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Home My WebLink About1000-55.-2-15 ;4 TOWN OF SOUTHOLD ., Rental Permit 0826 Owner Palooka 4000 LLC Occupied as Single Family Dwelling Located at 4000 Youngs Avenue Southold 55.-2-15 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. 3/6/2023 Code Enfor e n o ►ca 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 Ac P.O.Box 1179 Southold,NY 11971-0959 �w �2 uv/LIC5 BUILDING DEPARTMENT TOWN OF SOUTHOLD . a RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two W)i 017 SOU"TrVOP—) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION -BLOCK -LOT - SECTION B. OWNER INFORMATION: Property Owner Name: �0®0 Property Owner Legal Address: Property Owner Mailing Address: i45- Telephone Number (s): Daytime -� Evening J Emergency Property Owner Email Address: S. i '` i-C LA I Q-GnhL)--cap,\ C Page 1 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road ��i Fax(631)765-9502 P.O.Box 1179 �a Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD 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 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 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 °,rc� AWA Town Hall Annex „ Telephone(631)765-1802 54375 Main Road �a � fr �} Fax (631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 �4rJ 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: Use and Dimensions of each room in Rental Dwelling Unit: .,..RJ • 1H - I L "15 Page 3 of 5 Town Hall AnnexTelephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 %M1k i Southold,NY 11971-0959 2 m � 41 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. I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ I 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 OFA FIF t. 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 .v C � d0^ 'v Town Hall Annex Telephone(631)765-1802 54375 Main Road r 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: oo, Property Owner's Signature: Sworn to before me this ay of20 Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No,01 BU6185050 Qualified in Suffolk County Commissim Expires A pM 14, 2,044 Page 5 of 5 TOWN OF SOUTHOLD BUILDING DI 631 -765-1802 INSPECTION Z FOUNDATION 1ST [ ] ROUGH PI-13G. FOUNDATION 2ND [ ] INSULATION/CAL FRAMING / STRAPPING [ ] FINAL [ FIREPLACE & CHIMNEY [ ] FIRE SAFETY INE [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PEN ELECTRICAL (ROUGH) [ ] ELECTRICAL (Fit ] CODE VIOLATION [ PRE C/O REMARKS: oil OC16 u 1:24 DATE , T TT � Town Hall Annex SOUTHOLD TOWN 54375 Main Road Po Box 1179 Southold, Rental Inspection NY 11971-1179 a Tel: 631-765-1802 Fax 631-765-9502 SCTM # Date r'. - i♦` r�- Owner Phone :Ad:dresS Zip Inspector P0 City . LEVELS SUB 1 2 3 Smoke Detectors (#-bedroom detectors excluded) Carbon Monoxide Detectors (#) Fire Extinguishers (#) Exits (#) BEDROOMS 1 2 3 4 Smoke Detector Alarms (#) _, Carbon Monoxide Alarms -- Egress (windows) (Y/N) BUILDING SYSTEMS Y/N CONDITION OF PROPERTY Y/N Heatisl s stern maintained/operational Building Interior is clean /maintained Hot waters stern maintainedlo erational Building Exterior is clean /maintained Electricals stem maintained/o erationa! Property is clean (safe!maintained Mechanical system maintained/o erational Handrails & guards present COMMENTS: Rental Inspection Form 417/2021 � e OF SOUTHPROPERTY RECORD CAI - OWNER :STREET VILLAGE DIST SUB. LOT — I FORMER OWNER ' N } E - _ I } S I W TYPE OF BUILDING z_ t .-4 3 RES SEAS, VL FARM COMM CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS i x y 3 � s tea- `! t x I E i S x - -aT r 3 j AGE BUILDING CONDITION _ NEW NORMAL BELOW ABOVE FARM Acre Value Per Value i Ac re I Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD 3 Meadowland DEPTH House Plot BULKHEAD { DOCK I Tota I I i IC, - z s � TRII e t t s I - - — 1 e E I i Extension - a Extension Extension .�� Foundation Porch Easement Floors I<. Porch :Ext. Walls :Interior Finish Breezeway Fire Place � FHeat DP, Garage TY-e Roof � Roorns ist Floor �r , Patio P.ecrection loom ' Roams-lid Floor = u ' 0. B. Dom-mer Driveway Total t THE EXISTENCE OF RIGHTS OF WAY UNAUTHORIZED ALTERATION OR ADDITION DRAWN MM CHECKED MM DAff OCT,2022 DRAWING k J08 N0.22-746 AN EASEMENTS OF RECORD IF TO THIS SURVEY IS A VIOLATION OF """"A_._....____�_ ........� ....____.. ANY. N07 SHOWN ARE NOT SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. GUARANTEED. COPIES OF THIS SURVEY MAP NOT BEARING L OR Area= 9,133 sJ. Premises known as: THE SEAL SHALL LAND SURVEYOR'S INOT BEECONSIDERED TO BE A VALID TRUE COPY. # 4000 Youngs Avenue, Southold GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTI— TUTION. GUARANTEES ARE NOT TRANSFERABLE. �f TA%LOT 14 OpGEN NOW OR FORMFENLy N79'47'OOxE 145.00' x `r x �,ience swat' .... a ~asphalt r �; °siaaN.ad ` Mcliimme>' 8.b fence `�l stoty water toot tea` meter tank p 0' �.y rJ, lreeµrow canlarM1lna---.—''—� 47'W'* --chain link ience CD `0� s 0.6S 145.00' To LOT 1s NO'N OR FORMERLY NOUSN£R O tP North Road (Middle Road) C.R. 48 N&0 Certified to: Survey of Described Property MICHAEL SIRICO situate at Southold Town of Southold Michael W. Minto, L.S.P.C. Suffolk County, New York LICENSED PROFESSIONAL LAND SURVEYOR NEW YORK STATE LICENSE NUMBER 050871 District 1000 Section 55 Block 2 Lot 15 87 Woodview Lane Scale 1"= 30' Surveyed October 29, 2022 Centereach, N.Y. 11720 GRAPHIC SCALE PHONE/FAX: (631) 580-1202 CELLULAR: (631) 766-9714 30 a is 30 so tenV1, EMAIL: rnikemintolspcOgmail.com ( IN FEET ) 1 inch = 30 ft. -00. DICING BEDROOM BL-oom FOYER WING SUN LA= ClVESTIBULE OM SECOND FLOOR PLAN r"`- FIRST FLOOR PLAN NJ.MAZZAFERRO,P.E. PROFESSIONAL ENGINEER P.O.BOX 57,GREENPORT NY,11944 f 'N� FLOOR PLANS SHEET NO: 4000 YOUNGS AVE SOUTHOLD.NY 11971 A-1