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Home My WebLink About1000-125.-4-14 a , - A WNOF SOUTHOLD � F01Wr , Rental Permit 0561 ,V Owner Eric & Jennifer Klodnicki Occupied as Single Family Dwelling Located at 3x20 Delmar Drive Laurel 125.4-14 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. 11/27/2023 Cod f r o i This Notice must be posted by the main entrance at all times *VTOWN OF SOUTHOLD BUILDING D0 631 -765-1802 10?5 " INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PEBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAt FRAMING / STRAPPING [ ] FINAL [ FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN! FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII [ ] CGDE VIOLATION [ PRE C/O [ I REMARKS: 051al DATE INSPECTOR Town Hall Annex ` ` 54375 Main Road Town Of Southold �~ PO Box 1179 Rental Inspection Report ZM Southold, NY 11971-1179 rl Tel: 631-765-1802 Date�.. . w. ... Phone Owner _.__.. .. Address Visible Hamlet Inspector .... Floor Level Quantities Sub I 1 2 3. ....._f Smoke Detectors (not located in bedrooms) _. Carbon Monoxide Detectors Fire Extinguishers - Exits _ Bedrooms 1 3 4 5 6 Smoke Detectors - Egress Occupant Count Building Systems Maintained & Operationalondition of Property Heating Building interior Hot water Building exterior Electrical _ ., cai maintained &safe .Propy . Wean, ma Mechanical Handrails &guards installed &secure Pool Safety Pool on Site Surface water alarm 'Date of CO issuance Door alarms Pool completely enclosed �., „e._... ..._.... �,.._ . Self closing/ latching gates is _ _ Pool fence to code reuiremen CosforalI i ' terns present Prior Rental Comments: i uWN btju U D Rental Permitr 0561 Owner Eric & Jennifer Klodnicki Occupied as Single Family Dwelling Located at 3320 Delmar Drive Laurel 125-4-14 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. 11/19/2021 _ h-- Code Enfor t Official This Notice must be posted by the main entrance at all times Town Hall Annex SOUTHOLD TOWN 54375 Main Road PO Box 1179 Southold, Rental Inspection v- NY 11971-1179 Tel- 631-765-1802 Fax 631-765-9502 SCTM # � C Date Owner phone' " v, Atltlress � Hamlet Inspector Address�Islble,frorn streets LEVELSSUB""'"' 2 Smoke Detectors (#- bedroom detectors excluded) Carbon Monoxide Detectors (#) Fire Extinguishers (#) Exits17, (#) . . BEDROOMS 1 Smoke Detector Alarms (#) Carbon Monoxide Alarms (#) . gym° Egress (windows) (Y/N) 1 BUILDING SYSTEMS Y! CONDITION OF PROPERTY 7 Heating system maintained/operational Building Interior is clean /maintained Hot water system maintained/operational Building Exterior is clean/maintained Electrical system maintained/operational Property is clean/safe/maintained Mechanical system maintained/operational Handrails &guards present POOLS Y 1 01 POOL BARRIERS Y/N Pool present Pool is completely enclosed Pool surface alarm and/or door alarm Barrier is a min. 48" high resent POOL GATES Y/N All openings in barrier less than 4" Self-closing, self-latching Max. 2" clearance @ bottom of barrier Latch on pool side of gate,meets height Barrier capable of being locked &child- requirements proof when unattended COMMENTS: I 5 O O , CD c o r-h (D N fD rD CL (puNr °, N o in N O Cf) CD rF uh (D O o � ip C DO D w - " a p CT 3 O 3 CD d QCT CD w - K 0 cn o x s N nc z CD O CD F CLCD - CD (D � m m `° w z CD `° Oo ccD 0 O O ro p C� p 3 :3 O V V �' m Cn n r C O r=D N -- c C7 CD 3 rt = CD n CO d = CO O O W c � I 4�3 C on v m CSC Dbh 0 0 '� Z CD N rD 3 — m m ~ wk `c ,p O O rr� Vl V� Town Hail Annex � �d � Telephone(631)765-1t,3 54375 Main Road isaan,(636 1"517 P.O.Box 1 179 Southold,NY 11971-0959 JUL 3 0 2019 BUILDING DEPARTMENT TOWN OF SOUTTIOLD I',7_1- RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION -BLOCK -LOT SECTION B. OWNER INFORMATION: E K) O 4 PropertyOwner Name: :. . .... � � .