HomeMy WebLinkAbout1000-78.-8-3 TOWN OF SOUTHOLD
Rental Permit
0711
Owner Paul Maloney
Occupied as Single Family Dwelling
Located at 1020 Goose Crk Ln Southold 78-8-3
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.
7/26/2022
ode of ce 4entOffikcial
This Notice must be posted by the main entrance at all times
P19 'SO
N41
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
r
Southold,NY 11971-0959
BUILDING DEPARTMENTMAY 2 3 2022
TOWN OF SOUTHOLDR . 0
BUILDING DEPT
RENTAL PERMIT APPLICATION -rOVVN OF SO,,111OLD
Rental Permit Fee$200(Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
-7k
Tax Map Number: 1000 SECTION V75yr -BLOCK'. -LOT 3
SECTION B.
OWNER INFORMATION:
Property Owner Name: 4aL 0-. YVVLoAl
Property Owner Legal Address: Property Owner Mailing Address:
2,3
Z-3
IV-e,v
5�- A)!l IV611 A/0-LV 4. IUV
Telephone Number(s): Daytime6111-67,e- f'Oening Emergent*
Property Owner Email Address: MA"�e)�A�Vc , eom
f
C)o-
Page 1 of 5 1b`%
Town Hall Annex 4 Telephone(631)765-1802
p =`,
' 631 Fax 765-9502
54375 Main Road ( )
P.O.Box 1179 ;:
•✓4hj• 4r:e
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: A
Telephone Number(s): Daytime Evenin Emerge n"cy
Email Address:
Section D.
Managing Agent Information:
Name of Authorized Agent of dwelling unit, if any:
Address of Authorized Agent(no P.O. Boxes):. N
Mailing Address of Authorized Agent:,
Telephone Number(s): Daytime Eve ng Emergent'
Email Address:
SECTION E.
SITE MANAGER INFORMATION:(required for rental properties containing 8 r more rental units)
Name of Managing Agent of dwelling unit, if any: N
Address of Managing Agent (no P.O. Boxes): -7Z
Page 2 of 5
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax (631)765-9502
P.O. Box 1 179
Southold,NY l 1971-0959 =.jf
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent: )Evng Telephone Number (s): Daytime 4 Emergency
Email Address:
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on property: Dag
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 2jiving Room) and the dimensions of each
room.
For properties with multiple Rental Dwelling Units use "Rental Permit Application
Addendum."
Rental Dwelling Unit Identifier: 1020 Cvvctge k LA-JE
Requested Maximum number of persons allowed to occupy Dwelling Unit. 9
Number of rooms in Rental Dwelling Unit: 10
Use and Dimensions of each room in Rental Dwelling Unit: 5LW9g0" - �6�7�4- x 7-' 7�g
Liv,Li� Qom... -- 15=7" x 21 '4' vesmaut-rte 13.34 g to-4-',bl&iJy &gH - 12-7/q'x 13=8
Wi TcHa -16 11'i-x 60'-7- Msu. Rj? IS`-7'� (i3'-3QyE.c-- &EzRooK 12- t",c 13'_a..
�Et7120oM !- 11-/"x 13-2 , Apga-w+ 'Ir-2- IS-3" 11-0' S7VZS� - 11�83:s
Page 3 of 5
•A
L;-
Town Hall Annex A r Telephone(631)765-1802
54375 Main Road cry .{ Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959t"`/�/�/y�rA
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 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)
RAJ-oWeV ,.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
SOO.
Town Hall Annex 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, Managing Agent, or Site Manager.
Property Owner's Name: -?&aL.,7
Property Owner's Signature:
Sworn to before me this L.L day of 4zaol 20
Official Notary Public Signature and Original Notary Stamp I III/,///
H
STATE
OF NEW YORK 3�
NOTARY PUBLIC
C'4 Z
Qualified in New York County
02TH6359515
' 0'
Cj
801 Fi?\O;
Page 5 of 5
souryOlo 1 d w
1� 6vz1cv--I/A•
# TOWN OF SOUTHOLD BUILDING DEPT.
631-765-1802 1Ar C4
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PL13G.
[ ] 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
REMARKS:
IL
0
JON
ri
DATE " ?/ INSPECTOR
Town Hall Annex lit t 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 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
ProfessionaFseal required for A'rchitect:or Engineer,.licensed Nome Inspector�must provide
copyofvalid current certification.
