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HomeMy WebLinkAbout1000-117.-6-13.1 Wit TOWN OF SOUTHOLD Rental Permit 0756 Owner Lori Cannell Occupied as Single Family Dwelling Located at 215 Kouros Road New Suffolk 117.-6-13.1 Maximum Permitted Occupancy 9 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. 10/17/2022 de E orc m t fficial This Notice must be posted by the main entrance at all times P Town Hall Annex .; Telephone(631)765-1802 1; { 54375 Main Road .. Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200(Application must be renewed everyo' sDdG S E P 1 5 2022 Section A. Property Information: BUILDING DEi PT. TOWN OF SOUTHOLD Rental Property Address: 215. KOU 026 a-)Ol Tax Map Number: 1000 SECTION--i--q_ d _BLO.CK-©(o-C --LOT-0j-a---= SECTION B. OWNER INFORMATION: Property Owner Name: Mrl CQnntoj 1 Property Owner Legal Address: Property Owner Mailing Address: tid T Telephone Number(s): Daytime Evening Aency Property Owner Email Address:, i I Conn421 I W—Cl©l-COW) Page 1 of 5 fi7 . Town Hall Annex ' Telephone(631)765-1802 54375 Main Road = Fax(631)765-9502 P.O.Box 1179 . , t. ,.� Southold,NY 11971-0959 cotOil Oil 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: .. N/A 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:_ 7`t - Address of Managing Agent (no P.O. Boxes):... Page 2 of 5 40 Town Hall Annex Telephone(631)765-1802 5437.5 Main Road � ""` � Fax(631)765-9502 P.O.Box 1179 °K; Southold,NY 11971-0959 A BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime ..Evenin' Emergency Email Address: SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: I 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 ni : 2 Number of rooms in Rental Dwelling Unit: n - Use and Dimensions of each room in Rental Dwelling Unit:. OraI I AP P Y . Town Hall Annex Telephone(631.)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 � 4U to 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. ;t I am requesting afire 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 OF SUFFOLK) 1 Lno �I(1 I ,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 w �,, Telephone(631)765-1802 54375 Main RoadFax(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, o/r�Site 1 Manager. Property Owner's Name:. � u. C0 V 4 Property Owner's Signatur . Sworn to before me this jL day of. j.20:-1c) aot Official Notary Public Signature and Original Notary Stamp REBECCA A LUCAK Notary Public-State of New York No.01 LU6386882 Qualified in Suffolk county MY commission Expires Feb.04,2023 Page 5 of 5 SOUTyo� y�� ,vvs- # # TOWN OF SOUTHOLD BUILDING DEPT. �ycouto, 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] AL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI L) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: E o DATE 0 w INSPECTOR �•i BDRM 3 BDRM .4' VICRCLAU HEADER N � - too yi, Jit u - =,k:A; BDRM 2 MBDRM 1, a: o?sem: t ,A. : .:' .._ � C. - ,... ',r.....•._� _:n..-.�-_�-.-;_ .._.. :....o'er,•,- � _ - sit - p• r. t — i" 1, f"e •- �1 - - .. .. - .. - .., .. ,. , .. ... �.. as. +.��Bei�_•aPs37iTAd=d'0.'Tet^t�} il FAMILY 'ROOM': rn0111 P/NTetYZOO?TU o r �zoo^^` s LIVING- RMj >- D_ ENTRY 8'=49�oary - i - 1 " fz - - Yt r j W . W. �.__;__—_ ____i—...;_--•---.�._—.._.....: `tea , i t �- , , : ' 4 i s _...........r..:.. ........�..,._.. .. ._._._..._._._ ....,._......._:..._. . i.. i : ; , -- - -- I ry Iv1. Blda S Foundation I Bath ���' F i j i 1 xtension € Basement i Floors ; � # t Extension Ext. Walls. Interior Finish , I Extension. i. .r ; Fire,Place Neat r Ra Porch ' i f of TYPe. . .-.-.-.-��-----.............................--- -._._ i.........--- --............... .........._ Porch L Rooms 1 st Floor . Breezeway Patio i Rooms 2nd Ffoor, 4 Garage ? Driveway' s*rhe 6 : „ { Dorir�er I -- a;� � ef ' �T.n-a�aD W�T,i'� '�r'4r"..b' ww,•ce g" as `� f , ., ' i r�_ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23181 Date AUGUST 25, 1994 THIS CERTIFIES that the building NEW DWELLING Location of Property_ 215 KOUROS ROAD NEW SUFFOLK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 117 Block 6 Lot 13.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 4, 1993 pursuant to which Building Permit No. 21592-Z dated AUGUST 13, 1993 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 OUR FAMILY DWELLING WITH ATTACHED WOOD DECK The certificate is issued to STEVEN & LORI CANNELL (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 93-SO-60-JULY 12, 1994 UNDERWRITERS CERTIFICATE NO. N-317495 - JUNE 16, 1994 PLUMBERS CERTIFICATION DATED AUGUST 23, 1994 - EDWARD F. SCHILLER Building Inspe or Rev. 1/81