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HomeMy WebLinkAbout1000-78.-9-67 TOWN OF SOUTHOLD Rental Permit 0785 r Owner Christine & Adam Lacku Occupied as Single Family Dwelling Located at 380 Eds Road Southold 78-9-67 Maximum Permitted Occupancy 8 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 Counc I. Expiration is two (2) years from date of issue. The operator is responsible for arranging for the bi-annual inspection. 12/12/2022 e Ery rce t o ictal This Notice must be posted by the main entrance at all times S004 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENTLl TOWN OF SOUTHOLD u-W111L:.NG DEPT RENTAL PERMIT APPLICATION Rental Permit Fee $200 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: 3 $o eds Q,,, S ovt+6l Tax Map Number: 1000 SECTION c7 7 •00 -BLOC 0 9 . 00--LOT-06 J�- - OW SECTION B. OWNER INFORMATION: Property Owner Name: U0, M - 1 Property Owner Legal Address: Property Owner Mailing Address: v-a �G( sAdvt s.4r—e- Telephone Number(s): Daytime Evening Emergency Property Owner Email Address: 4 LACel,4 R 6#7$l L . 01M ," r�- 01 Page 1 of 5 ' ^ Town Hall Annex Telephone(631)765-1802 54375 Main RoadFax(631)765-9502 tc P.O.Box 1179 � « Southold,NY 11971-0959 Couxww KK ;, . BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Author d Agent Information: Name of Auth ized Agent of dwelling unit, if any: Address of Authori " d Agent (no P.O. Boxes): Mailing Address of Authb(ized Agent: Telephone Number (s): DaYt�M w,e� Evening;'- Emergency Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwellingsnit, if any: ,� Address of Authorized Agent(no P.P. Boxes): Mailing Address of Authorized Agent: Telephone Number(s): Daytime EveningEmergency Email Address: SECTION E. SITE MANAGED INFORMATION: (required for rental properties containing 8 or more rental units) i Name of Managing Agent of dwelling unit, if any: Address ofVlanaging Agent (no P.O. Boxes): Page 2 of 5 soMN Town Hall Annex w 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 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. am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ 1 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) [ dQ LC7lC�lrl 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 fi Town Hall Annex s Telephone(631)765-1802 54375 Main Road Fax (631)765-9502 P.O. Box 1179 Southold,NY l 1971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing`Add°mss of Managing Agent: Telephone Number p (s).�.Da.� timp� ---. - ..~�--1Wv+en'l0 -. Emergency Email Address. , SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: D+J�( L,4 N I 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: U Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: �® Use and Dimensions of each room in Rental Dwelling Unit: ._ivr Page 3 of 5 wS 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 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: w1 Property Owner's Signature: Sworn to before me this day of JU11-- 2048. �V4OffiPublic Signature a 111riginal Notary Stamp ACEY L. DWYER NOTARY PUBLIC,STATE OF NEWYORK NO.01 DW6306900 QUALIFIED IN;SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30, Page 5 of 5 Wo tA s m4geb l TOWN OF SOUTHOLD BUILDING -of 631 -765-1802 ��', INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATIOWCAL [ ] FRAMING / STRAPPING [ ] F AT C l FIREPLACE & CHIMNEY [ FIRE SAFETY WE [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PEI [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII [ ] CGDE VIOLATION [ ] P C " [ F s INSPECTORDATE PtAi D"A W A4 14 y c;rm>orc- -7 AV timer �Do- «�� ? ^ ^ / z z . �. . . . .. ��. . . .. _ . �. . . . � . . . .. . . . . � � � . .. . . . .. . D/o) ® ƒ [� ! � � { « . a . . ! © : ! � ( , ! ; ! ! ! r , ! ! ! ( | ( : - ; � . . . . � : { � � I f vv V61 olL, 4%. r TOWN ��� � `� IOLD PkO ERTY RECORD CARD OWNER STREET = VILLAGE DIST. SUB. LOT l - FORMER OWNER N ACR. , � �a I •a L r E �"" ,�6 G S W - ; TYPE OF BUILDING _fit ✓t% n. RES SEAS- VL, FARM COMM. CB. MISC. Mkt. Value � 3 t LAND IMP, TOTAL DATE REMARKS s d e AGE BUILDING CONDITION NEW f NORMAL BELOW ABOVE FARM Acre Value Per Value [ AcreF x•F� � s� R �� Tillable 1 Tillable 2 Tillable 3 Woodland Swampland FRONTAGE ON WATER Brushland ! FRONTAGE ON ROADm- House Plot DEPTH BULKHEAD Total DOCK z _ OLOR E � ZLZs 1 RIM 4 f -�-i —r s I f I . { t 78.-9-67 37/2019 � r- s S mandation Bath $ Dinette Floors K. Extension Basement /7 r, Extension Ext. Walls I Interior Finish - . LR. Extension Fire Place r Heat ` tf, ;. DR 'Type Roof Rooms 1 st Floor Recreation Room Rooms 2nd Floor FIN. B. a Oormer , Breezeway t Driveway Garage � y 3 Patio Total 1 FORM NO. 4 WC /n- LIVV5 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No--Z-19.4-T......... Date ...... ...... .........()4tober.....l)....... 191A. THIS CERTIFIES that the building located at ..15/.x:.. ....... Street Map No. ..XXX........... Block No. ......y.=........ Lot No, -XX. ..... .SoUtjj,0jd.0...X..y.....I.............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... .........M".ah....25..... 19.64... pursuant to which Building Permit No. ...2339..Z dated ..... ......----... .......-April.....7--, 19-61c., 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 ........ ...........-1.1---....................... ........ ........ The certificate is issued to ........... ...I... ..— ..--- -- ... (owner, lessee or tenant) of the aforesaid building. H.D.Approval August 20o 1964 by R. Villa 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-22431 Date J'UN'E 30 1993 THIS CERTIFIES that the building ALTERATION Location of Property 380 EDS ROAD SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 78 Block 9 Lot 67 Subdivision Filed Map No. Lot No._ -� conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 1 1993 ____pursuant to which Building Permit No. 21472- dated JUNE 8 1993 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 SECOND FLOOR OF EXISTING ONE FAMILY DWELLYNG AS APPLIED FOR. The certificate is issued to CATHOLIC CHARITIES of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING - JUNE 30 1993 PLUMBERS CERTIFICATION DATED JUNE 30 1993-PECONIC PLUMB. & HEATING di.rg Inspector Rev. 1/81 " t Town of Southold 6/14/2018 P.O.Boz 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE Off' OCCUPANCY No: 39709 Date: 6/14/2018 THIS CERTIFIES that the building AS BUILT ALTERATION Location of Property: 380 Eds Rd, Southold SCTM#: 473889 See/Block/Lot: 78.-9-67 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 12/11/2017 pursuant to which Building Permit No. 42384 dated 2/15/2018 _._............r.�... _. _w....,a w..._......................................w ..ww.....mm._............- 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: BUIL --ALTERATIQNS A UNTT ANI"I DECK: DDI"l`1C.�lq"1,�C.�. N_ rIIN -QNF Iw._.... 1:� DWELLING AS APPLIED FOR The certificate is issued to Catholic Charities of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 42384 06-07-2018 PLUMBERS CERTIFICATION DATED ..�. � th_w_.t ....Signature ........�...........