The URL can be used to link to this page

Home My WebLink About1000-78.-9-24 TOWN OF SOUTHOLD '�Cm Rental Permit z 0902 Owner Philip Loria Occupied as Single Family Dwelling Located at 200 Summer Lane Southold 78.-9-24 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. 5/15/2023 cid rc rn �cia[ This Notice must be posted by the main entrance at all times Telephone(631)765-1802 Town Hall Annex Fax(631)765-9502 54375 Main Road ��R P.O.Box 1 179 Southold,NY 11971-0959 BUILDING LA.t'P"ARTM N"1 TO CMS" SCkUI"°OLD '�� 1 �? � rAPPUCATItN Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: 00 Tax Map Number: 1000 SECTION E -BLOCK -LOT_ SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mail ni g Address: e5 �. / � _ " - Telephone Number(s): Daytime I( Evenln ; yEmergeny �.�,,,,,;,,_.�....�.. Property Owner Email Address: c4 6 ' r` Page 1 of 5 A$Z, Telephone(631)765-1802 Town Hall AnnexFax(631)765-9502 54375 Main Road P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SO TOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit,if any: N d + Fo R�� 1 ° 5 N Address of Authorized Agent(no P.O. Boxes): / ° , `-kl-e-e4. Mailing Address of Authorized Agent: ✓R� N �� 3)" Telephone Number(s): Daytime 2- 1090 Evening Emergency Email Address: Section D. Managing Agent Information: Name of Authorized Agent of elling unit, if any: Address of Authorized went(no P.O. Boxes): " Mailing Address of uthorized Agent: Telephone Number(s): Daytime Evening..Emergency Email Address: _w SECTION E. SITE MANAGER INFORMATION: ( eQ01/red for rental properties containing 8 or more rental units) Name of Managing Agent of del"dg unit, if any: Address of Managing Agen no P.O. Boxes): Page 2 of 5 ` Telephone(631)765-1802 Town Hall Annex �°��" Jr Fax (631)765-9502 54375 Main Road P.O.Box 1 179 . Southold,NY 11971-0959 BUILDING;DEPARTMENT TOWN SOUTHOLD Mailing Address of Managing Agent' Telephone Number(s): Da a 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: . NMS,vMwuMwm'wwnp&nrvxrvnMmummWw'MrvrvwPoYaMmm'Y4W µ� 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: fmw 4e 0 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 OF SOUTHOLD SECTION G-- INSPECTION: :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 ...........--- M 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 rom-the Town of Southold ❑ I 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) f..O Acertify 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 So Telephone(631)765-1602 Town Hall Annex w" Fax(631)765-9502 54375 Main Road W P.O.Box 1179 "* Southold,NY 11971-0959 �B BUILDING DEPARTMENT Town of SOUTHOLD applicable laws and rules. I further acknowledge that I will notlfy 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 dame: Property Owner's Signature: Sworn to before me this—day of �(-A . ..-►20 Official Notary Public Signature and Original Notary Stamp Page S of 5 �rA toAI TOWN OF SOUTHOLD BUILDING DI 631-7654802 194,10009 "j, INSPECTION [ ] 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 (FIN [ ] CODE VIOLATION [ ] PRE C/ [ I REMARKS: INSPECTORNO f�v yw-.(\ DATE A4—,:�ov� e f- g a i v d � �-- T -_ to � _ a O_ e rl 1_ ;Jot a 1 } - R 4� ; — j i ` FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z 4195 Date April 20 , 19 71 THIS CERTIFIES that the building located at , Stammer Lane, Street Map No. Bayside. 1'eftadeNo. Lot No. 25 Southold N.Y# conforms substantially to the Application for Building Permit heretofore filed in this office dated Oct 9 19 69. pursuant to which Building Permit No. 45002 dated Oct. 9 19 69, 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 Pri.v4ate . one family dw'olling The certificate is issued to char# Z Qonrm.T=bueh Cwnexs (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval pendin& arpr.aval. of C.I. sewer line 11 / 12 / 70 House # 200 �` ' , --- Building Building Inspector .......... Town of Southold Annex 10/11/2011 54375 Main Road Southold,New York 11971 ........... CERTIFICATE OF OCCUPANCY No: 35274 Date: 10/11/2011 THIS CERTIFIES that the building ALTERATION Location of Property: 200 SUMMER LANE SOUTHOLD,N.Y. 11971, SCTM#: 473889 Sec/Block/Lot: 78.-9-24 ............. ............ - Subdivision; Filed Map No. Lot No. ......... .......... . . ...... ........... conforms substantially to the Application for Building Permit heretofore filed in this officed dated 3/10/2009 pursuant to which Building Permit No. 36609 dated 8/5/2011 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: roof.q erations honLe4s t _._4ppL pLf pL The certificate is issued to Loria,Philip&Loria,Heather (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED it 67, 'ignat�re