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Home My WebLink About1000-63.-1-23 + TOWN OF SOUTHOLD Rental Permit 0783 Owner Peconic Land Trust Occupied as Single Family Dwelling Located at 44600 CR 48 Southold 63.4-23 Maximum Permitted Occupancy 6 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, 12/5/2022 _ Enfor reg t offci This Notice must be posted by the main entrance at all ti Town Hall Annex ; , Telephone(631)765-1802 54375 Main Road ti ��fi Fax(631)765-9502 `l P.O.Box 1179 Southold,NY 11971-0959 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: 4460 County Rd. #48, Southold, NY 11971 Tax Map Number: 1000 SECTION 63 -BLOCK 1 --LOT 23 SECTION B. OWNER INFORMATION: Property Owner Name: Peconic Land Trust Property Owner Legal Address: Property Owner Mailing Address: 296 Hampton Rd. 296 Hampton Rd. Southampton NY 11968 Southampton, NY 11968 Telephone Number(s): Daytime 61-za'-31a5ext,4k Evening 631-506-1210 Emergency .,,_, Property Owner Email Address: dheston@peconiclandtrust.org/jwilson@peconiclandtrust.org Page 1 of 5 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 'GOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Daniel Heston Address of Authorized Agent(no P.O. Boxes): 296 Hampton Rd. Southampton,NY 11968 Mailing Address of Authorized Agent: 296 Hampton Rd. Southampton,NY 11968 ��,_ ._.... Telephone Number(s): Daytime 631-734-5630 Evening Emergency Email Address: dheston@peconiclandtrust.org Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: Daniel Heston Address of Authorized Agent(no P.O. Boxes): 296 Hampton Rd. Southampton,NY 11968 Mailing Address of Authorized Agent: 296 Hampton Rd. Southampton,NY 11968 Telephone Number(s): Daytime 631-734-5630 Evening Emergency Email Address: dheston@peconiclandtrust.org 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 Town Hall Annex hone 631)765-1802 �� Telephone 54375 Main Road ; Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime Eueniag _ ._ 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: House -2nd Floor Requested Maximum number of persons allowed to occupy Dwelling rwi Number of rooms in Rental Dwelling Unit: 7 _. Use and Dimensions of each room in Rental Dwelling Unit: Bedroom 1 (22ft.x 10ft.2in.),Bedroom 2(19ft.x 7ft.21n.),Bedroom 3(14ft.21n.x 10ft.4in.) Bathroom (9ft.6in.x 8ft.),Living Room/Dining Area(22ft.x 15ft.10in.),Kitchen (12ft.x 9ft.6in) Page 3 of 5 r Town Hall Annex Telephone(631)765-1802 54375 Main Road P �� Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-09-59 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 Pamela Greene-PLTSr.VicePresident 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 1 179 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. 1 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: WW1O � Sr.Vice President Peconlc Lan Trust -Pamela Greene - M Property Owner's Signature: _. __. Sw rn t before me this �p�' ay of „�� ° , 20�� w .............. .....w� w .. .. w ___-_--.......... _. ....................... Official Notary Pub Signature and inal Notary Stamp K1hAl3�...�.....� NOTARY PUBLIC.-STATE OF NEW YORK ReWsimuon No.OIGUS249267 CjUsiiBed in Suffolk County Commisebn Expim Octobw 3.20223, Page 5 of 5 btq�,ov C"19 " 16 TOWN OF SOUTHOLD BUILDING DEPT. 765$1802 llm*plv=uTl0N [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CA . ING [ ] FRAMING./STRAPPING [ ] IAL [ ] FIREPLACE & CHIMNEY JZ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: On k- 6 Val 6r/tj VCA o - • �09� tow P,- 00 aVF. CGv M • �k k- DATE INSPECTOR t lt j Al _ _- m x;'01A (060t, 'LA A z a Ea U -- - --- -- - -- - )LOR - �9T TRIM law 63.-1-23 312014 F , a [ i i r � s E E A l 4 , 6 � r 6 I , 4r I M. Bldg. g Extension I E � � Extension I E f � r a - Extens i on-� I , ;Foundation Bath Dinette ` Porch =Basement 'Floors I K. F i - 6 . K . Porch F 'Ext. Walls Interior Finish ELR. Breezeway I ;Fire Place f ;Heat „ . DR. Garage IType Roof IRooms 1st Floor BR. Patio _ Recreation Room ?Rooms 2nd Floor FIN. B ; i arra i Driveway I i Total i s FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. CERTIFICATE OF OCCUPANCY No. Z. 3505 . , . Date . . . . . . . . . .J O. .. .11.. . . . . .. .. 19.69. THIS CERTIFIES that the building located at .j(i *. . . . ...... ..... Street Map No. . . . .. . . . . .. . Block No. . .. . . .. .. ...Lot No. . Soytliol.d,. not$ •YOz)t. . ... . . .. . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . .. . . . "t. . 19.. • •, 19.68. pursuant to which Building Permit No. 4 . dated . . . . . . . .Augvft. . 