HomeMy WebLinkAbout1000-108.-3-7.1 £_ TOWN OF SOUTHOLD
Rental Permit
1017
Owner JB Tut Holdings LLC
Occupied as Single Family Dwelling
Located at 13936 CR 48 Cutchogue 108.-3-7.1
Maximum Permitted Occupancy 5
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.
11/3/2023
Code E once of official
This Notice must be posted by the main entrance at all times k
Y
TOWN OF SOUTHOLD-BUILDING :DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1 179 Southold, NY 11971-0959
Telephone (631)765-1802 Fax (631) 765-9502 1t µw / ,, tn1 )ctan .6 ` „ "`
RENTAL PERMIT APPLICATION
Rental Permit Fee $300 (Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
4T, 6"t U e, AJ
Tax Map Number: 1000 SECTION 10 1?° -BLOCK 3
SECTION B.
OWNER INFORMATION:
Property Owner Name:
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
6 ba ao�s
I r:
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Telephone Number(s): Daytime jJ-7f- 41744Evening 56Me- Emergency
Property Owner Email Address: 'I o-Ai II A e mac-_ cc
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Page 1 of 4
BUILDING DEPT.
TOWN OF SOUTHOLD
Section C.
Authorized Agent Information: N/.A
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: �JJ
�A
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. NlA
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):
Mailing Address of Managing Agent:
Telephone Number (s): Daytime Evening Emergency
Email Address:
Page 2 of 4
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on property:
e
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:
Use and Dimensions of each room in Rental Dwelling Unit: a o m — 39 5F
2 - X27 <,r zs,F
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
m the Town of Southold
I° I am submitting a completed Town of Southold certification form from a licensed
architect or a licensed professional engineer.
Page 3 of 4
SECTION H.
DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit.
STATE OF NEW YORK)
)
COUNTY OF SUFFOLK)
I certify under penalty of perjury,the following:
1. I 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
applicable laws and rules. I further acknowledge that l 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 s to any change to the information
regarding Authorized Agent, Managing Agent, or Site M/'ana Eger.
Property Owner's Name: "
6Ltr fh t �I
Property Owner's Signature: &g,k*
Sworn be o me this�Q d ay of � 20
0 ficial otary Publk Signature and Original Notary Stamp
.NeNNA KOCKEN SN STER
Notary Public,.State of NV York
uag
Ctu No.01 K4 6402096
idfied in Suffolk court
Commission Expires Det embed,2022
Page 4 of 4
V sou,
TOWN OF SOUTHOLD BUILDING D
631 *,765-1802 A&
INSPECTION
FOUNDATION 1ST [ ] ROUGH PEEG.
FOUNDATION 2ND [ ] INSULATION/CAI
C ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] TIRE SAFETY IN',
j 1 FIRE RESISTANT CONSTRUCTION ] FIRE RESISTANT PE
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII
[ ] CODE VIOLATION [ j PRE C/O L
Aule"I n>
AEE INSPECTOR
b
Town Hall Annex �y Telephone(631)765-1802
54375 Main Road ' Fax(631)765-9502
P.O.Box 1179 aa;
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PROPERTY CERTIFICATION
Form is to be completed by a license architect, licensed engineer or licensed p
Separate form is required for each individual Rental Dwelling Unit
Rro essionol seal re aired r Architect or Bn Ineer licensed dome lns actor must pro�vidq
coDv of valid current certification
Rental Property SCTM Number:
Rental Property Address: 6
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Owner/Name: WV 4dU11A,*,,
Rental Dwelling Unit Identifier: h
Number& Square footage of each bedroom as depicted in the attached floor plan:
(i.e. Bedroom#1 -100 sq., Bedroom#2-90 sq., etc.)
SF
Property Description (include all improvements indicated on survey)
I certify that I have done a physical inspection of the subject rental dwelling unit and find that it
fully complies with all the provisions of the Code of the Town of Southold,the Residential Code
of New York State,the Building Code of New York State, the Plumbing Code of New York State,
the Fuel Gas Code of New York State, and the Energy Conservation Construction Code of New
York State.
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Print Name and Title l� Origin I nature
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Please place professional seal: �J
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®F N 10,011
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SCTM #
TOWN OF SOUTHOLD PROPERTY RECORD CAI I '
OWNER STREET VILLAGE DISC LOT
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ACR. REMARKS
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TYPE OF BLD
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PROP. CLASS
LAND IMP TOTAL DATE
3
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FRONTAGE ON WATER HOUSE/LOT
BULKHEAD
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TOTAL
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TOWN OF UT OL PRY RECORD
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WNER� STREET �� VILLAGE
DIST.= SUB. LO
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FORMER OWNED ., N E AGR.
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S I W I TYPE OF BUILDING
RES. SEAS. VL. "FARM COMM. CB, MICS. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
3
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NEN NOR t 1 L B VI
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TIlable FRONTAGE ON WATER F y
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Woodland FRONTAGE ON ROAD
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Total T DOCK - -
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Porch Ext. Walls €Interior Finish R, l
Breezeway -.. . ire Place Heat DR.
Garage v Type Roof Rooms 1 st Floor BR�
Patio y Recreation Room Rooms 2nd Floor t INl B
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Breezeway Rooms 1st Floor
Garage Driveway Rooms 2nd Floor
Pool
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