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Home My WebLink About1000-144.-1-11 fat TOWN OF SOUTHOLD g �s 5UZ -£ Rental Permit 4 0830 Owner George Maltese Occupied as Single Family Dwelling Located at 1790 Sigsbee Road Laurel 144.4-11 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. 3/13/2023 d of ce ent Official This Notice must be posted by the main entrance at all times to (949 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 � .W Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200(Application must be renewed every two years) Section A. Property Information: Rental Pro erty Address: 7 Tax Map Number: 1000 SECTION , 1*4 _- LOCK___J--LOT_ --_ SECTION B. 0 OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: VS0 Telephone Number (s): Clayti e Evening„ Emergency ,t ,_ Property Owner Email Address: O ° Page 1 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax (631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 ` 'com, BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number (s): Daytime EveningEmergency Email Address: SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: _ For each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier(for example, Unit 1, Unit 2, Unit 3 or Apt A, B, C); the use of each room in the Rental Dwelling Unit (for example, Kitchen, Bedroom 1, Bedroom 2, Living Room) and the dirhensions of each room. For properties with multiple Rental Dwelling Units use "Rental Permit Application Addendum." Rental Dwelling Unit Identifier: Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: ` . Use and Dimensions of each room in Rental Dwellin Unit: ft S� I��. " Page 3 of 5 " r4f50�j�, Town Hall Annex Act Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD SECTION G. INSPECTION: Pursuant to the Town Code of the Town of Southold Chapter 207 (Rental Properties), a safety inspection by Code Enforcement Official is required. If the owner chooses not to have said inspection performed by the Town, a certification from a licensed architect, a licensed professional engineer or a home inspector who has a valid New York State Uniform Fire Prevention Building Code Certification is required stating thy$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 regulation's of the County of Suffolk and by the laws adopted by the New York State Fire Prevention and Building Code Council. V/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) l rtify 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 4of5 . n o Town Hall Annex Telephone(631)765-1802 54375 Main Road ir Fax(631)765-9502 P.O.Box 1 179 402 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: Q�r "`' Property Owner's Signature: Sworn to before me this y of , 209— Official Notary Public r na ure and Original Notary Stamp PAUItjA-,", "f 1 1 Notary Pu 1 d t46#1 t*N°of*Wy rk otlttOlk Count�aom rl( t 1 y 04, 0 Page 5 of 5 Q sout ' Town Hall Annex 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 RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: o *2- Z Nky 1 `1 Rental Dwelling Unit Identifier: k Requested maximum number of persons allowed to occupy ea�ch,dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to py each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: tv so 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 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 Pro essional seat reguired for Architect or Engineer,llcenl ed Home fns ector mustoro copy of valid current card cation Rental Property SCTM Number: t q °' I"" — Rental Property Ades: 1 Owner/Name: Fr LT — Rental Dwelling Unit Identifier: Number& Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 —100 sq., Bedroom #2-90 sq., etc.) ll 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 Plumbing Code of New York State, the Fuel Gas Code of New York State, and the Energy Conservation Construction Code of New York State. Print Name and Title Original Signature Please place professional seal: 640&/ , , 0 4 A , 'e," TOWN OF OUTHOLD BUILDING T1 631-765-1802 INSPEC ION [ ] FOUNDATION 1 ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATIOWCAL [ ] FRAMING STRAPPING [ ] INAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INc [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PEI [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI [ ] CODE "I L TION [ ] PRE C " [ REMARKS: 0 VAW ............ 9 M&A . ......... IN 1 % DATE 3 Po al W 00 00 00 V W !9 NUUNTAQI REAR AOWRON _=g4===4=====3;=..=..—. -------------------- 9 i � I co aIX2WWRWM fX2SWWVQW EL2SWWROM EL2=VrMW E L U :3 m i3Af Al i K 1 `t}. 634- I Q It ROOF RAFrERST X fr A l(r 0 r L7 6iR O M i to -6 B41 CLG HT m to 0 BEDRO HT:_- LU -08 P CG.HT. IlLsw 17 1 FMA NE i DaSTING OOOfl$€ � � TO EtE REMOYE� � t � EX STING WAU r I i ®oa CL. G.G MORTORMOVAL . EJOSI�NG AIOGE fat D�T1NG AIOGE Exi871NGRIDGE _ om ` k3 OWNG TORE '� ( 100 s 00 ifi• ' yo 9 _ z-xa WOE LIVING ROAM ' CIJ JolS #r KITCHEN �. V-O*Ma�. : � { € lr4r LL 21 - N a # o t a r } f € , C O EXISTING FIRST FLOOR PLAN V4'- VIP F- LCD = W 1 w co 00 So W �n rD . � e BEDROOM nr � ; s CL _ . 8 # UNFllN.C� Q !I CRACE 0 _ ROOV lqtrHEN + 3 EXISTING FOUNDATION Fl4Ofl PLAN E[' TI€G FIRST FLOOR PLAN , . I CD I I < _ a Ex1ST1NG HEAR ELEVATION t(STGWrSID €l. dATIO# e TZ-1 3 I; W TOWN OF SOUTHOLD PROPERTY RECON OWNER , STREET VILLAGE DIST. -fSUB� LOT FORMER OWNER N —E ACR. S W TYPE OF BUILDING RES, - SEAS. VL. =FARM =COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS r m v € }' Av l � AGE BUILDING CONDITION = NRE,11 NORMAL BELOW ABOVE - i IFAiM_��AceV alue Per Value Acre Tillable l Tillable 2 E Tillable 3 Woodland I Swampland FRONTAGE ON WATER FRONTAGE ON ROAD = �� Brushland � � `-- House Plot DEPTH ;BULKHEAD Total DOCK x� { s c i t os F a a l t 1 S f l i M s 1 s 144.4-11 10/04/2017 M. Bd z x ,Faun anon Both Dinette _ g i tenni � ; --- � sement xv_ Floors K. Extension : !Ex'-. Walls LR- Interior Finish :€ I Extension Fire Place Heat P_ Type Roof l Rooms 1st Floor BR. _ Porch 'Recreation Roorr Rooms 2nd Floor, F3i B _ - - Porch Ljc) Bree e o 3 . C)r€veway � E Garage i ^ Patio i t l = ' - � P--A Total I