HomeMy WebLinkAbout1000-78.-8-10 so 291M"WN OF SOUTHOLD
Rental Permit
0833
Owner: 150 GCL LLC
Occupied as: Single Family Dwelling
Located at: 150 Goose Creek Lane Ext Southold 78.-8-10
Maximum Permitted Occupancy: 8
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.
Issued: 05/08/2025
Expiration: 05/08/2027 bode iUforceme1nt "a'
This Notice must be posted by the main entrance at all times
TOWN OF SOUTHOLD BUILDING DEPT.
` .� 631-765-1802
INSPECTION
[ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI AL)
[ ] CODE VIOLATION [ ] PRE C/O [ RENTAL
2er 7 e
(�41elz ens-
DATE INSPECTOR
Town Hall Annex
Town of Southold 54375 Main Road
Rental Inspection Report PO Box 1179
rll� ill
Southold, NY 11971-1179
NVI
Tel: 631-765-1802
SUM # — Date O a
Owner Phone
Address ,v 6 Visible
Hamlet y Inspector
Floor Level Quantities Sub 1 2 3
Smoke Detectors(not located in bedrooms) r I
Carbon Monoxide Detectors r
Fire Extinguishers
Exits
Bedrooms 12 3 4 5 6
Smoke Detectors
Egress
Occupant Count A.
Building Systems Maintained &Operational Condition of Property
Heating Building interior
Hot water Building exterior
Electrical Property clean, maintained&safe
Mechanical Handrails&guards installed&secure
Pool Safety Pool on Site
Surface water alarm Date of CO issuance
Door alarms Pool completely enclosed
Self closing/latching gates Pool fence to code requirements
CO's for all items present Prior Rental 33 ?
Comments:
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TOWN OF SOUTHOLD
g
Rental Permit
0833
Owner 150 GCL, LLC
Occupied as Single Family Dwelling
Located at 150 Goose Creek Ln Ext Southold 78.-8-10
Maximum Permitted Occupancy 8
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 Q� a%wy 0
ode Ent rc t fficial
This Notice must be posted by the main entrance at all times ( )
Val
Town Hall Annex F Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-09594
BUILDING DEPARTMENT
TOWN OF SOUTHOLD "," "
�.p fi
RENTAL PERMIT APPLICATION
Rental Permit Fee$200(Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address: �t t
Tax Map Number: 1000 SECTION F/g -BLOCK 0 -LOT
8
SECTION B.
a
OWNER INFORMATION:
Property Owner Name: l �=�L L L �-
Property Owner Legal Address: Property Owner Mailing Address:
� zo 0a,x.. /
/:(,.
Telephone Number (s): Daytime ���� Evening Emergency .
Property Owner Email Address:
Page 1 of 5 '
�olltj4
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
4
Southold,NY 11971-0959
w 2nr;W"
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
r
f SOUP,
Town Hall Annex ' , Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1 179
Southold,NY 1 1 97 1-0959
rou
zz X°
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:
I,Iv . 1200`✓I l9,& X 1 '7 Be t
r]( i1 64 3 /3. Ll X / Z • I
t y - L604�-tE U'�-
Page 3 of 5
J 5
,�� w
Town Hall Annex w Telephone(631)765-1802
54375 Main Road N � Fax(631)765-9502
P.O.Box 1179
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 th6 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 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 O FOLK
1 certify under penalty of perjury,the following:
�w
1. 1 am the owner o�thep rty 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
Town Hall Annex , Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 �4
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, Manag ng Agent, or Site Manager.
Property Owner's Name:
Property Owner's Signature:
let tiome is da of 20Sworn to � y
O tAN FRANiiCE
f Public Signature and Orig1aa15Na& tamp
Qualified in Suffolk County
My Commission E zPites September 09,20 Z�
Page 5 of 5
a ,
TOW'N OF SOUTHOLD BUILDING I
� W 631 E6r5r 18 2
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PL13G.
[ ] FOUNDATION 2ND [ ] INSULATION/CAL
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN.
