HomeMy WebLinkAbout1000-22.-3-1 Rental Permit
0792
Owner: Berry P 2021 QPRT
Occupied as: Single Family Dwelling
Located at: 2840 Stars Rd East Marion 22.-3-1
Maximum Permitted Occupancy: 10
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.
Issued: 01/02/2025
Expiration: 01/02/2027 Cod EnforamentOfficial tl
This Notice must be posted by the main entrance at all times
TOWN OF SOUTHOLD BUILDING DEPT.
v� 631-765-1802 Za_ 3-/
INSPECTION
[ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ NTAL
REMARKS: ' a
DATE INSPECTOR
S��FFOC,� Town Mall Annex
Town of Southold 54375 Main Road
Rental Inspection Report PO Box 1179
Southold, NY 11971-1179
" Tel: 631-765-1802
SCTM # .o2..w . ,!
Date
1
Owner Phone
_ _ _.. .._...Wa. ..... __ ._� .. ... _..... ...__Address i ...._.� ....._ V
a��� �" Visisi
ble i
Hamlet _.....,.,W.,_ __...., __._ ..._ ,.Insp actor..
.,_ _ let _....m„_._ �. ... .._,.w_.__..._ ._..._.�
Floor Level Quantities Sub 1 2 3
located m bedrooms ...
Smoke Detectors._ _ W..... . .e _...
not l td
Ca I bon Monoxide Detectors r .
Fire Extinguishers
Exits
3 4 5 6
Smoke Detectors "
Bedrooms t 2
Egress
g
Occupant
Count ,
BuildingSystems M intained & Operational m .
Y ? .. ,. � Property
. , . .. .. Condition of . . . _ ........�.. _ _. . .,;
Heating Building interior
Hot water - _-_ ng exte
rior
_'_._... .
_ erior
Electrical _ , ...... _ _,.. ...._...m_ . . .o.e.-Property clean, maintained &saf ...
e
Mechanical Handrails &guards installed &secure
Pool Safety ,Pool on Site �
Surface water alarm Date of CO issuance
Door alarms Pool completely enclosed
Self closing/ latching gates Pool fence to code requirements
CO's for all items present Prior Rental
Comments: ._�...,. _. .w.... � __... ....._ .�. .�...........
g� TOWN OF SOUTHOLD
s,
Rental Permit
0792
Owner Berry P 2021 QPRT
Occupied as Single Family Dwelling
Located at 2840 Stars Road East Marion 22.-3-1
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 Council. Expiration is
two (2) years from date of issue. The operator is responsible for arranging for the bi-annual inspection.
12/20/2022
ode r1orc)
ffica
This Notice must be posted by the main entrance at all times
Ped PLC ( o
Town Hall Annex „w elep,one(631)765-1802
54375 Main Road Fax(631)765-9502
Southold, ss
NY 11971-0959 %
P.O.Box 1179
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BUILDING DEPARTMENT
T�""
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION
Rental Permit Fee $200 (Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
v 9
Tax Map Number: 1000 SECTION
-BLOCK -LOT I
SECTION B.
OWNER INFORMATION:
Property Owner Name: 'P0.J to,
Property Owner Legal Address: Property Owner Mailing Address:
29`l6 S i�ead , ' rd,"e -
Telephone Number (s): Daytime q0-3,`L ZA)SEvening Emergency
Property Owner Email Address: 'v,1\,j, OWN
Pagel of 5
nor
Town Hall Annexa Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 " PZ�
Southold,NY 11971-0959
`
BUILDING DEPARTMENT
TOWN OF SO HOLD
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any: /l zA-
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:
Name of Authorized Agent of dwelling unit, if any: VI ,a
Address of Authorized Agent (no P.O. Boxes):
Mailing Address of Authorized Agent:
Telephone Number(s): Daytime Evening__, ,_,,,__„_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: n Ck
Address of Managing Agent (no P.O. Boxes):
Page 2 of 5
Saw-
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax (631)765-9502
P.O.Box 1 179
Pr-
Southold,NY 11971-0959
. OU01 Ptd
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:
Requested Maximum number of persons allowed to occupy Dwelling Unit: `
Number of rooms in Rental Dwelling Unit: I I
Use and Dimensions of each room in Rental Dwelling Unit:
I• V c c Vc�dM 1
11x. 1
Page 3 of 5
Town Hatt Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1 179 �� 18�
Southold,NY t 1971-0959e,
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
❑ 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)
rL4 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 l79
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:
Property Owner's Signature:
�--
Sworn to before me this���day of 20_ _, —
Official No y Public Signat r and Original Notary Stamp
N0'1'AR'1Y&'L;E31...IG,ST,'CTE 0 F NE-." YORK
COUW4S'SiCki EXf-1RES,JWqE 30,12P-4.(4
Page 5 of 5
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TOWN OF SOUTHOLD BUILDING D
ou 631 -765-1802 �
INSPEC ION,
] FOUNDATION 1ST [ ] ROUGH PL13G.
