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Home My WebLink About1000-4.-7-4 TOWN OF SOUTHOLD 15 x Rental Permit 0942 Owner Louise Gaumond Occupied as Single Family Dwelling Located at Oriental Ave.aka 16121 E Main Rd Fishers Island 4.-7-4 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. 1 6/30/2023 � � c►r Ce fficial This Notice must be posted by the main entrance at all times Town Hall Annex Telephone(631)765-1802 1A114 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 ° BUILDING DEPARTMENT TOWN OF SOOTTOLD RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every tw ar JAN 2 5 rD Section A. � � � '� Property Information: TOWNOFS01WUD Rental Property Address: lC� a JCAS- --- y u. `S� is rs 7s l._ JN Tax Map Number: 1000 SECTION -BLOCK f -LOT ` - SECTION B. OWNER INFORMATION: Property Owner Name. LOU Property Owner Legal Address: Property Owner Mailing Address: °�.�� Mt ►( a �e, �� Lk Lt�� y�. Telephone Number(s): Daytime Evening ` Emergency Property Owner Email Address: Id v2e 1 otic Page 1 of 5 Town Hall Annex .fit Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 , U UK BUILDING DEPARTMENT TOWN OF SOUMOLID Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent(no P.O. Boxes): ('� � C etik�� vv' 1 � � s� U S A N^-- Mailing Address of Authorized Agent: Telephone Number(s): Daytim\a Evening Emergency Email Address: J��' S << I S�P+( C� �. Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent (no P.O. Boxes): ° Mailing Address of Authorized Agent: Telephone Number(s): Daytime 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 (no P.O. Boxes): Page 2 of 5 r um, Town Hall Annex % Telephone(631)765-1802 54375 Main Road `i Fax(631)765-9502 P.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, 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. 'w" W" W Requested Maximum number of persons al d to oc py Dwelling Unit: Number of rooms in Rental Dwelling Unit Q�S �`� A ''`�'1'`s o�o Use and Dimensions of each room in Rental Dwelling Unit: Dc';L-- 121-�5 VDVLL\ —Ct 'rtl Page 3 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 114 �� Southold,NY 11971-0959 � g , Fl r. 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) I L vKS.P 6"11''"'""'i 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 e Town Hall Annex f' Telephone(631)765-1802 54375 Main Road � i Fax(631)765-9502 G P.O.Box 1179 �` 9 , Southold,NY 11971-0959 u do 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: v v t s e— 60,L&rn o n0�_ Property Owner's Signature: ^-r notary pub IC or other officer completing this certificate verifies only the identity of the individual who signed the document to which this Certificate Is attached,and not the truthfulness, accuracy,or validity of that document. Sworn to before me this day of 20'X " state oralifataia t County of` .. me Official Notary Public Signature and Original Notary Stamp snb ritredandswornta rraflirrned)1lcfoyelt" his daty�. as by " proved to me on the basis of satisfactory evidence to be the (4 who reel re me. r 't acute ay.wrw4 ERICA Y.JOUBERT NOTARY PUBLIC-CALIFORNIA a COMMISSION#2381922 + MARIN COUNTY Page 5 of 5 My Comm.Exp.December3,2025 oF So�r,�� rpm n� on ci *Q� TOWN OF SOUTHOLD BUILDING DI 631 .765-1802 � t,.. �.0 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [7ATIOWCAI FRAMING / STRAPPING (FIREPLACE & CHIMNEY [ AFETY IN: [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F [ ] CODE VIOLATION [ ] PRE C/O [ I REMARKS: (04A-*,te- A Ll � o �n m s l�o�J p, s ! � ...... sir � DATE 1 '7 Lf �i 7.'3 INSPECTOR \ v r a s z; E i _ s ., spa r ED 4m a` S6x 36 - t R at i - - � 1pwy ORF � i it• 3 Wcy v 1 �0126,t ; VIP :AS MTfT4g_ UAB:i 4 'CUA—qTWN-r AT - R THE Q'' 7d5 i8B2 4 AM TO d PM FOR _ FOLLOWING INSPECTIONS: i.FOUNDATION-TWO REQUIRED ,f•� S € �( 'i $ _ FOR POURED CONCRETE € v 3V O { E 3 �y ue I , 2.ROUGH-FRAMING&PLUMBING r = T -fit - 3.RNALA CONSTRUCTION MUST - . : f E. - - t �u vlac- d BE COMQI FTE FOR C 0. i �a ,� ALL CONSTRUCTION SHALL MEET '[[ I 36 _ s _ ; "'ioe _ - - - THE REOEtRCAnE4T5 OF THE N.Y. �4 m - - CORES NOT RESPONSIBLE l .�-.. - STATE CONSTRUCTION ENERGY �e - ( \ DESIGN OR CONSTRUCTION ERRORS. X14-v h b/ ,�/' � € 1 _ �� - - - # _ € � i �';9. � .3&��G>•TI L1"[`S' 6P,ACb- �=-Ty' € • 4 e [ dZ(t - `- �7TiT�(LFV42D {'{QJSE � 21 0_.. x � E 4 } E La tT 1 ry"I"�:-, I A x= i = a i L f a s i E px5f .� r 4 - jL s — ,.� may. E t i . € s 774 -71 o 3-WASCo CA ZZ�6 SeyueHts t rwTCQLImr Lib i 700= —Y Ott OPfA1 [o c 3 [ {, � = Soup 20.i�. iWIT 4- € -01 2b4 _ OpeN To771 t RI 5-COR.gG�. ad"� ---- - ( ST.RACo6 If f]PNER , - .aem 4o6Eff 7 # :� 9j 60 •yah 8�.zt = -. - - _� _ - 3eP�uL. i t 47i J UPS tR.s RRN _ 1 y 1 16_82 TOWN OFSOUTHOLDP R Y R 516 I e VNFR STREET VILLAGE DIST; SUB. TLOT I V, FORMER OWNER t�4-, E F ACR P BUILDING W ; TSEy'OF �H RES. SEAS VL. FARM COMM. CB. MICS. Mkt. Value 1 LAND IMP. TOTAL DATE REMARKS l V. b ,a ( - — x it kv s I t AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre ? Value Per Value I Ac re Tillable FRONTAGE ON WATER Woodland � - FRONTAGE ON ROAD a MeadowlandDEPTH House Plot BULKHEAD Total DOCK : DR TRIM f Mum # 1 t J41 � i 3- -S, 1 1 r 4,74 3/06 l M BISq S e z s $ ___ - € - ,.' • --s € 7 e a€ � } ; € - _ate€ E , C = } _ Extension I r ` a 1 s i S c Extension F r 1 = s a # t "nsior a I x Foundationi $ Bath E Dinette parch 3— Floors u L_ rs _ v. <.. 3 W Interior Finish R. �� i €. t 'Ext. alts � � 1 s Breezeway Fire Place Heat DR. .Garage Type Roof =Rooms 1st Floor BR. Patio Rooms 2nd Floor ' :__ FIN. B 1 O. B. Dormer i Driveway x¢ Total FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31232 Date: 2 24/05 THIS CERTIFIES that the building NEW DWELLING Location of Property: ._ ORIENTAL AVE FISHERS ISLAND (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 472889 Section 4 Block 7 Lot 4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 14, 2005 pursuant to which Building Permit No. 31538-Z dated OCTOBER 18, 2005 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 SINGLE FAMILY DWELLING WITH ATTACHED GARAGE AS APPLIED FOR. NOTE: THIS DWELLING WAS CONSTRUCTED IN 1982 . The certificate is issued to LOUISE D GAUMOND (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-03-0091 0$ 2 505 ELECTRICAL CERTIFICATE NO. N-605550 06 10/83 PLUMBERS CERTIFICATION DATED N/A c ored Sianature 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-33731 Date: 0.522/09 THIS CERTIFIES that the building ALTERATIONS Location of Property: ORIENTAL AVE .�.............. FISHERS ISLAND (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 4 Block 7 Lot 4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 25, 2007 pursuant to which Building Permit No. 33294-Z dated AUGUST 3 2007 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 WINDOW ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. . The certificate is issued to LOUISE D GAUMOND mm (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A as ori cd S ature Rev. 1/81