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Home My WebLink About1000-103.-3-9 TOWN OF SOUTHOLD DPW rw^ W u Rental Hermit 0804 Owner Kathleen & Thomas Galgano Occupied as Single Family Dwelling Located at 2250 Beebe Drive Cutchogue 103.-3-9 Maximum Permitted Occupancy 4 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. 1/13/2023 a orn oicial This Notice must be posted by the main entrance at all times ,.. Town Hall Annex - Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 C P.O.Box 1179 PC Southold,NY 11971-0959 r1w room-. DEC 0 2022 BUILDING DEPARTMENT UD TOWN OF SOUTHO 0F_ RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: Z4 C 13 Tax Map Number: 1000 SECTION / 03, 07) -BLOCK-03-0V -LOT SECTION B. OWNER INFORMATION: Property Owner Name: e e ;rip l Xe)m Q S Property Owner Legal Address: Property Owner Mailing Address: €w � Telephone Number (s): Daytime Evening ✓ Emergency Property Owner Email Address: CA 0, a AOa Page 1 of 5 � |Y�� 8 || DEC � � 9O99 «��m ' � w''" LD,. T*epm,n*(66!)7�-|8oz l��n�dl�m�^ �� Fax�30�b5�5Vz �4�?�muiv �oxu BURDINGDEPT 9/]. Box |no Yr`wm``~~'' —^'' &ovmuu'wY 1/971-0959 BUILDING BBPARTyNGNT TOW.NL OF SO-0THOLD / Mailing Address ofManaging Agent: Telephone Number/�>� Daytinlev�//. O / �/ Evening Emergency ^� Email Address: .__-��£��` --�---------- SECTION F. PROPERTY DESCRIPTION: � Number of Rental Dwelling Units on propertys For each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier (for example, Unit 1 Unit 2, Unit 3 nrApt 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 ofeach room. Forpropertiesvvithrmu|tip|eRenta| DvveiUnQUnitsuse =Renta| PernoitApp|ioation Addendum." Rental Dwelling Unit Identifier: _ Requested Maximum number ofpersons allowed tooccupy Dwelling un/( Number ofrooms inRental Dwelling Un)t:_____l�______.______-_'_��______-_-__ Use and Dimensions of each room }nRental Dwelling Unit: ' ' kJ Page 3 of 5 } Al Town Hall Annex Telephone(631)765-1802 54375 Main Road �� Fax(631)765-9502 P.O.Box 1179 , Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SO THOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Al 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,® Elergency 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): Page 2 of 5 N: Town Hall Annex' Telephone(631)765-1802 :a 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 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 i-oq,.�- 6— aM9 , 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 a � Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 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: 7�/1'► oto` (;-a l (D(-,'v Property Owner's Signature: Sworn to before me this / day of =`y✓I 20oa ficial Notry Public Signat -and Original Notary Stamp `� KAREN STAFFORD CARNEY NOTARY PUBLIC-STXrE (DF !AEW! YORK No.01CA6383565 Qualified in Nass@<,cc,ugty l\i;y Commission Expires 03-11-2023 Page 5 of 5 so 4447 Y� Df (A J TOWN OF SOUTHOLD BUILDING 631 -765-1802 INSPEC ION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAL [ ] FRAMING / STRAPPING [ j FINAL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INS [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PEI [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (Flb [ 1 CODE VIOLATION [ ] PRE C/O [WF MRK -yov A-1 CSA 904—)b� Lq ) kl_ DATE lffl/VV INSPECT OR - -i Town Hall Annex �� Telephone(631)765-1802 54375 Main Road \ Fax(631)765-9502 P.O.Box 1179 \ \ Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SO [OLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a license architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit rcfessicrrrci seal reacrired for architect ar