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Home My WebLink About1000-31.-4-29 SOWN OF SOUTHOLD � ;WN� £ Rental Permit 0780 Owner Florence Mazurowski Occupied as Single Family Dwelling Located at 11005 Route 25 East Marion 31.4-29 Maximum Permitted Occupancy 2 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. 11/17/2022 tide o e t Official This Notice must be posted by the main entrance at all times ) i qSOV :. Town Hall Annex 631 Tele 765-1802 � Telephone( ) 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 � g BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: C aha Tax Map Number: 1000 SECTION .-BLOCK SECTION B. OWNER INFORMATION: Property Owner Name: C, (t tA 64, 7- U V- C) yj t Property Owner Legal Address: Property Owner Mailing Address: 00 Telephone Number (s): Daytke , veni Emergency Property Owner Email Address: o Mallr ,6121 0 Q0 ko 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 raa BUILDING DEPARTMENT TOWN OF SOD`THOLD Section C. Authorized Agent Information: C) y jC�,rte',I�., 1 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: ( & ` c'a'b I P � 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. � PP1 I /C SITE MANAGER INFORMATION: (rea uired 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 u Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax (631) 765-9502 P.O. Box 1179 Southold,NY 11971-0959 KK BUILDING DEPARTMENT TOWN OF SOUTHOLD own e_ r^ 1 s on of Mailing Address of Managing Agent: d--P ', V, 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: C Requested Maximum number of persons allowed to occuy Dwelling Unit: �- Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: o ' fw Page 3 of 5 Town Hall Annex z Telephone(631)765-1802 54375 Main Road UC Fax(631)765-9502 P.O.Box 1 179Ss 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. _. I 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) �( 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 Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 �k 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. I 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. WS I Property Owner's Name: 7C Property Owners Signature, L&tyoQ(.,4,/�-e_Sworn to before me this Official Notary Public Signature and Original Notary Stamp Page 5 of 5 M 631 -765-1802 31 , IN PEC ION [ ] FOUNDATION 1ST [ ] ROUGH PEBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAL [ ] FRAMING / STRAPPING [ ] F L [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INS [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PEI [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL [ ] CODE VIOLATION [ ] PR C/ [ F % 4D'ff�k 9DA01-V r V YOio A ki ,8 TOWN OF SOUTHOLD BUILDING DI 631-765-1802 INSPEC ION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAL [ ] FRAMING / STRAPPING A,L [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INS" [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PEI [ ] ELECTRICAL (ROUGH) [ ] ELECTRICALF ,( [ ] CODE VIOLATION [ ] P [ REMARKS: � ��. . ; . . . . . . : . . . . . � . ray / I � - ! ° 2 : � - 1 : � : ( � � � , � ( � ( � / � � , � ! y \ �� 6 �� ~ . : ` . | } : f � . . , - i�� ` ; � � � . - i � , � . _ . z « ( } < «y ° - ° w °� , m 2\6 � « z - �� - - / � � ( \� - ! \ : ) } ��d�� Z� ! ` ~ � � / / } _ & ( OR[ OVER STREET f ?�� VILLAGE DISTRICT SUB LOT FORMER OWNER WO Z-U COA��f E N ACREAGE ! z- c W LDING e C-1 0 f 0 TYPE OF BU I Al VL. FARM COMM_ IND. CB. misc. REMARKS LAND IMP- TOTAL DATE se J j %0 _J zz 44� L 0,7 f -7 3VILDI B 1LD1 CON IT i- i I "S N EVY NORMAL BELOW ABOVE Form Acre Value Per Acre Value je- Tillable I -killable 2 -t Ej5k'. �-qkiq z-ur&,W5k(- diable 3 1 A 7 Woodland Swampland Brushland House Plot Toto I F a 3 i I f f � J l � 3 ------------- Lj M. Bld _ 7�, s �=� E Bath f 9- Z 7 �` Foundation Extension ,, _ Basement , Floors F - Extension /SX _ Ext. Walls ' " Interior Finish „ A Extension g l Fire Place Heat JA. a Porch Attic Porch Rooms 1st Floor BPatio Rooms 2nd Floor 0Driveway r N 0. B, E r GL 0 I LL-1 V1 L u , - ` t i E 31-4-29 11/01 [ Mt"M4, B1d k X25 Foundation P� r Bath Dinette 1� Basement �W Floors - Kit. Extension s�Ae 4a Ext, WallsInterior Finish L.R. _SEtS Exte � �l�� ..,��r��' Fire Place `�t�.a Heat tiak, D.R Extension - Patio Woodstove BR E a Fin. B. Porch _ Dormer Attic � Deck Breezeway Rooms 1st Floor } 'nh�.,N � I��r'- �.,-� ' Garag4aV<_ 1p—Z C> .1$S5 1'L� 11$o Driveway Rooms 2nd Floor 7 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, NEW YORK CERTIFICATE OF OCCUPANCY NONCONFORMING PREMISES THIS IS TO CERTIFY that the Land Pre C.O. #- z14857 Building(s) Date- c X/ Uses) u located at 11000 Main Road East Marion Street Hamlet shown on County tax map as District 1000, Section bay, Block 04 Lot 29 , doesLnot)conform to the present Building Zone Code of the Town of Southold for the following reasons: Non conforming 2nd dwelling. Insufficient front yard set-back on On the basis of information presented to the Building Inspector's Office, it has been determined that the above nonconforming J�/Land Jam/Buildings) /_/Use(s) existed on the effective date the present Building Zone Code of the Town of Southold, and may be continued pursuant to and subject to the appli- cable provisions of said Code. IT IS FURTHER CERTIFIED that, based upon information presented to the Building Inspector's Office, the occupancy and use for which this Certifi- Property contains 2 single family, wooden tate is issued is as follows: mad dwellings,, and two stora e accessory buildings_ Property located in the A-Residential-Agricultural zone o Main Road a State Hi hwa and Ketcham Lane, a private road. The Certificate is issued to Frank and Ethel Begora (owner, ��i�741�E14X4t of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERIVRITERS CERTIFICATE NO. N/A NOTICE IS HEREBY GIVEN that the owner of the above premises HAS NOT CONSENTED TO AN INSPECTION of the premises by the Building Inspec- tor to determine if the premises comply with all applicable codes and ordin- ances, other than the Building Zone Code, and therefore, no such inspection has been conducted. This Certificate, therefore, does not, and is not intended to certify that the premises comply with all other applicable codes and regula- tions. i' ing inspector FORM NO. 4 , .,,qIU pt nab "'hwximwd � ®Wnwnmo� Y & TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector p Town Hall Southold, D .Y. 9 CERTIFICATE OF OCCUPANCY e No: Z-26733 Date: 10/08/99 i THIS CERTIFIES that, the building ALTERATION & ADDITION - Location of Property: 11005 MAIN RDEAST MARION 1 (-HOUSE Na. ) (STREET) m (HAMLET) a County Tax Map No. 473889 Section 31 Block 4 Lot 29 wrtp subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 11998 pursuant to which Building Permit No. 25531-Z Gated FEBRUARY 10,-11999 was issued, and conforms to all of the requirements of the applicable r provisions of the law.: The occupancy for which this certificate is issued u is ALTERATION AND ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR "BS BUILT." .............. B ° The certificate is issued to KEVIN T & EILEEN BOWEN (OWNER) d of the aforesaid building. SUFFOLK COUNTY DEPARTMMEIQT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE No. 26231 D9/29/99 6 PLUMBERS CERTIFICATION DATED 10/05/99 WALTER ESTES V 8 p � W Building It2a for Rev. 1/81 u