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Home My WebLink About1000-126.-11-1 r TOWN OF SOUTHOLD Rental Permit 0695 Owner Lawrence Holfelder Occupied as Single Family Dwelling Located at 6600 Gt. Peconic Bay Blvd. Laurel 126-11-1 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. 7/11/2022 This Notice must be posted by the main entrance at all times de Enf rce 0 ficial Town Hall Annex ,; f '= �. Telephone(631)765-1802 54375 Main Road , f, "' ', Fax(631)765-9502 P.O.Box 1179 Southold NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ,� MAY 2 5 2022 Rental Permit Fee $200(Application must be renewed every two years) D7 Tr Section A. Property Information: Rental Property Address: Cr �3 H 0 12 cc n Rei 73 l�'8 Tax Map Number: 1000 SECTION 2,� -BLOCK I -LOT SECTION B. OWNER INFORMATION: Property Owner Name: LA-%jJ cGc(1 c 5, Property Owner Legal Address: Property Owner Mailing Address: 63 �� Telephone Number (s): Daytime o Evening Emergency Property Owner Email Address: C)"� Page 1 of 5 °`<- : Telephone(631)765-1802 Town Hall Annex :'; ;I. ' .. 54375 Main Road E . :` ",: - = Fax(631)765-9502 P.O.Box 1179 :V;,, Southold,NY 11971-0959 w% }rte BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: "D� Address of Authorized Agent(no P.O. Boxes): C� Mailing Address of Authorized Agent: -c./v C�3 I Ll"73�3�•� q 26 72 U Cc, Telephone Number(s): Daytime Evening Emergency Email Address: eQ c v, .E 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 ening E rgency. 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: A V A Address of Managing Agent (no P.O. Boxes): Page 2 of 5 YO Town Hall Annex t 4.. -:, Y = Telephone(631)765-1802 54375 Main Road ':; "' ;,", "'' Fax(631)765-9502 P.O.Box 1179 rte: Southold,NY 11971-0959 �� a•^ ,,. BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): DaytimeEvening 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: v IV / 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: �, Rho►�`1 30 S Page 3 of 5 'sou/', ,Ali ,l h� 631 hone C Tele 765-1802 Town Hall Annexe, �::' / ` " ,��v} P ( ) 54375 Main Road Fax(631)765-9502 P.O.Box If 79 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 ❑ 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 Lawrance Nol(�tld t--y , 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 ' ;.i�� .r;='��•*:^fie. �' r, r:•r Telephone(631)765-1802 Town Hall Annex ,t'.-*! r•---, `;~„Y Fax(631)765-9502 54375 Main Road P.O.Box 1179 Southold,NY 11971-0959 '_ 0` 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: A l o l Fe 1 cl r r Property Owner's Signature: s� Sworn to before day of � /M A---S 120 Z Official Notary Public Signature and Original Notary Stamp WV� SAMUELT.BUCKLEW MY COMMISSION#HH 232200 ', oF F,p`�' EXPIRES:April 15,2026 Page 5 of 5 0 SOGTyOlo - Pet. '/ v,% �/ ✓ ' V f # W . OUTHOLD BU OF SILDI4G DEPT. 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSU ION/CAULKING [ ] FRAMING /STRAPPING [ ] AL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI L) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: Um UIXVA/ LA DATE Y?