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Home My WebLink About1000-18.-2-35 TOWN OF SOUTHOLD 4 Rental Permit } 0840 Owner Pierre Paulden & Imogen Rose-Smith Occupied as Single Family Dwelling Located at 24775 Route 25 Orient 18.-2-35 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. 3/23/2023 e c enOcial This Notice must be posted by the main entrance at all times Telephone(631)765-1802 Town Hall Annex �'� ��r� �{ 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 Ju� BUILDING DEPARTMENT FEB 2 4 2023 YAWN OF S+LI!°O°HOLD BUWNG DEPT TOWN O SCi ` 0 : RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION ---BLOCK— 2— SECTION B. OWNER INFORMATION: Property Owner Name, . l -a'q" AS,. . oS"rf Property Owner Legal Address: Property Owner Mailing Address: 5�5 N Cul, Telephone Number(s): Daytime f'�L P;537EvenindO65-�*7 Emergency (? `foS33��f Property Owner Email Address: I M-6 �^�� dk "�L Cev,,, recd 103�4 Page 2 of 5 1 Town Hall Annex j Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 f5 �b ami, d P.O.Box 1179C1111", I Southold.NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: .,,......... . _ .. .. ,µ„,,.., . . ..._...� � Telephone Number(s):Daytime Evening Emergency EmailAddress: nn_......._..�_....__. _ .-.----..... ..,w. 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 dimensions of each room. For properties with multiple Rental Dwelling Units use "Rental Permit Application Addendum,” 24775 Main Rd., Orient, NY 11957 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: 1h Vt\W4✓h ,55/6... I2' 3 '�lcF.'.r. I. s/�. �` l3• y X3. C r 7c W`i'lt Page 3 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 ` BUILDING DEPARTMENT TOUN 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 ❑ 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) Si...... M , 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 w � p r Town Ball Annex 0' ��`/1 Telephone(631)765-1802 54375 Main Road �� Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 , NT 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:, *0 t ,. _ SMt Property Owner's Signature: .. - Sworn to befor sjaf 20_Z3 cial Notar Pu �.�Offi y _ iginal Notary Stamp SANDRA V. SAIEGH NOTARY PUBLIC-STATE OF NEW YORK No.02SA6407223 Qualified in Suffolk County AAy Commission Expires 05-113-2024 Page 5 of 5 Dy t TOWN OF SOUTHOLD BUILDING DI m ' 631 -765-1802 INSPEC ION [ ] FOUNDATION IST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INS LATION/CAL [ ] FRAMING / STRAPPING [ ] AT ] FIREPLACE & CHIMNEY [ FIRE SAFETY IN* [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PEI [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL ( I [ ] CODE VIOLATION [ ] PRE C/O [ S: c � w. DATE JA ANSPECTOR 24775 Main Rd ':an.rt,Nr nasr g — zr t EXISTING �- � g .. CONDITIONS �i � .F� ueu<te,r7�rwe, TC YORAecuHe I Fxbtln@A,@ulnQNk'u:7 Intl €'- MUI Rniak Am Sd,ed•m{Gnus 8u• 4}. Existing First Floor Plan e EC 24775 Main Rd I, -� onent er ne6l _ 41. EXISTING CONDITIONS a�� ( Tw.MwtAaiveb e � ( N ye^ v �m�swear 1 area swmw I�oee eemew) _ - Existing Second Floor Plan amrmar ..... ,,,•„•� EX03 .�..n ey.EC 24775 Main Rd on.n,Yv nesr u� EXISTING CONDITIONS ff --$ _ Mb0Wghgmm9tivumm - 1M YM Attu�b ,i [Ytlnoc='14 �BumY��nd ■ Ss wyr.rr�r++...rer�r. 2wbbn 6d"" Existing Basment ^� 0 Floor Plan erz M w ey EC t Town of Southold 3/1/2017 53095 Main Rd Southold,New York 11971 PRE EXISTING CERTIFICATE OF OCCUPANCY No: 38849 Date: 3/1/2017 THIS CERTIFIES that the structure(s)located at: 24775 Route 25,Orient SCTM#: 473889 Sec/Block/Lot: 18.