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Home My WebLink About1000-53.-4-23.1 TOWN OF SOUTHOLD Rental Permit 0749 Owner Kaidin Campbell Occupied as Single Family Dwelling Located at 2540 Bay Shore Rd Greenport 53.4-23.1 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. 10/6/2022 ode fo c t Official This Notice must be posted by the main entrance at all times c 01 r79 y (of SO Town Hail Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 .P.O.Box 1179 Southold,NY 11971-0959 a}� BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION MAR 3 0 2021 Rental Permit Fee$200(Application must be renewed every two years)`; Section A. Property Information: Rental Property Address: 2,5 YO au Shop-c �o��l �r ren�o►�-� NY n q vLl Tax Map Number: 1000 SECTION �I �J g g -BLOCK 5 3 -LOT y 3 SECTION B. / OWNER INFORMATION: / Property Owner Name: �QI�I"l 117 Ca VYIDb� Property Owner Legal Address: Property Owner Mailing Address: LSg0 '13 aw ,Brno 40C )lq y noc� R Telephone Number (s): Daytime R I46SQVEvening Emergency Property Owner Email Address: yal-s i n s calm p b e[10 4m a i l co rn Pagel of 5 Town Hall Annex Telephone(631)765-1802 .54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 Tr UNVI BUILDING DEPARTMENT" TOWN OF SOUTHOLD. RENTAL PERMIT APPLICATION INSTRUCTIONS Rental Perm t:Fee $200 (Application must be renewed every two years) The items"listed",below are required to be submitted with the completed application: Floor Plans: Floor plans of each Rental Dwelling Unit, please show location of all smoke'&carbon monoxide detectors. Certificatesr of Occupancy and Pre-Certificates.of Occupancy: Certificates of occupancy or Pre=Certificates of Occupancy for'each rental dwelling unit. oh. .f=r'I e . "iA 't f3u i�'n p e-p� 0 Certification of Code Compliance(form enclosed): Must be submitted by a license',architect or engineer or license home inspector if an inspection by Town of Southold.Inspector is declined. Rental Permit Fee: $200.00 C;K,"& 4,L4 to 4 Town Hall Annex ` _ Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 1.1971-0959 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: JjQ I'll 117 .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:(requ•ired 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 Town Hall Annex Telephone(631)765-1802 .5.4375.Main Road Fax(631)765-9502 . P.O.Box-1179 ' South6ld,NY 11974-6959i, 'C � BUILDING DEPARTMENT TOWN.OF SOUTHOLD ' :;Mailing Add'r'ess•of Mana in Agent: ging g Telephone Number, (s): Daytime Evening Emergency Email Addre§s:.- SECTION F.: PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: F.or,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 multi Ie'Rental Dwelling Units use "Rental Permit Application Addendum," . Rental Dwelling Unit Identifier: 1 Requested Maximum number of persons allowed to occupy Dwelling Uni " t a Number ofrooms in Rental Dwelling Unit: -- Useand Dimensions of each room in Rental Dwelling Unit:. g5tandard 'hor 1p- `I bilro0 -)S� 2 bqt-hL20m3, k,12- wn mUCLVV0rn1 ► V+nA E�D yr 1 n+ r7O r0i2p04 11 Pjd-r 1 r s Page 3 of 5 .y 1 . Town Hall Annex Telephone(631)765-1802 54375 Main Road , Fax(631)765-9502 P.O.Box 1-179 k ;Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD .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 bythe 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 permif.. pplicatiori 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 adapted by the New York State Fire Prevention and Building Code Council. Ai a m'requestirig'a fire safety inspection to be,performed by a Code Enforcement Official from the Town of Southold n 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 (1albvl� ,.certify under penalty of perjury;the following: 1: I 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 SO Town Hall Annex 4. Telephone(631)76.5-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 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 Name:: Ila 141I n abLLl1 Property Owner's Signature: Sworn to before me thin Ilay of lyk-al LGh 20 Official Notary Public Signature and Original Notary Stamp CONNIE D.BUN,1 Notary Public,State o ,, -wv York Oualified in Su,r',,.,. .,;,ounty suC �t9r�".'Fjbt;..;;b�; Commission Expires„err+i 14,2 Page 5 of 5 -- pF SOUIy�� )� # # TOWN OF SO�LUUTHOILL BltllLD NG DEPT. 631-765-1802 /.; r INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FIN [ ] FIREPLACE & CHIMNEY [ ] RE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI L) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: cwm III . DATE3 WIRVI-" INSPECTOR pF SOUIy�� # # TOWN OF SOUTHOLD BUILDING DEPT. cou631-765-1802 h4NSPECTION [ ] F%0 i ATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] INAL pe. „L Q [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTAN/lA ATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (CODE VIOLATION [ ] PRE C/O [ AL REMARKS: (1 .