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HomeMy WebLinkAbout1000-126.-7-5.2 TOWN OF SOUTHOLD Kemal Permit 0823 Owner Jordon Doroski & Silvia Duran Occupied as Single Family Dwelling Located at 225 Fifth Street Laurel 126.-7-5.2 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. 2/27/2023 Code Enforcement Official This Notice must be posted by the main entrance at all times c� 6ur Town Hall Annex Telephone(63 1) 165-18022 54375 Main Road - RP - 31 765-9512 P.O.Box 1 179 , 1 g Southold,NY 11971-0959 _ 1 � i `SOWN OF SOUTH&D 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: Tax Ma Number: 1000 SECTION t `4 -BLOCK -LOT - SECTION B. OWNER INFORMATION: r Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: - " 4 Telephone Number (s): Daytime Eveni�jng Emergency Property Owner Email Address: 174 0 6�V 3 C I'� `l C 0 b+�` Page 1 of 5 Town Hail Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Qiz Southold,NY 11971-0959 K ln ou BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number (s): Daytime Evening Emergency Email Address: SECTION F. a 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: 6 Number of rooms in Rental Dwelling Unit: 3 Use and Dimensions of each room in Rental Dwelling Unit: f, d // ' -)C //'6 `' t1—th13 , �, i 3 6,e d j - / 6 ' 3 '6 LoLItr, l �9 Page 3 of 5 4 Town Hall Annex _ 'telephone(631)765-1802 Fax(631)765-9502 54375 Main Road P.O.Box 1 179 Southold,NY 11971-0959 ,Im -, 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•ofthe 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) Tfar. C),a ry 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 k_ `mar Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O. Box 1179 Southold,NY 11971-0959 �£p rel � f 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 j:ode 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: jorile,w Do,irr,bjc�, Property Owner's Signature: e Sworn to before me this; day of �� _ , 20 a� Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.01 BU6185050 Qualified in Suffolk County commission Expires April 14,2 Page 5 of 5 - TOWN OF SOUTHOLD BUILDIN 631-765-1802 INSPI�ECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAI. [ ] FRAMING 1 STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INEE [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (Fit [ ] CODE VIOLATION [ ] PRE CIO [ vrl INSPECTORDATE FICO N iak G ir) � r a CIpdi TOWN OF SOUTHOLD R PET RECORD I OWNER�' � �� J STREET VILLAGE DISTRICT SUB. LOT l ! W , FUER OWNER N. E ACREAGE _.. . 2 ' S W TYPE OF BUILDING �.._._ ..:��._ _... . ..�: w �. RES SEAS, VL. FARMcomm. ISC. Est. Mkt. Value w.._.._. ..LAN.D,,.� .. IMP. .e._ .._..._._.....�. TOTAL DAT_ __._..._._„�....__...._.,......._ ..... �. ...... .�. _..m ...MMM ......_...,_... _._...�..._� ...M__.._._.�._....,,�...,, ...,�...... W . ..........E E REMARKS Lxbcy Ap �7l E' ._.,... ......... f V yf / yI�9,...'"�Nf�,C"7�� d' s^� 7"�, �� � ..�_ .w' ���+��✓(_i 1 AGE BUILDING CONDITION . i� `�(� NEW NORMAL BELOW ABOVE FRONTAGE ON WATER Farm Acre Value Per Acre Value FRONTAGE ON ROAD Tillable 1 BULKHEAD Tillable 2 DOCK Tillable 3 Woodland Swampland Brushland,, 4 ... .. ,. House Plot Tote-1 „ 4 4 u.. r„= I C>(� w f �r , f ...... ,. _ ..,�... .... .. .. ... _. e , Nw, e , s d a � 126.-7-5.2 03/22/2017 .... .... lvl. 61a ' i i=ound.etion °crl Paw ens'ia ri � , d B•-osernent Floors :efor Finish Extension � EXt. 'r^Jails i � ', � lr��" 1 Extension vire Places Heat Porch Drof Type Porcli Rocrns 1st Floor 1 Breezeway Pa,iv <c irls Z:nd Floor Garage Driveway Dormer 0. B La f 5 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No E-22325 Date MAX 13, 1993 THIS CERTIFIES that the building NEW DWELLING Location of Property 225 FIFTH STREET LAUREL,_ N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 126 Block 7 Lot 5.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated. OCTOBER 3, 1979 _ pursuant to which Building Permit No. 1i 2L0427-E dated OCTOBER -5 1979 _ 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 ONE FAMILY DWELLING WITH ATTACHED GARAGE The certificate is issued to WILLIAM F. & RITA STEWART (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 9-SO-94 - JANUARY 28, 1980 UNDERWRITERS CERTIFICATE NO. N-462653 - JANUARY 7, 1980 PLUMBERS CERTIFICATION DATED N/A n Building Inspector Rev. 1/81