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Home My WebLink About1000-87.-1-22 TOWN OF SOUTHOLD NA Rental Permit 0996 ,vas Owner Ballenger Fmly Ltd Liblty Occupied as Single Family Dwelling Located at 1695 Old Woods Path Southold 87.-1-22 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. 10/2/2023 d�r)nengficial This Notice must be posted by the main entrance at all times Town Hall Annex Telephone(631)765-1802 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 e�ery two years) Section A. Property Information: Rental Property Address: OV Tax Map Number: 1000 SECTION -BLOCK RIOT - _ SECTION B. OWNER INFORMATION: Property Owner Name: ' C-- Property Owner Legal Address: Property Owner Mailing Address: - c/o---', 53 ef Telephone Number{s): Evening Emergency_ Property Owner Email Address: .. pe� 0-6-ac)a o Page 1 of 5 S Town Hall Annex _ Telephone(631)765-1802 Fax(631)765-9502 54375 Main Road P.O.Box 1179 ` Southold,NY 11971-0959 69 BUILDING DEPARTMENT TOWN OF SO OLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: 01 C �A-C' L I✓s��-�� Address of Authorized Agent(no P.O. Boxes), t`' Z;>lD 13 t `I Mailing Address of Authorized Agent: - Telephone Number(s): Dayttme Evening Et Email Address: tP- 3 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 Evenings _ 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 Z � tom. Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 x A- 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: 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: t1t N Requested Maximum number of persons allowed to occupy Dwelling U t: ( � Number of rooms in Rental Dwelling Unit: l Use and Dimensions of each room in Rental Dwelling Unit: l I GF'(C/l� I'Y 'K Page 3 of 5 Utz t Town Hall Annex - _ Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SO ` [OLD 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 from the Town of Southold ❑ lam 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 "1l��L, G° I -C � 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 W10, Town Hall Annex � Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 � BUILDING DEPARTMENT TOWN OF SOUTHOLI) applicable laws and rules. I further acknowledge that I will notifythe 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; f!C 5' L L-Zf � C� Property Owner's Signature: c Sworn to before me this day of � '%. ,20-2-% i Official Notary Publi 'mature an4- riginal Notary Stamp IIeli -- — g AARON KING GARY NOTARY PUBLIC REGISTRATION# 607 COMMONWEALTH OF VIRGINIA MY COMMSSION PIKES Page 5 of 5 00 SOUTHOLDBUILDING 631 -765-1802 INSPEC ION [ ] FOUNDATION 1 ST [ ] ROUGH PEBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAI [ ] FRAMING 1 STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] EIRE SAFETY IN! [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL {E [ ] CODE VIOLATION [ ] PR C/ [YF ] REMARKS: Wjol� W 0'4) 0 TOWN OF SOtlTHOLD BUILDING DI �conrn�� 631 .765.1802 — I — INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAI [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INc. [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F [ ] CODE VIOLATION � [ ] PRE CIO [ F REMARKS: &4 � on fin��& A- C S�na1G� A1+�bv�0 � cn Av ( do o �- O p� DATE „��_ INSPECTOR m�'mq w4t>p4l saA)4[& TOWN OF SOUTNOLD BUILDING D 765-1802 ��-,- 1 - Y� IN EC ION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CA [ ] FRAMING t STRAPPING [ ] INAL I*V4 [ ] FIREPLACE & CHIMNEY FIRE SAFETY IN [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT P'. [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI [ ] CODE VIOLATION [ ] PRE C/O REM KS: (N cm D TA C!!t/ t f 7Ul r DATE lv 70N7 INSPECTOR SKETCH/AREA TABLE ADDENDUM Address 1695 Old Wood P (Private Road 1t1 File No 13n001pa Southold Coln Suffolk State NY Borrower NIA Zio 11971 Lenderklient Betsy Sat L)G s Name Phyllis Atkinson,NYSRERA Appr Address PO Boz 63, - NY 11952 SUBJECT DWELLING 1st Floor 2nd Floor - 16.5' S.s• b bedroom pib d 19 X Be " a� 6.5' '4 B 0 O 6.5' Clst Closet 6 0. v ` pen c Bedroom Bedroom c f jB�th � t S,tY Bath f caN Bedroom' v I Living Room Bedroom 1-f I g 144 §21 mm r m-L__Fro, - b 5.a 5.01 Enclosed Porch m f; 4.tt* Sketch W A001 N Wk%da t AREA CALCULATIONS SUMMARY U%nNa AREA B +s 60a■ 541 7eelta =A1I1s■e (leer 12if.1! 12p •!c■.1! k flow -- - ,Gw leCo.d /leer 1221.13 1227.1! 3.3 a �.! 13.17 1/1 lere■ryd ►ece► 0 0.5 ■ 1.0 ■ 3.3 3.73 =3 ~ fbral 90•� 3.0 ■ 3.3 5.23 10■ed tole! 1er•�� Niv 100.00 000.00 20.0 ■ 20.0 l7i.00 10.3 ■ 22.0 393.00 Saeead Rar _ 3-.0 • 3.0 13-me 3.0 • !,a 23 21_01 a 34 • GLAD w M TO S T T � CARD OWNED? EET j VILLAGE DISTRICT SUB LOT ... STR ................... .... �... _e r y fG�t�r! !� fit i. �v41 FO :P0ER OWNER N E ACREAGE e � _ ..,_„a ^�r ^�° f✓U .,�� „L�.✓^a TYPE OF BUILDING �. RES SEAS. VL F, RM comm. IND CB IC. «,�.,.... ..._.. ._.,, .Jy.,.. b f �.... .... .....,a �,.,,,.,..,.,..,.............�.«........,. LAND IMP. 1 TOTAL DATE ( REMARKS __m_ _. .. _... _ ....... . ........ ................. -,�L,4-r (I', ,ze � J .a. ., ... .... ,;Pi,27 < C01-11 0 1 01 1c� i a r� S?�� /S'�' ✓ _� d AGE BUILDING CONDITION f; 2. 4 _ Ago I 1 p o f l _.w Foundation ' ., Both r _A s, � y 771 Extension � / G BasementFloors _Extension Ext. Walls Interior Finish " L t � Extension Fire Place Heart Porch Attic Rooms 1st Floor _. _ Porch 000 B�ez t c� ewoy 3 Patio Rooms 2nd Floor Go Driv'e' wa - ..,�. �.. ....-- ._ __.. . _ . I✓ Cd T C 7 ww.+mruw 0 B, Y Y FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24266 Date APRIL 8, 1996 THIS CERTIFIES 'that the building ALTERATION Location of Property 1695 OLD WOODS PATH SOU'1'HOLD, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 87 Block 1 Lot 22 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated CH 12, 1996 ___pursuant to which Building Permit No. 23303—Z dated MARCH 15, 1996 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 REPAIR & ALTER EXISTING RAISED CONCRETE PORCH WITS WOOD PLATFORM ON EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to W.S. BALLENGER (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL X/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A /�4da/g Inspector Rev. 1/81