HomeMy WebLinkAbout1000-96.-2-2 TOWN OF SOUTHOLD
Rental Permit
E 0696
Owner Rebbie Straubing
Occupied as Single Family Dwelling
Located at 4900 Depot Lane Cutchogue 96.-2-2
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.
9/25/2024
0 eTnt Official
This Notice must be posted by the main entrance at all times
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co 631-765-1802
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[ ] FOUNDATION 1 ST/ REBAR [ ] 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 [ ] RENTAL
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DATE _ NS ��T
TOWN OF SOUTHOLD
cm Rental Permit
0696
Owner Rebbie Straubing
Occupied as Single Family Dwelling
Located at 4900 Depot Lane Cutchogue 96-2-2
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.
7/12/2022 •
C de E o ce e t Official
This Notice must be posted by the main entrance at all times
i
Town Hall Annex 1 Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 • ��
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION_ _
Rental Permit Fee$200(Application must be renewed every two �
AUG - 9 2019
Section A.
Property Information:
Rental Property Address:
Tax Map Number: 1000 SECTION. V q6. -LOT ,cSt
SECTION B.
OWNER INFORMATION:
Property Owner Name:,--- .�EuL— 5 I-&
Property Owner Legal Address: Property Owner Mailing Address:
0.Lq �e b-e f-e-5 5-
Telephone Number(s): Daytime 56 176, �l vening5t,910c Emergendy. d r –C
Property Owner Email Address:_ 6AZE'tj(4 i-J 5 6-1mf41 L , C dy
Page 1 of 5
Town Hall Annexe Telephone(631)765-1802
54375 Main Road _ Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
e4UNT`1t�` 'c
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION INSTRUCTIONS
.Rental Permit Fee $200 (Application must be renewed every two years)
The items listed below are required to be submitted with the completed
application.
B"Floor Plans: Floor plans of each Rental Dwelling Unit, please show location of
all smoke&carbon monoxide detectors.
ED,,-Certificates of Occupancy and Pre-Certificates of Occupancy: Certificates of
occupancy or Pre-Certificates of Occupancy for.each rental dwelling unit.
❑ Certification of Code Compliance(form enclosed): Must be submitted by a
license architect or engineer or license home inspector if an inspection by Town of
Southold Inspector is declined.
2- Rental Permit Fee: $200.00
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Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 •
Southold,NY 11971-0959
C nil
OW
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent:, -
Telephone Number(s): Daytime. __- Eve ' .g Emergency _.-....
Email Address:
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on property: 1
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: d
Requested Maximum number of persons allowed to occupy Dwelling Uni : ----
Number of rooms in Rental Dwelling Unit:
y�Cl�
Use and Dimensions of each room in Rental Dwelling Unit: KiA c� !
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Page 3 of 5
Sol/
Town Hall Annex 4 Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 . .
�c®UNTI,�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Section C.
Authorized Agent Information:
,k
Name of Authorized Agent of dwelling unit, if any:. _ �U (1 -
Address of Authorized Agent(no P.O. Boxes).
Mailing Address of Authorized Agent:
Telephone Number(s): Daytime Evening_ • - Emergency
Email Address: �. ( � 1 s ki �gc�5CI co- -- -- -
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
Town Hall Annex Telephone(631)765-1802
54375 Main Road CP-. `c'— 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.
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') --
1�C ,certify under penalty of perjury,the following:
1. ( am the owner of the property identified in "Section A" of this dppllcation='
2. The property owner's legal address set forth in "Section W"oflhis application;is'my legal
address and I understand the Town will use the address for service pursuant to all
Page'4 of 5
L
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 Y
Coo
BUILDING DEPARTMENT
TOMW 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 befor his day of ;-2017
Official N tary Public Signature a riginal No ary Stamp
DONNA LENT !
Notary Public,State of New York
No.01 LE6101246 -..
Qualified in Queens County IC,
Commission Expires Nove►n6er 10,
Page 5 of 5
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# TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULK G
[ ] FRAMING /STRAPPING [ ] INAL �G�4✓�v �l
[ ] FIREPLACE &-CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT-CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS: Owllf�lm
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DATE V MOO INSPECTOR
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# # 'TOWN OF SOUTHOLD BUILDING DEPT.
co 765-1802
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INSPECTION
[ ] FOUNDATION 1 ST 1 [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [YFIREINAwf- -FIREPLACE & CHIMNEY [' L PryAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] 'FIRE RESISTANT'PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATIO [ ] PRE C/O
REMARKS:
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TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER STREET G-1 VILLAGE DIST, SUB. LOT
FORMER OWNER E CR.
