Loading...
HomeMy WebLinkAbout1000-17.-1-9.2 �- Fj � }} TOWN OF S UTH LD Rental Permit 0861 Owner Sharman Family Trust Occupied as Single Family Dwelling Located at 283 Stephensons Rd. Orient 17.-1-9.2 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. 4/17/2023 rr)m t icial 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 P.O.Box 1179 0 (Z'S Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION % Rental Permit Fee $200(App/i of! s �"d every\tto yeors) i ly y 1 Section A. Property Information: �al Property Address: / Rent s "'��"' °�,�,".r � /",� •� � �., "' ' Tax Map Number: 1000 SECTION Z4� Z 1 " '1-4I LOCK -LOT -� SECTION B. _ OWNER INFORMATION( T,,a�K Property Owner Name: , ... �� Property Owner Legal Address: Property Owner Mailing Address: - � 67 �3�3 36 ro Telephone Number (s): Daytime Evening EmwV.1FVv Property Owner Email Address: - c Page 1 of 5 Town Hall Annex �° ax Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 pig wr �� X Southold,NY 11971-0959 , BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: jcc e14- Address of Authorized Agent (no P.O. Boxes): Mailing Address of Authorized Agent: � , , � 6 36 e' ' -1 4, 631-If-7 7 001-,3- Telephone Number(s): Daytime Evening Emergency Ce- T 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: <�I ell,- 6?31 Telephone Number(s): Daytime,-g _ Evening Emergency 371r 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 Town Hall Annex „°, Telephone(631)765-1802 .54375 Main Road �� �s Fax(631)765-9502 P.O.Box 1179 Southold,NY 1 1 971-0959 $) v 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, 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 Identifie 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: ` e, 3 a"F11-2 e w��0 Pe1W Page 3 of 5 Town Hall Annex m C Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 w � Southold,NY 11971-0959 . 5rwu 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 ❑ 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 a towner of the dwellln STATE OF NEW YORK) ) COUNTY OF SUFFOLK) 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 w Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1]79 t �w o Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SSOUTHOL D 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: Sworn to before me this_day of 20_ Official Notary Public Signature and Original Notary Stamp Page 5 of 5 CA:LIFO .NIA JURAT CERTIFICATE A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California County of Orange Subscribed and sworn to (or affirmed) before me on this day of w , 2022 by _ �to C � !L __. ���C�� �provee on the basis of satisfactory evidence to be the person who appeared before me. Signature KEVIN J iNT � SC886 1I - FO ORNa CAXRM W Term . 3t, ADDITIONAL INFORMATION (OPTIONAL) DESCRIPTION OF THE NOTARY PUBLIC ATTACHED DOCUMENT CONTACT INFORMATION The UPS Store (Title or description ofattached document) 668 N coast Hwy Laguna Beach,CA 92651 (Title or description ofattached document continued) 949-494-4420 tel Number dpages Document Date 949-494-9850 fax store0120 20@theupsstore.com (Additional information) www.TheUPSStore.com/0120 SMOKE AND CARBON MONOXIDE PROTECTION 283 Stephenson Rd Sharman 7/27/2022 Codes used: "S" (Smoke)" "S/C" (Smoke+Carbon Monoxide detectors) "N" (No Requirements) "R-S" Require a smoke detector "R-S/C" Require a smoke detector with Carbon Monoxide detector Battery operated alarms are Warrantee for 10 years. What is What is. Installed Battery or Newly Locations Required Pre 2022 Hard wired Installed Lower Level Cellar Stairs Down N S/C Battery Basement Level S/C N Battery S/C installed 6/2022 First Floor Stare-way Up. N N Battery S installed 6/2022 BR#1 S S/C Battery BR#2 S S/C Battery BR#3 S S/C Battery Hall Front S/C S/C Battery Hall Back S/C N Battery S/C installed 6/2022 Attic Storage Area#1 S/C S/C. Hard Wired Storage Area#2 S/C S/C. Hard Wired Storage Area#3 S N Battery S installed 6/2022 Storage Area#4 S N Battery S installed 6/2022 Hall Front S/C N Battery S/C installed 6/2022 Hall Middle. S/C N Battery S/C installed 6/2022 Hall Back S/C S/C Hard Wired PD w �r � , —N d- _ ( tie !r' / E _ s j jTIN \ , if i cl tl�0 , PIZ . Gt -' •� ITY Clef(- k , 7 . . E Moo t V(�' *ME '. . �s a . Vr } rx� re IN p � f 6 x 117 �cvA x tz I' P t�f1 • �, to � r �c��?