HomeMy WebLinkAbout1000-30.-2-42 TOWN OF SOUTHOLD
Rental Permit
� 029
Owner Welsh620 LLC
Occupied as -Single Family Dwelling -
Located at 620 The Greenway East Marion 30-2-42
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.
8/23/2022
Co nfo c en Official
This Notice must be posted by the main entrance at all times
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Town Hall Annex Telephone(631)765-1802
54375 Main Road 1 (§,31)765-9502
CA
P.O.Box 1179 G'
Southold,NY 11971-0959 �!/' • ��4��
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BUILDING DEPARTMENT wNOFSpU�r
TOWN OF SOUTHOLD 6C0
RENTAL PERMIT APPLICATION
Rental Permit Fee$200(Application must be renewed every two years)
Section A.
Property Information:
Ren I Property dress: I , �✓� �� �q�� �� /��/
c,j 6 -7t, 6,reo
Tax Map Number: 1000 SECTION d -BLOCK p2 -LOT�-
SECTION B.
OWNER INFORMATION:
Property Owner Name:
WAS do
Property Owner Legal Address: Property Owner Mailing Address:
� J4-eel 5JA0,71
4 A "t 4 / InI9
7 7�
r"007 t /'0' 7 ;9 -f� I /;",
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Telephone Number(s): Daytime oe Eve-ping_ Emergency
er - L7 o I tY - 7 k5d
Property Owner Email Address:
11,A �cX,01156veA710V'q
. Co .
Page 1 of 5
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Town Hall Annex Telephone(631)765-1802
54375 Main Road CP Fax(631)765-9502
P.O.Box 1179 ® O
Southold,NY 11971-0959 Q
Con un
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
SO�,�� ,
Town Hail Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1 179
Southold,NY 11971-0959
+ COWN
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
e� el
Mailing Address of Managing Agent:
Telephone Number(s): Daytime Evening Emergency
Email Addree.ALI
ss: <JG�/V� %"/Y
SECTION F.
PROPERTY DESCRIPTION:
q7t�4
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, 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:
69-
Number of rooms in Rental Dwelling Unit: - _ --. --V 'V-OA - ,
ts�
Use and Dimensions of each room in Rental Dw [ling Unit:.*�-6
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Page 3 of 5
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Town Hall Annex , Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 1IOUTY,
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.
S I am 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 OFSUFFOL )
t
I �&P�141rtify 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
®� soupy
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Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 �+
cauNT1,t��'
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 e hame:_ / _� l / Ci
Property Owner's Signature:
Sworn to before me thisd5 day of T14 lja dXjAj e
Liam
Official NotF#
Public Signatur nd Original Notary Stamp
TRACEY L. DWYER
NOTARY PUBLIC,STATE OF NEW YORK
NO.01 DW6306900
QUALIFIED IN SUFFOLK COUNTY
COMMISSION EXPIRES JUNE 30,2ka*
Page 5 of 5
OF 50U
* # TOWN OF SOUTHO BUILDING DEPT.
cou631-765-1802 �0 / 'L i (�v
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING/STRAPPING [ ]16AL
[ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FIL)
[ ] CODE VIOLATION [ ] PRE C/O [ _ RENTAL
REMARKS:
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DATE g l Y INSPECTOR
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LAND IMP. TOTAL DATE REMARKS
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House Plot BULKHEAD
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Patio Recreation Room Rooms 2nd,Floor FIN..B
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: 3-25749 Date: 06/01/98
THIS CERTIFIES that the building NEW DWELLING
Location of Property: 620 THE GREENWAY EAST MARION
• (HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 30 Block 2 Lot 42
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 16, 1998 pursuant to which
Building Permit No. 24772-Z dated MARCH 17, 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 ONE FAMILY DWELLING WITH ATTACHED GARAGE & WOOD DECK AS APPLIED FOR.
The certificate is issued to ALICE RYAN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 87-SO-184 05/11/98
ELECTRICAL CERTIFICATE NO. H059670 04/29/98
PLUMBERS CERTIFICATION DATED 05/27/98 THOMAS RYAN
of
Building ffnspector
Oe-
Rev. 1/81