HomeMy WebLinkAbout1000-14.-2-19 -3` TOWN OF SOUTHOLD
Rental Permit
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0651
Owner Mark Wilson & Kristin Baird
Occupied as Single Family Dwelling
Located at 730 Bight Road Orient 14-2-19
Maximum Permitted Occupancy 8
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.
5/18/2022 f"V 11L
rc nt officialThis Notice must be posted by the main entrance at all times rerl
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Town Hall Annex Was�d& �,��,��� Telephone(631)765-1802
54375 Main Road � � "i�u I'4 QOLD Fa 765-9502
P.O.Box 1179 � �tl
Southold,NY 11971-0959
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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
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SECTION B.
OWNER INFORMATION:
Property Owner Name: ...... __.. ..'.. .......�....._.... ...,_...... .__w�. .. ........, _ ., ..... .
Property Owner Legal Address: Property Owner Mailing Address:
Telephone Number (s): Daytime, Evening, Emergency 99
._..._
Property Owner Email Address: .___.. .,., ......_..--.--
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Page 1 of 5 0"'
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 SOU OLD
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any: .,.__ . . . .._, ._m...__. ._ ..................
...___ ww
Address of Authorized Agent (no P.O. Boxes):_„-_....... ................
....._� _,......._.._........... � _._..�._......._�__
Mailing Address of Authorized Agent: ..._.._........_....wwww___,.,_ _....... . __........... ...... ...n,� _,.,. _. .__
Telephone Number(s): Daytime.......__._._............. ......w........vwv.... Evening,,_.._.,.. ........___Emergency........._..., ._.__--
Email Address: .. .w._...._.................�w..._. ........
.w..�.��.������..�.,.�.�.�.�.�. �._.. .�_��._._...ww_._...._.._..,�_. ............��..........a�.._w_ .. M..._.-_����__......_.a.� _�.
Section D.
Managing Agent Information:
Name of Authorized Agent of dwelling unit, if any: w m � .....,..�.._._.....,___�. .... _..........__
Address of Authorized Agent(no P.O. Boxes):_..---.,---.--...... ......... �..._
Mailing Address of Authorized Agent: _,.......... �...,,,,,.._ www... ._.. mm. ... _. ... .
Telephone Number(s): Daytime-......_,. ___n,,,.,_ .,_,_Evening Emergency
EmailAddress: ,,. -.......�........................_._.w_ ......� _................M� w_�. .__�._ ....�._ ._...... _........ _�w...._� �.�..._ Mw _ __��www ...
SECTION E.
SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units)
Name of Managing Agent of dwelling unit, if any: _,_,.............W.. __.._ _......��..,...._v_....�_........... .........
� ..._..��.
Address of Managing Agent (no P.O. Boxes):_...........
.�� ���_.._..._..v. .......... ...........�_,. �.�....._�.�...�..__......_ �w_..... ..
Page 2 of 5
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1 179
Southold,NY 1 1971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent: ......._ _..www __.....���.... .._.._��............�._ �..........._.. .�......��__........�_ ..._....�.....�.�.w.. .. ._
Telephone Number (s): Daytime, ......- Evening........... Emergenry �w�.... ..................�.�... ...
EmailAddress: w m.........._... _ ...._........_....._.M..... u.........,.._.._........... _�.�w_..._ __._........._ .ww�.. .....�......�.ww�..� _.
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on property. ,_,,,,,,,_ �ww._......._,......... ww........... ...w_.�_.__w_....
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: . __.._.... ._.,. . ......_M ....... .........._......_ W_..._._..._..
Requested Maximum number of persons allowed to occupy Dwelling U �m...
Number of rooms in Rental Dwelling Unit: .,,_,,,
... _........
....
� ....M_w_.,, ..m...r .......a...... ��'
Use and Dimensions of each room in Rental DwellingUnit: �
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..ww.......Pea . �Me�... _..w.._.....�'...w ...........:..w......`�..a _ ..�_
Page 3 of 5
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 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
❑ 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)
. ..W. h2—..... ..., 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 Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SO SOLD
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: _V,
Property Owner's Signature: __ ___. w............................. ....._
�.�.._.�...... �.,. ..
Sworn to before me this_day of.. ._ m ,.,...,, ., _.. ., .� 20._.__
Official Notary Public Signature
natu
re and Original Notary Stamp
Page 5 of 5
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FORM xa a '''"y, ,'
TOWN OF SOUTHOLD
BUILDING DEPARTIdENT
Town Clerk's Office
Southold, N Y.
Certificate Of Occupancy
No. A7.?6:+. , , . . . Date . . . . . . . . . . . . . e11 . .�. . 4, . , ., 19.7b
THIS CERTIFIES that the building located at .Bight_ Aqad. . . . . ! . . . Street
Map No.1'gtt, Dj&tBlock No. . . . . . . . . . .Lot No, . jp. . , Orient. . . . . . . . . . . . . .
conforms substantially to the Application for Building Permit heretofom filed in this office
dated . . . . . . . . . . . . .12 April 10. . pursuant to which Building Permit No. P.4941 .
dated . . . . . . . .Apri1 13 19.?6., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for whish this certificate is
issued isPrivate one family dwelling. . . . .. . . . . . . . . . . . . . a . w w µ µ µ w 4 w . * µ w
George Newman "weer
The certificate is issued to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval AQP:( . .?1. . .197A . ,by 4! Villa. .
UNDERWRITERS CERTIFICATE No. Pending. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HOUSE NUMBER . . . . . 7aQ . . . . . Street . . Fsight, Koad, Orient. . . . . . . . . . . . . . . . .
Building
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46
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-27930 Date: 09110101
THIS CERTIFIES that the building DECK ADDITION & ALT
Location of Property: 730 BIGHT RD ORIENT
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 14 Block 2 Lot 19
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST,
8, 2000 pursuant to which
Building Permit No. 26713-Z dated AUGUST 11 2000
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 DECK ADDITION AND ALTERATION TO EXISTING DWELLING AS APPLIED FOR.
The certificate is issued to BRUNO J & FELICE SEMON
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. H072486 08/13/01
PLUMBERS CERTIFICATION DATED 03/06/01 BRUNO SEMON
cilk
Authorized Signat e
Rev. 1/81
0
�,. �� �� FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28983 Date: 10/10/02
THIS CERTIFIES that the building ACCESSORY
Location of Property: 730 BIGHT RD ORIENT
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No_ 473889 Section 14 Block 2 Lot 19
Subdivision Filed flap No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 8 2002 pursuant to which
Building Permit No. 28156-Z dated MARCH 11, 2002,,
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 INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR.
The certificate is issued to BRUNO J & FELICE SEMON
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 1060576 06/24/02
PLUMBERS CERTIFICATION DATED N/A
Authorized w. nature
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-25825 Date: 07/14/98
THIS CERTIFIES that the building ACCESSORY
Location of Property: 730 BIGHT RD ORIENT
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 14 Block 2 Lot 19
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 10 1997 pursuant to which
Building Permit No. 23905-Z dated FEBRUARY 3 1997
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 GARAGE AS APPLIED FOR.
The certificate is issued to BRUNO J & FELICE SEMON
(OWNER?
b
of the aforesaid building.
a
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. H--059265 03/27/98
PLUMBERS CERTIFICATION DATED N/A
B uli46 Inspectc
Rev. 1/81
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