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Home My WebLink About1000-46.-1-31.1 (Unit E45) o .L O c = _ O u M CU tt-- Q O CD X w a� Cl) =3 0 o Q CD Is N 0 ca U � o CU �, c v U W ca cu cu LD ' " ID — Cl1 cu L � � Q Vol olU o AO Alt OCO 3 pN � cu C um v a� w 4-J .L o z CL CLo o E �, cu Awbo -0 cu O E = -0+� o N a cu U o c M >> � •ccam ' � � ZG La) -0 O o � � o O '4 yrs p (D M f� (3) c) o N_ N a 0 O\ j O O 0 N TOWN OF SOUTRO1,D—BIJ ILDING DEPART :t NT TovAi Hall Annex 54375 Main Road P. 0. Box 1179 Southold, 11971-04V' � f�,�'3 Telephone (631) 765-1802 Fax(631) 765-9502 littjs-"L�� ( soYLoi ioy Llu, _. rr R 7_5 RENTAL PERMIT APPLICATION `"ccw / a" "7,7 0-4 Rental Permit Fee$300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION -BLOCK yy t 3 � • I SECTION B. OWNER INFORMATION: Property Owner Name: D Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) \` (o q S U, 0944 Telephone Number(s): Daytime Emergency Emergency Property Owner Email Address: 'S + Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: mcu—wrIbelvl a�f..Wel Address of Authorized Agent (no P.O. Boxes): - N Mailing Address of Authorized Agent: Telephone Number (s): Daytimes( Evening Emergency Email Address: ri ► O 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): 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: 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: S 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: Ji r b�vw. 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. 10* 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. 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 . - ' q, a +r 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 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 s to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager. Property Owner's Name: o zoo• Z !. Property Owner's Signature: `1 4nbefore me this 3 day of MV6MPW-� , 20-.)1 Al y Public Signature and Original Notary Stamp :HkG KRM. � R Notary F ba q, e)f k G^-Av fork F, rad ,:xr Page 4 of 4 ou 631 -765-1802 INSPEC ION [ ] FOUNDATION IST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAI L l FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN: [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ELECTRICAL (FIN [ ] CODE VIOLATION [ PRE C/O [ REMARKS: Ufii o IL DATE — INSPECTOR Town Hall Annex Town of Southold 54375 Main Road Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 SCTM# _.._._. ... .. Date Phone Own .- _.. .-. !Address i Visible Hamlet lnspector Floor Level Quantities Sub 1 .__.. .._ .. .. .. _._. 3......a.....? Smoke Detectors (not located in bedrooms) Carbon Monoxide Detectors Fire Extinguishers �. _.. . Exits Bedrooms 1 2 3 4 5 6 Smoke Detectors Egress p - Occupant Count� Building Systems Maintained & Operational Condition of Property Heating - Building interior Hot waterBuilding exterior Property clean, ma Electrical �p,.. .,yw .w ed &safe 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: _ . , O 257" i, r tri i ,,, a �� ii! ii ✓,,,,.,„r/, // ��,,/ ,�� / G////%, � �aooi � �,,,�%f%%�,��/ c ✓ ✓iiia .. ri � oar ,�� nnn r�i� �r ,...i i ��._/ ,1/��r ,nil �a�r� �i�r ✓ areG/�c aa...., 1.. - �iri/ ✓...... /�...., i i iii/%/i , % � ilii ✓. /.