-2-35 Subdivision: Filed Map No. Lot No. conforms substantially to the requirements for a built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 38849 dated 3/1/2017 was issued and conforms to all the requriements of the applicable provisions of the law. The occupancy for which this certificate is issued is: Ab._.._fin a oilywelwlimitch t log d, qr } axa , m—Qj raM.. Note:BP 41377 alterations COZ-38848 The certificate is issued to Wysocki,Helen (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. ft .. . . ...� .... ��'www.....�........._�_........ A - d Si e BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 24775 Route 25,Orient SUFF.CO.TAX MAP NO.: 18.-2-35 SUBDIVISION: ___..... __.w...........................� NAME OF OWNER(S): Wysocki,Helen OCCUPANCY: ADMITTED BY: Edward Wysocki SOURCE OF REQUEST: Wysocki,Helen DATE: 3/1/2017 DWELLING: #STORIES: 2 #EXITS: 3 FOUNDATION: concrete block CELLAR full CRAWL SPACE: BATHROOM(S): 1 TOILET ROOM(S): 1 UTILITY ROOM(S): PORCH TYPE: enclosed DECK TYPE: _PATIO TYPE: BREEZEWAY: FIREPLACE: no GARAGE: DOMESTIC HOTWAT :R: x TYPE HEATER: see BP 41377 AIR CONDITIONING: TYPE HEAT: ,WARM AIR: forced air_ HOT WATER: #BEDROOMS: 4 #KITCHENS:..............................._. .M.M..M.M.........._ �w.....w w_._._. I BASEMENT TYPE: unfinished _._............ _wwwwwwwwww wwww........_wwwww�. OTHER: ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: wood frame STORAGE,TYPE OF CONST: SWIMMING POOL: GUEST,TYPE OF CONST: OTHER: VIOLATIONS: REMARKS: INSPECTED BY: JOHNJ DATE OF INSPECTION: 2/28/2017 TIME START: 2:36pm END: 3:10pm Town of Southold 3/1/2017 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 38848 Date: 3/1/2017 THIS CERTIFIES that the building ALTERATION Location of Property: 24775 Route 25, Orient SCTM#: 473889 See/Block/Lot: 18.-2-35 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 2/16/2017 pursuant to which Building Permit No. 41377 dated 2/22/2017 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: alternans chicon water heater Curnac to a oefanul�cllin>as Elie —for. The certificate is issued to Wysocki,Helen of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 41377 2/23/2017 PLUMBERS CERTIFICATION DATED ... m..H. Signature _ - > -71.31 1 aO 18 • SOWN OF SOUTHOLD PROPERTY kmltu %;Axo 775 OWNER Rf VILLAGE DIST. SUB. LOT e, FOi „ &ER OWN ER & N.Wy4�tC�� , --E - ACR a S W l TYPE OF BUILDING w. RAS SEAS, YL. FARM „COMM. CB. MISC. Mkt. Value g LAND IMP, TOTAL DATE REMARKS - � _ -_�z.,. �, --- 3 i . _ - 120 = -.2 _ AGE BUILDING CONDITION NEW NORMAL i BELO W ABOVE FARM Acre Value Per - Value Acre Tillable 1 Tillable 2 Tillable 3 E Woodland FRONTAGE ON WAT SwamplandER } FRONTAGE ON ROAD '= Brushland DEPTH House Plot ,BULKHEAD DOCK Total I - COLOR r I - .TRIM g 18.2-35 6/11 M. Bldg : Foundation - - Bath Dinette a _ - Etersan Basement Floors F � Interior � F L RExt Walls Extension g- � Extension Fire Place Heat DR. Type Roof Roams 1st Floor BR Porch ! Recreation ROOD Reams 2nd Flaw FIS BJ Porch r - - Drme Breezewa Y Driveway a - Gar age Patio t - O. B. - Total \IRS \ \ ` Is Nq am $ \IN \\\ \\ t CA _y al f f sAl NINE \ e �yvyy�y y_ gr\ \m \\ Al \\ \\ 2 �-'' d . e� \ � V \\ �\ a ol OW IN \\ \ \\\\ \ IQ A �