HomeMy WebLinkAbout1000-75.-4-27 TOWN OF SOUTHOLD
w Rental Permit
® o 0726
Owner Dominic & Maria Fonti
Occupied as Single Family Dwelling
Located at 522 S. Harbor Rd. Southold 75-4-27
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.
8/15/2022
de E em n Official
This Notice must be posted by the main entrance at all times
�
of so ,ryolo�
Town Hall Annex , Telephone(631)765-1802
54375 Main Road f Fax(631)765-9502
P.O.Box 1179 G iri
Southold,NY 11971-0959O`�,� � yO
UUt�`l,
®
BUILDING DEPARTMENTT
TOWN OF SOUHOLD APR 18
2022
_RENTAL PERMIT APPLICATION TOWN OFSOUTHOLD
Rental Permit Fee $200(Application must be renewed every two years)
Section A.
Property Information:
Rental Proper yAddress: %7�KP
Tax Map Number: 1000 SECTION 2 r BLOCK -LOT A7 -.
SECTION B.
OWNER INFORMATION:
Property Owner Name: ®'All It—`6— T/
Property Owner Legal Address: Property Owner Mailing Address:
le
_X 111;K171
Telephone Number(s): Daytime i9y y 4ening Emergency '711 a
Property Owner Email Address:
Page I&S
1�p'f
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 G •
Southold,NY 11971-0959 �0 Y
r�Courm
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: T
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: 0V/0
— y
Number of rooms in Rental Dwelling Unit:
Use and Dimensions of each room in Rental Dwelling Unit:
ZZ(, sF- 6R Z s-'
rl 44
Page 3 of 5
roe so�ryo .
Town Hall Annex 41 Telephone(631)765-1802
54375 Main Road C01-1- Fax(631)765-9502
P.O.Box 1179 •
Southold,NY 11971-0959 '�!
`�4AMUM
;t��'��
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)
I �i��h✓�e �� „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 Annex ', Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 Q
CCUMf'1
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:C
Sworn before a is J day of &61- 2022
fficial Not ublic Signature and Original Notary Stamp
oSpiE
0^ Dawn Johnson
5,...........,
NOTP.RY',.-A-%Notary Public,State of New York
* No 01306349053
a PUBLIC;: c
Qual'if'ied in Suffolk County
"1 rump Commission Expires 10/11/20Zl
Page 5 of 5
o��OF SOUIyo �•2/� ' ���hl"W� �� `��
# TOWN OF SOUTHOLD BUILDING DEPT.
o •
`ycou631-765-1802 ',+-, � Let --'
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [XFIRE
ATION/CAULKING
[ ] FRAMING /STRAPPING [
[ ] FIREPLACE & CHIMNEY [ AFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI L)
[ ] CODE VIOLATION r ] PRE C/O [ RENTAL
REMARKS:
Q
1
DATE INSPECTOR
Telephone(631)765-1802
Town Hall Annex ' Fax(631)765-9502
54375 Main Road
P.O.Box 1179
Southold,NY 11971-0959 ��� .
�UN(°� t
BUILDING DEPARTMENT
TOWN OF SOUMOLI)
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 seal required forArchitectorEnaaineer,licensedHome.inspectormust.provide
copy of valid current certification
Rental Property SCTM Number: 1000-75-4-27
Rental Property Address: - 525 South-Harbor Rd Southold.NY
Owner/Name: Dominic Fonti
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.)
Master Bedroom: 204 sq, Bedroom 2: 177.sq
Bedroom#1;226 s Bedrooip 3:150'°sq
Property Description (include all improvements indicated on survey)
land 2 story wood frame vinyl siding-with cellar,wood deck and.wood steps aboveoTg and Uool
and fire pit,'and asphalt-basketball court with stone bar.
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 ode of New York State,
the Fuel Gas Code of New York State, and the Energy Conservation Co ru ion Code of New
York State.
Anthony Portillo, R.A
Original Signature
Print Name and Title
Please place-professional seal:
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JUN 8 2022
BUILDING DEPT.
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A.
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-19819 Date MARCH 27, 1991
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property, 525 SOUTH HARBOR ROAD SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 75 Block 4 Lot 27
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 19, 1989 pursuant to which
Building Permit No. 18595-Z dated OCTOBER 25, 1989
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 AS APPLIED FOR.
The certificate is issued to MICHELE BEINERT
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 89-SO-101-3/15/91
UNDERWRITERS CERTIFICATE NO. N-134061 - JUNE 8, 1990
PLUMBERS CERTIFICATION DATED MARCH 20, 1991-TRT PLUMBING & HEATING
Building Inspector
Rev. 1/81
c
�oo�gtlFF�t,�coG Town of Southold 3/21/2019
0
P.O.Box 1179
53095 Main Rd
�ytjpl �ao�� Southold,New York 11971
�t
CERTIFICATE OF OCCUPANCY
No: 40278 Date: 3/21/2019
THIS CERTIFIES that the building AS BUILT DECK
Location of Property: 522 S Harbor Rd., Southold
SCTM#: 473889 Sec/Block/Lot: 75.-4-27
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
2/8/2019 pursuant to which Building Permit No. r43487 dated 2/19/2019
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"DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED
The certificate is issued to Beinert,Michele
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
th Signature