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Home My WebLink About1000-70.-10-58 TOWN OF buU TH LD �� Arvr9u 'Wu Y fano Rental Permit A �' � � 0715 N "" Owner Diane Hepworth Occupied as Single Family Dwelling Located at 900 Beachwood Lane Southold 70-10-58 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. 8/4/2022 This Notice must be posted by the main entrance at all times ode E-('6' r)erjt offficial Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631);765-9502 P.O.Box 1179 Southold,NY 11971-0959 �h BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200(Application must be renewed every two years) FI V l U €� Section A. UI,.3 ' 7 2022 Property Information: aD F�— g U "r1 Rental Property Address: = 'jc>o 13e_-J\v-400_ L&,� L 1 11 -4 ) Tax Map Number: 1000 SECTION -BLOCK -LOTS- SECTION B. OWNER INFORMATION: Property Owner Name: Proper wner Legal Address: Property Owner Mailing Address: � �Z,3 '�re�e.l.�-l-owv. '�2,� Sa.u•� 0 �br Telephone Number (s): Dayti &1 !�;t0--? ` wening _0 as__)By)Emergency S Property Owner Email Address: `� S V)-I- Q�- , AL i CA m Page 1&5 �p�� 0 .a Town Hall Annex _ Telephone(631)765-1802 54375 Main Road r .f Fax(631)765-9502 P.O.Box 1 179 - Southold,NY 11971-0959 _ BUILDING DEPARTMENT TOWN OF SOUTHOLD i Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: AIX 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: 1 1,114 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: Address of Managing Agent (no P.O. Boxes): Page 2 of 5 i 1 Q� & - Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 Ni P.O.Box 1 179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number (s): Daytime Evening Emergency Email Address: SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: f 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: t2pZ5 Lam-- Requested Maximum number of persons al td upy Dwelling Unit: 12Z2� Number of rooms in Rental Dwelling Unite ,.,'tc Use and Dimensions of each room in Renta ing Unit: 46,4ez m ,,,: LL L414 k il x Sacr Page 3 of 5 i � � 1 .s Town Hall Annex Telephone(631)765-1802 54375 Main RoadFax(631);765-9502 P.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 (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. ❑ 1 am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold 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) -OLA-,-+ , 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 it s Town Hall Annex so "IQ 4 OW_ OF SOU HOLD BUILDIN 765-1802 I N PEC I W0`6N [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CA [ ] FRAMING I STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT P [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL {F [ ] CODE VIOLATION [ ] E C1O REMARKS: DATE INSPECTORv 4,417 so� � - Town Hall Annex Telephone (631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 v 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 Professional seal required for Architect or Engineer, licensed Home Inspector must provide copy of valid current certification Rental Property SCTM Number: 1 m Rental Property Address: Vo EM 4.�. � Owner/Name: L-1 Rental Dwelling Unit Identifier: Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 -100jsq.,Bedroom#2-90 sq., etc.) n(® 1(C> 5 l Property Description (Include all improvements indicated on survey) 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 Co � Yuck State, and the Energy Conservation Construction Code of New York State, 17 Print N a'rt-d Original igA ure Z ietz 17ID4 4 Please pla Gr nwww� �wnrmmnwumni IOX ryry p p V v III m✓ q e p w,Iw�IW�wllll�w�w��„�� I lbeeckwood tome , 401 Sw uco II SII IIIIIIISmo ice beet e �a TOWN OF SOUTHOLD PROPERTY C�.�_ OWNER STREET VILLAGE DISTRICT SUB LOT q � ,, �. .d;�Rd r FORMER OWNER ". re n 0,> * � � N E ACREAGE S WTYPE OF BUILDING ..:.. _ _ RESA7_16 SEAS VL FARM COMM IND CB MISC Est. Mkt. Value LAND IMP, TOTAL DATE REMARKS , 1 V Y �^ ._.. ,m __ .., .,.. .,....._. .. �,r 9 > a n `• b"°'x ,ry ,u µaJ L " n �_� �;, �� ", �;,y "^",o- r ! ,p "�. !® ;�" F„�;°� ..,��}� ,e �e a � ._.e,.'�`GE _ � ��...r��. B !I DING CONDI _ � f �� ....�� "' �� ' �� ,� � � � � j �" °��r ��',�"�a� �r�e� �� „�,� U2 7e NEW NORMAL BELOW ABOVE FR r ,. _ _ ... _ ONTAGE ON WATER e _' Farm Acre Value Per Acre Value FRONTAGE ON ROAD Tillable 7 . _. 1 4ounm� AaJ�,m,"" BULKHEAD i Tillable 2 I DOCK _. Tillable 3 l , a Woodland a /E . . . . . . Swampland Brush land House Plot .. .. . .. ..,....._ Tota a a 7 i I M. Bldg n Foundation, �.,.�,. �..� _.,.,,...��,...._�_...... � _.., .... �, r� �� p C� th Extension Bosement — �' rw Floors Extension I Ext Walls Interior Finish „ m Extension Fire Place Heat " � r ;V Porch f o 1 Type. Porch Rooms 3 st Floor Breezeway ; Patio Rooms 2nd Floor Garage4 -G, e� 2 .,f,�, A , �w, Driveway Dormer _ ,., - j _ m 0. Be �.. 1 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Officei L4 Southold, N. Y. Certificate Of Occupancy No. .Z. 0932. . . Date . . . . . . . . . . . . ♦Pril . . .n. . . ., 19- 73 THIS CERTIFIES that the building located at . Z*otah .vcod .L4L. . . . . . . . . . . Street Map NoBoutbNood . . Block No. . . . . . . . . . .Lot No. . .19. . . . .8outhold . .N.Y.. . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . .Deo . .11. 19.72: pursuant to which Building Permit No. . .6289Z dated . . . . . . . . DOG- . . .1$. . . . .. 1972 ., 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 .family. dv*ll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . .Acberl;. A.Uplan.]3r. , . . . . .Qvmore (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .Mar... .26. . .1973• • by. R• .V . . . . UNDERWRITERS CERTIFICATE No. . R .766563 . . .Murch. . .?. .19.7.3 . . • . • . . . . . . . . . . . . . . HOUSE NUMBER. . .900. . . . . . .Street. . . . Retaftmod. La . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Building Inspector