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HomeMy WebLinkAbout1000-114.-11-9.1 Nit TOWN OF SOUTHOLD Mo =x Rental Permit �a 0976 Owner 13200 Main Road Corp. Occupied as Commerical. Building (Apartment 1) Located at 13200 Route 25 Mattituck 114.41-9.1 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. 8/7/2023 PA ` e Enf tem nt tial This Notice must be posted by the main entrance at all times t TOWN OF y ��� SOUTHOLD �o Rental Permit 0977 Owner 13200 Main Road Corp. Occupied as Commerical Building (Apartment 2) Located at 13200 Route 25 Mattituck 114.-11-9.1 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. 8/7/2023 de Enf ce en O icial This Notice must be posted by the main entrance at all times 30 Town Hall Annex , Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 L� BUILDING DEPARTMENT OCT 2 1. TOWN OF SOUTHOLD 2022 RENTAL PERMIT APPLICATION n Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: t, f J c7 oTvc Tax Map Number: 1000 SECTION. _�/- ---- BLOCK. .. & -LOT SECTION B. OWNER INFORMATION: Property Owner Name: .,Z3O 0 A/ �o Property Owner Legal Address: Property Owner Mailing Address: a/ ?o -3 833 Telephone Number(s):Daytime Evening_ Emergency Property Owner Email Address: /1/ sf��+Ao .S' (047 P 61 fts Li00 0"a.�—a-� Page 1 of S Town HalI Annex ; Telephone(631)765-1802 54375 Main Road ' E Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 cs ; BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. " Authorized Agent Information: Name of Authorized Agent of dwelling unit,if any: &LWV Address of Authorized Agent(no P.O. Boxes):. J,3 00 �;✓ �� T��� Mailing Address of Author �1� ent: �� o Telephone Number(s): Da im G r78 Evenin Emergency Email Address: La�'�.hlo &Ir a . a. Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit,if any: Address of Authorized Agent(no P.O. Boxes).- Mailing oxes):Mailing Address of Authorized Agent: Telephone Number(s):Daytime. Evening Emergency- Email mergencyEmail 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: �v . Address of Managing Agent(no P.O. Boxes), Page 2 of 5 h Town Hall Annex 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,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: Requested Maximum number of persons allowed to occupy Dwelling Unit: T Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room irg Rental Dwelling Unit 4 i 8 x 1 �cl/�OJia7 q " .k- l 3 Page 3 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main RoadFax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 Q r 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. X'Tam 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) 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 3; Town Hall Annex , Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 OU BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: 1�1 f 0� , Requested maximum number of persons allowed to or���� each dwelling unit: l Number of Rooms in Rental Dwelling Unit: Use a d Di ension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: �l l'` � Town Hall Annex .E Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 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,;anagin ent, or Site Manager. Property Owner's Name:. 00 r �� Property Owner's Signature: � — CONNIE D.BUNCH Sworn to before me thi day of © :20-) Notary Public,State of New York i� No.01 BU0 Qualified in Suffolkffolk County Commission Expires April 14,2�j Official Notary Public Signature and Original Notary Stamp Page 5 of 5 so Mr # TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 ll l ®' [[-- 01, ! .-INSPECTION [ ] FOUNDATION 1ST [ ] ROU PLBG. [ ] FOUNDATION 2ND [ ],INtULATIOWCAULKING [ ] FRAMING /STRAPPING V-1 FI [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETR ON [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI ) [ ] CODE VIOLATION [ ] PRE C/O RENTAL REMARKS: lel i oyd A� Fwy/ Lil Ccte!!!� DA , �Vv INSPECTOR �� rs l9NHa LEE oth t-<« «�/� C-,e I o 0 LLJ > N 0 N w = w m cm0 N CIO w 00 U U °o W W cc O p q- ath ,Zl d31d0� O MCHa m W U LLJ � Cf� o aC o W a NOLVIS ANOM/SIAIIHS � LI cr, CD U W o L,_ ¢ Of W � � o— �C CD Eo � © � V) � FCN uj — 0 o (f 7 F-- F— U O T Q-000, W LQ U Q 0 � � O f— >- C~/7 z � —1 ,9-�L O m z W = oo w � Q > V) = U - � W WO IU— � Q � m � c� cr� m = r W UUW WOE O C/-) C.� p V) � z � O z N w U v . . � J � cnOW � Q- t2 � MW ,th0-<« o �'-� Q � Ozcr = o o Q (�/� U J m w ` ,�►►►►������ W p O Wcm m e5soso p ' C.� Q m D W � '°i �� ��bi .,shy �: Q I � i c� OO •cC z � I M3N C/) FYI, I ��� cel -� W I— C/7) V f �—' U Z S C!7 W O o�Ss oad90 ON o3s o 0 a no`r`�o'��' bail M3N L5�5H0 CRUHLIlob-ioN"If 1d-D0ON10-11 ,, L90a O �y �oia dooij aNZ _CZ. 0 CRC _ _ z 1` cV O 8001U Is 101 KIM 4 1 C D w O _l O i Z Z m Q �-- m CD c� O i F— _ 5O W � Z V) 00 i � � f F— o c� LLJ C> t� W _ n 00 ------ 4 1 ' g/�9/Z w � m � -ac ------a N c.rn Q co ao W O W --- --- � c hT � W o Z cn ,. 00 �, o N �� cnLLJ 0 F—I c o U ^ Z = W Z w 8/9�9/Z w M < O «t/� 0-601 «o-,z go-ccisoa Q o >- o 13S010 13S010 0 L.Lj �-- « 6 .0-it w to W w I— C,4 CW -- n �� � C� Z � r� -I .� O t� O W m F U W U Q > Z Or, Cw m O c �O N Q -�J Cin C/) Z p W I— o O t� O O 0 v� � � � uo) C/")m = OUV 01 dfl c' lil N ~ v w rY N LLJ � M� 7 © w Z �.., R/9�� Z t W o \ Z Z CEJ F—I� ` f— � N t� O Z t� = O � C) < LLJ •. —1 M O p WI_I Q W F-- LOW COO Z _I Z L1J z V) O Q p J / r)+ W � (o ) Q Vw P- V^) �..J M U7 � WoF- O