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Home My WebLink About1000-78.-9-12 Qom_ TOWN OF SOUTHOLD Rental Permit 0805 Owner Rachel Reiser & Robert Antona Occupied as Single Family Dwelling Located at 355 Summer Lane Southold 78.-9-12 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. 1/13/2023 *oder� ficial This Notice must be posted by the main entrance at all times IJ Town Hall Annex C"elePho „ 1802 jig 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUOLD RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years) Section A. OEC 12 2022 Property Information: Bulu)iNGUEPT: 'DOWN OF SOLffHOLD Rental�Property ..Address: Tax Map Number: 1000 SECTION .� ..__.� .w.�...� �_.......-BLOCK �_ww„1 �.� .�.................-LOT_ _... ....... .�. ��........�..._�.._ SECTION B. OWNER INFORMATION: Property Owner Name: ;.. .., MS ' .._ ? ._........._....... ..._......._,...,... ... Property Owner Legal Address: Property Owner Mailing Address: Telephone Number(s): Da tiro E�reninn Emegen _. Property Owner Email Address: .. ��r.` '. � ..... ...�� .. .. a` .. . _��_. . �.... . 4P`3.o b Pagel of S 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 SO HOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: t 5 Address of Authorized )( " no P.O. Boxes Agent Boxes)::,. �� " g t Mailing Address of Authorized Agent:a.. U- ,...�� (S... te-V..1., 1194� ,....-.. 3� Telephone Number sO: Da time � �5� Evening._.......... _... .. Emergency ..w.... . ... ...��,.. Email Address .. . . . .i. i .. � . 'Y... .. . . � I�'.6._. �.. : . .w_.. 1.._....... . .. Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: ....__._...._..—.......m...__._......____.._.._.................... _........w ,�mw..._..�.. ............�.....�..... 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 g or more rental units) Name of Managing Agent of dwelling unit, if any: . Address of Managing Agent (no P.O. Boxes),; .......... ... Page 2 of 5 Town Hall Annex,q 7 Telephone(631)765-1802 54375 Main Road ? Fax(631)765-9502 P.O.Box 1179 R Southold,NY 1 1 971-0959 mo t s BUILDING DEPARTMENT TOWN OF SOU OLD Mailing Address of Managing Agent: ....._ . _.. .. ..... _. _..._... _. .... ............ Telephone Number (s): Daytime Evening Emergency.„,„ Email Address: SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property:,w _ ,.... µ,. ..................._www._ __ww......w_ 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.” leo Rental Dwelling Unit Identifier w Requested Maximum number of persons allowed to occupy Dwelling Uni Number of rooms in Rental Dwelling Unit: .w.... � . _...,.. Use and Dimensions of each room in Rental Dwelling Unit: . ...m _ w ..2 , a Page 3 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 r -" Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SO HOLD 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. l� I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ I 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 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 1179 a Southold,NY 11971-0959 ' BUILDING DEPARTMENT TO 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: ._� . .... � 'a .... ...._._ _ .... ......._w.w. ... ... .. .en. Property Owners Signature - Sworn to before me this li� day of 20(;- ,.. BOGUMfLA T. ROSEBURO .� m :w. __.._ �w. . _... -Notary-Public-State of New York Official otary Public Signature a Original Notary Stamp No.01R0507"'1459 21"! Ovaiified in Queens County Commission Expires January 13,20 Page 5 of 5 ">> svmme� oWN OF SOUTHOLD BUILDING DI 631 -765-1802 [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAL [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] EIRE SAFETY INS [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL {FI [ ] C EVIOLATION [ ] PR / [ F dP RSA gh. 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SOT FORMER OWNER w...�, ¢°�� N - E ACR. APIC S WTYPE OF BUILDING - i RES, SEAS, VL. � FARM COMM. CB. MISC. Mkt. Value LAND IMP, TOTAL DATE REMARKS a 2/3 r : a� s a ,3 AGE; w BUILDING CONT ( N - r. f - -- NEW NORMAL � W ABOVE «N < FARM Acre Value Per Value Acre ic 1= Tillable 1 I _ Tillable 2 i i .. <�'7 - f rot 4 Tillable 3 i - =_ #, Z Woodland Swampland FRONTAGE ON WATER t Brushland = FRONTAGE ON ROAD E - � House Plot I DEPTH BULKHEAD - Total ;DOCK I I � I a a k t Y ( OR i , I i 4 s ;RIM 1 � a l I M-9-12 9/22/2022 4 e � Bath i Dinette M. Bldg Foundation 1 Extension 'Basement Floors ,, = K. 1 - -„ .Ext. Walls Interior Finish 1 LR. `� Extension _ r - - Heat DR. Extension Fire Place �� «_ = r,-� Type Roof Rooms 1st Floor BR. Porch I creation Rrni F Rooms 2nd Flood IN B. �Dormer � . Breezeway i Driveway I � i Garage s a TotalIfi Town of Southold 9/2/2022 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43394 Date: 9/2/2022 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 355 Summer Ln.,Southold SCTM#: 473889 Sec/Block/Lot: 78.-9-12 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/12/2021 pursuant to which Building Permit No. ,47241 dated 12/20/2021 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: ccesso in- o nd swimming of fenced to code as a lied or. The certificate is issued to Reiser,Rachel&Antona,Robert of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 47241 6/28/2022 PLUMBERS CERTIFICATION DATED A o e Si naturewmm