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Home My WebLink About1000-64.-4-19 TOWN OF SOUTHOL Rental Permit 0791 Owner Nicole Witzke Occupied as Single Family Dwelling Located at 1165 Founders Path Southold 64-4-19 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. 12/14/2022 rfo ce e Official This Notice must be posted by the main entrance at all times � � x Town Hall Annex �o Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 k °` Southold,NY 11971-0959 � �� ice e 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: L1 1 I GS VourOJq-rpS T o lh 5bUJ1 1 I Tax Map Number: 1000 SECTION —Li - -BLOCK SECTION B. OWNER INFORMATION: l Property Owner Name: P W i Property Owner Legal Address: Property Owner Mailing Address: (4 too Telephone Number (s): Daytime G3 i'767-36d I Evening, Emergency Property Owner Email Address: N' Cole, 5 �hn'��.� 0d tZ6 C nil 3� ADO — Page 1 of 5 Town Hall Annex Ila, Telephone(631)765-1802 54375 Main RoadFax(631)765-9502 P.O.Box 1 179 a , Southold,NY 1 1 971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: I Z�e— Telephone Number(s): Daytime I-7��"36'Evening Emergency 16_ qo"oZo�S Email Address:_ nil COICSto'-,'n DLP qmoo I i c0yn 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: " Requested Maximum number of persons allowed to occupy Dwelling Unita ro ..,1011000 � Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: Lo, � baa � �e►rDD Page 3 of 5 � ��MU 4JM MnJ"R�l�B'/iiik Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 4 !, 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. ll� I 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) I I d '1 �� w� � 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 A� ^ Telephone(631)765-1802 54375 Main Road „ V Fax(631)765-9502 P.O.Box 1179 q r 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 anaging Agent, or Site Manager. Property Owner's Name: Property Owner's Signature: Sworn to before me this) day of 20 �. Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No. 01BU6185050 Qualified in Suffolk County commission Expires April 14, 2Z_ay Page 5 of 5 o�,�oFsuut,�6 400000 vv�� TOWN OF SOI/THOLD BUILDING D 631-765-1802 � 1.�, _ q .10 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAI [ ] FRAMING / STRAPPING [ ] SIAL [ ] FIREPLACE & CHIMNEY [Vj FIRE SAFETY IN: [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F}! [ ] CODE VIOLATION [ ] PRE C/O [V] REMARKS: i nim lof)#A—,,AA r .............. .......... DATE 17 'N1lle'L' INSPECTOR FLOORPLAN SKETCH trL NiCote K.VVi'tzkeFile No.: 100772121 LIL Base Nw 170 584 C" _Souftld Sf :Nl" 1 ;11971 Lelr6em:PNC MPC s °rte ' L S I a = SmoK�— �leker�o C,Dtih (�onot(►oiZ O2��c�ot A.FSS,Flaw x IM IS"t'r WIiB1 rod C!wrC&tlrt'�r.d F' ;3`x 15 x t.:.� 2'A w 27i IDD= 1 141 tF «9:4rlamt�rvt ��" 's co A. 6z IZ'r i_RJ= TOWN OF SOUTHOLD PROPERTY RECORD y, 0 OWNER \. 1 STREET VILLAGE DISTRICT SUB. LOT T FORMER OWNERI N € E ,�ACREAGE E ;S W TYPE OF BUILDING RES. SEAS. VL. FARM COMM. IND, CB. MISC. 1 Est. Mkt. Value LAND IMP. TOTAL DATE REMARK l , -Z 0 _ 1. lE .= i�'�" 1 -7911a, r s, — AGE BUILDING CONDITION NEW NORMAL i BELOWABOVE FRONTAGE ON WATER Farm Acre Value Per Acre I Value ` FRONTAGE ON ROAD Tillable 1BULKHEAD i Tillable 2 i DOCK 1— Tillable 3 Woodland Swampland Brushland House Plot Tota I ? 4-1 I i _ e e - Bath C SOL M. Bidg. �. Foundation ' s m _ Basement Floors Extension Extension ¢ Ext. Walls Interior Finis - Fire dace Heat ' s Extension s --- - - Porch Roof Type Porch Rooms 1 st Floor Breezeway Patio Rooms 2nd Floor [ Garage s Driveway ' Dormer r £� �t as B, -— - Ai se- - _ e�u z L�nJ ate a Wj"we 6 + Town of Southold Annex 10/1/2013 54375 Main Road Southold,New York 11971 PRE EXISTING CERTIFICATE OF OCCUPANCY No: 36547 Date: 10/1/2013 THIS CERTIFIES that the structure(s) located at: 1165 Founders Path, Southold SCTM #: 473889 Sec/Block/Lot: 64.-4-19 Subdivision: Filed Map No. Lot No. conforms substantially to the requirements for a built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 36547 dated 10/1/2013 was issued and conforms to all the requriements of the applicable provisions of the law. The occupancy for which this certificate is issued is: i rclµfractic c r c targtl vvd ling ry tll c�ayp q cc r aqa t� a4ti01,tnd. 1t dh l..tAQ C-Ar nv, The certificate is issued to Prince, Helen (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. ......... Att rn �m ltt tic"tre a BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 1165 Founders Path, Southold SUFF.CO.TAX MAP NO.: 64.4-19 _ SIGN: SUBbIVI _-....._... _ . .......... ... NAME OF OWNER(S): Helen Prince OCCUPANCY: ADMITTED BY: _... SOURCE OF REQUEST: Prince, Helen DATE: 10/ I/2013 DWELLING: #STORIES: 1 #EXITS: 3 FOUNDATION: cement block CELLAR: full CRAWL SPACE: BATHROOM(S): 2 TOILET ROOM( .... S): UTILITY ROOM(S): PORCH TYPE: DECK TYPE: PATIO TYPE: covered cement BREEZEWAY: REPLACE: I... GARAGE: , ... two—car es rid A�GAIR CONDITION G cs., DOMESTIC HOTWATER. y TYPE HEATER Grid WARM AIR: HOT WATER: TYPE HEAT: . . Natl Gri.... ..... at . OTHEROOMS. 3 #KITCHENS: I BASEMENT TYPE: unfinished ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: SWIMMING POOL: GUEST,TYPE OF CONST: OTHER: VIOLATIONS: REMARKS: INSPECTED BY: GARYF DATE OF INSPECTION: 9/26/2013 a '✓l TIME START: .... I0:00amEND: ]0:30m ......... _.......