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Home My WebLink About1000-77.-3-15.2 TOWN OF SOUTHOLD Rental Permit 0816 Owner 100 Pine Ave LLC Occupied as Single Family Dwelling Located at 650 Pine Avenue Southold 77.-3-15.2 Maximum Permitted Occupancy 16 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. 2/7/2023 1 foc t fficial This Notice must be posted by the main entrance at all times Town Hall Annex "9- Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 IOC �� 0 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: 650 Pine Avenue,Southold Tax Map Number: 1000 SECTION 77 -BLOCK 3 -LOT 15 _ z SECTION B. OWNER INFORMATION: 100 Pine Avenue,LLC Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: 3083 NW 30th Way Same Boca Raton,FL 33431 1 (917)446-4030 1 (917)446-403 1 (917)446-4030 Telephone Number(s): Daytime Evening `mergency b6 anreiss07@gmaii.com Property Owner Email Address: ,o �a(1�� 4 Pa elof5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959Cou � � dr , BUILDING DEPARTMENT TOWN OF SCi► 1THOLD 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 In ation: Name of Authorized Agent of dwire unit, if any: Address of Authorized Agent(no P.O. Boxes . Mailing Address of Authorized Agent: Telephone Number(s): Daytime EveninL�� Emergency Email Address: SECTION E. �� SITE MANAGER INFORMATION: (requ 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 2 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime Even Emergency Email Address: SECTION F. PROPERTY DESCRIPTION: 1 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: 1 Requested Maximum number of persons allowed to occupy Dwelling Unit: 16 Number of rooms in Rental Dwelling Unit: 15 Use and Dimensions of each room in Rental Dwelling Unit: Basement-Bedroom 1 11'7"x13'1",Bedroom 2 132"x187"includes bathroom,rec space 33'6"x187". 1st Floor-Bedroom 3 23'6"x21'7"includes sitting room&bathroom, dining room 13'x11'5",Kitchen 13'4"x19'1",Great room 34'6"x19'1",bathroom 7'x7',laundry room. 2nd Floor-Bedroom 4 15'x16'4" Bathroom 12'6"x10'6",Bedroom 5 12'4"x11'4",Bedroom 6 16'4"x13'8",bathroom 13'x8'11",Bedroom 7 13x12'5",Bedroom 8 13'x12'4", bathroom, 10"x7"10" Page 3 of 5 Town Hall AnnexTelephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179M Southold,NY 11971-0959 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) I Brian Reiss 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 (r Town Hall Annex Telephone(63 I)765-1802 54375 Main Road "(11 C Fax(631)765-9502 uv P.O.Box 1179 3outltold.NY 11971-0959 BUILDING DEPARTMENT TOWN OF SO OLD applicable laws and rules. I further acknowledge that 1 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. Brian Reiss Property Owners Name: Property Owners Signature: Sworn to before me this 36dayof ,20 tie Official Notary Pu lic Signature and Original Notary Stamp B Notary PuNt Stater of Florida Made"Son$Gaston 1tion H Miss Exp.312712026 Page 5 of 5 (0 ?(nt TOWN OF SOUTHOLD BUILDING D 631 -765-1802 2�► , INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAI [ ] FRAMING / STRAPPING [ ] F L. [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY IN! [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (T [ ] CODE VIOLATION [ ] PRT C/ [ ] REMARKS: ........... 0�n� ........ ... DATE INSPECTOR ib : - - TOWN OF SOUTHOLD PROPERTY RECORC f ' OWNER STREET VILLAGE DIST SUB. LOT a L e A e AOR_ REMARKS _ $ _6421- TYPE OF BLD_ ; . PROP.OLA - S LAND IMP= TOTAL DATE Lil - `_ 1-4 LJ r a FRONTAGE ON WATER TILLABLE FRONTAGE ON ROAD WOODLAND � DEPTH � MEADOWLAND l BULKHEAD HOUSE/LOT TOTAL I I ' 11b, NWARD TOWN OF SOUTHOLD PROPERTY OWNER STREET VILLAGE DISTRICT SUB. LOT A FOR-MER OWNER N E ACREAGE S TYPE OF BUILDING RES- SEAS, VL. ! FARM Comm, IND. CB, misc. Est. Mkt. Value mr LAND IMP. TOTAL DATE REMARKS f I -Z w J AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FRONTAGE ON WATER Form Acre Value Per Acre Value FRONTAGE ON ROAD Tillable 1 i BULKHEAD 4- Tillable 2 DOCK Tillable 3 Woodland Swampland Brushland House Plot Total r I w. 7 77 WN OF SOUTHOLD PROPERTY RE WKI %.JAnj °a 4 OWNER -STREET DISTRICT SUB. LOT e NA s g FORMER OWNER 1N ,E jACREAGE , S W TYPE OF BUILDING I RES. SEAS. I VL. ' FARM COMM. IND. CB. ( MISC. Est. Mkt. Value LAND IMP, TOTAL DATE REMARKS I i [ � i AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FRONTAGE ON WATER Farm ; Acre Value Per Acre Value FRONTAGE ON ROADr r Tillable 1 BULKHEAD Tillable 2 DOCK Tillable 3 i Woodland Swampland =F. Brushland House Plot t _ i Total � i I M ma =! WCARTHY MANAGEMUM INC. 46520 COUNTY ROAD 48 SOUTHOLD, NY 11971 yp .,..�..��.�_�..�qp�..._,.,........ _.�...�,.,...._....._.....��............... � ,.,.,..,.......,......„„„ ._..................,.mom. (631) 765-5815 FAX (631) 765-5$16 �.�.�.�.�.�.�.�.�.�.�.��.� T � F: O .......w__ _.._. .. W._ ......._,,, _ _. _.° m_m..w.. ...... ..M.M.M._m..www...w._.. ___ . Ik .. �. . hip _.. _ ..._.w. ._..www..... ._.....w WE ARE SENDING YOU ❑ Attached ❑ Under separate cover viaAhe following items: 5 ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ,. __m_m_wk...w_www .... .w_.� ....._ _.... �.,....._www_........._ MEN= • _ � _......_ ��_...,�,�www ...,.,....�._.. ...... } . .. _ . ...... m_...... _w_ .a_tm.w__ _. ....._...._.. ,...._.w...... } —_.w.w ww_.i...._w. .... l�c-`� , : w .... ...... _...._ .......w_. (-1 . ..wt-. THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return .,.......__.. ,.......corrected prints y ❑ For review and comment .:.i ....._ _ .... .. _...., _...__......... ❑ FOR BIDS DUE _........................................._..............0..........._..._... _w........................... ._...................._......_,. ❑ PRINTS RETURNED AFTER LOAN TO US ,...... ... .. __.°_.... ..... w..._w _ REMARKS 4 b �( 1 ° w COPYTO ......... ..........w .w. _......... ... ... ........... SIGNED: . ,...... _................_�. If enclosures are not as noted, kindly notify us at once. OPENING SCHEDULE rw. 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