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Home My WebLink About1000-111.-7-21 � � a TOWN OF SOUTHOLD Rental Permit 0890 Owner Barthel Family Trust Occupied as Single Family Dwelling Located at 675 Old Menhaden Rd Cutchogue 111.-7-21 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 Code n or e rpt officiay This Notice must be posted by the main entrance at all times Town Hall Annex wp Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 �, „� Southold,NY 11971-0959 1p BUILDING DEPARTMENTnD, TOWN OF SOUTH0LD APR d 6 2023 J RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: N� Ig 35 Tax Map Number: 1000 SECTION SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: 1 Telephone Number(s): Daytime 5f 0116 Evening yl�7�K'2�r�o Emergency 1 ” _ 741 Property Owner Email Address: Page 1 of 5 Zo w. Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 1 Southold,NY 11971-0959 BUILDING DEPARTMENT T OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent (no P.O. Boxes): 3 ,aw 15-lo Mailing Address of Authorized Agent: Telephone Number(s): Daytime SI6, 45j-016 Evening .4,16W-29 Emergency Allo y5116$16 Email Address: WO 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: Telephone Number(s): Daytime Evening Emergency 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 cti Town Hall Annex 9M� Telephone(631)765-1802 54375 Main Road Fax(631)765-4502 P.O.Box 1179 Southold,NY 11971-0959 , BUILDING DEPARTMENT TOWN OF SOU OL 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 Identifier: Requested Maximum number of persons allowed to occupy Dwelling Unit: <t Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: Qs �R' tv ViWAUA- (° 13 041,,4ex - x R Ii K 3(- ra l31:? - ID yap 6p, 7- - 14 X%3 (A A"'m 27t2x. 14 11_1--7 0P010111 �`ht_- Page 3 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 OFS U 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) I ( �4fC ) . 'e 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 Town Hall Annex yw Telephone(631)765-1802 54375 Main Road r Fax(631)765-9502 P.O.Box 1179 �yk Southold,NY 1 197 1-0959 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: II ,,,, 1 Sworn to before me this�-�' ay of (^1 I 20aA'�) f Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.01BU6185050 Qualified in Suffolk County ,^t� Commission Expires April 14,2 OC�"1 Page 5 of 5 so TOWN, OF SOUTHOLD BUILDING DI 831 -765*1802 IN PECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSUTATION/CAl [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN; [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII [ ] CODE VIOLATION [ ] PRE C/O REMARKS: �n D vw eplkt O 6 tW . 4e.... ........... 504 DATE c;z6— --�3 INSPECTOR °gyp' Town Hall Annex ®UTH®LD TOI N 54375 Main Road PO Box 1179 Southold, ,J Rental Ins eCti®In NY 11971-1179 Tel 631-765-1802 s �7, �,«• � wFax 631-765-9502 SCTM # Date Owner Phone Address 04W m6/7/Aw-a Zip City . Inspector LEVELS SUB 2 3 Smoke Detectors (#- bedroom detectors excluded) � / _.. Carbon Monoxide Detectors (#) �� 1 ....---� Exits (#) BEDROOMS 2 S 4 Smoke Detector Alarms Carbon Monoxide Alarms C# -- -- —� Egress (windows) (Y/N) MEMO BUILDING SYSTEMS Y/N CONDITION OF PROPERTY YIN Building Interior is clean / maintained ma nta maintained/operational rationial Buildingp+ w Heatin s s Hot water systemExterior is clean /maintained Electrical s stem maintained/o stational Property is clean/safe/ maintained Mechanicals i stem maintained/'o erataonal Handrails & guards present COMMENTS: Rental Inspection Form 4/7/20-21 s�y6 s4..