S W t TYPE OF BUILDING
RES. 210 SEAS. VL. FARM COMM. CB. MISC. Mkt. Value
LAND IMP. TOTAL DATE REMARKS 2 ,1
6 �� ��• 1� �e @ 7-" /" & C! t 1.7 7,-
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AGE BUILDING CONDITION ie,
NEW NORMAL BELOW ABOVE
FARM Acre Value Per Value
Acre
Tillable 1
Tillable 2
Tillable 3 _ cry �? G •t1 - U o
Woodland �9 a s• u ,s' a
Swampland FRONTAGE ON WATER
Brushland FRONTAGE ON ROAD 1
.House Plot DEPTH
! BULKHEAD
Total � DOC K
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-22688 Date October 29, 1993
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 4900 DEPOT LANE CUTCHOGUE, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 96 Block 2 Lot 2
Subdivision Filed Map No. Lot No.
conforms substantially to the Requirements for a One Family Dwelling built
Prior to: APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z-22688 dated OCTOBER 29, 1993
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 ONE FAMILY DWELLING WITH TWO ACCESSORY STORAGE SHEDS &
ACCESSORY BARN*
The certificate is issued to ANTONE CHITUK
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
w�
ildi g Inspector
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOunlOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 4900 DEPOT LANE CUTCHOGUE, N.Y.
number S street municipality
SUBDIVISION MAP NO. LOT (r)
NAME OF OWNER (s) ANTONE CHITUK
OCCUPANCY A-1 RES. OWNER
(type) (owner—tenant)
ADMITTED BY:. ACCOMPANIED BY:
KEY AVAILABLE SUFF. CO. TAX MAP NO. 1000-96-2-2
SOUP,:;Z OF REQUEST: WILLIAM WICKHAM, A1TY DAA: OCT. 21, 1993
DWELLING:
TYPE OF CONSTRUCTION WOOD FRAME 0 STORIES 2 0 EXITS 3
FOUNDATION CEMENT BLOCK CELLAR FULL CRAITL SPACE
TOTAL ROOMS: IST FLR. 3 2ND FLR. 3 3RD FLR.
BATHROOM (s) ONE TOILET ROOM (s) UTILITY ROOM
PORCH TYPE ENCLOSED PORCH DECK, TYPE PATIO, TYPE
BREEZEWAY FIREPLACE NO GARAGE
DOMESTIC 13OT14ATER YES. TYPE HEATER ELECTRIC AIRCONDITIONING
TYPE HEAT OIL WARM AIR HOTWATER XX
OTHER: WASH M N'
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST. STORAGE, TYPE CONST. TWO STORAGE SHEDS
SWIMMING POOL GUEST,-TYPE CONST.
OTHER: BARN
VIOLATIONS: CHAPTER 45 N.X. STATE UNIFORM FIRE PREVENTION b BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
BASEMENT IT APPEARS THAT ELECTRIC HOTWATER HEATER IS LEAKING NYCRR 9 (B)
EXTERIOR ROOF IN NEED OF REPAIR (HOUSE)
EXTERIOR REAR SHED IN NEED OF REPAIR.
REAR YARD
RL••MARKS:
INSPECTED BY: � DA'TI: ON INSPEC'PION OCT. 26, 1993
G S. Pish TIME START 9:30 E�j 9:55
=o�guFfUl,��oG�� Town of Southold 7/12/2022
P.O.Box 1179
0
b--- �. 53095 Main Rd
Southold,New York 11971 .
CERTIFICATE OF OCCUPANCY
No: 43240 Date: 7/12/2022
THIS CERTIFIES that the building AS BUILT ALTERATION
Location of Properly: 4900 Depot Ln, Cutchogue
SCTM#: 473889 Sec/Block/Lot: 96.-2-2
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application•for Building Permit heretofore filed in this office dated
11/7!2019 pursuant to which Building Permit No. 44422 dated 11/18/2019
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:
"as built"alterations to an existing single family dwelling as applied for.
The certificate is issued to Straubing,Rebbie
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT'OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 44422 7/12/2022
PLUMBERS CERTIFICATION DATED 6/30/2022 Wils g
ut iz d Signature
Pontino, Susan
From: rs <greenrows@gmail.com>
Sent: Tuesday,August 20, 2019 12:06 PM
To: Pontino, Susan
Subject: Rental Management change to application for permit
Dear Susan,
I enjoyed talking with you today. To recap:
My application for a renters permit is in and I"m awaiting an inspection.
I will be having the following company managing the rental of 4900 Depot Lane in Cutchogue:
Vacasa Services
Contact: Levi Logstrom. Levi.logstrom@vacasa.com. 631-905-9567 or 631-527-7936
If you need to reach me about the house or property, please contact me directly.
If you need to reach me about the rental, pease contact Levi.
As you mentioned in out phone conversation, I understand that this is official notice of change in my application.
Many Thanks,
Rebbie Straubing
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