Fttcsneer„licensed Home inspector must wide cry of valid current ceryacation Rental Property SCTM NuM&V& _ ( . Rental Property Address: Owner/Name: N -0 n Rental Dwelling Unit Identifier: Number&Square footage of each bedroom as depicted in the attached floor plan: i . e root"#1-100 sq., Redrnm#2-90 sq., J Property Description (Include all improvements indicated on survey) ( I certify that I have done a physical inspection of the subject rental dwelling unit and find that it fully complies with all the provisions of the Code of the Town of Southold,the Residential Code of New York State,the Building Code of New York State,the Plulbi of New York State, the Fuel Gas Code of New York State, and the Energy Conservatio "Ccs a on c de,of New York State. 3 Print Name and f itle Original SigA : 7� Please place professional seal: �� _ «' .,f 4v 5c A 4, 4_4 kk 419 .......... do b..., .. -4-4- ............ CD �P L3 Yl 19µYl �re ZD-. . 04 T1UTHOLD PR'OPERTYRECORD CARD .. . . _ ..m,__.__ ., VILLAGE DISTRICT SUB LOT OWNER STREET y .. _ ..w �.........�.. ........ . FORMER OWNER N E ACREAGE 5 W TYPE OF BUILDING /A VL .., ARM COMM..... ...._�..M.�,. ��, RES. SEAS D CB MISC Est. Mkt. Value LAND IMP, TOTAL DATE REMARKS_..x x j� l/1,..., ....... ....,,.._... ..w.w.. ... . 1 ./.�.. .�..W, .�s�' �'"��";J"" �,� .,...��v"��d � .��i �� .,.,.X«^ �_.,. .-� 'd dY..._ �'�, �+`.,,..�� ,r.^^_„�`, *” ...,;�,"�"c'...,�.�✓��d,� � �d /� E !f r .w AGE�..._.� ,� _.._ _ .....__._..._....,IT.� ........._,.___, BUILDING CONDI UILDIGCODI .ION m.. ...� NEW NORMALBELOW .. _ ABOVE B_OVEWATER ... F...RONrvT._A.._�G._E._O..._N._WATER_.... �. ,j jC _............ ..._ Farm _ Acre Value Per Acrem Value FRONTAGE ON ROA Tillable 1 BULKHEAD Tillable 2 j DOCK Tillable 3 Woodland Swampland Brushland House Plot Tota I 9 .._ . .. ..__ .v _µ ...- � a M. Bldg. Foundation , Bath Extens on. ... ._...._...... ...._ � 3 � g Basement Floors _,.._,.,... _ . .,... .. _,,,,,,,...... .. ........._.,.., .., r ..,.,,. .._. ........_ ........ ., _. _,_w .m _ _ _... . ,., Extension Ext. Walls � �Interior Finish Extension Fire Place Heat Porch ! Roof Type . _ Porch ooms 1st Floor . Breezeway Patio ;Rooms 2nd Floor '_... ,,,.... _. ...... Garage i Driveway i Dormer 0. ..B .........__ ......_.... _. ... ._ .._..__ ._..._ .__r._,__.. .. ........ .. ....._ ......... .._ ...,. ..�.....__... . , _.w ... ....,.. _. ..w ....w. _. _.....,. ._... _.._ 1 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. No P L1A NI-S CERTIFICATE OF OCCUPANCY No. ....Vln: ........ Date ---........ QOAIPIW ......?A.. .._.. 19.6.3.... THIS CERTIFIES that the building located at .....................................I... Street Moose cove F-Sto Map No. ...................... Block No. ........?9%...... Lot No. -.15a............ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......I........................�.0.........4U.......... 19-63. pursuant to which Building Permit No. YA.2.134. dated .. .......... ........—jay...........%.......... 19.63.., was issued, and conforms to all of the requirements of the applicable provisions of the low.. The occupancy for which this certificate is issued is ........ Private one famil dwell .............- .......................I.........T........--im...................................................................................... The certificate is issued to Jq!k 08 KankaOmer .................................. ........ ..................... .............. (owner, lessee or tenant) of the aforesaid building. H*D# Approval Oat. 28t 1963 bY Bi- Villa ...............—....... ....... ...... .................... ........... ...... Building 1grJtor