The URL can be used to link to this page

Home My WebLink About1000-117.-2-7 TOWN OF SOUTHOLD Rental Permit 1014 Owner Nancy Peters Occupied as Single Family Dwelling Located at 5400 New Suffolk Rd. New Suffolk 117.-2-7 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. 11/1/2023 Coderef rcerU e t Official This Notice must be posted by the main entrance at all times Town Hall Annex Telephone(631)765-1802 Fax(631)765-9502 54375 Main Road P.O.Box 1179 �M Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION . must be renewed o years Rental Permit Fee $200(Applicationever y T 6 2023 .� BU11DING DEPT. Section A. TOWN FX" " zea ,`"". Property Information: Rental Property Address: Tax Map Number: 1000 SECTION 1, -BLOCK -LOT - SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: Telephone Number (s): Daytime65k--714- Evening Emergency Property Owner Email Address: � boa r� C l p S�-21 Page 1 of S Telephone(631)765-1802 Town Hall Annex Fax(631)765-9502 54375 Main Road P.O.Box 1179 southold,NY 11971-0959 BUILDING DEPARTMENT TOWN Off`` SO THOLD Section C. Authorized Agent Information: 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: 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. 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 Page 2 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road w Fax (631)765-9502 P.O. Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: �4T Telephone Number(s): Daytime Evening_w.w Emergency www. . 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: Requested Maximum number of persons allowed to occupy Dwelling Unit: L Number of rooms in Rental Dwelling Unit: . 5 -- Use and Dimensions of each room in Rental Dwelling Unit: tic 41 Page 3 of 5 Town Hall Annex Telephone(631)765-1802 Fax(631)765-9502 54375 Main Road P.O.Box 1 179 „. Southold,NY 11971-0959 C®u 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. ❑ 1 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) 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 2 Telephone(631)765-1802 54375 Main Road 0 vz Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971 BUILDING DEPARTMENT Towle 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 Owners Signature: .: Sworn to befor �,ffiehis day of OCTV A , 2 SETH G BANK ry Notary Public-State of New York w NO.01 BA6427783 Official Notary u lic Si ature and Original Notary Stamp My Comm ss onnEires Jan 3,2026 Page 5 of 5 TOWN OF SOUTHOLD BUILDING I 631 -765-1802 07 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAI [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] TIRE SAFETY IN; [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII [ ] CODE VIOLATION [ ] PRE C/O [vl I REMARKS: pzg�oz9 DATE 0- 30- 95 INSPECTOR CTOWNOFS LV ILDING DI N 'P ION ; 1p I l FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSUTATIOWCAI [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN; [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FIN [ ] CODE VIOLATION [ ] PRE C/O [ REMARKSN /10 (,r �9VI)cill?. ........................... �d�' DATE /0-/&- INSPECTOR .,. Town Hall Annex Town Of Southold 54375 Main Road c Rental Inspection Report PO Box 1179 coo Southold, NY 11971-1179 ' " Tel: 631-765-1802 SCTM# ff/ Date 1 . ,.. _ ...... ._ _..._...... ... ..w,,. ,,.. -- ,Owner Phone Phone Address - /(,,�uJ Visible Hamlet ,P, Inspector Floor Level Quantities Sub 2 3 Smoke Detectors (not located in bedrooms) Carbon Monoxide Detectors Fire Extinguishers ._. .n..,. _ _. Exits Bedrooms 1 2�, 3 4 5 6 .. Smoke Detectors Egress Occupant Count Building Systems Maintained& Operational Condition of Property Heating Building interior Hot water Building exterior Electrical Property clean, maintained & safe Mechanical Handrails &guardsinstalled d� all . & & 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: =I �. - r' [ s AV Av MON M- g� t1t. Bldg. r Foundation ; Bath Extension f Basements . b., Floors = Extension > a s il a W Interior Finish Extension � ;Fire Place i Heat Porch � �Roof Type 1 Porch Rooms 1 st Floor Breezeway u ; Patio Rooms 2nd Floor Gary e t c ' rivewoy Dormer d. B. ' f e ' v I E moo= ' { -41 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PREEXISTING CERTIFICATE OF OCCUPANCY No—Z-17583 Date DECEMBER 9 1988 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Proper' y 5400 NEW SUFFOLK ROAD NEW SUFFOLK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 117 B.1ock 02 Lot. 007 Subdivision Filed Map No. Lot No. conforms substantially to the Requirements for a private one family dwelling built prior to: APRIL 9 1957 ursuant to which CERT. OF OCCUPANCY #17583 dated DECEMBER 9 1988 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 ONE FAMILY DWELLING The certificate is issued to ESTATE OF EUGENE A. RAYNOR JR. (owner, X ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N A 'Building Inspector Rev. 1/81 " T0:'54 OF SOUT::OLD, N. Y. FOUSI::G COD.: IiTSFECIIO?i R CRT Locaticn 5400 NEW SUFFOLK ROAD NEW SUFFOLK, N.Y. �numoer ca szreez) l,,•iuni.cipalitfj Subdivision iRap No. Lat(s) Name of 0:•iner(s) ESTATE OF EUGENE A. RAYNOR, JR. Occupancy 'A' RESIDENTIAL AGRICULTURAL (type) oti ner-;enanz) Admitted by: WILLIAM WICKHAM Accompanied by: SAME Key available Suffolk Co. Tax No. 117-02-07 Source of request WILLIAM WICKHAM Date NOV. 29, 1988 D'.ELLING: Type of construction WOOD FRAME ;;stories Foundation CEMENT BLOCK Cellar FULL Crawl S-oace Total rooms, lst. F1 4 2nd. F1 3rd. F1 Bathroom(s) 1 Toilet room(s) Porch, type Deck, type Patio, type, Breeze,:•eay Garage 1 car attached Utility room Type Heat OIL Warm Air Hotwater xx Fireplace(s) NO No. axits 2 Airconditioning YES Domestic hotcvater Type heater ELECTRIC Other ACCFSSCRY STRUCTURES:NONE Garage, type const. Storage, type const. Swimming pool Guest, type const. Other V10 AT:�"1" NS°IS: Housing Code, Chapter 45 N.Y. Statq. Qnif;orm Fire Prevention Lnca;tion Descrintion ( Art. Sec. G � E NO 3/4 HR. FIRE SEPARATION FROM GARAGE TO HOUSE pp717.3 F 6 G AREAp INSTALLATION OF SMOKE DETECTOR 1193. f I yy� Y P I y� 8 p� Remarks: HOUSE IN GENERAL IN GOOD REPAIR. WINDOWS NEED WORK. Inspected by: Date of Insp. 12/8/88 GARY F:St' .Time start 9:55 end 10:10 am