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Home My WebLink About1000-117.-4-14 TOWN OF SOUTHOLD E Rental Permit 0933 Owner Daskin Evelyn Living Trust Occupied as Single Family Dwelling Located at 455 Fred Street New Suffolk 117.4-14 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. 6/20/2023 C er r n Official This Notice must be posted by the main entrance at all times //Y Town Hall Annex . -Telephone(631)765-1802 54375 Main Road a ,` - Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 "°�Y BUILDING DEPARTMENT FE 2 2P.03 TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION V�"j'vv or-golmin� r% Rental Permit Fee $200 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: r AOL, AY\-t �Z Tax Map Number: 1000 SECTION h�. -BLOCK 0 -LOT-- 014 SECTION B. OWNER INFORMATION: Property Owner Name: iottiA t V,A _- Property Owner Legal Address: w Property Owner Mailing Address: —A n am r Q�7 � � S' Emergency ( Telephone Number (s): Daytime � vening gency � 3q t2— Property Owner Email Address: __ � Page 1 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 r�✓ BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent:.,..,. .. Telephone Number (s): Daytime10 _w _. .�Evening,,_, .ww�.Emergency Email . „ww 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, 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: Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: ._ww..3S°r Z Use and Dimensions of each room in Rental Dwelling Unit: _, �. aL � e Mka '~ ramal 1b6 �Nkx" .; . Page 3 of 5 Telephone(631)765-1902 Town Hall Annex W� ' 54375 Main Roads Fax(631)765-9502 i. P.O.Box 1 179 1 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) ) 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 ' p Telephone(631)765-1802 54375 Main Road i Fax(631)765-9502 �� P.O.Box 1179 Southold,NY 11971-0959 i10 " 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: Property Owner's Signature:_ _....._.. �. Sworn to before me thislaAay,of ,M h 20_ Official Notary Public Signa mina otary Stamp SETH G BANK [N.C,,.ry Public-State of New York N0.01 BA6427783 ualified in Suffolk County ommission Expires Jan 3,2026 Page 5 of 5 as 460- I:W dw �44w(lt--o TOWN OF SOUTHOLD BUILDING DI 631 -765-1802 ..•- . INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION TND [ ] INSULATION/CAl C ] FRAMING STRAPPING [ ] INAT [ ] FIREPLACE & CHIMNEY /] FIRE SAFETY IN% [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE C ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII C ] CODE VIOLATION [ ] P / [ I REMARKS: Additiorial Ke Certification, w. may BeR a u : AT � 2'-4"X4'—01/ `.e4"� UY OCCUPANCY aA 4" ..:,:.µ »ms...,. ............._�.::" ..c ,i wwa UNLAWFUL 2'.8" — 2'-4°"- 2n 4n« 2'-8" UW umi T iiwwa wwwrymiw w a wyr.. 2" �� s. wawa i wolCu' P "P ..0 ,p$ tE to :1C' I —_ — � �a � � pE-C,, N REw ROOM ON LEA C ,TENT'BEF-0 CERTIFIC APOP, L 2c 26 tiw� .m (�,MwDE-n USED IN WA TEF STAIRS: _.,... p/ w , E (WW' ' - 12 TREADS @ 9-1/2" EXCEED 21'10 OF15 RISERS @ 8-1/4„ uP�r _. N n 31 J t rYfs iPF B ATH, Q ri «, G2° q2" ROOM 2 � L------JG I -2* Z — — —.. i, _.., Juszo aOIL, � ail "It .I i } AS T101lD 7 _ a KrI ISN m P uvlN(I P-CM Y1 AM j4 PNI - ' } nwno . c; -X- = � - rte: STAYT Kim. -q - faA�aE ,¢ RLI is t WAW T PLN zoo 4 DRAMINQ me US } y y - FH RSCS.i:MNIa' .CJITTOWN�KY.1f1EL"` �U V V'X 4oI { APPROVED AS NOTED t DAM 79 t T -' 765=2 *AM ft 4PM FOR RjWW. c !ate as MAWNG 09 tomTqucncK IRRMS t €AU COH Mu s€ a s r t OF H t STATE EOM A.a0TOWN WgatSthoCoft aZQ,,Nr y_ A - y. , I Fr�r.In •4Q .,� WELL- 0 Lor SP ". .1 -79 _ ----_ - _ E _ fs4 _ ..•�. ate �_ - ,f --_- IW PpALY{A L/NF L6Ut440WM N,Y 91YGF ` TOWN OF SOUTHOLD PROPERTYRECORK OWNER 'STREET VILLAGE DIST.; SUB. LOT e FORMER OWNER N � � E ACR. � kS r W TYPE OF BUILDING z RES. fw, SEAS. ! VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS _ ir r' 0 F AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre I Tillable FRONTAGE ON WATER ' Woodland FRONTAGE ON ROAD Meadowland DEPTH House Plot BULKHEAD Total DOCK I COLOR TRIM f Bill I� 3 _ t 7- _ k M. BI x ' a 4 t i i Extension Extension 3 0 .1 s, .Foundation Bath ' ` Dinette PmCti 7 R. .= Basement f' I< ;Floors Porch `Ext, Walls ?Interior Finish LR. Breezeway !Fire Place Neat 'DR. Garage r IType Roof t� Rooms 1st Floor j` Patio 'Recreation Room w 'Rooms 2nd Floor !FIS B O. B. 'Dormer ;Driveway Total i q FORM INO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Date . . . . . . .Au&ust. k. . . . . . . . . . . . . . . ., 19 A? THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property435 . . . . . . . . . . . . . .Fred .5�no.4 . . . . . . . . . . . . .�uffo�lc . . . House No. Street Hamlet County Tax Map No. 1000 Section . A 17. . . . . . .Block . .04 . . . . . . . . . . .Lot . . . .01!4. . . . . . . . . . Subdivision . . . . .X. . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. X . . . . . .Lot No. . X. . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . aune. 29 . . , . . . . . 19 .7.9 pursuant to which Building Permit No. .103.ZQ .7. . . . , . . . . . . . dated . . .July. 1 A . . . . . . . . . . . . . . . . 19 7.9. ,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 , . . . . . . . . . . . . . . . a. private. nue-faJni.ly. .dwQllAnsp. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . . . . . . . . .Ue.M411. .& ;VOA .gsk3n . . . . . . . . . . . . . . . . . . . (owner,l ep*mrnt of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . . ..1138 . P.E. UNDERWRITERS CERTIFICATE NO. . . . , A 492?$. . . . . . . • . • . • . . . . . . . . . • . . . . . . . . . . . A . . ..1 . Building Inspector Rev.1/81 ... �