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
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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
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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
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`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
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TOWN OF SOUTHOLD R PET RECORD
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OWNER�' � �� J STREET VILLAGE DISTRICT SUB. LOT
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FUER OWNER N. E ACREAGE _.. .
2 '
S W TYPE OF BUILDING
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RES SEAS, VL. FARMcomm. ISC. Est. Mkt. Value
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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
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Paw ens'ia ri � , d B•-osernent Floors
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Extension � EXt. 'r^Jails i � ', � lr��"
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Extension vire Places Heat
Porch Drof Type
Porcli Rocrns 1st Floor 1
Breezeway Pa,iv <c irls Z:nd Floor
Garage Driveway Dormer
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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