� �� �_7 ������ ���` Srx� fs t� r.4- acs[ ©EBF c3 7siviat4ox,� eof Viet tx:kld lS sfe-sp r D) ri Oc � v. .� TOWN OF SOUTHOILD Arm C N1µ �� pi�� �.A NryVppp JF V 11 M1 P o- h p terr r, ✓ % fi ' Wi //! iii i "KI/11, ' "a r �+ ria v /%� r LL- J F r M ' Q 4I d 4; gµ � A UJ LLI 1 ^%r tri 5 n l z z 0 0l W ul d ; " w l7 i7 LU l I ., fyyli z z i„r ka J rJ 0. � m a c w L� C7 u . u Q m C1 � r . ....q ., ... .. LO j tf w ` > cn p z , LLa C3 w t r r” s u ' �,Nzl m > tjj / � r '" �a LU r— cv 9G /j /°J lu 2ill �1 i]. :,,.�' J 711 j 1 L11 LU _ 4J�r Z _ ^' n � �, r�,. . an 0 „ y t Y a co gg �� .. LL I I yam, wrwu,u 4c Y � a wm wro 4MD J Al LL Y V ❑ LA In 4 S f J a r 1 N i o t F z y b 2 E ul ",•" ❑ CO C i f s J Alt, ti rrW ti z 6 uj /r r% µ Town of Southold 4/17/2023 " 11ff84,11& 53095 Main Rd Southold,New York 11971 PRE EXIS'T'ING CERTIFICATE OF OCCUPANCY No: 44016 Date: 4/17/2023 THIS CERTIFIES that the structure(s)located at: 283 Stephensons Rd,Orient SCTM#: 473889 Sec/Block/Lot: 17.-1-9.2 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- 44016 dated 4/17/2023 was issued and conforms to all the requriements of the applicable provisions of the law. The occupancy for which this certificate is issued is: wood frame single laip ly dyyw l ng w tlx r shed sltt and Agg u,nd rr,t Thecertificate is issued to Sharman Family Trust.......�,_u_._..,,.,._..�................. _v._.�....W.._._._......._.w._._,....�..................._.......rv._.....�.�_µ___.._....�.,........ ............_...... (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. ,._... a i�c�.. _w..........w_.....mw_...�. iz Signature BUILDING DEPARTMENT TOWN OF SOUTHOLD IIOUSING CODE INSPECTION LI.EPORl' LOCATION: 283 Stephensons Rd,Orient SUFF.CO.TAX MAP NO.: 1..._.............. .__.._._.. _ __... ........_..... _ ,,.........._ _w_................ ..._....._.._.......m.. 7.4-9.2 SUBDIVISION: NAME OF OWNER(S): Sharmanan Family Truss t OCCUPANCY: ADMITTED BY SOURCE OF RE &EST:.. Sha... ......_F..... ... ........... ........ _ ... ... .... ..... ....M'..--4-'/"-17—/2023 _ ._. Q nnan Family Trust DATE: 4/17/2023 DWELLING: #STORIES: 1 #EXITS: 4 FOUNDATION:-----'- stone CELLAR: yes CRAWL SPACE: yes _ UTILITY TOILET ROOM(S). .,,.. BATHROOM(S): ..2 ......... LITY ROOM(S): ..w_w_.µ.LLµ.. ..M. PORCH TYPE: DECK TYPE: PATIO TYPE: ,...... .......... _.w w_.............�__..._.......M_...w.._. BREEZEWAY: FIREPLACE: 2 GARAGE: under DOMESTIC HOTWATER. .w. WW yes TYPE HEw_........,,,...www.._._._..... ___._._.... . _......_..w �www_.............._�www._. _ww ATER: off boiler AIR CONDITIONING. TYPE HEAT: oil WARM AIR: HOT WATER: baseboard .......................... - _--w-_. #BEDROOMS: 3 #KITCHENS• :I BASEMENT TYPE: unfinished OTHER: �._...............M�w�w�..� ....�...�.......�....__ ACCESSORY ST II!CTUR S: GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: SWIMMING POOL: GUEST,TYPE OF CONST: ._............. OTHER: w_.............. VIOLATIONS: REMARKS: INSPECTED BY: JOHNJ DATE OF INSPECTION: 1/12/2023 TIME START: END: Town of Southold 4/17/2023 P.O.Box 1179 53095 Main Rd Southold,New York 11971 a tax CERT'IFICA'TE OF OCCUPANCY No: 44014 Date: 4/17/2023 THIS CERTIFIES thatthe building ADDITION/ALTERATION Location of Property: 283 Stephensons Rd,Orient SCTM#: 473889 Sec/Block/Lot: 17.-1-9.2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 8/11/2022 pursuant to which Building Permit No. 48531 dated 11/28/2022 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: as buiuilf alterations and addition ineluc n deck .wto a:istinl singlejf m l plltA a a .lie fpr The certificate is issued to Sharman Family Trust of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 48531 1/12/23 PLUMBERS CERTIFICATION DATED 1/17/2023 E rd H. lei, d lEtll,p07 Town of Southold 4/17/2023 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44015 Date: 4/17/2023 THIS CERTIFIES that the building HOT TUB Location of Property: 283 Stephensons Rd,Orient SCTM#: 473889 Sec/Block/Lot: 17.4-9.2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 8/11/2022 pursuant to which Building Permit No. 48531 dated 11/28/2022 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: Has,belt'bqt t ab as a0lied fear., The certificate is issued to Sharman Family Trust of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 48531 1/12/2023 PLUMBERS CERTIFICATION DATED it or a Signature