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Home My WebLink About1000-30.-2-17 TOWN OF SOUTHOLD Rental Permit �� ► �� 0707 Owner Susan Bunda Occupied as Single Family Dwelling Located at 405 The Cross Way East Marion 30-2-17 Maximum Permitted Occupancy 5 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. 7/22/2022 Cod Enf rc r Official This Notice must be posted by the main entrance at all times SQ�jy Yeti.. Town Hall Annex �, ,,��,, c; Telephone(631)765-1802 54375 Main RoadE Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD 7_ 2-1–2 L RENTAL PERMIT APPLICATION Rental Permit Fee$200 (Application must be renewed every two ea )E�3 C�aV'� L V JUN 2 1 2022 Section A. Property Information: -TJX`X7— �° Rental Property Address: ` Tax Map Number: 1000 SECTION b3O .-BLOCK-0 Z -LOT ' 17 SECTION B. OWNER INFORMATION: 1 , Property Owner Name: S��. Property Owner Legal Address: Property Owner Mailing Address: Telephone Number(s): Daytime%11312 W Vening Emergency Property Owner Email Address: i" l bun m Page 1&5 �,D �Z .; Town Hall Annex N Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 t � �,i qu BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: , Name of Authorized A ent of dwelling unit if any: NX Address of Authorized Agent (no P.O. Boxes): Mailing Address of Authorized Agent: Telephone N.umber(s): Daytime Evening Emergency Email Address: 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: ��'1 i Address of Managing Agent (no P.O. Boxes): Page 2 of 5 Town Hall Annex �ti Telephone(631)765-1802 a; 54375 Main Road r 3 Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 �iD 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, Q 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: dd_ Requested Maximum number of persons allowed to occupy Dwelling U t: lG Number of rooms i ntal Dwelling Unit: I F2 Use and Dimensio f each room in Rental DwelliQniV A 0 I Z(l 2/f k i/ -�21 ' '00X ),7-16 Page 3 of 5 � so I�1 Town Hall Annex , Telephone(631)765-1802 54375 Main Road , cry Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 C® � �f�{l 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) I —Sru,5" BU&1 PO , 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 �fifi+4 Telephone(631)765-1802 54375 Main Roadh{ Fax(631)765-9502 Cyt, P.O.Box 1179 � � Southold,NY 11971-0959 �%G� �} 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 this day of a 20� Official Notary Publi Signature and Original Notary Stamp DONALD GOLDSMITH hlotwy public, State of New York No, 01 GO5021034 Malitic,d in Westchester County � CC Expires Dec.6,2Q& Page 5 of 5 a L co0►- 881 5 4 il ( E(A' a" CID* ------------- ci 160 1 , LAM D,� "'1• 0 KrE'cH 3 p 13'8" x i�'�^ I OQ -PEM va 100 141,1 1.,h1. R _ A R AC. -- -- ( i o am o NJ � AY GLG _ BED1{M. 2 RE � � `_c1x 11T, I °l`x IO��.i 21' x 12'ca" �lREP6pCf r-- -- Troop ( a I 14 O i ~, m • m RP s�h I+ ' I 3 F#J P. VNA LZ Tom- KIT— --------------- 601, 4 ry wa jgmagi FIRST FLOOR PLAN r r3 61 2 fig! �--TE6 -T FOUNDATION PLAN TOWK OF SOUTHOLD, PROPER'L'Y AR�� 1� i --------------7- OWNER GE STREET- VILLA DIST. LOTS -4 1&,q Aui Fat FORMER.OWNERi ,t V!AIA "Pa5l n' .N E. ACR. YZZ -i TYPE 0 S W F BUILDING ea a-/A,2Lv RES..' SEAS.' VL, FARM comm. CB. MICS. Mkt. Value IMP. TOTAL DATE REMARKS 10c, -2 74 A :�-j t0liC '2 2- 131— 0 kyh�7 lei 4y ._4GS�D 71- 10h .......... Tillable FRONTAGE ON WATER .WoodlandFRONT-AGE ON ROAD 'Meadowlond DEPTH House Plot BULKHEAD Toto I �Gt; rf. Ffx3CL'YR�, f �♦j c ��' X17 �t f� � A 5 l C"4 r '?.. '•y P _'L.A '"'Sim �� .. .*. :.,a W s-Y ;+'ye•.« N �:k �n�4..�,-..A.w'..-•ra r' �,'; 3 �..<->�.�:s£+.,rd.' � � �� . N � d oesouryo� 0� � Crass W Q�� - - f #. TOWN OF SOUTH4D BUILDING DEPT. 'cou631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] AL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI ) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: H2nwz Vwmk DATE INSPECTOR FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28227 Date: 02/22/02 THIS CERTIFIES that the building NEW DWELLING Location of Property: 405 THE CROSS WAY EAST MARION (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 30 Block 2 Lot 17 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 22, 2001 pursuant to which Building Permit No. 27543-Z dated AUGUST 10, 2001 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 REAR DECK AND ATTACHED ONE CAR GARAGE AS APPLIED FOR. - The certificate is issued to SCHEMBRI HOMES INC (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-00-0182 02/19/02 ELECTRICAL CERTIFICATE NO. 2389 01/22/02 PLUMBERS CERTIFICATION DATED 02/20/02 ED ZIMMER r Authorized Si ature Rev. 1/81