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Home My WebLink About1000-9.-3-2.2 TOWN OF SOUTHOLD h'3 2 4 Rental Permit 0997 Owner Pirate Aye LLC Occupied as Single Family Dwelling Located at 776 Bell Hill Ave. Fishers Island 9.-3-2.2 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. 10/2/2023 Code Enforc n �ffc This Notice must be posted by the main entrance at all times 105 � Town Hall Annex 3, Telephone(631)765-1802 54375 Main Road ti, Fax(631)765-9502 P.O.Box 1179 �,� m Southold,NY 11971-0959 �y�� i E AUG 9 re BUILDING DEPARTMENT TOWN OF SOUTHO " ldIng De partment RENTAL PERMIT APPLICATION Town of Southold Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: 776 Bell Hill Avenue,Fishers Island,NY 06390 Tax Map Number: 1000 SECTION 9 -BLOCK 3 -LOT 2 2 SECTION B. OWNER INFORMATION: Property Owner Name: PIRATE AYE LLC c/o EhzabethoJ. Furse Property Owner Legal Address: Property Owner Mailing Address: 2412 Peninsula Rd.Bx 107 Same Fishers Island,NY 06390 Telephone Number (s): Daytime 631-788-7963 Evening Same Emergency Same Property Owner Email Address: mobilview@comcast.net Page 1 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 � 01 Southold,NY 11971-0959 Cour.f BUILDING DEPARTMENT TOWN OF SOUTHOL D Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: c/o owner 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: c/o owner Address of Authorized Agent (no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number(s): Daytime ,w 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: c/o owner Address of Managing Agent (no P.O. Boxes): Page 2 of 5 Town Halt Annex '� �' Telephone(631)765-1802 54375 Main RoadFax(631)765-9502 P.O.Box 1179 � Southold,NY 11971-0959a 4F ' 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: 1 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: Unit 1 Requested Maximum number of persons allowed to occupy Dwelling Unit: 6 Number of rooms in Rental Dwelling Unit: 6 Use and Dimensions of each room in Rental Dwelling Unit: Bedroom#1 - 14'-4"x 10'-10" Bedroom#2 - 13'x 18'-6" Bedroom#3 - 14'-9"x 9'-10" Living Room -20'-6"x 19'-0",Dining Room- 14'-4"x 9"-11",Kitchen- 14'-4"x 7-9" Page 3 of 5 Town Hall Annex "telephone(631)765-1802 54375 Main Road Fax(631)765-9502 Y.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 Y-**"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) 10-IMA ETI+ W. rv�m(2-; ,�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 BUILDING DEPARTMENT TOWN OF SO "TO,'OLD 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 Owners Name:, ....C--- Zv9-9FT K- W _..._, Q2 ._... ....__mM .....,.,w.... . Property Owner's Signature: _........ ' _... .w....._... .._...m ....................... o..._..w.w. Sworn to before me thisday of mrr .,..m ww.._....._..,.._r...,., 20-0 641 Notary lic Signature and Original Notary Stamp 1ci4 / #&e, 22.Z6?,3 Page 5 of 5 � NO Town Hall Annex ; jowlTelephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 �` �� Southold,NY 11971-0959 �' y't ° "a, BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: Unit 1 Requested maximum number of persons allowed to occupy each dwelling unit: 6 Number of Rooms in Rental Dwelling Unit: 6 Use and Dimension of each room: Bedroom#1 - 1.4'-4"x 10'-10" Bedroom#2 - 13' 18'-6" , Living Room-20'-6"x 19'-0",Dinin Room- 14'-4"x9"-11",Kitchen - 14'-4"x7'-9" 