� �iak,,.,��,yZ• E 12 Y 3G �Jaod Duk. -7€ ®_T'_ ---7 Bc,SLp.lI t } Sf I€ t t} it Lica i t ] vi _ f 7 T r f �O r rJ St y t FIR5T FLOOR PLAN' N5z q L►Y NRt~A. tom Am F V F- 1 r 1 r [ — F- L J -LJ LJ L J �j L.1 go sou Ro s or s f^T �edr�� Fam►1� �roowr r � � � 1060 LtV ARE A i i �eclrnom• F— c s a c 33 I( s r 1n L;J LIJ LIJ LIQ DECK POST Fta• R�ARENT RET ptN1x� Wg1L 16x16 x6- (,=o.c D11�41N1�11 t7tS vS ADE i t � � P�t�r� t� �xnt�tr-• � � I � I TI- 1 -m 1 a - I t I � M- �a�• � I t I lj $SIG- QG.FOdtl1`l6S oto 9ra.d� i � � � I� k� � 12 COPRSE�S 8•l6$1,oC,�( I. i � f I n 0 q PC• FLoaR [ I mCID i FOU NDAZ 101A PLAN I a 3 0 PAPER 15ARVUERv UNPM SLAB SCALE , - 1'0" o $ sra e,. �_ true p Bw 1c Rc• — NOTE A Front EWtrRnCe —_ —. _— �—� CUT F-dunDatlaw G Ccl4vwQ-- [ 6 I = l I ' all wlndoua o�n1+,1s- OY7��%Vy mid Sym I Azo be cut G cows..... bvlm� kor o�-ft-u.,da•6iow ] zea,= _ * a C ,mac« :.•., ,a:; I TOWN OF SOUTHOLD ERT -ORD OWNER tSTRE r VILLAGE DIST. ? SUB. LO E ,,,FPRMER OWNER N E ACR. 3 STYPE OF BUILDING t � , IW RES :SEAS. VL, FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS 7712. - 4 v t r i i I -o 4 Tillable FRONTAGE ON WATER Woodlond FRONTAGE ON ROAD Meadowland DEPTH House Plat BULKHEAD Tota i I COLOR TRIM It 1 -F7-F7 17 4-� 1 7r V-- V--o' r M. Bldg. Extension F- Extension Extension Toundation j) Both Dinette !Basement Floors K Porch ;Ext. Walls Interior Finish LR. I Breezeway lFire Place Heot DR. BR. [Type Roof Rooms 1st Floor Garage Recreation Room Rooms 2nd Floor FIN. B cito :Y 11 Dormer r Driveway O. B. FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy 7. -7 43SE PT X20 "74 No. . . . . . . . . . . . . Date . . . . . . „ . . „ . . , . . LL . . . . . . . . . . . .. 19. . . . &75 &b MEN HA0EN ROAD THIS CERTIFIES that the building located at . . . . . . . . . . . . . . . . . . . . . . . . . . . . Street Map No. . 9 rO 1—. . Block No. .� . . . . . .Lot No. . . . . . . . . . . . . . . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . „ . . . . . . . . „ . .� �. . }3., 19.?.' pursuant to which Building Permit PW, �Z dated . , , . . . . . . . . . . . . . . . . ., 197. . .16, was issued, and conforms to all of the meets of the applicable provisions of the law. The occupancy for which this certificate is issued is . . .p111VATE. „ . ONE . . .FAMI.LY. . DwELLING WITIA 141TMGNI:-b GAizllc�rk J(ANE-rt C JOH?,i ape: IieS j The certificate is issued to . . . . . . . . . . . . . . . . . . . . . . „ . . . , . . . . . „ „ (owner;,! y of the aforesaid building. Suffolk County Department of Health Approval . .{,01, 1 ' . . . , . „-5 p^` . . ,. UNDERWRITERS CERTIFICATE No. . . „ . . . ,�. . . . , HOUSE NUMBER „ , . 67r . . . . . . Street , ,. MENHADEN. . . . . . „ VC)... . 7> {. t/rC 14 v `U E' Building Inspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. r Gl r �a Certificate Of Occupancy ,�'?,4.3 S e PT i2 D "7,6 No. . . . . . . . I . . . Date . . . . . . . . . . . . . . . . . . . . . I . . . . . ., 19. . . , THIS CERTIFIES that the building located at� .�1 N.�.�� ,M, , . Ra�D Street Map No. . . Q to. . . . Block No. .� . . . . . .Lot No. . , . . . . . . . . . . . . . . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in 9 dated p. . . 3., 19. . �.' pursuant to which Building Permit No. �4 � dated . . . pF . . . . . ., 19...I, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . . .PIR.Ir/A'TE . . . .OME. . . .FA,M1LY bwELLtN&. Wi,h A.WACH�D GA.A6* L-'A m E-rt C ,ip Hrli S Jr' The certificate is issued to`�. . . . . . . . ,, . . . . . . . . . . . . .. . . . . . of the aforesaid building. tt Suffolk County Department of Health Approval M��t. .�.� . � '. . . . TEP" 6 4-50-s UNDERWRITERS CERTIFICATE No. . . . . . ? d. . ! .0. . . . . . . . . . . . . . . . . . . . . . . . to-75 Of-b HOUSE NUMBER . . . .. . ... . . . . . Street . . . .. . . . .MENHADEN. . . . , , . . . . . . . . ,rv-rC'M UGU E" Building Inspector A