Rental Property SCTM Number: 1000- 078 - 0008 - 003.000
Rental Property Address: 1020 G-+t00s6 GREED t-, gF- . SoyrK.oL.D- Nom. 1197_1
Owner/Name: PAUL- H HA-1.oMS!d
Rental Dwelling Unit Identifier:. 1020 1,300SE G1i2EEk' L'40E-LogE Si N FSM IL.L1
DW1E!LLiQr,.)
Number&Square footage of each bedroom as depicted in the attached floor plan:
(i.e. Bedroom#1 -100 sq., Bedroom#2-90 sq., etc.)
B97zI2oo 206 So— rt: &S 1
#Afir
— I45 SQ 8 — 134— Q-S
Property Description (Include all improvements indicated on survey)
2 s-ro S i NGtX-- -PAHI'Lyl, D i til w o Eck- Gv Eer-,D. P eci 1.
W E NGE
I certify that I have done a physical inspection of the subject rental dwelling uni and find that it
fully complies with all the provisions of the Code of the Town of Southold,theR i ntial Code
of New York State,the Building Code of New York State,the Plumbing Code of Ne rk State,
the Fuel Gas Code of New York State, and the Energy Conservation Construction C d of w
York State.
N/CfrL. Ko BEQTI.j 1" AtA -AeCJI I TGT.
Print Name and Title Original Signature
5
Please place professional seal:
. J
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E ctension -
Foundation ; Bath Dinette
AorciiJ.a=: �. � - , .. �a +R i Basement ,z, Floors 0 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-2352__ Date MARCH 6, 1995
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 1020 GOOSE CREEK LANE SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 78 Block 8 Lot 3
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-23525 dated MARCH 6, 1995
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 ACCESSORY 2 CAR GARAGE
The certificate is issued to WILMA SOLOMON
(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.
r
Building InBP,96tor
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 1020 GOOSE CREEK LANE SOUTHOLD, N.Y.
number & street municipality
SUBDIVISION HAP NO. LOT(s)
NAME OF OWNER (s) WILMA SOLOMON
OCCUPANCY SINGLE FAMILY
type owner-tenant
ADMITTED BY: MR. SAM EPSTEIN ACCOMPANIED BY:
KEY AVAILABLE SUFF.CO. TAX MAP NO. 1000--78-9--1
SOURCE OF REQUEST: WILMA SOLOMON DATE: FEB. 17, 1995
DWELLING:
TYPE OF CONSTRUCTION WOOD FRAME # STORIES 2 # E%ITS 2
FOUNDATION CONCTELAR FULL PANE
TOTAL ROOMS: 1ST FLR.14 3 2NIj FLK. 5 3RD F R.
BATHROOM (s) ONE TOILET ROOM (s) ONE TY I ONE
PORCH TYPE ENCLOSED FRONT - COVERED BEAR HECK, TYPE PATIO
BREEZEWAY FIREPLACE ONE GARAGE
DOMESTIC HOTWATER YES TYPE HEATER OFF BOILER AIRCONDITIONING
TYPE HEAT OIL WARM AIR HOTWATER YES
OTHER: REAR FOYER - BASEMENT BILCO DOOR
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST. 2 CAR CEMENT BLOCK STORAGE, TYPE CONST.
SWIMMING POOL , GUEST, TYPE CONST.
OTHER:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION b BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
REMARKS:
INSPECTED BY DATE OF INSPECTION FEB. 24, 1995
JOHN M. BOUFIS TIME START 9:50 END 10:10
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
NO: Z-27010 Date: 03/31/00
THIS CERTIFIES that the building ALTERATION
Location of Property: 1020 GOOSE CREEK LA SOUTHOLD
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 78 Block 8 Lot 3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 9, 1998 pursuant to which
Building Permit No. 24764-Z dated MARCH 13, 1998
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 RENOVATION & ALTERATION TO EXISTING ONE FAMILY DWELLING WITH
NON-HABITABLE ATTIC AS APPLIED FOR.
The certificate is issued to PAUL H MALONEY
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 27765 01/26/00
PLUMBERS CERTIFICATION DATED 03/30/00 N.F.PLUMB.&MAINTENANCE
utho ized Signature
l
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-32389 Date: 06/11/07
THIS CERTIFIES that the building ACCESSORY
Location of Property: 1020 GOOSE CREEK LA SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 78 Block 8 Lot 3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 19, 2006 pursuant to which
Building Permit No. 31930-Z dated APRIL 20, 2006
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 UNHEATED GARAGE AS APPLIED FOR PER ZBA #5748 DATED 10/27/5.
The certificate is issued to PAUL H MALONEY
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 114824C 03/05/07
PLUMBERS CERTIFICATION DATED N/A
Authorized Signature
Rev. 1/81