22,. . ., 19. 69, 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 . ..pxivato. XMO.faMiLy. *U JM . . .. . . .. .. .. .. • ... . . . . . The certificate is issued to .Joe .R. . p.IrAm...• ...,.... . .. .. .M . . . ... . . .• . • . •. .• . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .SAY. 16, . 196%, -R t.Villa. .• • • . Building Inspector . Houso # 41600 X14dl* Road FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z4M . . . . . Date . . . . . . . . . . . + ► . . . . . . . . . . .. 19. .72 THIS CERTIFIES that the building located at g .XSA4j* Street Map No. . . . . . . Block No. . . . . . .Lot No. I= . 44atholA. . X*T* . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . . .Q7. ., 19.71. pursuant to which Building Permit No. . 4 . . dated . . . . . . . . . . . .July . . . 28, 19. 71., 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 A4"08807. rggo) d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . w The certificate is issued to . .;,*A pk At.LOO.Pa:rt'oA . . . .4r►Ae.VO. . . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 11*1�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Building Inspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22371 Date .1UNE, 3 1993 THIS CERTIFIES that the building AL71 'T°ION Location of Property 44.6090 COUNTY ROAD #48 SOUTHOLD N YEiamlet House No. Street County Tax Map No. 1000 Section 63 Block 1 Lot 23 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 13 1992 ursuant to which Building Permit No. 21096-Z dated NOVEER 20 1992 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 ALTERATION TO EXISTING DWELLING FOR CHIROPRACTOR'S OFFICE AS APPLIED FOR. The certificate is issued to LISA B. COWLEY (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-269726 - MARCH 1`7 1993 PLUMBERS CERTIFICATION DATED 2 1393 -' TT. PLUMB & HEATING CORP. tau .lding Inspector Rev. 1/81 I'I'tVOKEt µ Town of Southold Annex 1/24/2012 54375 Main Road Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 35411 Date: 1/24/2012 THIS CERTIFIES that the building ALTERATION Location of Property: 44600 County Road#48, Southold,NY, SCTM#: 473889 See/Block/Lot: 63.4-23 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 6/24/2011 pursuant to which Building Permit No. 36513 dated 6/24/2011 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: A ter4fitans to a Commercial 13uilding_witkl tl_. a tr ent in a 1,,B Z Rear Wood Deck];gnQKt.oqs,�,. Wil ed fair. The certificate is issued to Peconic Land Trust,Inc. _.........................„ ......................._.. _.................m...w..._............. ._ .....__...............�. ..,w._-..._._....,...... OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED A w t to ed . , gat tyre Town of Southold 12/3/2022 P.O.Box 1179 53095 Main Rd � q Southold,New York 11971 CEWI'IFICAT'".E OF OCCUPANCY No: 43653 Date: 12/3/2022 THIS CERTIFIES that the building- AS BUILT ALTERATION Location of Property: 44600 CR 48, Southold SCTM#: 473889 Sec/Block/Lot: 63.-1-23 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 7/11/2022 pursuant to which Building Permit No. 48382 dated 10/7/2022 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: "as built""alt ration 'includin r is ca,.pf c_n mercial office to existing in f mily a a a alit i f The certificate is issued to Peconic Land Trust of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 48382 11/3 2022 PLUMBERS CERTIFICATION DATED .. .. .. .. _ __...uthot ze i atta:re._�.,.._...._........... PECONIC LAND TRUST February 11,2021 To: Town of Southold Building Department Town Hall Annex 54375 Main Rd. PO Box 1179 Southold, NY 11971-0959 rs RE: Application for Rental Permit Cowley House-4460 County Rd. #48,Southold, NY 11971 SCTM#: 1000-63-01-23 Dear Sir/Madam: The Peconic Land Trust is requesting a Rental Permit for our Cowley House, location referenced above. Enclosed please find our check#38532 in the amount of$200.00 to cover the rental permit application fee along with the following: • Application for Rental Permit • Floor Plans • Certificates of Occupancy and Pre-Certificates of Occupancy Should you have any questions or require additional information,please do not hesitate to contact me. "Very truly y L1rs, acquline Wilson Stewardship Program Coordinator Southampton,NY 11969 (631)283-3195 Ex.43 fwdSQI'C ca rai laII tL9_,5,..:Q% Enclosures 296 HAMPTON ROAD I P.O.BOX 1776 1 SOUTHAMPTON,NY 11969 1 TEL:631.283.3195 1 FAX:631.283.0235 www.peconiclandtTUSt.org