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Home My WebLink About1000-79.-3-14 F TOWN OF' SOUTHOLD y Rental Perm"I 0847 Owner Geoffrey & Cynthia Wells Occupied as Single Family Dwelling Located at 4415 N Bayview Rd Southold 79.-3-14 Maximum Permitted Occupancy 10 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. 4/4/2023 "crd cry err .:n Official__.. This Notice must be posted by the main entrance at all times } Telephone 631 765-1802 Town Hall Annex P P ( ) 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 k LP ._ a BUILDING DEPARTMENT TOWN OF SOUTHOLD �4 LIZ RENTAL PERMIT APPLICATION 7F Rental Permit Fee $200 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: . R; UrL � �� 5�(Tr�o � p Nq f1G? `71 Tax Map Number: 1000 SECTION -BLOCK -LOT-4 --- Z SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: 4 16'0 A%4 Vdie � '-1/-116- N. i A'�-\/ Telephone Number (s): Daytime y6 qIq "&ening Emergency Property Owner Email Address: tj R T C LI �1 •C OWE, Vic -3=4 ' q 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 } 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: .L 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." Rental Dwelling Unit Identifier: Requested Maximum number of persons allowed to occupy Dwelling Unit Number of rooms in Rental Dwelling Unit: 3` Use and Dimensions of each room in Rental Dwelling Unit: I l a ► 3 �kT N 8(?d Page 3 of 5 Town Hall Annex Telephone(631)765-1902 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 CU 0 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. 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) 1 , 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 .r .. as 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 Property Owner's Signature: 347 Sworn to before rye this day of � _j 20s)3 :, Official Notary Public Signature and Original Notary Stamp CONNIE D. BUNCH Notary Public,State of New York No. 01BU6185050 Qualified in Suffolk County Commission Expires April 14, 2 Qa4 Page 5 of 5 ti vl� 500* "v TOWN OF ITHLD BUILDING D 631 -765-1802 410.0m"5 .000 INSPEC ION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ j INSULATIOWCAI [ j FRAMING / STRAPPING [ ] AL [ j FIREPLACE & CHIMNEY [ FIRE SAFETY IN [ ] FIRE RESISTANT CONSTRUCTION [ j FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICALYF [ ] CODE VIOLATION [ j P / [ DATE ��' ? INSPECTOR TOWN N F S T D 1P�� ' � � � M'ARD_.,,... � _' ppV1LLAG . ... .. ._. OWNER STREET.._, ESUBLO DIST o -�-(21/67- -61A FORMER OWNS N E ACR S W TYPE OF BUILDING _..... e__� FARM._ COMM. .�... ._CB. ,;.._,...._MICS. .._,, ,Mkt. Vafuemm:��..:,:w.�.��-��:..,.��_. �� ._....�.._..�.�._..._ .� MMMMM µ RESSEAS. VL. LAND IMP. I TOTAL DATE REMARKS 00 "65 F A r'roi) i _.m_...._ ...... : � i AGE BUILDING CONDITION NEW NORMAL i BELOW ABOVE FARM Acre Value Per Value Acre Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD " Meadowland _ ..........,...�.m,._ _...,_ ..,......._w. . ,..m___��. ._�.,.._,,.._.,..._.......w __�,�.w_.,._.__, .._...��,...,....._..,, DEPTH House House Plot BULKHEAD Total DOCK s Lt 3 Tyr CO OR ,' TRIM o r N � I y a _. o- .J..., ,u �, .......... o- r t { .. . Extension I �:= �~ � ,� -� � r �_ �� ... .._n v.. .. _ Extension M Extension , . _.... ". �.._...., w 3 a G Frsuntat€on Both Dinette .�m Por+ch. Basement � y Floors . Ext Walls Interior Finish ILR. a y w Breezeway Fire Place Heat DR. Garage Tie Roof Roomss I st Floor BR Patio Recreation Room Rooms 2nd Floor FIN. B O B 'Dormer _ ° Driveway Total N ;4`6hf`)i" FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33870 Date: •08/03/09 THIS CERTIFIES that the building NEW DWELLING Location of Property: 4415 N BAYVIEW ROAD SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 79 Block 3 Lot 14 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 3, 2009 pursuant to which Building Permit No. 3775-Z dated AUGUST 3, 2009 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 COVERED ENTRY AND ATTACHED ONE CAR6G_ GE AS APPLIED FOR. The certificate is issued to JOHN H & REBECCA J BECKER (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF E[EALTH 'APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED NIA oe s Au o;ized Signature Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33871 Date: 08/03/09 THIS CERTIFIES that the building DECK ADDITION Location of Property: 4415 NORTH BAYVIEW RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No_ 473889 Section 79 Block 3 Lot 14 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 29, 2009 pursuant to which Building Permit No. 34840-Z dated JULY 81 2009 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 "AS BUILT" DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JOHN H & REBECCA J BECKER (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO_ N/A PLUMBERS CERTIFICATION DATED N/A Aut orized Signature Rev. 1/81 "NIS 41,-"CT $'fT'/N 1;1 E7 1 a I3Eo /n s N ° p RREAwafT. ... aT�, s, ,• ., 'ice"'.'. .�.,. -�r— LEF7 JWd f6fV 117/O/V. rFAONT GAhA 66(lNc)') 'CO'%P° �" t' C'2)2-A{'x4 pasT✓Vcrerr�n. *qi. ,,,,, � � .. � 7 . L E2 AGE ATT'c P400/2 PLSN4e o A N07,; o ' I I �Ro iPf ATTicf ur r FaEE AREAL NTNE fo<4N�ry aver Tl eP Ilei + /NA.N ROaf < S/o/'q.GU Am 2 4-I' / IG11T J/DE ECEVAT/P/Y. ,.., * DATE: ONE FAMILY RESIDENCE PLAN ND..`�'.�.�'r:..`97 REviS1ONS! HERMAN H. YORK ARCHITECT 4oF5 DMWING ND............. 10 l{ f . ,... _.,.. r - .... _. ----- ..._._ .. .. Jl— I ,....... '."� w',f— L'3 /M,::' ,.. rol f 12 - 13er� >r m.IV / .�3 /r�a2 �.� 4 �`•�l�ecavc q� '+. a �0 ._ ,y + u G r, °:ry �. � pyo --tYYYYY , n opli I I rrr z< I 0 1. 114 -6 I _ ,W,., r,...... ��r~� 5 a i✓ � u.�a�.r `y ��h N �'��. 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" I .� r� u.<G coor,Na S/zer wrtE Ar faG.o,uJ: /!a'..8"e.,vz,e,u. ,P, P 9 ro ' G_'EGLAR„�ENIkANCE OATS: ONE FAMILY RE51IpENCE V REvIvoNs: HERMAN H. YORK ARCHITUCT F0611YO,4710 PCAN. . G 4444,(N.S,J ,..