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Home My WebLink About1000-14.-2-1.2 A$ TOWN OF SOUTHOLD CC05 2-1 Z Rental Permit 0667 Owner Terry Mulford House Inc. Occupied as Single Family Dwelling Located at 30675 Route 25 Orient 14.-2-1.2 Maximum Permitted Occupancy 10 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. 6/14/2024 _ 1 ode V f rc t Official This Notice must be posted by the main entrance at all times p TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 1 2 S P E(Ok T 10 [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING XFIllRE NAL FIREPLACE & CHIMNEY SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENET ATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI L) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL RE,RKS:: r inv mob 0MAeAUA �r .. _7 T DATE S C JUN 1 2 2024 Bullding Department Town of Southold 4- 0 C/) c its C= 0 0 r-- = Cj3 CU 75 X LU S& 0 -00 cu 'm cc AVMV& cv a cp 'E15 --L cu -0 cn 0 _0 cn 1=CU 4-- cu cn E ce) = 0) o .E- 0) m CD C C (D cu m 2 " U cu cu a co CL -5 a- — AOW& cri 4) 0 -0 U Cf) cn Alk %� CD c E A*A% 0 C) 0 a) cn -J 0 0 UL 4 O 0 CU CL PLO 0 0 MM "" W6 E -0 F— u :F; a) . kn -a CD CIA 0 C) = z _0 U) U) E c CO -U) .9U) F- S2 �: IWM fu > cv a) -0cu E 2 CD Ca cu (D cu a) cf) o CD 41PI, 4-j 0 0 U) :s 0 0 h" Town Hall Annex x, Telephone(631)765-1802 54375 Main Road �r Fax(631)765-9502 Ik r. P.O.Box It 79 � �? or Southold,NY 11971-0959 �} BUILDING DEPARTMENT ub TOWN OF SOUTHOLD "' RENTAL PERMIT APPLICATION Rental Permit Fee $200 (Application mast be renewed every two y661t$) a P u, Section A. Property Information: Rental Property Address: 30675 Main Road, Orient, NY 11957 Tax Map Number: 1000 SECTION 14 -BLOCK 2 --LOT 1 - SECTION B. OWNER INFORMATION: Property Owner Name: Terry-Mulford House, Inc, Property Owner Legal Address: Property Owner Mailing Address: 30675 Main Road PO Box 96351 Orient, NY 11957 Portland,, 646-209-7910 Telephone Number (s): Daytime 646-209-7910 Evening 646-209-7910Emergency 631-965-4955 Property Owner Email Address: tmh.board@gmail.com Page 1 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 r P.O.Box 1179 �r ��... Southold,NY 11971-0959 � r a: n BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: wNicholas Wilkinson��_ Address of Authorized Agent (no P.O. Boxes):__ 4441 46th Ave SW, Seattle, WA 98116 Mailing Address of Authorized Agent: .._.4441 46th Ave SW, Seattle, WA 98116 646-209-7910 Telephone Number (s): Daytime 646-209-7910 Evening 646-209-7910Emergency 631-965-4955 Email Address: tmh.board@ mailcom Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: Nicholas Wilkinson Address of Authorized Agent (no P.O. Boxes): 4441 46th Ave SW, Seattle, WA 98116 Mailing Address of Authorized Agent: _ 4441 46th Ave SW, Seattle, WA 98116 646-209-7910 Telephone Number (s): Daytime 646-209-7910 Evening 646-209-7910Emergency 631-965-4955 Email Address:,... tmh.board@mailcom 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 r Town Hall Annex P ' Telephone(631)765-1802 54375 Main Road �� Fax (631)765-9502 Y.O. Box 1 179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: ,, Telephone Number (s): Daytime .. ___ Evening_Emergency___,,, Email Address: 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, 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." N�µp Rental Dwelling Unit Identifier: Terry-Mulford House (single unit) �.. X10 00 Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: _eO16 Use and Dimensions of each room in Rental Dwelling Unit: Living room 17'6"x22'3", Dining room 17'6"x 144", Kitchen 12x 144", Pantry 6'x 5'9", Bedroom #5 157x 13', Bathroom#4 8'5"x 6'6", Laundry 7'5"x 6'6", Office 15'6�x 9', Bathroom#3 9'x 9', Bedroom#1 164"x 17'9 , Sitting room 10'x 13'6", Bathroom#1 6'10"x 13'6w Bedroom#2 12'3"x 11'3", Bedroom #3 16'9"x 112", Bedroom#4 22'x 142", Bathroom#2 6'10 x 13'6" Page 3 of 5 J�ilT rar , 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. ❑ 1 am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold IR 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) Nicholas Wilkinson, President I Terry-Mulford House, Inc. 