block/Lot: 88.-5-28 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 2/24/2016 pursuant to which Building Permit No. 40501 dated 3/2/2016 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: ler at in of ali"a ._rrj It""aqq�, . play li e with: ut ide staircase as plia fir. The certificate is issued to Karras Upstate LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 40501 10/17/2017 PLUMBERS CERTIFICATION DATED Si,iature Town of Southold 11/17/2017 " P.O.Box 1179 53095 Main Rd A Southold,New York 11971 CERTIFICATE OF OCC ANCY No: 39346 Date: 11/17/2017 THIS CERTIFIES that the building ABOVE GROUND POOL Location of Property: 11920 Main Bayview Rd., Southold SCTM#: 473889 Sec/Block/Lot: 88.-5-28 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 2/24/2016 pursuant to which Building Permit No. 40501 dated 3/2/2016 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: ""g _ glt", earbove ound sinartuLsoo ,m ✓ith, q c to code as applied for. The certificate is issued to Karras Upstate LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 40501 10/17/2017 PLUMBERS CERTIFICATION DATED ized ign;aturo F Y i rir m r 6 r, r AMIE, / /i