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HomeMy WebLinkAbout1000-106.-8-21 TOWN OF SOUTHOLD Rental Permit 0747 dam, Owner Panayioti Rauseo Occupied as Single Family Dwelling Located at 565 Dogwood Lane Mattituck 106-8-21 Maximum Permitted Occupancy 4 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. 9/26/2022 ode Ifficial,,."„ . This Notice must be posted by the main entrance at all times orc m Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 =f Southold,NY 11971-0959 r a 3 BUILDING DEP-ARTMENT, TOWN OF SOUTHOLD ter.__= _ �. REI' TAL PERMIT APP-LICATION,. Rental Permit Fee$200 (Application must be renewed every two years) Section X Property Information: Rental Property Address Tax Map Number: 10.00 SECTION SECTION B. OWNER INFORMATION: Property Owner Name:- _ - Property Owner Legal Address: Ped I erty Owner Mailing Address: e 631 Telephone Number(s): Daytime f (" ' ening __ Emergeni Property Owner Email Address: C)VrCP61e \j6!1KJ0 . O'DAI Page 1 of S Town Hall Annex °; Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1]79 Southold,NY 11971-0959 BUILDING•DEPARTMENT TOWN.OF SOUTHOLD Mailing Address of Managing Agent:, Telephone Number(s): Daytime: _ Evening _ Emergerr .__._, .. ... Email Address: . SECTION F. PROPERTY DESCRIPTION: Number of Rental DwellingUnits e on property". fir;: 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 Perrilit Application Addendum." �Ot Rental Dwelling Unit Identifier: le. I I r, � - Requested Maximum number of persons allowed to oc8 y Dwelling Unit:_ Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit;; I ;gra.. /a .s• . Page 3 of 5 he 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 SRental 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 Preven.ion 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 r' t am submitting a completed Town of Southold certification form from a licensed architect or a licensed professional en jrleeir, SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. f STATE OF NEW YORK) COUNTY OF SUFFOLK) I Alf O �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 i I Page 4 of 5 i Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(63 1)765-9502 P.O.Box 1 179 " Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD applicable laws and rules. 1 further acknowledge that I will notify the Town of Southold Building Department'of any changes of address within five (5) days of any changes t' thereto. is 3. 1 have read and received a copy of Chapter 207 of the Code of the Town of Sduthold and j 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 6wner's Name.. __� ` "'4-'- _ 09 � Property Owner's.Signature: �-- ` Isorn to before4thld y of. , ` :29A Official ry Pre an riginal Notary Stamp TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK NO.01 D W6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2-02X Page 5 of 5 i Bui[din Department Application AUTHORIZATION (Where the Applicant is not the Owner) residing at U6, ; On, (Print property owner's name) s—z (Mailing Address) do hereby authorize U (Agent) to apply on my behalf to the Southold Building Department. (On is Signature) (Date) (Print Owner's Name) Town Hall Annex $. Telephone(631)765-]802 54375 Main Road Fax(631)765-9502 P.O.Box 1]79 Southold,NY ]]971-0959 BUILDING DEPARTMENT TOWN OF SOUTTTOLD Section C. Authorized Agent Information: g 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 _. e: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 co airing�2,e rental units) Name of Managing Agent of dwelling unit, if any: 1 Address of Managing Agent (no P.O. Boxes). Page 2 of 5 t M46 TOWN OF� SOUTHOLD BUILDING Ill 831 -785-1802 too INSPEC ION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CA[ [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] TIRE SAFETY IN! [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL {TI [ ] CODE VI LATION [ ] PR C/ [ I t 4V sojjt' Tele Town Hall Annex Phone(631)765-1802 (631 54375 Main Road Fax )765-9502 P.O.Box 1 179 , Southold,NY 11971-0959 �CV 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 Prolslaal seal rerlll�,ed far�rcl� tect ar �ll�eer,llerrsed/ owe lls�ectr�l� a�1s aral/ide copy oLvalld c rre t certi icotio Rental Property SCTM Number: 0 �— RentalPropertyAddress: X65' 1)0 Owner/Name: Rental Dwelling Unit Identifier: /dr✓CJ—<I n'G 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;iyIWC Av0�-7 /C X /r Property Description (Include all improvements indicated on survey) C . 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 ergy Conservation Construction Code of New —York00-0 State. O NEW A. Oaf Print me and Title 0 ignature B Please place professional seal: e VC S 1 ,. ..,,»....,......_....................W. N,- ,. Al $� I C, c 12 0 +� Iq•a. �._. sew ;� ........ 4 $a b EQ q � ppy Cr f � �, ..u" M' LO O 2 I"3LAh.I 0 r 0 0 r h 4 C"W, s PMCE � Ig ti p fi a � Y 13 4' 8 q 7,4' 7-5- 7"S __ -- 7r .� - 7V— ._ 74' @ o ' u t 4 p " V 777 �..." r sl-o 4 � ou�NnaT+c� P�wr✓ N s ti � w V, F 1I TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET VILLAGE DIST. ! � .SUB ... 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Donner Driveway TQtol ^ �� 7 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z 5008. . . . . . Date . . . . . . . . . .Feb. . . . . . . . .. 19.73 THIS CERTIFIES that the building located at Dogwood. La . . . . . . . . . . . . . . . Street Map No. Sunset .fo.Uvk No. .II . . . . . .Lot No.41 . . . . .Mattituck . .N*Ys . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . . . Rapt. . .22, 19. pursuant to which Building Permit No. .616.4Z . dated . . . . . . . . . . . . Sept. - .22., 19 7>-r-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 Private QIIe. .f' x.41 x 6. . . . . . . . . . . . . x . . . . . . . , . . . . . . , . , . , , , . , . , . The certificate is issued to .Haimr& !Mills . . . . . . .Owner. . . . . . . . . . . . . . . . . . . . . . . • . , . , (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Dec, .12,. .1972. . .by. R O .Yilla. . . . . . UNDERWRITERS CERTIFICATE No. IK .67281 , •Z .17+ 1973 . . . . . . . . HOUSE NUMBER. .565. . . . . . . .Street. . . . . .Dogwood- la. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x x s • �A • • • : x x x s 1 e x Building Inspector I