HomeMy WebLinkAbout1000-117.-6-19.3 a,
c TOWN OF SOUTHOLD
Rental Permit
0903
Owner Richard & Pamela Fahey
Occupied as Single Family Dwelling
Located at 480 Kouros Road New Suffolk 117.-6-19.3
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.
5/15/2023 %1-
ods € ffici
This Notice must be posted by the main entrance at all times hf
,r
S so
Town Hall Annex �° Telephone(631)765-1802
54375 Main R6ad p Fax(631)765-9502
P.O.Box 1 179
Southold,NY 1 1971-0959
`° TI �
I
BUILDING DEPARTMENT �
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION
Rental Permit Fee$200(Application must be renewed every two years)
Section A.
Property Information:
Rental Property Adress: / 1
Tax Map Number: 1000 SECTION ,,,_,-A0 -LOT !_�1
SECTION B.
OWNER INFORMATION:
Property Owner Name: . C1,G1
Property Owner Legal Address: Property Owner Mailing Address:
W61
Telephone Number(s): Daytime Evening Emergency I 9 c1 S 1�—
Property Owner Email Address: '�'� ---
Page 1 of S
SO
(`Y .w
Town Hall Annex Telephone(631)765-1802
54375 Main RoadFax(631)765-9502
P.O.Box 1179
Southold,NY 1 197 1-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent:__
Telephone Number(s): Daytime Evening Emergency_.
Email Address:.
SECTION F.
PROPERTY DERIPTION:
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: www
Requested Maximum number of persons allowed to occupy Dwelling U i
a'
Number of rooms in Rental Dwelling Unit: C�`e n
Use and Dimensions of each room in Rental Dwelling Unit: kAhoo . ��ZX�y \\J C,
nS k.9,v-1
�"+ �► a'8.� /o �� ,n7c,
9129-X"2-7
j3
Page 3 of 5
SO
� Town Hall Annex Telephone(631)765-1802
54375 Main Road ra q Fax(631)765-9502
P_O.Box 1 179
Southold,NY 11971-0959
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
fro'n the Town of Southold
e[ am subnr tting a completed Town of Southold certification form from a licensed
rchitect&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)
Iwo \-} _ 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 Annexe Telephone(631)765-1802
54375 Main Road ' Fax(631)765-9502
j r
P.O.Box 1179
Southold,NY 11971-0959 , p4V� er4s,`
BUILDING DEPARTMENT
TOWN OF S+ J UTHOLD
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: 16,e,,.kN0—
Property
Owner's Signature:
Sworn to before me this 1�-day of 2 CI
17 ,
Offi ial Notary Public Signatu' Origin I Notary Stamp
LILLIANNA R KIEL
Notary Public-state of New York
No,01KI6424267
Qualified in Suffolk County
My Commission Expires Oct 25, 2025
Page 5 of 5
'4f s, o qfo V-,w v-o
TOWN OF SOUTHOLD BUILDING I
�
6311 -765-1802 it
INSPEC ION
[ ] FOUNDATION 1ST [ ] ROUGH PL13G.
[ ] FOUNDATION 2ND [ ] INSULATION/CAI
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN!
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL {FII
I ]
CODE VIOLATION [ ] PRE C/O [ '" N
INSPECTORREMAR S:
DATE
Town Hall Annex Telephone(631)765-18021
14375 Main Road Fax(631)765-9502
P.O.Box I l79
Southold.NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
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
leqyh _)'ic-e se(f Amar I (- ,
Enrlim,,er _
Rental Property SCTM Number:
Rental Property Address: LTo OaSA-
Owner/Name: A;2) CA.,
Rental Dwelling Unit Identifier:
Number&Square footage of each bedroom as depicted in the attached floor plan:
e. Bedroom#t1-100 sq.,Bedroom#2-90 sq.,etc.)
la?
.......... ......
Property Description (include all improvements indicated on survey)
...........
have done a physcal urj5pecjj(>rjof thesubject rental dwelling unit and find thatit
c,)jrr�rdies with all the pro%Asaorrs&the Code of the Town of Southold, the Residential Code
fr,,,,rk State,the BuiKng Code of New York,State,the Plumbing Code of Neve York State,
the Fuel Gas Code of New York State,and the Energy Conservation Coristru0on Code of New
York State
vrwrr
kel
Print Name and Title ori rg.— Signature
Please place professional seal:
Ground floor/basement
---------- 18'710
Utility Room
Garage
ti
CO detector
1 k
IA-
itb
Denotes smoke detector F q Denotes CO alarm
1 st Floor
L<
Vi 1 51 r
Bedroom #1
168 sq ft
y
I i w
fr77
L—A A—A
C\I
C\j
rav!
71
Bedroom #2
126 sq ft
,J,41) )Denotes smoke detector Denotes CO alarm
2nd Floor
Closet/Storage Closet
ff
Bedroom #3
161 Sq ft
F
{ _g
r•.4
Closet/Storage Closet
IA
Denotes smoke detector Denotes CO alarm
TOWN OF SOUTHOLD PROPERTY RECORCI
Di
��YN
STREET
01A VILLAGE
SUB. LOT
,FORMER OWNER L h a sera 4 � N
E ACR.
S W TYPE OF BUILDING
.3anuic,
iK
RES. SEAS. VL. FARM comm. CB, mics. Mkt. Value
LAND Imp- i TOTAL
DATE REMARKS
S..