� 0 oym i fe,G -tom✓ 'C ims setoviA a i L4/ DATE '�v� INSPECTOR .r Ilf"Wor o�aOF SOUTyO �� ; �' w / • �/��L D '� THOLD BUILDING DEPT. TOWN OF SOU & i� c � -1802 norm, 765 1 NSPECTION [ ] FOUNDATION 1ST [ ] 'ROUGH PLBG. [ ] FOUNDATION�2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ CODE VIOLATION [ ] PRE C/O REMARKS: _ �v DATE INSPECTOR I . i I I I I I- - 1 -- I J - -- I I - I -t_ ► _ I III !_ ._ II ►_ I -! _ I - - III_ -[ _ 1- - II I Ii I _ i I ! I I I H - j IiI I IT-1 H 1 1 ' of I - - I - 1 -I - zo�� _ , I- I ► _ I ! i I ! I I II !_ DL Ll ' ' � ► If3's� I I - I I ! j ! if I I-Poe o-m i ra,5 I I I j I I- I I- i ! ! Illljl I _ III �IIiIiI - II �IIIIi ! I � ! 1 I I I I ! door ! ! ! I4 b �rr�Q n �tzs &ter�e..f co �� as I - - - - I I I ►� ��y j I I I i I - - - --| - 1 |� - | / | j | -F- 7 | � � | 15' | - | \ | / | � | � . | | | � | | | \ � | | / / ! - - | | 1 � | - | - | l | i � ) \ | // \ l ! - - - i � | � ! 1 -1 T-- _� | FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. . Z. .9303. . . . Date . . . . . . . . . . . .November. .16,. ., 19.7 THIS CERTIFIES that the building located at .254.0 .Bayshorer .Road . . . . . kk=k Map No. . . .1124 . . . . Block No. . . XXX. . . .Lot No. . .11.7.-119. .inclusive . . . . . . . . . . REQUIREMENTS FOR ONE-FILY DWELLING built prior to conforms substantially to the c*j�ft 1�1 ftw09t 1eretoforefiled in 0s office CERTIFICATE OF OCCUPANCY ftXat . . . . .Apr i 1. 23, . . . . . ., 19. 5 7 pursuant to which 2kdkVM923exaat No. Z 99.43 . . dated . . . . . tdovember .1 b.,. . . ., 19.7.8 ., 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 -ONE-F.AMIDY .DWELLING. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . Warren .Kalbackex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . of the aforesaid building. (owner, kW*WAV bA") Suffolk County Department of Health Approval . . . .Pre-Exist.inq. . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE No. . . . . . . . . . . . . , HOUSE NUMBER . .254.0 . . . , , . . Street . . BaYshore, Road,,. ,Greer}pQrt;. .New ,York . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1000-053-4-22 . . . . . . . .fry' '. . . :X0 9. . . . . . . Building Inspector BUILDING DEPARTMENT TOWN OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT G I ;o'►� Location c{S;416 7AY-5'f/O/zc. .t'o C' T ,v• number & street Municipality Subdivision Map No //dSL • Lot(s) Name of Owner(o) % �N[ Occupancy R-/ type ovm er-tenant Admitted by: 0Lu/"" =2 Accompanied by: OWrvEIt_ Key available Suffolk Co. Tax No.fano -OS3-5�-ZZ Source of request_IleeerGI - .2zc- Date ,i i,j 7a' DWELLING• Type of construction [u000 F.PAi`7 , stories Foundation -rY,� �G'LoC Cellarrawl space 4,-cr Total rooms, lst. F14 - 3,s 2nd 1 ;.,T 3rd. Fl Bathroom(9 o,u�- �" ,z Toi t room(s Porch, typeo--)�A./FL.4l,- ck, type Patio, tYPe ,,C,,n_�T c Breezeway Garage Utility room Type Heat off- FI/e4o Warm Air Hotwater 444 ebo15 Fireplace(X) No. Exits Tu,u Airconditioning — Domestic hotwater X/i Type heater z7i� cs uT•e fl Other ACCESSORY STRUCTURES: Garage, type const.2 �'0'�,��FPA,,�;_ Storage, type const. [uooc FiPNr1z Swimming pool / Guest, type const. Other �j 55&o llzcn2 Tdlic�C _Ja�f� icy cir�r� VIOLATIONS: Housing Code, Chapter 52 Location Description Art. Sec. Remarks: Inspected by: /i' cztu_Date of Insp. 1111,51 Time startZ.-ry end �5 r'/�• ��o�pS�F LkcoGy Town of Southold 8/23/2022 a P.O.Box 1179 o ` 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43348 Date: 8/22/2022 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 2540 Bay Shore Rd.,Greenport SCTM#: 473889 Sec/Block/Lot: 53.4-23.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/12/2022 pursuant to which Building Permit No. 47796 dated 5/9/2022 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"additions and alterations, including deck and second floor living space(non-sleeping)to existing single family dwelling as applied for. The certificate is issued to Campbell,Kaitlin of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 47796 8/10/2022 PLUMBERS CERTIFICATION DATED u orizea Signature