/ INSPECTOR INX\pF SO(/r�o� Town Hall Annex 3tt Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 C�k • S Southold,NY 11971-0959 �<i, 17 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 seal required for Architect or Engineer, licensed Home Inspector must provide copy of valid current certification Rental Property SCTM Number: Rental Property Address: V:� LID / c�E��✓G , A� 3 jr/O� r �J Owner/Name: � �tJ�'F'i�c't /mac ✓c� r' 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.) Ste' Property Description (Include all improvements indicated on survey) -5 1 1C''IC- 1 1I -c ,c4 r,tn C c- `TIt_�c, 1~ w -i 1 is 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. Print Name and Title Original Signature �,� � 1. k�I O Please place professional seal: g 3 2'1'� •• DFFSSID �� 6 TOWN OF SOUTHOLD PROPERTY RECORD Car<�� r OWNER STREET r'" g VILLAGE DIST.. SUB. LOT ' I JMZ FORMER OWNER N a n E ACR. m r S W TYPE OF BUILDING ' v r)c,rncty Ma :e4 92i:i�8cr LI FRES ` SEAS. VL. FARM COMM. CB. S Mkt. Value LAND IMP, TOTAL DATE REMARKS 14 /1.4 j ` ° C+''.. @;°; `°•T i t .,t if Frd }�7 d? 8- Q.�l4 f JI 3 y `lf dh. f Q � - 1 /� h.4 'Il �r 7 } 9000 /O )..t 114 912M I L I t a _f-401 cher -�a +�o��e.��er - 4,1 00 AGE BUILDING CONDITION N4 NORMAL BELOW ABOVE I . FA+A Acre Value Per Value Acre Tillable 1 Tillable 2 Tillable 3 fI Woodland I !Swampland FRONTAGE ON WATE /f c) 'IBrushland FRONTAGE ON ROADlei — - House Plot DEPTH . .; BULKHEAb � ' — bk { Total DOCK i = -.� �i' _ ■ ■■ ■ NOON ■■■�■■ •. '} . '� •. . � " .' NOON■■ ��■■■■■■■■■■■O ■ mom mown - _ '. f - . ■■■■��■■ NOON■■ _ : ; ■ NOON '■■ ■ ��■■ ■ ■■■■■■��i p NOO ■ ■■ its■ ■ ■■■N■■ N■■ ■■ ■ =10■ ■ NOON■■ . . .* ■COMM ■■■■■'�1■ NOON:::■ ®NOON■ ON MIME NOON■■■ NOON■■■ E. NOON■■■ ■■ ■N■■■■■1110■■■ME ■ ■■■ ■■ c �r�■rrr■■■rrrrrr P •• u ei • •• • •• ®� • :• ement •• Is Interior Finish Fire Place • Type Roof Rooms I st Floor Recreation Room Rooms 2nd Floor� Dormer .• • _ SmIllllllllllllll _■ April 19, 2022 Der Mary Beth Enclosed, please find a copy of the Building permit / CO submittal which was mailed to the Town. You will also find a copy of the form for the rental permit which needs to be notarized and returned to me ASAP along with a $200.00 check payable to the Town of Southold. I'll file the forms as soon as I receive the form and check. Please sign the items #4 Regards Steve K. 2". AE Steven James Kromer c Licensed Professional Engineer. MAY 2 5 2022 CD May 18, 2022 BUILDING DEPT. , TOWN OF SOUTHOLD Southold Town Building Department Town Annex Main Rd Southold, N.Y. RE: Submission of Plans and Application for Rental Permit Lawrence Holfelder,6340 Peconic Bay Blvd, Lure[, N.Y. SCTM#1000,Section 126 Block 11-01 Bldg Permit#46932. Dear Sir or Madam: I am enclosing a completed application for a Rental Permit on a property located at 6340 Peconic Bay Blvd, Laurel.This property has recently been inspected for a CO, by John Jarski. The property is located at 6340 Peconic Bay Blvd, Laurel, N.Y.This residence has just undergone a partial, renovation. Along with this permit request,we realized that we had to clear Trusties. It is our intention to resolve their requirements as soon as possible. In the meantime, I include the rental Application for your review. It is my hope that it satisfies the Town of Southold requirements. Regar Steven Kramer, P.E. • ghpe@optonline.net ow ID �t - (� 7 (-� VIAY 2 5 2022 BUILDING DEPT TOWN OF SOUTHOLD ole mop Ro 14 --� 2B x ,22 t in �1 1 GGG w �j 000 Sect 1,2 3 t�c l 1 - 0 t J. c-on I c C.-\ry f °Friss► - _