Loading...
HomeMy WebLinkAbout1000-53.-1-13.3 0 cn U) a 0 kn = Co ." cc -5 CL CD X (2) LU 00 (V U) a) = 0 o- =0 0 in uj a 0 co C) 0 ca cu swum tb cn Oft CU a tm cu LD -9 O a a tm =FCd CD ca ca>. " w -6 2 " u M co r_ cu Cd CU E CL 0 — 0 a) C/) %pop U) 0 0 >- (D O 0 CL CU ar CL 0 CL z U) -0 U) U) 2 Ln > 0ca 8- CD -0 (D E 0 cu CU CD ,0> (D (/) 0 cu = >, cu CL a)rx' rn 0 0 G ( i 123 Pa.A_ok re c J046 q 1 IU Town Hall Annex (i Telephone(631)765-1802 54375 Main Road " Fax(631)765-9502 P.O.Box 1179 �X Southold,NY 11971.0959 " s A BUILDING DEPARTMENT . vn TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ., Rental Permit Fee $200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: w, 2 Tax Map Number: 1000 SECTION -BLOCK -LOT 7 - SECTION B. OWNER INFORMATION: �Q Property Owner Name: j—a_,t e J_ . Property Owner Legal Address: Property Owner Mailing Address: 15'4 S- P�pes N e cjz, V24 rS7 Cc 'I , a f, ( Telephone Number(s): Daytime Evening Emergency Property Owner Email Address: J 04 -&Lc rv�L, C-Oyvi Page 1 of 5 110 Town Hall Annex �" 4 ati> Telephone(631)765-1802 54375 Main Road ) 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: 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 Town Hall AnnexTelephone(631)765-1802 -9502 54375 Main Road Fax(631)765 P.O.Box 1179 ib 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) ,-6,ecertify 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 d2�r� tia �' 07 Town Hall Annex Telephone(631)765-1802 54375 Main Road r Fax(631)765-9502 P.O.Box 1179 vy 9 Southold,NY 11971-0959 a g µ 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-Lday of - un ' _ , 203 4,Q,6 cx, Official Ncatary Public Signature and Original Notary Stamp Rebecca A. Luck Notary Public„ state of New"Mork leg. No. OILU636662 Qualified in Suffolk COW* commission Expires 0210412027 Page 5 of 5 so T WN OF' SOUTHOLD BUILDING &� 631 -765-1802 lill INSPEC ligi I ljllg� 10mmlkm [ ] FOUNDATION 1ST [ ] ROUGH PEBG. [ ] FOUNDATION 2ND [ ] INSULATION/CA1 [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] TIRE SAFETY IN! [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (T1N [ ] CODE VIOLATION [ ] PRE CIO [ REMARKS: ' f'o, Ul r14, 9,4A01 ez,4 A DATE INSPECTOR tJ;, Town Hall Annex ` HOL® TO N 54375 Main Road ®��� � �� �� �� PO Box 1179 Southold, RenLal Ine^� NY 11971-1179 Tel 631-765-1802 Fax 631-765-9502 SCTM `� �? . . �..._ ..._ Date ':` � �.�.. .... Phone Owner __.._ . Address Zip } City__ .... .w_.. Inspector LEVELS._.m_.. _....._... .. _ . __. .. _w.. 2 _. Carbon Monoxide Detectors # detectors Smoke De to Fire Extinguishers (#) _... ... _ _.......ti._.._.. ... Q Exits (#) 4 BEDROOMS �..__. 2 3 Smoke Detector Alarms (#) .. ........,. Carbon��°noxide dowsl (A larms Eg� Y"__.._.... . .... ..... ..._ . �,.-„�. ess ) 1� ��� ,, ��1� � ° �� a �v� �,r �� �✓%�i� � �� BU SYSTEM CONDITION O,F PROPERTY _�. Building Interior is clean i maintained HeatinLl tem maintained/r erationa s. Hot water system maintained/operational Building Exterioris clean I maintained _..." oper-ty is clean safe maintaHandrails & guards present Ined Electncal s item maintained/o perational Pr Mechanical s stens maintained/operational ° COMMENTS .. w_... win.... ...._. ...�_ � . _. ��..w.. _.. ... .._�_:.....w �w:._. �. _.�.......... � ,..._ w ..._.. . ..... ....._..�� ._._ . .. . ..,._.w.., . .... Rentai Inspection Form. 4/7/2021 r° �f�p+ / � r I rt f .µp^ W j 11 �j ' a4 a� hi+" �e✓ W..., I/. J \ e ! f p' Ii � 4 r tI 1 � d o a. R 1 o A, 1 d . p u r a, . . I i h B CA h I LL ... c� wM I ( k � `, �r r va 09 900 �- LLJ LLJ Lu U U d „ "" „ ., W wv LuLL MI U p r C LIJ 0 k I LU { i 6 ] t K Q z w zLn j � v z a L , hr O a Q V ( a U CZ CL LU 44 i { wuj v -ci w O S� ri J w Q D o j o �w C7 u. % 4 Z w > _ % V r........w,.,. ..............._....__.......... .... � ......._.... _,.,.._�� _.. E t ( 4 f I } e P p cn � I I P _ v f V �1 CJ i U. LL O ' Y U OS C, m e r � � P k I_ I f � a ✓ Cy dr V k r QS C CD to � ) V) N O LL fel Ul U. .. Jr 73, f q i M �y F r, f d• E I 6 f f d %dpi r ��nrr/"i'no q 2 CL m II FORM NO-4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ..,A..372........... Date ........................August. ..6................. 1959.... THIS CERTIFIES that the building located atX/3....Pipee..NopY..ftfid............................ Street Map No. .............. Block No. ...... ................Lot No. ..LXX.......... .................I conforms substantially to the Application for Building Permit heretofore filed in this office dated C...... .............. .. 19�� . ., pursuant to which Building Permit No. ......x...55.3."1-........... dated ..................... e.ae ber ...,3........, 19.�� ...,was issued, and conforms to ail of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is.............» Private one family driel Ing Thiscertificate is issued to ........(..wo..o .).................................................................» (owner, lessee or tenant) of the aforesaid building.. Bu i lding..Inspector.............: .......» FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9537 Z Date ............Ae.cemb . ..3.....«.««...«..«....... 101- Permission is hereby granted to: Juin f,,%un..r.....A/C.....Paul....-Eckardt....................« ............Ctr ...... Y•....................x.«.««... .......,««.«.. . ....,.«..............«.. to ........Bxsild. new..dtielling. ...........................«.....,......«..«.....».«......«»««.»..««... ............,«...,.«........... at premises located at . 31 ... .P-1-P?:r i eair>:•.Rae'd. ................................««........,«,,.......«..w........»...«.. ..x........»«.......«......,..rx...«..«..,.».«..��.L.�.��.it�.L.J...I.Y A�+M\..........�...,.,....«w«.,w«........w.o......«x....xn.w....x «.,,....».......».. pursuant to application dated .....««»...,....x,.....,1)P'aF:mbP,I?......31...........19...8., and approved by the Building Inspector Fee $-3.0,-00.......... .. .. .......«, Building Inspector