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE'
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII`
[ ] CODE VIOLATION [ ] PRE C/OL4 F
REMARKS:
k
DATE
0 xl�l INSPECTOR
TOWN F SOUTHOLD PROPERTY RECOF
W�
F STREET i VILLAGE DISTRICT SUB. [ LOT
}
1ER OWNER N E ACREAGE
a 3 -
S W TYPE OF BUILDING
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RES= _ SEAS. VL. 1 FARM COMM. IND. CB. MISC. Est. Mkt. Va[u -
LAND IMP, TOTAL DATE REMARKS
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AGE BUILDING CONDITION `S _
NEW NORMAL BELOW ABOVE FRONTAGE ON WATER ,
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Farm i Acre Value Per Acre i Value FRONTAGE ON ROAD
l
1- - -
_ -
BULKHEAD
Tillable 2 Zl ?
Tillable 3 1 l i
Woodland i
Swampland I
Brushland I
House Plot
Tota
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ARE,
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K Bicg. tl Foundation B at h
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Extension Basement Floors
Extension Ext. Walls Interior Finish
Extension i Fire Place Heat
Porch : Roof Type
Porch Rooms 1 st Floor
Breezeway Patio Rooms 2nd Floor
Driveway Dormer
O. BF
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: 2-26570 Date: 07/20/99
THIS CERTIFIES that the building NEW DWELLING
Location of Property: 150 GOOSE CREEK 'LA EXT SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
county Tax Map No. 47889 Section 78 Block 8 Lot 10
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed In this office dated APRIL. 9, 1998 pursuant to which
Building Permit No. 24864-Z dated MAY 11 1998
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 WOOD DECK AS APPLIED FOR.
The certificate is issued to JOHN G KENDALL
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL RIO-97-0113 07/08/99
ELECTRICAL CERTIFICATE NO. 94625 06/ 0/99
PLUMBERS CERTIFICATION DATED 06/17/99 GERARD STEWART PLUMBING
Building Inspector
Rev. 1/81
I
FORM No. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-26571 Date: 07/20/99
THIS CERTIFIES that the building ACCESSORY BARN
Location of Property: 150 GOOSE CREEK LA EXT SOUTHOLD
(HOUSE NO. ) (STREET)
County Tax Map No. 473889 Section 78 Block 8 Lot 10
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 9� 1998 pursuant to which
Building Permit No. 24865-Z dated MAY 11 1998
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 ACCESSORY AGRICULTURAL STORAGE BARN AS APPLIED FOR.
The certificate is issued to JOHN G KENDALL
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. NO ELEC* 07/20/99
PLUMBERS CERTIFICATION DATED N/A
*NO ELECTRIC IN ACCESSORY BARN AT S TIME.
Building infector
Rev. ]/81
1t, Town of Southold 2/17/2023
P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 43862 Date: 2/17/2023
THIS CERTIFIES that the building ADDITION/ALTERATION
Location of Property: 150 Goose Creek Lane Ext., Southold
SCTM#: 473889 Sec/Block/Lot: 78:8-10
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
5/27/2022 pursuant to which Building Permit No. 48020 dated 6/29/2022
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:
d ifigg Rd r4ti_�ala _.sr1 m1d ► c vpreel, r r nth ggutraL irwco ditLonin kit jl n Ltd k thr opa Frei tion and
fn sl ed_C sgmeilt with reecre tion LggLip,b tea qQj aLi vet rya Jcitch!;a to q xi tin irk at il�dN y llin a
p!:ed for.
The certificate is issued to Kendall,Beverly
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 48020 12/14/2022
PLUMBERS CERTIFICATION DATED 2/13/2023 'ar ratan PI r bing
....... . _ .. nth r..�d Signature ........... .._�...
SUET (
Town of Southold 2/13/2023
;i P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 43848 Date: 2/13/2023
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 150 Goose Creek Lane Ext, Southold
SCTM#: 473889 Sec/Block/Lot: 78.-8-10
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
2/13/2023 _ pursuant to which Building Permit No. �48902 _ dated 2/13/2023
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:
eleeftic�for accessory barn.
The certificate is issued to Kendall,Beverly
Q
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 48902 12/14/2022
PLUMBERS CERTIFICATION DATED
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