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 1j,, Telephone(631)765-1802 54375 Main Road tr Fax(631)765-9502 P.O.Box 1179 nN a rr; 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: .Nicholas Wilkinson, President, Terry-Mulford House,Ince Property Owner's Signature: Sworn to before me this day of (1 G1 , 202.2 1�Iota FUNIC State of Wass n B TANY KJM _.... LICENSE,#21033169 Official otary Public Signature and Original Notary Stamp My COMMISSION S SEPTEMBER BER 2 ,2025 Page 5 of 5 0 � N A �04tO(' 144000 OWN T SOUTHOLD BUILDINGI 631 -765-1802 flowIq .. a INSPECTION [ j FOUNDATION IST [ ] ROUGH PL13G. [ j FOUNDATION 2ND [ j 1NSULATIOWCA1. [ j FRAMING / STRAPPING [ j FINAL [ j FIREPLACE & CHIMNEY [ j FIRE SAFETY INE [ j FIRE RESISTANT CONSTRUCTION [ j FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ l ELECTRICAL (Fit [ ] CODE VIOLATION [ ] P / [ I . REMARKS. pf 5 J(eA pr---__(- 11001 April 10, 2022 Town Hall AnnexTelephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179c Southold,NY 11971-0959 " fill 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 Professional,seat required µqtr Architect or Fn irteer iicerrsed Home ira ecicrr mosi tovid covy of valid current cerci l ation Rental Property SCTM Number: Rental Property Address: 30675 Main lid. Orient N " 11957 Owner/Name: Nicholas Wilkinson 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 2 132 saft Property Description (Include all improvements indicated on survey) family bome 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 �� 161,1ZI-1 Print Name and Title ceo# 1216-0283 Original Signature Please place professional seal: mf k'r T 3 o E f0 Lf) II 9 Ln 4- �� "I O S. M O i m O X O h -O in m � m E v ac O L O V x 0 x Y N C � h O M _. O N N � X C ZD L O O LL O CL r z° N n M ry EO T E ^ O X O — M O X m N �p m 0 E � O a x � O N a m � o Ln O ON c r 3 40— Z z m 4-? lf1 � o�D o m lfl •— E o Ix v x N _ E �2 7s o o x E i2 O X O , m m 3 io 0 _ I V X M O n u o ° wwwwww O x L � R m L N LL LU CE cl ON _ LU i Ln uj LU ujCk - n= LL LL ❑ m LU cNi 4, VIC o i k � � LL _... ' . uw Lri .r' a ' Ln LAJ �: ❑ r �'i �� c C LLJ ""U-1 v v N o L o '3 q Ir dy N ...............0 V N " w C Y J Ce m m� O w c `S ti 1 -j LL ll J J(n 711 1 .0 a �d 1=1.U fq G.. rpi m 76 u ^� E r CL CD o A S; x o r00 i NY O ,y c4 f � "X i� it uui 09� y ii' O 6 2 fl CL C) b 0 y lei r e I I t i Tr r _ ._ ... .. ... r 1.0 � � l , r � - r t j e 4 LL f u V I r1 l � µ � a � r P 3ryI } 1 � r b g e e oil P 9� I J _ , S r IF FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold,N.Y. Certificate Of Occupancy No. . . ?9554. . . . . . . . . Date . . . , . , June. . .3 . . . . . . . . . . . . . . . .. 19 . .7.9 THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . , .. . . . . . . . . . • . Location of Property . . .W�M. . Main, ?d. . . . . . . . . . . . . . . . . . . . . . . . . House No, Street Hamlet County Tax Map No. 1000 Section . . O14. . . . . .Block . . . . . . . .Lot . . . . . .00.1. . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . » . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . . REQUIREME21TS FOR ONE FAMILY DWELLING BUILT PRIOR TO conforms substantially to the Apri! '" CER „ °'SCA ,1 QF OCCUPANCY Z9a54. . . . ' " , 197. pursuant#o which E o. dated . . . .June $. . . . . . . . . . . . . . . . 19 .79,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 . , . . . . . . , Private One Family 4elling with Accessory Structure The certificate is issued to . . . . . a . . . . , ,,Helen H. Burden , . , . . . . .. , (owner, of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . . . .NIR. . . .Pre-Exiatit1g. . . . . . . . UNDERWRITERS CERTIFICATE NO. . . .N/R . . . . . Pre--.7xi C-tin; . . . . . . . . . . . . . .. . . . , . . . . Building Inspector Rw 4na BUILDING DEPARTMENT TOWN OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT Location x`66/;'- number s°'°teatkNunicipalityl Subdivision Map No. Lot(s)� Name of Owner(s)' Occupancy type owner- enan Admitted by: dY,241 —Accompanied by: � Key available Suffolk Co. Tax Source of request__F + �.-- DWELLING: Type of construction Wood F1Z/-rM.S #stories'a,c,--�Tivo FoundationR. "ft Z 4t� .��°e�"� �' ,r;,,-,.t,, Crawl space �i-�.eT'.� , Total rooms, 1 2nd. Fl d• F1dfTT•c •r�oc�c Bathroom(s) cr Porch, type�mFirnovZ2 Deck, type Patio, type BreezewayGarage Utility room^^ f � Type Heat ,z44-- 'Warm Fireplace(s) -6 No. Exits Airconditioning.. Domestic hotwate � "_"`yPe heater Other ACCESSORY STRUCTURES: L&coop riray.�rF Garage, type const. Storage, type const. Swimming pool Guest, type const. Other VIOLATIONS: Housing Code, Chapter 52 L cation r^� Description j Art. Sec. / 11 G"-J /6 Remarks: 7,-1 4c4c"O-ZO _. Inspected by: ate of Insp. _ �7 7 _ end Time start 3 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31999 Date: 11116106 THIS CERTIFIES that the building ADDITIONS ALTERATIONS Location of Property: 30675 MAIN RD ORIENT (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 14 Block 2 Lot 1.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 20, 2006 pursuant to which L.Building permit No. 32238-Z dated JULY 25 2006 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 ADDITIONS INCLUDING COVERED PORCH AND ALT'E'RATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to TERRY MULFORD HOUSE INC _._. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTM WT OF HEALTH APPROVAL N A _ ELECTRICAL CERTIFICATE NO. N 531544 07/27/00 pLUPMERS CERTIFICATION DATED 09/01/o6 KING PLUMBING 1 Au orie Signature Rev. 1/81