� i, � ,, : ///%%%%%%%�/ ,,,�� ilii ,�� /� %� � � % �, /......, a. / .✓ �„ ��i, i �/ �.,� / O/ ✓ �iiiiiii%iii iii/ ilii/ �///%n o:, ��i� �� O� ��. ,,,,,,,,,,iia � � ,,,,, �✓ ..,. ,,. r.. ... i:,f�,,,,, ,.. ,,,,<„/. rr/air ,,r,,,.., c i,,,,,,,/i (viii//r�/i l i... // in//„ ii a. � � ,iit� ,,,,,,✓ //�/ //��/iii f,,,,,,,, ,ll ,, r, ,.% ,✓ � i, /ii i - „ ��„//.r ,,vii i, -' J,, i /i i, i � ✓ w�� G r ,�/ ,iii /aaaaaa/ ,,,,, ✓ ii ,-, ., Oaaa �.. ... /� r%%%% ii/% .. iii//� i„✓ / /,,, ,,, �i.: �//,��, ��. //,{/��, „// ,,,,; ,,,,,,, ,�.. � �/i/ a r � / :,, Oj gym) �/ � , �, �/�,;/, �,�„/ ✓ �, �„�, �,,,/,i ��, �, ,/„ ��„� /, � / /, �/,,,,,, ,4'+ ,. r waaai i ,� ✓ �, r/%�� w, �� +�✓' ,riiic„� / ,,�,///,,,,,/li ii///�,��//��i/iii, � / ,,, ,,, .. ,,...% � i�/// � ��i„ ', ani„ _� aa,// ,�%90,.1 i l/,i/i�„�� /i/��,r/,/r�..i��i�,/�o�/✓�Gfrllrttfllnrlil,� ,llf, � ,,: i � / ✓ilii,,. �o% , /� r , r ,, ��i., r i i i ioi r a� dal r � O ' �� i ova ��/ ��/ � � / �� <, ii- ✓ ��///iiii�.,�i �,,, ,. ,/. ooi ✓///�� /0000 , r/„% O 0////� 0 +( /// /� ,i � n � i /r i,rrr/ri n/�l � i i,ii ii �ri a,,,rG ,/ /r.,iii.. nGi� c„✓cw.,./ /iG ;✓/� /Gi// /%%%�/,,,,,,,,,,,,,;,,,�%iii io�%� � i, ,,,,,i„//%/ ,;,,,,,,,ii%/� �� ,�%/ / %„,% ✓„ /, ,, ,,, .,y//� � Irk/ ,i%I//% /%� // // .,/ % --, / /li/1//,,., �/ � iii/// i%//�„ � ,� .1/ /%/r /,,,✓ 1 % / 1%/ „///// i��i�/////r% i%//�� - ��.... ,. ,,: ,:,, ,,, l� a ��;> /. �.. ,,/,,�,,,,nu�� Y� ,r,�.,� / i;,� /... ii� �, ��o,..�ii riv¢r w//�// 11/� ,rr�/r✓ii �/�i,i �//iii��r/ 1 /,,,,,,, /,,,, ✓,,, �� // ia,,,, �,,,, r i i 100 c , // ii%% - // r r r , r1 n i oris,r..a ...../n�i/v r.. �ir �Ui iii / f i � .,,✓. ...of 1. w 11, ��. / } r W LL �J r G P 4 Y � m m � y Q _ IT LL LL 5 11,11111011; " P ti .- ... i_ T ! �w p �. c w� o an Ln 3 t m L L Y p ' r p 4- N p gyce p/ /L� L a �„ co �L I ce a a ,v y OK U _ L o N a u k .,.._. _ LiJ .... ,.. ...,_ .. fin Y on � gg j J f N ail w v � l n Y r n A, 4 m C C t t N p 0 - m yf I f 1, 1 � a w a . I I .......... _j m f t E- o _ ...... L EL LL c IF ...m .�M. .w�....M �.... � wpm ..°... ._.._ O CL............. u p., .._.. q �� C 4 LL .H G' All CF AAJ \ C O � r r � � 1 i LL{ d° m C7 a O FOUX NO. S TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. XWO. . . . . . Date . . . . . . . . . . . . . N4. . . 1 . . . . ., 19. 73. THIS CERTIFIES that the building located at .Main. Rd(2fg5).& -9`t' $fA Street Map No. X= . . . . . . . Block No. XX. . . . . . .Lot No. Greexparts. R%Y#. . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . April. . . .30-, 19.73. pursuant to which Building Permit No. 41W dated . . . . . . . . . . . .April . .30, 19-73., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .one. bedraoa. apartment. ,- .bnildings The certificate is issued to $.x..Conat.ruetion.Corp• • Omer. U.Dani aaw)• • • (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Pnb. grater. A. S sr. appro al. . . . UNDERWRITERS CERTIFICATE No. 01C 0. -Ite 17. .90 "D*114. UAit�w a25D24, � X2 1225012 1 "1"-f� .two-X22502 5 5 HOUSE �U' ER . . . . . . . . . . . . . . Street . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Novara* aumbors to be assigned on oompletion of proJeot Building Inspect