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Home My WebLink About1000-68.-1-2 TOWN OF SOUTHOLD j Rental Permit 0880 Owner Simone Shubuck & Adam Rapoport Occupied as Single Family Dwelling Located at 400 Diamond Lane Peconic 68.-1-2 Maximum Permitted Occupancy 5 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. 4/24/2023 ""Y� Code Enfbrtent Official li This Notice must be posted by the main entrance at all times � 151 ► Town Hall Annex ,n° Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 CN Southold,NY 11971-0959 e2 n o A �X BUILDING DEPARTMENT MAR l} TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200 (Application must be renewed every two years) Section A. Property Information: Rental Property Address, Tax Map Number: 100IION Q) _ -BLOCK Q') 0 _ -LOT 20Q - SECTION B. OWNER INFORMATION: Property Owner Name: 1 \�- t7(� j ✓�4�/t SI-�/ tl�(� Property Owner Legal Address: Property Owner Mailing Address: ZC Telephone Number (s): DaytimejIlLS& Avening Emergency��__ Property Owner Email Address: a Ll CA m I I Page 2 of 5 a Soo Town Hall Annex Telephone(631)765-1802 54375 Main Road ";; Fax (631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 w )" 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 nit:,, <� Number of rooms in Rental Dwelling Unit:. �- � r Use and Dimensions of each room in Rental Dwelling Unit: a , Page 3 of 5 so Telephone(631)765-1802 Town Hall Annex 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 , k Southold,NY 11971-0959 `" n q k' " 4�F 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 theprovisions 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. he 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 ❑ lam 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) IA0- nC✓h � certify under penalty of perjury,the following: 1. 1 am the owner of the property identified in "Section A" of this,-.a,p:phcation, 2. The property owner's legal address set forth in "Secticip:6" 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 so Town Hall Annex r", Telephone(631)765-1802 54375 Main RoadFax(631)765-9502 Ncp P.O.Box 1179 Southold,NY 11971-0959 � c°o � BUILDING DEPARTMENT TONVN 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"'rown within five (5) business days as to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager. Property Owner's Name: 3L P�a k p Y Property Owner's Signature: '" y 7 Sworn to bef r ne this day of .. 20 Official No ary ublic Signature and Original Notary Stamp ALEKSANDRABDURAKHMANOV Notary Public,State of New York No.01AB6143871 Qualified in Queens County Certificate Filed in New York County Commission Expires 04!17!2026 Page 5 of 5 TOWN OF SOUTHOLD BUILDING D1 r 631 -765-1802 INSPEC ION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] 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/O [ I o M v. -6 DATE INSPECTOR L( oo tv =a i € 3 a , . 1 � E t 2 � fi l TOWN FS Di)ROPERTYI9P6119 9 ARD ? OWNER a STREET VILLAGE DITRICT i SUB. LOT 4fp � a ., N E A SREAGE S W i TYPE OF BUILDING � { RES. f SEAS. VL. FARM comm. � IND. CB. misc. LAND IMP. TOTAL DATE REMARKS t, c s T �> f e AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE Farm Acre Value Per Acre Value � Tillable 1 - — — Tillable 2 — I !Tillable 3 Wcodlond pland Brushland :House Piot i Tcta' a� t _ u a „ _ t t 3 a 14, s M. Bldg ,�� Foundation th Extension = Basement ti b� Floors Extension Ext. Walls 6 Interior Finish Extension Fire Place Heart Porch Attic — - s Porch Rooms ]st Floor I Breezeway Patio Rooms 2nd Floor Garage 3 -- - Driveway E ew Q. B. / 7 " 70 : ' TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN H LL SOUTHOLD, NEW YORK CERTIFICATE OF OCCUPANCY NONCONFORMING PREMISES THIS IS TO CERTIFY that the Land Pre C.O. #- Z15114 Building(s) Date- November 20, 1986 Use(s) located at 400 Soundview Ave. Peconic Street Hamlet shown on County tax map as District 1000, Section 068 . Block 01 Lot 02 , doesknot)conform to the present Building Zone Code of the Town of Southold for the following reasons: Insufficient total area; sideyard set-back. On the basis of information presented to the Building Inspector's Office, it has been determined that the above nonconforming /X/Land /_/Building(s) / /Use(s) existed on the effective date the present Building Zone Code of the Town of Southold, and may be continued pursuant to and subject to the appli- cable provisions of said Code. IT IS FURTHER CERTIFIED that, based upon information presented to the Building Inspector's"Office, the occupancy and use for which this Certifi- cate is issued is as follows: Property contains one story, one family,_ wood framed dwelling; deck; screened porch; garage under house; all situated in e �- dview Avenue; a town maintained road. The Certificate is issued to EVELYN GORDON (owner, ftRXqK . , 1# ) of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERViRITERS CERTIFICATE NO. N/A NOTICE IS HEREBY GIVEN that the owner of the above premises HAS NOT CONSENTED TO AN INSPECTION of the premises by the Building Inspec- tor to determine if the premises comply with all applicable codes and ordin- ances, other than the Building Zone Code, and therefore, no such inspection has been conducted. This Certificate, therefore, does not, and is not intended to certify that the premises comply with all other applicable codes and regula- tions. wui.di_x .nspector 4 V pgµpr R gq� h 40 V 1 ' f �� I IIIIIIIII. V IIIIIIIII I 111111I I � 1 /%i fl / rr