(0
A—
L
i7
7
A-
7,
,e
ic
Y
nvil j I
Tillable
FRONTAGE ON WATER_
Woodland
FRONTAGE ON ROAD
Meadowland
DEPTH
House Plot bn(n -7,p BULKHEAD
TF
Toto I
g
DLOR
TRIM
A
,
i
s
117.-6-14.3 1108 -g -
`/
ILL
M. Bldg
•
Ext -.i t Jr D T / �I �r t '� 4 L.J
l
P d
b• - - -
� s
I
r i L
_ m e _
t �
E tension i
Extension
Foundation [ �; ' Bath
n _ Dinette ette
` s
Basement fi s,t Floors - K
-PQ"h y, Ext. Walls .Y Int
Finish � f
I SLR
Breezeway Fire Place t ; Heat !� QR,
T e
Garage �; � � _ yp Roof Rooms 1st Floor �BR
Patio —
? 7 Recreation Room. Rooms 2nd Floor FIN. B '
-
0. B. ' Dormer
Driveway i
Total
3 ;
jL�ln�
I I TOWN OF S UTHOLD PR PERTY � �
R -- w BARD
OWNER �STR �-�EET VILLAGE DIST . SUB. LOT
FORMER OWNER
I N tf E ,� ,.
ACR.
�3 —I_13
--_ W TYPE OF BUILDING
HOS
RES. 2 1 SEAS, VL. FARM COMM. CB. MICS. Mkt. Value
� e
LAND I IMPz TOTAL DATE REMARKS
J;
- _ 4
i
i
i I
I
[ I
f
f[
Tillable FRONTAGE ON WATER!
Woodland
I = ; FRONTAGE ON ROAD
I
Meadowland DEPTH
House Plot BULKHEAD
Tota
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No. . 66 . . . . . . . , . . . Date . . . . . September. 4 . . . . . . . . . . . . .. 19 -7.9
THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . » . . „ . . , . . . . . . . . . . . . . . , . . . .
Location of Property 48�! Kouros RaBd s. . . . . . . . . . . . . . . . . .IgM. &uffDo.k. . .
Hou No. t Pt. of 19HOMiei
County Tax Map No. 1000 Section . .117. . . . . . .Block . . . —96 96 . . . . . .Lot .F.t... .Of. .18. . . . .
Subdivision . . . . . . . . . . , . „ . . . . . . , . . . „ . . . . . . .Filed Map No. . „ . . . . . .Lot No. . . .. .. . . . » . . .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
. .Se
? ae . . . . . . . 19 78 pursuant to which Building Permit No. . .995?. . . . . . . . . . . . . . .
dated , „ .§"o. : ` r 25
. . . . . . . . . . . . . . . . 1978. ,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. . , . . . . . . m . .. . . „ . . . . . . . .
The certificate is issued to „ . Albin J' viek „ „ . R .
. tessie„er'tewr�'rlrt
of the aforesaid building.
Suffolk County Department of Health Approval . . .August .30,. .1.979. - El.. A. .Villa. . .
UNDERWRITERS CERTIFICATE NO. . N443962. . . „ . . . . . „ . . , . . . . . . . 3. . . . . . . . . . . . . . . . .
� � .
Buil , „
Building Inspector
Rev 4ng
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-33845 Date: 07/23/09
THIS CERTIFIES that the building SWIMMING POOL_. ...... ...... ..._ .,_
Location of Property. 480 KOUROS RD �µ NEW SUFFOLK
�m
(HOUSE NO. ) (STREET) (HAMLET)
Section 117 Block 6 Lot 19.3
County Tax Map No. 4...........73889�...._... ........_..._..
Subdivision �m Filed Map No. Lot NO.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated _ JULY 13 2009
pursuant to which
�5dated JULY 13, 20
Building Permit No_ 34855-Z 09`�..........._. ....
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 ACCESSORY IN GROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR.
The certificate is issued to ERIKA SHAPIRO
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 7532 04/09/07
FLUIMERS CERTIFICATION DATED N/A
_...............
Autigrized Signature
Rev. 1/81
, t► f01 Town of Southold 9/1/2023
P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 44516 Date: 9/1/2023
THIS CERTIFIES that the building ALTERATION
Location of Properly: 480 Kouros Rd,New Suffolk
SCTM#: 473889 Sec/Block/Lot: 117.449.3
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
12/15/2022 pursuant to which Building Permit No. 48783 dated 1/23/2023
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:
"asilli""g4diticns an alterationsracl din��ais add to l ent :recreation roorr�and athr oma to �ci tib sin 1
i1 dwellin as a lied for.
The certificate is issued to Fahey,Richard&Pamela
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 48783 4/4/2023
PLUMBERS CERTIFICATION DATED 3/1/2023 rd umbing U
A, rite inature,
STATE OF NEW YORK
Be it known that
Robert Bennett
has successfully completed the requirements of a Basic Code Enforcement
Training Program established by the Minimum Standards for Code
Enforcement Personnel (19 NYCRR Part 1208) in the State of New York as a:
BUILDING SAFETY INSPECTOR
John R.Addario,P.E., Director
Division of Building Standards and Codes
Buildin Standards Certification No. B0121-0001
g
and Codes
To maintain this certification,such person must satisfy annual in-service trainining requirements and advanced in-service training.