('ki�'1 I C Property Owner Legal Address: Property Owner Mailing Address: �a4 hn Q Telephone Number(s): Daytime ul?6 53lb Evening C Emergency5'8M Z Property Owner Email Address: t i kl 0 n l ck'i @' rv) M'. wm Page 1 of 5 J Gw✓�'W,R .Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 t Southold,NY 11971-0959 cout BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: N w 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:® N � 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: WA Address of Managing Agent (no P.O. Boxes): Page 2 of 5 Town Hall Annexe Y 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. Evening Emergency. . 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:_ Number of rooms in Rental Dwelling Unit:_ -I Use and Dimensions of each rqo i`n Rental Dwelling Unit: 3 bE� np qN s Ll 1v roe 7.1 iFc dii l9xll Page 3 of 5 Town Hall Annex �Yy Telephone(631)765-1802 54375 Main Road � Fax(631)765-9502 P.O.Box 1179 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 requir"ed 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. XI 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 EVC k l0 1 l<l 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 ��r Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 A Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN 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: )od I Ck Property Owner's Signature: Sworn to before me this_day of 20_ Official Notary Public Signature and Original Notary Stamp Page 5 of 5 TOWN OF SOUTHOLD BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST ROUGH PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING /STRAPPING FINAI_9,,� [ ] FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION I FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL-(FINAL) [ ] CODE VIOLATION CAULKING F7 RE ...................... O:tMWiA, VJWW, t&468 Mir DATE ,I l wRu OW A r 4` 00 x � " _ 0 � N 1 � e r r � s N N X A N s O N C) O �v N fD ul 3 � 0 lj-LRI--T (�D Z. -t A D H 3 O m A � O r ti Scanned by CamScanner w , T x e FY yy II 1� i wY _ r y -• u � ' �'i 'x�' `M.,'� YL' �,,�� Y +; � � < ��' �� Mid � y" n d 0 t--- a r1 i a � m " I„ M fg n h �' 'a'"•>�+ ,ate 77 fit .._ _ . R . J I D Z � w 70 r I a �n _WW i I � D r _0 M P7I (J5 6,e9 v l it �w 11 1 51 m r a) rnW X z D w r m i D G7 r ® rn D f iC i O m° co m 5 r I d o ° r r m O r O -1 t gb rn A I f I L � m 04 ro 1 n J � nni � E 0 0 n CD r , r. co N ' xi an ` kph L- r I d x �. o90o 9 L L _. i „. 4 t a, "RV, --.._. _.._ — p , a) T O .,,,..M. 70 w ._ _ _...,.. y I � " O H h N .. � m „you ca ao p r 7c C�7 TOWN OF SOMWOLD MIMING I)SPARTIMT To"Caw# 06 .. . . . . . . . . .. . . .., . I. ., . . .. map No. . . , . Biwk No. mdor=substAnU&Uy to the , p t hmgofmv nW in this office °. , . t to wbich Buildtag parmrdt No.73 5... . . .. . dated, 19 7 wenft f them applimhle pmVWom of Ow . a ®. . . . . . . ., .®... . . ®® . .. .. . . . ® .. . . .. ... . ... ......®® of the Cbunty DeParbuntf Hedth Appma 4 . . u, . . , .' , . . .. . . .. ® . � . t . ® .. . ®... bTle®. F. . . . . . . . . . . . . . . .. .. .. ... . .. .. . ... .. . .. . . . . ... ..k.1A.