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Home My WebLink About1000-31.-5-6.1 u TOWN OF SOUTHOLD Rental Permit 0738 Owner 12395 House Barn 6.1 LLC Occupied as Single Family Dwelling Located at 12395 Route 25 East Marion 31-5-6.1 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. 9/2/2022 dri e �"I Oficial . This Notice must be posted by the main entrance at all times - Ar -Lli— Town Hall AnnexA—MMTelephone(631)765-1802 11- 54375 Main RoadFax 631( ) 765-9502 P.O.Box 1179 Southold,NY 11971-0959 ell BUILDING DEPARTMENT` TOWN OF SO OLD RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: i 2j 15 MA--;N f? , F,4,rr A1,4 v a/ , 41Y 1/93 7 Tax Map Number: 1000 SECTION .3 • '�'6• ( BLOCK LOT SECTION B. OWNER INFORMATION: Property Owner Name: Z-,e J'vSE Mk4Ta Yo HDUfF RAktJ l.6 GLC Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) /30 FAQ ti T 4F Telephone Number(s): q1-7 Property Owner Email Address: ��tie se''ey4he yttA��. CSM 9aIle ay, C � Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: S F WR ,II DTtWW- co H 0JL-'Qg12J1/4; aC Address of Authorized Agent(no P.O. Boxes): ii 30 2 '/ti Vol Mailing Address of Authorized Agent: L a Telephone Number(s): q11- Email 11 Email Address: fe' KV-4 ''e fev.yaney)7,4,z .c�►� 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: s Telephone Number(s): 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) Mailing Address of Managing Agent: Telephone Number(s): Email Address: Page 2 of 4 SECTION F. PROPERTY DESCRIPTION: 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: 239r AIAi)/ )(ol-v z F,4f7 nib A P Requested Maximum number of persons allowed to occupy Dwelling Unit: . � Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: L/V/�Vls pooh : y x,52 3'9. Roo": _ 142,4 -1 N7&7- q ,-Po,eo0 s 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 NYS licensed architect, a NYS 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,I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold. Page 3 of 4 ❑ 1 am submitting a completed Town of Southold certification form from a licensed architect,a licensed professional engineer, or a licensed home inspector who has a valid New York State Uniform Fire Prevention Building code Certification. SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFOLK) I AZ 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 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 s to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager. Property Owner's Name: se-17-� e— Property Owner's Signature: __ n Sworn to before me thaw" day of WCVC�h 200; Official Notary Public Signature and Original Notary Stamp Page 4 of 4 CONNIE D.BUNCH Notary Public,State of New York No.01 BU6185050 Qualified in Suffolk County Commission Expires April 14,20-41-1 Town Hall AnnexTelephone(631)765-1802 ft.90 54375 Main RoadFax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 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 oom: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: bvi ,-A 5 ro r TOWN OF SDUTHOLD BUILDING D 765-1802 �3� , �- b INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CA [ ] FRAMING 1 STRAPPING [ /FINAL M4 [ ] FIREPLACE & CHIMNEY [� FIRE SAFETY IN [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PI [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI CODE VIOLATION [ ] PRE C/O REMARK /d-Jve(, t' l✓ a 'TWn � �011% N,000e m�� arn1 �h �OA I ih �*v V\/t tv DATE (D INSPECTOR To Full Annex Telephone(631)765-18132 375 Main Road \ � �V (631) 65-9502 P.O.Bax 1179 \ \ - Southold,NY 11971-0959 ` E VI LI BUU,DING DEPARTNTENI-IT TOWN OF SOUTH01M BUILDING DEPS TOVIIIN 0 F C, 4 RENTAL PROPERPf CERTIFICATION Form to be completed by a NYS licensed architect, NYS licensed engineer or licensed home inspector Separate form is requ red for each individual Ren to/Dwelling Unit o�essioai seal rewired fog architect aineer licensed�oe inspector must-provide a c a a valid�e� yard Mate bio dire prevntin �iidino bode certification, Rental Property SCTIVI Number: Rental Property Address. ', ental DwellingKnit Identifier: � ��` Y Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom #1 —100 sq., Bedroom# 90 sq etc.) _ F r f 3440 s Property Description (Include all improvements indicated on survey) 1? r€ = F I certify that I have done a physical inspection of the subject rental dwelling unit and find that the unit 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 laves adopted by the New York State Fire Prevention and Building Code Council. NEt- LoC, ANS Print Name and Title Original Signature d S/ 1 2 0 2 2 Please place professional seal: 1443 tot J Vx a , s -MI -S LI' UNIT1- St�� vE�aes • . /�� 10� �� . IN-SPLITUmT OFFICE . ! •� - � . . . � ■ _ . . 