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HomeMy WebLinkAbout1000-4.-5-5.11 £: n TOWN OF SOUTHOLD Rental Permit 0900 `gam$ a _ Owner Arthur & Roelfien Kuypers Occupied as Single Family Dwelling Located at Firestone Drive Fishers Island 4.-5-5.11 Maximum Permitted Occupancy 8 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. 5/10/2023 Code Enforcement offici This Notice must be posted by the main entrance at all times ' Telephone(631)765-1802 Town Hall Annex 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 � 1 5 A "1 1, 903 BUILDING DEPARTMENT „ TOWN OF SOUTHOLD 0m3:..)t 1. RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application rust be renewed every two years) Section A. Property Information: Rental Property Address: Firestone Drive, Fishers Island, NY Tax Map Number: 1000 SECTION 4 -BLOCI 5 -LOT 5 11 SECTION B. OWNER INFORMATION: Property Owner Name: Arthur & Roelfien Kuypers Property Owner Legal Address: Property Owner Mailing Address: 22 Orange Street Same Brooklyn Heights, NY 11201 Telephone Number(s): Daytime 4 -4 - OEvening Same Emergency Same Property Owner Email Address: arthur.kuypersPqrnai1.qqm Page 1 of 5 Town Hall Annex ' Telephone(631)765-1802 t 54375 Main Road �» Fax(631)765-9502 P.O.Box 1179rk r` na� Southold,NY 11971-0959 „ COU BUILDING DEPARTMENT TOWN OF SOU OLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Owner -- see contact info page 1 Address of Authorized Agent(no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening 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: 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 Town Hall Annexe, Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 COON 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: 1 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: Unit 1 Requested Maximum number of persons allowed to occupy Dwelling Unit: 8 Number of rooms in Rental Dwelling Unit: 7 Use and Dimensions of each room in Rental Dwelling Unit: Kitchen -- 14'-4" x 15'-1" Dining Room -- 17'-10" x 13'-11" Living Room -- 18' x 0" x 21'-0" Bedroom 1 -- 14' x 2" x 21'-0" Bedroom 2 -- 9'-4" x 8'-11" Bedroom 3 -- 11'-10" X 14'-11" Bedroom 4 -- 20'-11" x 9'-0" Page 3 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 �r Southold,NY 11971-0959 OUN 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 t I am submitting a completed Town of Southold certification form from a licensed architect or a licensed professional engineer. Page 4 of 5 � M k � e Ij Town Hall Annex �� , Telephone(631)765-1802 �� � 54375 Main Road ` Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 n M 'V cou BUILDING DEPARTMENT TOWN OF SOUTHOLD SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) ) COUNTY OF SUFFOLK) I N� 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 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 I day of l 20-9 3 --F- ' r Cl4It Offlc al Notary Public Signature and Original Notary Stamp N a � n r o,r .7;:,50454 Page 5 of 1'11 : , +O` _i, ,luvomber 07,2024 Town Hall Annex , �� Telephone(631)765-1802 54375 Main Road 3 Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SO SOLD 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 F"ro essional,seal re uired or Architect or Ln ineer licensed Home ins ector must provide My of valid current cern cation Rental Property SCTM Number: 1000 -- 4 -- 5 -- 5.11 Rental Property Address. Firestone Road, Fishers Island NY Owner/Name: Arthur & Roelfien Kuypers Rental Dwelling Unit Identifier: Unit 1 Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1-100 sq., Bedroom#2-90 sq., etc.) _Bedroom 1 -- 290 s . ft. Bedroom 4 -- 188 sq. ft. Bedroom 2 -- 88 s .ft. Bedroom 3 -- 157 s . ft. Property Description (Include all improvements indicated on survey) Two-story frame residence with basement entry. Lar e roof deck off of secona M.or, ravel drire. 