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Home My WebLink About1000-26.-3-12 4 :aa TOWN OF SOUTHOLD Z Rental Permit } - _ 0887 Owner Catherine Matthews Occupied as Single Family Dwelling Located at 275 Harbor Road Orient 26.-3-12 Maximum Permitted Occupancy 6 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. 4/28/2023 tide f ce e t official This Notice must be posted by the main entrance at all times M Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 It BUILDING DEPARTMENT AN 3 2023 TOWN OF SOUTHOLD BUIWINGUEP7. RENTAL PERMIT APPLICATION TOWN011F800THOUD Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: _a-15 t4a.r0vr Roar! OYlevlt- Irl I Tax Ma P Number: 1000 SECTIONC,��-BLOCI4 -LOT_ ��M SECTION B. OWNER INFORMATION/:: Property Owner Name: c--zA+\'_i"I rxt Kgffh wig Property Owner Legal Address: Property Owner Mailing Address: Z� (-irxr�clr Rid _ p0 Telephone Number(s): Daytime 63L 19k 1467 Evening s Emergency Property Owner Email Address: * 2co Rd l 3a 43 Y&C, L o3(�,os Page 1 of 5 Town Hall AnnexTelephone(631)765-1802 54375 Main Road `116 Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: '� ,w Address of Authorized Agent(no P.O. Boxes):,_ _ �r�¢w �t? N� Iig(g4 Mailing Address of Authorized Agent: _„5 - __ ...._.._, .... ... 646 — , Telephone Number(s): Daytime _ Evening Su. 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: w_. �__.....�. Telephone Number(s): Daytime Evening Emergeny�... 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. Page 2 of 5 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 Mailing Address of Managing Agent: _-„,.wwww,_,,,__��_. _M. ._.............._.w__ Telephone Number(s): Daytime_._ Evening .„ ,_. Emergency.gge_a _...._ ,. Email Address: SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: h�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: Use and Dimensions of each room in Rental Dwelling Unit: °_ : ? (o, OQA-c VI i�� c1 t�0 n GeAi'Voylet W I5 `` twin ._ �Z-oo rA I'�X1V �DrA S' ).S " W) 1 ' Y- 34G 2-+ ,c 30 Page 3 of 5 ri yon r Town Hall AnnexTelephone(631)765-1902 54375 Main Road Fax(631)765-9502 P.O.Box 1179 � SII, ti Southold,NY 11971-0959 �2, N44a ° .,'p�'�Ufr� �.�f , BUILDING DEPARTMENT TOWN OF SO°I TDOLD 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. E9/ 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) 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 "2 Town Hall Annex „ Telephone(631)765-1802 54375 Main Road " Fax(631)765-9502 s �I ° P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOU OLD 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 Property Owner's Signature: We,MM ._.: .� �_ ""_ -- .- - Sworn to before me this@--q day of " � �._ 20 S'VA1 tat r + ()1!1»� 1 "TI(Y'Al 12111111" m n ugiW diiati;Pti 1 "�¢urw Official Notary! blic Signature and Original Notary Stamp t"b Page 5 of 5 Town Hall Annex q N Telephone(631)765-1802 � 1 a � Fax(631)765-9502 54375 Main Road P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUT'HOLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a license architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit lro essional seal re ceired or Architect or �a ire licgpsed Dome frrpectar msrovidq pogyjoj valid current certiication Rental Property SCTM Number: I oy C— 0';-4� G 6 w 03t Rental Property Address: "X-7r ebo , Rx" OI^c Owner/Name: ,.k+~ 8-VIN M IS;; Rental Dwelling Unit Identifier: Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1-100 sq., Bedroom#2-90 sq., etc.) CV� 90'am t5' ` ;V1CIcedes a ewt SCA1-&L2"% q,'A'J L .. _ . �tctk SligI Da'41 lo�XIO` � 6 o Vn ei Bed r L) -A Room 15')L 23 B,;Ljepv1°er -XbiX 'at-I'' G6 L c Z-`1 0 Property Description (Include all improvements indicated on survey) Y i r ) ln1 Y ak ( 0 Gam. �� (� Lv'fly}c'✓ V i el,t S I certify that I have done a physical inspection of the subject rental dwelling unit and find that it fully complies with all the provisions of the Code of the Town of Southold,the Residential Code of New York State,the Building Code of New York State,the Plumbing Code of New York State, the Fuel Gas Code of New York State, and the Energy Conservation Construction Code of New York State. Print Name and Title Original Signature Please place professional seal: New York State Department of State,Division of Licensing Services NEW YORK Division o (518)4744429 STATE OF & OPPORTUNITY_ Licensing Services New York State Division of Consumer Rights (888)392-3644 New York State Housing Discrimination Disclosure Form For more information on Fair Housing Act rights and responsibilities please visit Ljqp o (�bls ( sun and � I, s: �wros.l o /Caoniir �Vc.IM� lw .IIq. This form was provided tome by (print name of Real Estate Salesperson/ Broker) of I YKa v, (print name of Real Estate company, firm or brokerage) (Real Estate Consumer/Seller/Landlord) acknowledge receipt of a copy of this disclosure form: Real Estate Consumer/Seller/Landlord Signature Date: Real Estate broker and real estate salespersons are required by New York State law to provide you with this Disclosure. DOS-2156 (04/20) Page 2 of 2 TOWNIiF SOUTHOLD BUILDING N � a 831 7651802 --- 0000, INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PTBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAL [ ] FRAMING / STRAPPING [ ] F AE [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY IM [ FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL {FII [ ] C VIOLATION [ PRE C/O [ I r- r , r a ,� ��` �� ►. , �� ILII .,�� 7 �vt IL G GI oc 1p �1 I � IUt .o� G re AV Rep o ryn h, JGsr �JUr 0� OrlClyr� i � 5 s n � a .