12,'(, 4— 9 ■ 2MoIre' ormC?b r - . TOWN OF SOUTHOLD 'PROPERTY R ---'0-- -IRD OWN ER TREET VILLAGE DIST SUB, LOT 7, .ACR FORIER OWNER f f ............ee .............. 1W TYPE OF BUILDING T RES SSS VL, FARM COMM. CB. MICS. Mkt. Value ................. LAND IMP, TOTAL DATE REMARKS -? L4'd z/ 17, .. ............ ..........'^. .. e I q'i It- I ---—------------- AGEBUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Vclue Acre ............. Tillable FRONTAGE ON WATER ............. Woodland FRONTAGE ON ROAD '2 Mead owl,and DEPTH 0 Hou'se Ptsf BULKHEAD Total DOCK .............. y� � 9 I w ro 9 A H a,y .^ COLOR t A 1 �" lal1 1 0 g $ x ggg��b r rAwli � 31.-5-6.1 3/13 ' M. Bldg. / _ . Extension 77 N Extension a q Extension u.,...�..„ „.�. .„._�.. .�....._ .Foundation tai°h_._..._._..__�.., Dinette . „ Porch......._..„..,. ;Basement ........ ..,�^ � _.„..... F ._.W,� ...._..,..„�,.„,. loors Porch ' ��. r� ;�. m�. . _.... m..... Ext ..Walls___ Interior Finish LR, �._ tea., Br® yA e Heat —Ti—,Garage Type Roof _ Rooms—' ooms ,_.lst Floor DR. � ire ac "� > Recreation Room '` Rooms 2nd Floor 1171N. B 55T. � /iii%, �r r e;�.,� ,..«....». �'+ a� t`,d�nY!_„„...;,.„..•.,.��._�.. 'L�. ,�., ,�DOrmer,..,,.. ..._ ....�„ ,,„. ..._ ....,.......„.�,.._„.,�...k,. DYIVeWG _.,_,..,,_._...,,W.,, ,._..,..�.�._........„ .,..�.....�. _..,.,,...„.w _„„__..�...,...�.,� ......,m.......,,,.... �— Total r I Town of Southold Annex 10/26/2012 54375 Main Road Southold,New York 11971 0�P}. PRE EXISTING CERTIFICATE OF OCCUPANCY No: 36024 Date: 10/25/2012 THIS CERTIFIES that the structure(s) located at: 12395 Route 25, East Marion SCTM#: 473889 Sec/Block/Lot: 31.-5-6.1 Subdivision: Filed Map No. Lot No. conforms substantially to the requirements for a built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 36024 dated 10/25/2012 was issued and conforms to all the requriements of the applicable provisions of the law. The occupancy for which this certificate is issued is: wood frame one family dwelli with cover porches and small date taatio and accsc barn with storage The certificate is issued to Oysterponds Historical Society (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 31-5-6.1 PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. A riz ,Signature BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 12395 Route 25,East Marion SUFF.CO.TAX MAP NO.: 31.-5-6.1 SUBDIVISION: NAME OF OWNER(S): Oyster-ponds Historical Society OCCUPANCY: ADMITTED BY: SOURCE OF REQUEST: Oysterponds Historical Society DATE: 10/25/2012 DWELLING: #STORIES: 2 #EXITS: 5 FOUNDATION: stone CELLAR: small pit CRAWL SPACE: BATHROOM(S): 2 TOILET ROOM(S): 1 UTILITY ROOM(S): pantry offkitchen PORCH TYPE: DECK TYPE: PATIO TYPE: slate BREEZEWAY: FIREPLACE: 1 GARAGE: DOMESTIC HOTWAT : X TYPE HEATER: off boiler AIR CONDITIONING: TYPE HEAT: it WARM AIR: HOT WATER: steam #BEDROOMS: 4 #KITCHENS: 1 BASEMENT TYPE: OTHER: ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: barn&storage STORAGE,TYPE OF CONST: SWIMMING POOL: GUEST,TYPE OF CONST: OTHER: - VIOLATIONS: REMARKS: INSPECTED BY: GARYF DATE OF INSPECTION: 10/5/2011 TIME START: END: FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.O38. . . . . . . Date . . . . . . . . . . . . 3 ept, . 30. . . _ . ., 19. r�+ THIS CERTIFIES that the building located afMa1n .R.oad. . . . . . . . . . . . . . . . . . Street xx Map No. . . . , . . . , , . Block No. . . . , . . . .Lot No. . . . . , . £'-10a>t P;ax' nn I aY conforms substantially to the Application for Building Permit heretofore filed in this office 3 dated . . . . . . . . . N°Y, . .. , 19, 2. pursuant to which Building Permit No.��3P-, . . dated . . . . . . . . . Nov. . . . . . . . ., 19.2., 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 . .Fr3 rrat;e one fame 1 ung, w�, h. �p�?. . . . . . . . . . . . . . . . The certificate is issued to Mrs W. Stein Owner` . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No. , . . . . . . 6 .��.7. . � �, /S>� HOUSE NUMBER . . :12395 . . . . . Street . . . 1a n Ito i . . . . . . . . . . . . . . . . . . . . . . . . . . . Building Inspe�tor