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 Conservatio Construction Code of ew York State. Samuel W. Fitzgerald, arc htct���° Print Name and Title " ° Origin I Signature 4 � ,m t a �f rf F4' 1 Please place professional ra1 'n4.. c "a' "Y „F TOWN OF SOUTHOLD PROPERTY-46CORID /()/'�Z(vf FORMER OWNER— 1N E ACR. S :W TYPE OF BUILDING R . SEAS. i VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS 4:7 z f-'y f-- dk- Co CIO 113 1 Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH House Plot BULKHEAD Total C2 Lik COLOR `,L,' TRIM l s t 0 s — - f • Tr� M. Bld - 9 / H 7 a z Extension i f 3 d _ i Extension - on 'BothDinette oc�ndati F t :K- Basement Floors E Interior FinisLRPorch Ext. Walls Breezeway Fire Place !Heat �DR. R _ — are - - ooms lst Floor 13 F2 GType Roof 1 io 'Recreation Room 'Rooms 2nd Floor 'FIN B 0. B, Dormer Driveway L Total x ifdd ' " Town of Southold 11/4/2022 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43560 Date: 11/4/2022 THIS CERTIFIES that the building SINGLE FAMILY DWELLING Location of Property: Chocomount Dr,Fishers Island SCTM#: 473889 Sec/Block/Lot: 4.-5-5.11 Subdivision: _ Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/13/1983 pursuant to which Building Permit No. 48296 dated 9/16/2022 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: single fa t it dwellin with a er level balcotly and second floor balcorz as V_pli d for The certificate is issued to Kuypers,Arthur&Roelfien of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-21-2687 11/20/2021 ELECTRICAL CERTIFICATE NO. 48296 9/29/2022 PLUMBERS CERTIFICATION DATED 9/19/2022 Glen Gello Aruttore igr-tune " M �uyrr Town of Southold 11/4/2022 P.O.Box 1179 Mi R` 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43561 Date: 11/4/2022 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: Chocomount Dr,Fishers Island SCTM#: 473889 Sec/Block/Lot: 4.-5-5.11 Subdivision: Filed Map No. Lot No. conforms substantially to theApplicationfor Building Permit heretofore filed in this office dated 9/24/1986 pursuant to which Building Permit No. _ 48297 dated 10/6/1986 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: additions and alteratiata includir sec;andacar balcon t eistin sin Ne fhrn`l eilin as a 1'ed fair. The certificate is issued to Kuypers,Arthur&Roelfien � of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-21-2687 11/20/2021 ELECTRICAL CERTIFICATE NO. 48297 9/29/2022 PLUMBERS CERTIFICATION DATED 9/19/2022 Glenn Gello .. Auto ed nat to Vo 0 ---------------------- Z� a cl9s _ N y t LU N CRAWL SPACE LL LU 0- t � t �C I ` BASEMENT UP s°r` STORAGE sc { ENTRY -------__-_----d=___e- ------------------- -------- PLAN LEGEND so SMOKE DETECTOR co CARBON MONOXIDE DETECTOR sc SMOKE&CARBON COMBINATION �n BASEMENT PLAN SCALE:3/16'=l'-O" ^ ^ � -- Z� \ LU's * BEDROOM 2 LU§ ( / \ U r ( ae g) \ : LU B�OOM1 e \ d (290 SF) z ©° - \ � � ■ _ \ © BEDROOM 3 � (199} � � \ � ® � z :---- � PLAN LEGEND 2 / . r e SMOG DETECTOR BEDROOM 4 � oCARBON MONOXIDE (188 SF) DETECTOR ® s SMOKE&CARBON COMBINATION 12 (# ------ -----2 LL FIRST FLOOR PLAN &) SCALE: w2 %@} cy) Lu 7k\ \ 7 7^1 LU« } DN ! LIVING ROOM xz . KITCHEN t �( (347 SF) @9 Sm O:f� DN \ 2 e s e e ) DINING ROOM ; (285 SF) \ � PLAN LEGEND e SMOG DETECTOR p . mCARBON MONOXIDE DETECTOR BALCONY e ( 81ST) Via. a SMOG& o //% COMBINATION %&\ � §« , uj to«9 . . . . . LL§$ 22 SECOND FLOOR PLAN \)2 SCALE:3/16"=l'-O"