] FOUNDATION 2ND [ ] INSULATION/CAI
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY ] FIRE SAFETY IN!
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII
[ ] CODE VIOLATION [ ] PRE C/O [ vrl
REMARKS: A
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DATE 1- 50- 49INSPECTOR
SOUTHOLD TOWN Town Hall Annex
54375 Main Road
PO Box 1179 Southold,
Rental Inspection- NY 11971-1179
� mr
Tel: 631-765-1802
' � c Fax 631-765-9502
°
SCTM # o?oZ - 3 Date
Owner Phone
Address o'ZJf 940 �_IeS Zip
city Inspector
LEVELS SUB 1 2 3
Smoke Detectors (#- bedroom detectors excluded)
Carbon Monoxide Detectors (#)
Fire Extinguishers (#)
Exits (#)
BEDROOMS 1 2 3 4 5
Smoke Detector Alarms (#)
Carbon Monoxide Alarms (#)
Egress (windows) (Y/N)
BUILDING SYSTEMS Y/N CONDITION OF PROPERTY YIN
He11 atinsystem maintainedlo stational Building Interior is clean/maintained
Hot waters stem maintained/operational Building Exterior is clean/maintained
Electricals stem maintained/operational I Property is clean /safe/maintained
Mechanicals stem maintained/operational Handrails &guards present
COMMS TS:
I
So LW
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Rental Inspection Form 4/7/2021
; w.. TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNS STREET VILLAGE DIST.
JVD.
st
ACR REMARKS
1�
` N,-,e. V-.a TYPE OF BLD
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PROP. CLASS
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LAND IMP_ TOTAL DATE
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FRONTAGE ON WATER TILLABLE
----
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FRONTAGE ON ROAD WOODLAND
DEPTH MEADOWLAND
BULKHEAD HOUSE/LOT
TOTAL
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22.-3-1 10/07 _ F
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noon
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A -_ - - - - -
Extension - -
a, t�
T ea
3
a
Foundation a Bath D r 1
ette
Porch �� 'Basement 'Floors K.
y a 4
Ext. Walls 'Interior Finish LR.
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Fire Place - 'Heat DR,
Garage Type Roof —m - — Rooms 1st Fico BR.
Patio � _ Recreation Room ooms 2nd F oor .: FIN B
D !Driveway
Dormer
Total
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31648 Date: 07/07 06
THIS CERTIFIES that the building NEW DWELLING
Location of Property: 2840 STARS RD EAST MARION
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 22 Block 3 Lot 1
Subdivision Filed Map No. Lot No_
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 30 2005 pursuant to which
Building Permit No. 31700-Z dated DECEMBER 302005
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 SINGLE FAMILY DWELLING WITH ATTACHED GARAGE, GREENHOUSE & BALCONY
AS APPLIED FOR. � -
The certificate is issued to SHAWN P TULLY
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-01-0037 06 30 06
ELECTRICAL CERTIFICATE NO. 54304C _w 05 300
PLUMBERS CERTIFICATION DATED 00�06 BURTS RELIABLE
4 C
/ithcr/,ze4dgnature
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31649 Date: 07 07/06
THIS CERTIFIES that the building ACCESSORY q.......
Location of Property: 2840 STARS RD - _ EAST MARION
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 22 Block 3 Lot 1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 30 2005 pursuant to which
Building Permit No. 31701-Z dated DECEMBER 30, 2005
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 ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR.
The certificate is issued to SHAWN P TULLY
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF BIALTH APPROVAL N/A _ww_....
ELECTRICAL CERTIFICATE NO. 015761 m� 03/11/02
PLUMBERS CERTIFICATION DATED N/A
Aut' oo�rize Signature �
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-34142 Date_ 12/18/09
THIS CERTIFIES that the building AS-BUILT DORMER
Location of Property: ,2840 STARS RD EAST MARION
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 22 Block 3 Lot 1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 1, 2009 pursuant to which
BER 1, 2009
Building Permit No- 35188-Z dated DECEMBER.................---
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" DORMER ADDITION TO ANEXISTING ONE FAMILY DWELLING AS APPLIED
FOR.
The certificate is issued to SHAWNP TULLY
................_.........._ _.
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUP03ERS CERTIFICATION DATED N/A
At ize Sign ure
Rev. 1/81
E
E 1
CERTIFICATION OF
NAILINGREOU Ri'- EOD.
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-------- -- _- - --= AYP?a'EDASNOTED
ALL t%'SMUCTIGti SHALL
�..EET'fHE AEQUTAEMo'dTS OFII iE
OFNEWYMSTAT
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TULLY REi�t+ 11 G�294C ITARS RD F,MbRiow
E t q,=t,�,,I�vvQ�Pd,
E rr rw USE IS UNLAWEUL
WITHOUT CERTIFICATE
OF GGGLIPANCY
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