HomeMy WebLinkAbout1000-15.-3-7 s TOWN OF SOUTHOLD
ze
f# Rental Permit
0982
Owner Areti La Valle
Occupied as Single Family Dwelling
Located at 555 Sound View Rd Orient 15.-3-7
Maximum Permitted Occupancy 8
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.
8/23/2023
ode of rce t Official
This Notice must be posted by the main entrance at all times
Town Hall Annex " �H� Telephone(631)765-1802
Fax 631 765-9502
54375 Main Road ( )
P.O.Box 1179
Southold,NY 11971-0959W
BUILDING DEPARTMENT AUG 18 2023
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION 6ullding 00PO tment
Town of Botalhola
Rental Permit Fee$200(Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
555 Soundview Road, Orient Point, New York
Tax Map Number: 1000 SECTION 15 -BLOCK 3 -LOT 7
SECTION B.
OWNER INFORMATION:
Property Owner Name: Areti La Valle
Property Owner Legal Address: Property Owner Mailing Address:
555 Soundview Road
Orient Point, NY 11957 SAME
---����
( 917 ) 414-6719
Telephone Number (s): Daytime,,, Evening Emergency
Property Owner Email Address: rlavalle@alphainterabstract.com
Page 1 of S
M pby
Town Hall Annex �� e.
Telephone(631)765-1802
54375 Main Road t', Fax(631)765-9502
P.O.Box 1179 °
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Section C.
Authorized 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 D.
Managing Agent Information:
Name of Authorized Agent of dwelling unit, if any: �..._._
Address of Authorized Agent(no P.O. Boxes):__,_MM.,,,,
Mailing Address of Authorized Agent: ._w-_._.__��
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
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ger "a�N 'r,, s4
Town Hall Annex +11, Telephone(631)765-1802
54375 Main Road p, Fax (631)765-9502
P.O.Box 1 179 �� 5
Southold,NY 1 1 971-0959
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 U t
tuber of rooms in Rental Dwelling Unit:
Use and Dimensions of each room in Rental Dwelling Unit:
t
(off .-
Page 3 of 5
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
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
I 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
Town Hall AnnexTelephone(631)765-1802
54375 Main Road Fax(631)765-9502
r
P.O.Box It 79 l�°
Southold,NY 11971-0959
r ,4' !,(
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
applicable laws and rules. I further acknowledge that I will notifythe 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: _ r
Property Owner's Signature:
U� r .
Sworn to before me this day of � 203
Official Notary Pub c Signat r r;Iginal Notary Stamp
WILLIAM LAVALLE
Notary Public,State of New Yak
Ido.C11LA48t11874
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Page 5 of 5
631-765-1802
EL a
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTAN/� AL)RATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL
[ ] CODE VIOLATION [ ] PRE C/ [ TAL
R M A jRIS:
1
DATE
INSPECTOR ...
vo
Town Hall Annex � Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179ty
Southold,NY 11971-0959
w �
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
Pro essional seal re aired for.Architect or Fra ineer licensed dome Inspector mustprovide
cogy of valid current certi cation
Rental PropertySCTM Number: 1000
Rental Property Address: 5-q 0 N Y
Owner/Name: Lt's
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.)
FSE lSbsF
2- F
2oa sF
Property Description (Include all improvements indicated on survey)
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,
0
Print Name and Title r ri Inal Signa are
SIAha
Please place professional seal:
ap
TOWN OF SOUTHOLD WI(I CARD
OWNER
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Town of Southold 1/9/2019
P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 40156 Date: 1/8/2019
THIS CERTIFIES that the building SINGLE FAMILY DWELLING
Location of Property: 555 Sound View Rd, Orient
SCTM#: 473889 Sec/Block/Lot: 15.-3-7
--------------
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
9/8/2017 pursuant to which Building Permit No. 42025 dated 10/5/2017
was issued, and conforms to all of the reuuiretnerits of the applicable provisions of the law. The occupancy for
which this certificate is issued is:
ONE FAMILY DWELLING WITH REAR ENCLOSED P0RC: L LU�AR_ IRST,AND SEQQN .w a"I t 'DECII S,
FRONT I _A:l`TAQlIED GARAGE AND UNFINISHED ED IAS, E"NT ICER ZBA DF.CIS It T- ?C► fa,I ATED
02-16-29,17 APLIED FOR
The certificate is issued to Lavalle,Areti
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL RIO-17-0053 12-31-2018
ELECTRICAL CERTIFICATE NO. 42025 10-15-2018
'PLUMBERS CERTIFICATION DATED
10-25-201$ Dale Gross
µµµµµppp
ut ` ed Signature �
in Town of Southold 6/17/2023
' P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 44204 Date: 6/8/2023
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 555 Sound View Rd.,Orient
SCTM#: 473889 Sec/Block/Lot: 15.-3-7
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
3/11/2022 pursuant to which Building Permit No. 47678 dated 4/14/2022
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:
accessory in arquji _ wimrn ng,pool withspa fenced to qgde as applied fi�rP r�1 A#752 dated 11/1 /2121.
1, / C2 orreotecl for C ertiflcate pnatpber only
The certificate is issued to Lavalle,Areti
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 47678 9/26/2022
PLUMBERS CERTIFICATION DATED
P "
Town of Southold 8/28/2021
P.O.Bog 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 42305 Date: 8/28/2021
THIS CERTIFIES that the building. GENERATOR
Location of Property: 555 Sound View Rd.,Orient
SCTM#: 473889 Sec/Block/Lot: 15.-3-7
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
5/7/2021 pursuant to which Building Permit No. 46300 dated 5/24/2021
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:
acg.e eneratcar as a died fcar,
The certificate is issued to Lavalle,Areti
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 46300 8/11/2021
PLUMBERS CERTIFICATION DATED
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