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Home My WebLink About1000-64.-1-14.6 � �, TOWN OF SOUTHOLD Y a� e, � a Rental Permit 0765 Owner Erin Streeter Occupied as Single Family Dwelling Located at 400 Town Creek Lane Southold 64.4-14.6 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. 10/28/2022 Code Wo I&ent O 'cial This Notice must be posted by the main entrance at all times r �o �o Town Hall Annex Telephone(631)765-1802 54375 Main Road Pax(631)765-9502 P.O.Box 1179 ® �O Southold,NY 11971-0959 p BUILDING DEPARTMENT TOWN OF SOUTHOLD - AUG 15 2022 RENTAL PERMIT APPLICATION BUILDING DEPT; {� Tovij,., Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION -BLOCK I -LOT, - V SECTION S. OWNER INFORMATION: Property Owner Name: Property Owner legal Address: Property Owner Mailing Address: I I� 1ej, Telephone Number(s): Daytimeb�l�0(1vening mergency M1 Property Owner Email Address: �° " I Q> 'P �V Page 1 of 5 O SOUT�� , Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 G1-1176 Southold,NY 11971-0959l�Co � , UNTI BUILDING DEPARTMENT TOWN OF 80UTHOLD RENTAL PERMIT APPLICATION INSTRUCTIONS Rental Permit 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. ❑ Certificates of Occupancy and Pre-Certificates of Occupancy: Certificates of occupancy or Pre-Certificates of Occupancy for each rental dwelling unit. ❑ 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 Town Hall Annex Telephone(631)765-1802 54375 Main Road 7` Fax(631)765-9502 P.O,Box 117 ` �o Southold,NY 11971-0959 coutfrt,�> ' BUILDING DEPARTMENT TOWN OF SOUTH LD Mailing Address of Managing Agent: Telephone Number(s): Daytime Evening Emergency Email Address: 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, Q 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 allovvedo occupy Dwelling Unit: Number of rooms In Rental Dwelling Unit: 3 Use and Dimensions of each room in Rental Dwelling Unit: &f'A. 'er� � (o '- (a Page 3 of 5 tpF SO!/T Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 AMC P.O.Box 1179 G' Southold,NY 11971-0959 l�coUiJY`i,� t.� 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: 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 propertie con aining 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 of SQUr�o Town Hall Annex 4 Telephone(631)765-1902 54375 Main Road Fax(631)765-9502 G P.O.Box 1179 �, O Southold,NY 11971-0959Lll�C OUNT`(, . 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 iaa uth a Town of Soold m 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 `"l_—✓1 1W..>SL �. 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 r oF Si .. Town Hall Annex ~ O Telephone(631)765-1802 54375 Main Road Pax(631)765-9502 P.O.Box 1179 O Southold,NY 11971-0959 Y 4UN1'(,t, 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:—t��+ Property Owner's Signature: Ljf*�- day Sworn to e e m LOCL 20 2 Z Faul Simmons Notary Public,State of New York , No.01S16411786 Official Notary P blic Signature and driginal Notary Stamp Qualified in suffolk county commission Expires 11/30/2024 Page 5 of 5 oF soulyolo # TOWN OF SOUTHOLD BUILDING DEPT. 4-oncouor+��'' 631-765-1802 -]D W n �INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE .SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINA ) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: �/u a��-e- C�iZ bi 6 eo/;zt �se,g-Son� �l DATE INSPECTOR lb. rr ML b I 4 I aper no�tt��ae�a tttOliar dab" 4/1 a 7 kIt r k{fiehen Ak- bedroom laYaut All - � wtr�aoes� r " reptaced vaulted to be EVIF-Ing— with new single 3' wimdovis 1�r bebirco1''`l New cfgl, 4`w�ci�h *n",3 �Y1Ci - - - - - foumtlon - - - - walk Wndep existing Porch - Gt;11 s A ,4 ma Kk5 art S 777 _777 y ti p PE T To.W. E�c`l OF r �419l ' Q.INN 13 - ER" STREET VILLA-GEz', DISTRICT', SUB. LOT Le -FORMER-,Zi,eLi N ER N E. CREME' - S' w TYPE,.OF-BL , ES. SEAS_ FARM AND. CB. VL. comm. MISC.; -LAND IMP. TOTAL DATE REMARKS 21-7 Lei Of 1� acr) --CIO Zo ".0 'o, 14 3 00 I CO AL LO VE 4 1-7 -7 Ip 7 Tillable 2 Tillable. 3 Woodland S%0 pland House Plot .......... ,fi- 77-77RF',771, _I.. tyc� I... # 64-1-14.6 10103 - } : 1V1. Bldg. ; ! Foundation C_ 3 Bath Extension s T� Basement 't"'� Floors :Extension Ext. Walls Interior Finish Y f�f Extensionk> Fire Place Heat 1 PorCh /:{ n Attic - a sa q ' D Porch Rooms I st Floor C?. -- -- - - - - ---- - LZ e w°}( {0 X eor , , Patio Rooms 2nd Floor Garage Driveway O. B. .. -------------------------moi ---- -------,- ----- ..` , -..r FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. CERTIFICATE OF OCCUPANCY No. . Z..6..90. ...... Date . .. .. .JUM. a$.. ... .... . li Q. THIS CERTIFIES that the building located of Pvt Rp; d ...g4ung$...Ave.... Street Map NOX... .. Block No.2:2=... . .. Lot No. MM .....Southold y X&Y. ........... . ... conforms substantially to the Application for Building Permit heretofore filed in this office dated .. ....... ........... Gvembejyj;719.59. pursuant to which Building Permit No. ....Z .904..... . dated .............. .-NoV er•90 , 19 59, 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 .... ... .Private• me .family• dwelliM .... T.4610 ... ..... . ........ . ..... This certificate is issued to . ......M,1Caet-LatS4?R Coroner) . .............. . ...................... (owner, lessee or tenant) of the aforesaid building. ...................... ..... . . .. ....... . .. .. . . .. ............ ......... Building Inspector FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30872 Date: 04/20/05 THIS CERTIFIES that the building ALTERATION Location of Property: 400 TOWN CREEK LA SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 64 Block 1 Lot 14.6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 29, 2003 pursuant to which Building Permit No. 29420-Z dated MAY 23, 2003 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 ALTERATIONS TO EXISTING ONE FAMILY DWELLING (COTTAGE) AS APPLIED FOR. The certificate is issued to PHILIP STANTON (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 3503-A 01/16/04 PLUMBERS CERTIFICATION DATED 09/15/04 PHILIP B. STANTON ho` zed ignature Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30844 Date: 04/06/05 THIS CERTIFIES that the building ADDITION Location of Property: 400 TOWN CREEK LA SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 64 Block 1 Lot 14.6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 23, 2003 pursuant to which Building Permit No. 29831-Z dated OCTOBER 23, 2003 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 DECK ADDITION TO EXISTING COTTAGE AS APPLIED FOR. The certificate is issued to PHILIP STANTON (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 3503-A 01/16/04 PLtM3ERS CERTIFICATIONS DATED N/A tho zed ignature Rev. 1/81