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: Town Hall Annex 4j` `t Telephone(631)765-1802 54375 Main Road Qs Fax(631)765-9502 P.O.Box 1179 ^ Cit `r 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 Professional seal required Lor Architect or Engineer,licensed Home Inspector must pLovi"de copy of valid current cerci cation Rental Property SCTM Number: 1000- 9 - 3 -2.2 Rental Property Address: 776 Bell Hill Avenue,Fishers Island,NY 06390 Owner/Name: PIRATE AYE LLC c/o Elizabeth H. Furse Rental Dwelling Unit Identifier: Unit 1 Number &Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 -100 sq., Bedroom#2-90 sq., etc.) Bedroom#1 - 155 sqft.,Bedroom#2 -240 sgft. ,Bedroom#3 - 142 s ft. Property Description (Include all improvements indicated on survey) One acre roe with frontage on Fishers Island Sound.East half of lot is flat and crooded.western. (water side)half is gently sloping lawn down to heavily vegetated coastline. One-story plus basement alae resi ence.Gravel drive and par " g area. 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 Conservatloq Construction Code of New York State. y LV Print Name an � � Origin Signature Please place On ssl OF l' Iv W Z � Lu (31W i2 D LL DECK HD LIVING ROOM DINING (371 sqft.) (142 sqft.) HD BATH 2 (53 sqft.) # D ift z BEDROOM 3 {11515ft 1 -LOSET (142 sqft.) ( } t 3 MUDROOM ` € BEDROOM 2 BEDROOM 1 I ` SD (70 ) (240 sqft.) (155 sqft.) CLOS (50 SQ& BATH 3 SD I W V E HD = HEAT DETECTOR N FIRST FLOOR PLAN SMOKE DETECTORLa WLL SCALE: 3/32" = 1'-0" - CO = CARBON MONOXIDE DETECTOR S 101 DLL co N d 41 �d t f-ITOWN OF SOUTHOLD PROPERTY RECON OWN E , STREET - VILLAGEDIST. SUB. LOT�� T - — - s. F E r FORMER OWNER, N E E ACR. a z S '�l TYPE OF BUILDING RES. _ - SEAS. VL, FARM Comm, CB. NtICS� - -Mkt.�Value e LAND CMP. TOTAL DATE REMARKS s E s P f P a r � ter, ;=e Tillable FRONTAGE ON WATER - 3 a Woodland FRONTAGE ON ROAD I Meadow loW DEPTH 3 House Plot BULKHEAD 'Total �f > , a E c� _ R - , OLO 4 l i t a i I 1 s s � • y € IN t e 1y a z � s s y I 9.-3-2.2 4/4/2022 , € M. Bldg. _ ,o o i s , Extension . I , _ � 3 Q Y / Z Extension � v Foundotion Both i D'nette I Porch 2 273 c-"i _ t 3. Basement N Floors ' K. i - =Ext. Walls I Interior Finish . . �LR. Porch I ,3 ;Fire Place _ Heat a, - , R Breezeway € I ype Roof (Rooms 1st Floor 113R. av Garage ! I FIN. B I Patio (Recreation Room Rooms 2nd Floor O. B. o�S 'IDorrner !Driveway E, Total i 61 FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. . ,Z-16948. . . . . , . . Date . .June 2, 1988. . . . . . . . . . . . . . . . . .. THIS CERTIFIES that the building s . . . .ONE. FAMILY DWELLING Location of PropertyBELL HILL AVENUE FISHERS ISLAND, N.Y. House No. Street Hamle[ County Tax Map No. 1000 Section . . .•. . . . . . . .Block . . . . . . . . . . . . . . .Lot . . . . . . . . . . . . . . . . .. Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . . Re u'recants 1 rivets one- a[ai'1 clwe'11ing built rcrr to conforms substantially to the ea txf i IF � 1t ice' 7 1 I 1 l ilArtiss'idfAiZ��,. m April 23 , 1957 CERTIFICATE OF OCCUPANCY pursuant to which lklikK NV* No. . .Z-16948. . „ „ June 2, 1988 dated , . . . . . . . . . . . . . . . . . . , . 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 2 CAR GARAGE, WOOD PLAYHOUSE & SECOND DWELLING* " The certificate is issued to . . , , , „ w GEORGE . . FURSE fo />er,lce�e� ii of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . N/A. . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . N/A µ „ . . . . . . PLUMBERS CERTIFICATION DATED: N/A loci *SECOND DWELLING LOCATED ON PROPERTY Building Inspector BP #5819Z issued 4/17/72-CO Z4877 & 9)ap DWELLING HAD AN ADDITION BP # 14457Z issued 12/9/85-CO Z16380. BUILDING DEP!',R=ENT TOGN OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT Location BELL HILL AVENUE, FISHERS ISLAND, N.Y. (number & street) ((Municipality) Subdivision Map No. Lot(s) Name of Owner(s) GEORGE FURSE & WIFE Occupancy R-I OWNER (type) owner-tenant) Admitted by: MR. FAULKNER ,accompanied by: SAME Key available ' Suffolk Co. Tax No. 9-3-2 Source of request STEPHEN L. HAM III' Dete May 23, 1988 D'.ELLING. MAIN HOUSE Type of construction WOOD FRAMED °stories 2 Foundation Stone & block Cellar partial Crawl space x Total rooms, 1st. Fl 6 2nd. F1_ 5 3rd. F1 Bathrooms) 3 Toilet rocm(s) Porch, type Deck, type Patio, type_ Breezeway Garage Utility room Type Heat oil fired Warm Air x Hotwater Fireplace(s) 2 No. Exits 5 Airconditioning Domestic hotwater YES Type heater ELECTRIC Other PANTRY, ATTIC ACCESSORY STRUCTURES: Garage, type const. 2 CAR wooD Storage, type const.WOOD PLAYHOUSE Swimming pool Guest, type const. Other THIS DWELLING HAS SMOKE & FIRE DET VIOLATIONS: Housing Code, Chapter 45 N.Y. Stag V i orm Fire Prevention Lration DescrirtionArt. � Sec, �NO VIOLATIONS WERE FOUND SECOND DWELLING LOCATED ON PROPERTY. BP #5819Z issued April 17, 1972-C/0 Z4877 SECOND DWELLING HAD AN ADDITION BP #14457Z issue . N December 9, 1985 -CO Z16380. Remarks: Property has two dwellings, one 2 car garage and wood playhouse Inspected by: ate of Insp. May 31, 1988 CURTIS W. NORTON fTime start 1,15Pm end 2.30 pm Town of Southold 8/15/2016 P.O.Box 1179 C3 53095 Main Rd 4yu` ca Southold,New York 11971 ——--------- CERTIFICATE OF OCCUPANCY No: 38843 Date: 8/15/2016 -——---------- THIS CERTHUS that the building RESIDENTIAL ALTERATION ............... Location of Property: Hay Harbor,Fishers Island .............-.—...... ...... SCTM#: 473889 Sec/Block/Lot: 9.-3-2.2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/29/2016 pursuant to which Building Permit No. 40657 dated 4/29/2016 .. ........ was issued, andconforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: A—LTERATIONUEQ The certificate is issued to Bell Hill Avenue LLC .............. ........ of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 40657 05-12-2016 PLUMBERS CERTIFICATION DATED 07-14-2016 Peter Mrowka Autho 1p ter F1C w Town of Southold 10/3/2023 P.O. Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44627 Date: 10/2/2023 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: Hay Harbor, Fishers Island SCTM#: 473889 Sec/Block/Lot: 9.-3-2.2 _.w _......_... . ._.. _...... .......... . .w._..... . . Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated P g _ .... 12/30/2020 pursuant to which Building Permit No. 48983 dated 3/4/2 023 was s isued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: It µ tic .. n.d aciclitio„r .,i,r ue i� els...tca e ►stt,lgm i�r 1 1 l u Ming.. �i.Appjwied forl? 1/21/2021. The certificate is issued to Pirate Aye LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 48983 8/2/2023 PLUMBERS CERTIFICATION DATED 5/12/2023 Ma4hew I olodnic i ._ Autho e Si....... . gnature