�_ Nall n � o r � TOWN OF SOUTH tARD _NER � - TREET YiLLAGE DIST., SUB. LOT s t P FORMER OWNER . N _. E v.� ACR a (.rc 3 W TARE OF BUILDING r r-` r e . RES. ! SEAS. VL. ;FARM °COMM. CB. MISC. Mkt. Value � � LAND IMP. TOTAL DATE REMARKS a s e e e z J. 5 17 40 dF BYL }I l (;q lD ION g �2 ` 161q,3 FARM Acre _ Value Per ' Value r, 7Acre i Tillable I " Tillable 2 i ' ¢ Tillable 3 Woodland Swampland FRONTAGE: ON WATER Brushlond = FRONTAGE ON ROAD House Plot DEPTH ''BULKHEAD Total DOCK I . n ' P- o � e F ° , J1 I a - s= y 26-3-12 10/00 a; i MBtdg z �? Foundation Dinette C e Bath _ I ° Basement - ZL Floors i � a �tenslon = s Ae _. Kit Extension Interior FinisExt. Walls h �3 Extension Fire Place Heat ° s_ D-R_ Patio Woodstove BR, a 7 r} Porch Dormer Fin_ B. l Deck ` t �� Attic . Rooms 1st Floor Breezeway pit Garage Driveway Rooms 2nd Floors { O.B. 7r(� Pool _ �6:;,.6en i V. _ r COLOR — � i c 15 1 f jgl- y\ TRIM — _ I t s s F f �1 Bath Dinette' t M. Bldg :' ` -= 'x_X Foundation - I_ 22 Basement E to i0� _ - - 1 _ E Floors Extension Ext. Walls --= Interior Finish LR. Extension Fire Place Heat DR- i - Type Roof Y ` 4_ Rooms 1st Floorl i BR. .. 'Porch- S Roams 2nd Flood ? s Recreation Room IN B = Dormer Porch ' Breezeway ' j Driveway Garage i Ratio Q. B. 4 3 t2- 2 t (v °� I 2 I - --- Total & �y FORM NO.4 �\ I TOWN OF SOUTHOLD ° `� ` —6 BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy Z10626 August 189 1981 , 19 . No. . . . .. . . . . . . . . . . . . . Date . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . » . . . . .. . . . . . . . . . . . . . . E/3 275 Harbor Road, Orient, fest York Location of Property . . . . . . . . , » . . . , . . . , . » . . . . . . . . . ¢ . . . . . . .. . . . .. . ..... . Houas lVfca. Street County Tax Map No. 1000 Section .026. . . . . . » .Block . .d3» « . . . » .Lo# .01?. . . . . . . . . . .. . Subdivision . . . . . . . . . . . . . . . . . « . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . .. . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated May 24 71 . . . . . . . . . . . . . . . . . . . . . . 19 . . .pursuant to which Building Permit No. . . . . . . . . .. Z. » . w . » . Say 24 71 dated . . .. . . . . . . . . . . . . . . .. . . . . . . . . • 19 . . . ,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 . . . . . . . . . . . . . .Private One—Family Dwelling V . . µ » . . , . » The certificate is issued to . . . . Vincent Matthews . , . » » » of the aforesaid building. Suffolk County Department of Health Approval . . 6/10/74µ . . . . . ! K, R. Jensen. . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . .1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Building Inspector Rev.1181 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27840 Date: 07/30/0 THIS CERTIFIES that the building ALTERATION & ADDITIONS Location of Property: 275 HARBOR RD ORIENT (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 26 Block 3 Lot 12 Subdivision Filed Map No. Lot No_ conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 12 2000 pursuant to which Building Permit No. 26497'-Z dated MAY 12 2000 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 ALTERATION ADDITION WITH TWO CAR GARAGE UNDER AND DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to CATHERINE E & JEROME DIPANE (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL, N/A ELECTRICAL CERTIFICATE NO. N 547692 01/15/01 PLUMBERS CERTIFICATION DATED 07 17 01HARDY PLUMBING & HEATING Authorized Sieg ature Rev. 1/81 FFOI Town of Southold 6/17/2023 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44184 Date: 6/17/2023 THIS CERTIFIES that the building GENERATOR Location of Property: 275 Harbor Rd,Orient SCTM#: 473889 Sec/Block/Lot: 26.-3-12 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/20/2023 pursuant to which Building Permit No. 49157 dated 4/25/2023 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: "as built' tc+ es cgiy R terator,a g lied far. The certificate is issued to Matthews,Catherine of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 49157 5/17/2023 PLUMBERS CERTIFICATION DATED ,.....�........w. tat. ort e A . �......_.�. ........._. _......._.. wwkwww _ ...w ww_._._...... .._w_ _.._wwww_.�_...........- .. _ __._.._.. ww_............... __....._ . g�tFtlC,f Town of Southold 4/28/2023 ' P.O.Box 1179 * 53095 Main Rd Southold New York 11971 CERTIFICATE OF OCCUPANCY No: 44057 Date: 4/28/2023 THIS CERTIFIES that the building SHED Location of Property: 275 Harbor Rd,Orient SCTM#: 473889 Sec/Block/Lot: 26.-3-12 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 7/14/1993 pursuant to which Building Permit No. 48941 dated 2/22/2023M 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: AgLc shed asa liedfor., The certificate is issued to Matthews Catherine of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED tho°i l i nature