�,. . ' -:. . . . ..� .. . .. .... . B FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NoZ�18705 Date JANUARY 11, 1990 THIS CERTIFIES that the building ACCESSORY Location of Property 3220 DELMAR DRIVE LAUREL NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 125 Block 4 Lot 14 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 10, 1989 pursuant to which Building Permit No. 18421-Z dated AUGUST 23, 1989 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 ACCESSORY SHED AS APPLIED FOR PER ZBA APPEAL #3845 The certificate is issued to PHILEMON & BARBARA. DICKERSON (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N A u: lding Inspector Rev. 1/81 - -. ------m_... _ _ ..�.,..... Town of Southold 11/22/2019 P.O.Box 1179 53095 Main Rd Southold,New York 11971 w CERTIFICATE F OCCUPANCY No 40879 Date: 11/22/2019 THIS CERTIFIES that the building OTHER Location of Property: 3220 Delmar Dr, Laurel ..................-,......m ..® .. SCTM#: 473889 Sec/Block/Lot: 125.4-14 ......... ...........- _ ..... . Subdivision: Filed Map No. Lot No conforms substantially to the Application for Building Permit heretofore mm filed in this office dated pursuant which Permit No. 44321 dated 10/22/2019 —.......10 15/20...19.....--- ursat to Building ed, and conforms to all of the requirements of the applicable provisions o .................. was issued, f the law. The occupancy for which this certificate is issued is: "SAS BUILT" CO 1TIONERT..J 1T_ . APP I TS FQR The certificate is issued to Klodnicki,Eric&Jennifer of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 44321 11-19-2019 .. PLUMBERS CERTIFICATION DATED „erid. Si e OCT 2 5 2021BUILDING TOWN OF S,)UDT Lp �dl I�k�e o rer,eAJ rn fe/i er�� Lure I w Thi are nfo c l kms C,s mz�4kQ, m StncQ 4 w e!'MSS I SSte 0't . Tltt7k yCk4, M rbc <�odlm�ckc 1 � U_ o O O CDm 0 0 fD �� N 0- J O t j o cin u N oCD N =3 — - N ocr N o < = O CL i CD o K CD occn o X Z CSD O� C V FV � QCD 3 �• 3 C CD O CD Or Q cD OO Z S: AlOft 0 0CD 171 @ rF O0 0 e--F ~• mn < cn rD UR C'1 rrr ct) CD 0 go Aft 3 =3 'L O NCD Cf) CD A C, CTS m < c� � CDn ~ ' CD JOWk r oo UG CD c a) cam. m 42 Q � CD 3 �-• cn-0 CL o c N CD C C o n m � CO � O o =3 cl) F 0 *VTOWN OF SOUTHOLD BUILDING D0 631 -765-1802 10?5 " INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PEBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAt FRAMING / STRAPPING [ ] FINAL [ FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN! FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII [ ] CGDE VIOLATION [ PRE C/O [ I REMARKS: 051al DATE INSPECTOR Town Hall Annex ` ` 54375 Main Road Town Of Southold �~ PO Box 1179 Rental Inspection Report ZM Southold, NY 11971-1179 rl Tel: 631-765-1802 Date�.. . w. ... Phone Owner _.__.. .. Address Visible Hamlet Inspector .... Floor Level Quantities Sub I 1 2 3. ....._f Smoke Detectors (not located in bedrooms) _. Carbon Monoxide Detectors Fire Extinguishers - Exits _ Bedrooms 1 3 4 5 6 Smoke Detectors - Egress Occupant Count Building Systems Maintained & Operationalondition of Property Heating Building interior Hot water Building exterior Electrical _ ., cai maintained &safe .Propy . Wean, ma Mechanical Handrails &guards installed &secure Pool Safety Pool on Site Surface water alarm 'Date of CO issuance Door alarms Pool completely enclosed �., „e._... ..._.... �,.._ . Self closing/ latching gates is _ _ Pool fence to code reuiremen CosforalI i ' terns present Prior Rental Comments: