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Home My WebLink About1000-80.-1-28 TOWN OF S UTHOL 40 Rental Permit loot 0944 s Owner Edward & Jacqueline Gould Occupied as Single Family Dwelling Located at 860 Paradise Shores Rd Southold 80.-1-28 Maximum Permitted Occupancy 4 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. 7/5/2023 / Code Enforcement Official This Notice must be posted by the main entrance at all times sP 104S � N ` Town Hall Annex 1, '� o�elephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179a4� � Southold NY 11971-0959 � t x v � BUILDING DEPARTMENT JUN 1 3 2023 TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: Ft.() tiµ " 3C- SNro,-,) Tax Map Number: 1000 SECTION Q -BLOCK SECTION � SECTION B. OWNER INFORMATION: Property Owner Name: (,—. '� 0— Property Owner Legal Address: Property Owner Mailing Address: n Telephone Number(s): Daytime ^ ' ening Emergency Property Owner Email Address: ,< `� �' �' /% Page 105 Town Hall Annex e° Telephone(631)765-1802 li 54375 Main Road Fax(631)765-9502 P.O. Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: M 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: mm Requested Maximum number of persons allowed to occupy Dwelling Unit Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: Page 3 of 5 a � Town Hall Hall Annex P n� Tele hone(631)765-1802 � � 54375 Main Road k Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 � BUILDING DEPARTMENT TOWN OF SO"[..T"THOLD 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 ❑ 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) I CI C u C I�o C G 0UI 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 AnnexTelephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 11791 ph4 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: SIC ue j1f\->` GZr� Property Owner's Signatur Sworn to before e.'this 1 . y of r�N _ 202.3 Official Notary Public Signat r and Original Notary Stamp Wendis M Rodriguez NOTARY PUBLIC,STATE OF NEW YORK Registration No.0'1 806445426 Commission Expires December 1 ,20_ Z(P Page 5 of 5 TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FIN ) [ ] CODE VIOLATION [ ] PRE C/O [ jyRENTAL REMARKS: 12� De- gal, oc, CATS � ��a� INSPECTOR TOR A rjf so TOWN OF SOt+1THC1LD BUILDING DEPT. 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ENTAL REMARKS: n 4 \0 eoOA h0 DATE: —�� _ INSPECTOR -)� , T own An[tex j 1, SOUTHOLD 'TOWN Ery 375 Mal�l Road 179 Scwt-lcld, PC) Box 1 -11-�9 Ren-tal NY 11971 -[el 631-765--,1802 Fax 63 765 9,1502 810— Date SCTM # Phone Owner Address f Zip Inspector aty EVE LS SUB-- ------- �.? 3 LE ..... ..... exckuded) Smoke Detectors (# bedroc,)rn di�,�tectors .I Monoxide Detectois (#) ............... . ....... orgymm, f1f, flA mou KF lj MAE 5 BEDROOMS smoke Detec�c ir p,j�jrns -— ------ C'art.)(Dri M(.�nomlo Aiamf; - .. w Eg�ess (wincloW5� (Y'lr'l) J "'ONDFFION OF PROPERTY BUILDING SYSTEMS Y/N Buiidr"g e I 'S e r . ......... martained ~lad e tiona Electrica! sys L-1-2-'- I'll. - .. ----- -- .— ---- "'- Handr,,-As guards preseni I .......... Mechanical systemi maintained,'op(-.wi',-dtic.)rlaI �o'KNO W IN! 'mom, W,A ONAMENTS.' 2 0 f T' 1 '� jJ i £- - . 10- r s -- - , ._..F.a.., - _ —g -•- _ ..____< t „ z # i F m tt-.zl i , <3 - a= r ' a F r m , x f i r = .a.33'9` ^m�/c.F^.✓Nk`E r.'cEr r✓f t #k=--�' � �� a� fr i OMEN rl s f� -SID. } t Ali - �U1NS_A?AKoYFG__�� :C IdNER Cs) _ x = TOWN OF SOUTHOLD NIOP OWNER T STREET ', VILLAGE SUB. LOT FORMER OWNER N E ' ACREAGE a I _ W . .�� TYPE OF BUILDING RES. SEAS. VL. FARM COMM. IND. CB. MISC. Est. Mkt. Value LAND IMP. TOTAL DATE REMARKS I I I z AGE BUILDING CONDITION ' NEW I NORMAL ; BELOW ABOVE FRONTAGE ON WATER Farm I AcreValue Per Acre Value FRONTAGE ON ROAD j =K Tillable 1 ' BULKHEAD i ? Tillable 2 � _ � ; DOCK Tillable 3 Woodland Swampland Brushland t i Total I ay t, k _ t mums Von Wiffil- D e M. Bldg. Foundation Bath Extension Basement Floors Extension s— Ext. Walls - Interior Finish 3 Extension Fire Place e Heat 6 Porch Roof Type Porch Rooms 1st Floor Breezeway 1 Patio Rooms 2nd Floor arae E Driveway Dormer O. B. FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z.5926. . . . . . Date . . . . . . . . . . . . .May. . . . 23 . . . . ., 19. 74 THIS CERTIFIES that the building located at .1;JS .Paradis.e .Shor*s. Rd Street Map No. . .XXXX . . . . . Block No. . xx . . . . .Lot No. . xx. . .SouthQ1dt. N9Y.. . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . Dec • - - 4 • • ., 19. .73 Pursuant to which Building Permit No. .7021 Z. . dated . . . . . . . . . . Dea. . .5 . . . . .. 19-73., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . . .Private—one. family. .dwezling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a . . . . . The certificate is issued to . Bra smo .Irrixarry.& W. . Owner. . . . . . . . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval - Nay. . .21. . -1974- • •by R. Vika• • • UNDERWRITERS CERTIFICATE No. -NI .56965. . . May. .1. . .1974 . . . . HOUSE NUMBER . . . .$60. . . . . . . Street . . . . Paradise. Shors.s. .J�oad . . . . . . . . . . . . . Building Ins ctor