HomeMy WebLinkAbout1000-63.-5-3 IF 01 �a TOWN OF SOUTHOLD
Rental Permit
b Irv, ' �a 0718
Owner Carl Stepnowsky
Occupied as Single Family Dwelling
Located at 500 Tucker Lane Southold 63-5-3
Maximum Permitted Occupancy 6
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.
8/4/2022
de E or e e t Official
This Notice must be posted by the main entrance at all times
Wi�
((/Tg�` T
Town Hall Annex , Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 G �Q
Southold,NY 11971-0959 �O
�yCOt1�fN� -
BUILDING DEPARTMENT
TOWN OF SOUTHOLD JUL 9 2022
RENTAL PERMIT APPLICATIONgU14D,MGTHOL
'TO\NN OF
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Rental Permit Fee $200 (Application must be renewed every two years)
Section A.
Property Information:
Rental PropertyAddre
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O
Tax Map Number: 1000 SECTION -BLOCK 6039 7LOT -
5� 3
SECTION B.
OWNER INFORMATION:
Property Owner Name: 2r
Property Owner Legal Address: Property Owner Mailing Address:
`Jp
Telephone Number (s): DaytlmeO/ -�973fvening S:; r-e— Emergency X-e rn
Property Owner Email Address:
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Page 1 of 5
q sov, O
Town Hall Annex Telephone(631)765-1802
54375 Main Road cry Fax(631)765-9502
P.O.Box 1179 . 0
Southold,NY 11971-0959
COU
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION INSTRUCTIONS
Rental Permit Fee $200 (Application must be renewed every two years)
The items listed below are required to be submitted with the completed
application.
❑ Floor Plans: Floor plans of each Rental Dwelling Unit, please show location of
all smoke &carbon monoxide detectors.
❑ Certificates of Occupancy and Pre-Certificates of Occupancy: Certificates of
occupancy or Pre-Certificates of Occupancy for each rental dwelling unit.
❑ Certification of Code Compliance(form enclosed): Must be submitted by a
license architect or engineer or license home inspector if an inspection by Town of
Southold Inspector is declined.
❑ Rental Permit Fee: $200.00
SQU�yo�o
Town Hall Annex Telephone(631)765-1802
54375 Main Road WIN y Fax(631)765-9502
P.O.Box 1179 • O
Southold,NY 11971-0959 Q
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent:
(03 )
Telephone Number (s): Daytime Evening S� e-- Emergency
Email Address: -21a-P e
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on property: p�z
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: ✓� TS
Number of rooms in Rental Dwelling Unit: �L
Use and Dimensio s of each room in Rental Dwpl pg,WAlt:; /c�
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Page 3 of S
SOUT�p`��,
Town Hall Annex Telephone(631)765-1802
54375 Main Road cn Fax(631)765-9502
P.O.Box 1179 AZ
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):
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:
Address of Managing Agent (no P.O. Boxes):.
Page 2 of 5
Z�N*tf so
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
COUNTY
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.
❑ 1 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)
IJ�6 _,,certify under penalty of perjury,the following:
1. 1 am the owner of th4popert;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
sooryo .
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. I 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 , 20_
Official Notary Public Signature and Original Notary Stamp
Page 5 of 5
OF SOUTy� /� ��
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# # TOWN OF SOUTHOLD BUILDING DEPT.
cOU631-765-1802 ��.�',�� •3
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENE ATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F AL)
[ ] CODE VIOLATION [ ] PRE C/O [ RENTAL
R MA S:
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DATE 24,v%ll INSPECTOR
�pF SOUK,. ., .
Town Hall Annex Telephone(631)765-1802
54375 Main Road T ] Fax(631)765-9502
P.O.Box 1179 G ! SON
Southold,NY 11971-0959 ~'Q
MUM
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
Professional-seai'.'reauired for.Arc)_i_tectlor Enaineer, licensed_Nome inspector must'provide
copy of:valid_current•certification
Rental Property SCTM Number:
Rental Property Address:..
Owner/Name: CAQ.L— f5fPNL-"
e
Rental Dwelling Unit Identifier: Si iyC4,gg— �!-ly✓11 C.vlo iM�
Number &Square footage of each bedroom as depicted in the attached floor plan:
(I.e. Bedroom#1 -100 sq., Bedroom#2-90 sq., etc.)
0 3 Th
6<o )t�3 2-1
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 Con r ion Construction Code of New
York State.
0 OF
Print Name and Title ^ 5�. ' 0 0 Original Signa e
M
Please place professional seal: soy �a
��ION
. SOF SOUTH
Town Hall Annex l�L Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 , ' �'A�
Southold,NY 11971-0959 COUN�,�
BUILDING DEPARTMENT
TOWN OF SOUTHOM
RENTAL PERMIT APPLICATION ADDENDUM
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:
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:
n T
EXISTING 2-STORY
STEPNOWSKY
RESIDENCE ST RS
N
500 TUCKERS LANE
C SOUTHOLD, NY 11971
d- DECK
336 SQFT
24'-0"
4 " 11 '-10%" 15'-5"
N DINING KITCHEN o
ROOM 168 SQFT
161 SQFT
15'-6" CL STARS
:AL- DN 77,
_ o
CC
HALF
BATH
w N
LUNG
ROOM \ FOYER
265 SQFT 73 SQFT
o •
17'-6„ 7'-5"
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EXISTING FIRST
pF Ne
F QR TONVITIONS PkAN
-
'� SCALE:a"= 1'-0"
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00P
sD = Wireless Combination Smoke and Carbon Monoxide Detectors
ST RS
EXISTING 2-STORY N
STEPNOWSKY
RESIDENCE
500 TUCKERS LANE
SOUTHOLD, NY 11971
-16'-8/
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CL �
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57 SQFT
�i BEDROOM
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Q 173 SQFT i-
o TUB
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CLOSET
BEDROOM
150 SQFT
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BEDROOM
215 SQFT
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SUN PORCH ROOF
EXISTING SECOND
oFE FLOOR CONDITIONS FLAN
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r er CC Wireless Combination Smoke and Carbon Monoxide Detectors
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TOWN UT ® . PROPERTY, RECO' R1 D-:)
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RES. ; SEAS. VL. FARM COMM. i IND: CB. —m M[SC:. I Est. Mkt. Value '
LAND IMP. TOTAL DATE REMARKS •,
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FORK NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No.4799P . . . . . . Date . . . . . . . . . ..TAW . . . . . 18. . . . . .. 1976. .
THIS CERTIFIES that the building located at . Tuckers .Lane . . . , . . . . . . . . Street
Map No. .XX . . . . . . . . Block No. =. . . . . . .Lot No. . xx. . . Southold. . K.Y.. . . . . . . . .
eqjygoAreme t f. , o fam 1 d el ,do ou� code
conforms substantially to the .AC
bb c r. fic• to . occupy ncy
date�lt. . bgfor.Q .Apr , . 23., 19.57. pursuant to which AQ o• & .7090
dated . . . . . . . . . Zuzne. . .18. . . ., 19-76., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is .FrIlMte. .QUe. .fam1lY .dweX11zg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The certificate is issued to . .garl, .4. Jean. Stepnawsl�j. . .from. J... .Ilromaich . . . . . .
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval PrQr. . XI-StAng. . . . . . . . . . . . . . . . . . . .
UNDERWRITERS CERTIFICATE No. PrIP7. exigtUg. . . . . . . . . . . . . . . . . . . . . . . . . . . .
HOUSE NUMBER . . . . . . 5 . . . . Street . . . . Tuckers Lane . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Y� iw ( . —Ifc. . . . . . . .
Building Inspector
HOUSING CODE INSPECTION
June 18, 1976
500 Tucker Lane R-1
Southold, N.Y.
Tax Roll: John Hroncich & Wife
Occupied: Carl Stepnowsky & Wf - new owner.
Upon receipt of an application for a Pre-Existing Certificate
of Occupancy, I made an inspection of this two story framed
dwelling. I was admitted to building by Mrs. Stepnowsky and
began this inspection at approximately 11:10 A.M.
The first floor has a kitchen, dining roomer and living
room. Second floor has three bedrooms and a :full bathroom.
Heat is furnished to all rooms from oil fired, forced warm air
furnace located in full cellar of building's foundation. An
enclosed porch runs the entire length 6 --'- south side of building.
Accessory structures consist of a two car garage and two small
sheds in rear yard area.
The. .following violations of the Housing Code, Chapter 52,
Town of Southold, N. Y. were found:
L.� cord outlets and lighting fixtures are
wired in following area: Cellar,
living room, enclosed porch, second
floor hallway, exterior light at
kitchen entry, and line running from
cellar to garage in rear yard for light
fixture. Article V, Section 52-56 A.I.
Stairway to second floor, no means of controlling
light for safe ascent or descent. Article
II, Section 52-26 B.3.
Sheds in rear yard on westerly line deteriorating
and deforming. Article III, Section 52-30
A.B. , Section 52-31 B.C.
Inspection completed at approximately 10:40 A.M.
Re ectfull submitted
ii
EH:mm ddw4ar`d�4/
ndermann
Building Inspector
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold,N.Y.
Certificate Of Occupancy
No. . . Z— 15.3.2.6 . . . . . . Date . . . March, 5 , , )P87 . . . . .
THIS CERTIFIES that the building . . DE C K. AD D I T I 0 N. . _ . . . .
Location of Property 500 Tuckers Lane . Southold
House No. Street Hamlet
County Tax Map No. 1000 Section . . .063 . ,Block . . 0 5. . . . . . . . . .Lot . , ,0??
Subdivision .M/o.Hunt inghurst , . . , , . . ,Filed Ma No. 6.12
p . . . . Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
June 8, 1985 pursuant to which Building Permit No. . �2G25 Z
1985
dated July 15, . . . . . , 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 . . . . . . . . .
DECK ADDITION TO EXISTING ONE FAMILY DWELLING
The certificate is issued to . . CARL & .JEAN A. STEPNOWSKY ,
(owner, aKX
of the aforesaid building.
Suffolk County Department of Health Approval . . . . . . . . N/A . ,
UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .
PLUMBERS CERTIFICATION DATED: N/A
uilding I Inspector
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-33844 Date: 07/22/09
THIS CERTIFIES that the building ADDITION TO GARAGE
Location of Property: 500 TUCKER LA SOUTHOLD
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 63 Block 5 Lot 3
Subdivision Filed Map No. ' Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 9, 1991 pursuant to which
Building Pexmi.t No_ 20022-Z dated JULY 9, 1991
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 ADDITION TO AN EXISTING NONHABITABLE ACCESSORY GARAGE AS APPLIED FOR.
The certificate is issued to CARL J & JEAN A STEPNOWSKY
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO_ 1188672 01/06 04
PLUMBERS CERTIFICATION DATED N/A
//tVrized Signature
Rev. 1/81
�ogUFFUt,f�o Town of Southold 7/9/2022
ao Gym
P.O.Box 1179
0
53095 Main Rd
Gy1jO� �,ao� Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 43229 Date: 7/9/2022
THIS CERTIFIES that the building ADDITION/ALTERATION
Location of Property: 500 Tucker Ln., Southold
SCTM#: 473889 Sec/Block/Lot: 63.-5-3
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
10/8/2021 pursuant to which Building Permit No. 47032 dated 10/26/2021
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:
"as built"accessory apartment with deck to existing accessoryygarage as applied for per ZBA#7030SE,dated
7/15/2017.
The certificate is issued to Stepnowsky,Carl
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-21-1398 9/29/2021
ELECTRICAL CERTIFICATE NO. 47032 12/15/2021
PLUMBERS CERTIFICATION DATED 6/13/2022 Ge e Berry Jr
ut o • e Signature