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HomeMy WebLinkAbout1000-18.-2-16.19 F TOWN OF SOUTHOLD Rental Permit 4AV0907 Owner Nancy Goldstein & Gail Cohan Occupied as Single Family Dwelling Located at 944 Youngs Road Orient 18.-2-16.19 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. 5/18/2023 %L% me o iii This Notice must be posted by the main entrance at all times e 7fj � ex) ►�e c4- 16 L4 J9 Telephone(631)765-1802 Town Hall Annex ° Fax(631)765-9502 54375 Main Road F.G.Box 1179 Southold,NY 11971-0959 �Po IIN !r Y BUILDING DEPARTMENT TOWN OF SOUTHOLD DENTAL PERMIT APPLICATION Rental Permit Fee $200 (Application must be renewed every two years) Section A. a Property Information: Rental Pro erty Ad ress: Tax Map Number: 1000 SECTION 1000 -BLOCK � -'LOT- SECTION R. OWNER INFORMATION, Property Owner Name: Cin .. =-� c 5 �n mac _ h �'1 Property Owner Legal Address: Property Owner Mailing Address: LK 7 3377 ..W. +y ...... � � Emergency Telephone Number(s): Oa ime � k` '`�' Evening 2 � C-µ,rv\cLI C �C-0 m Property Owner Email Address: Page 1 of 5 Town if iall AnnexTelephone(63i)765-1802 54375 Main Road Fax(63x)765-511)2 m P.O.Box 1179 Southold,NY 1971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent L$dwelling unit, if any - Address of Authorized Agent (no P.O. Boxes):_ Mailing Address of Authorized Agent:_wmm_ .. _..... .,, ..,,. . ... Telephone Number(s): Daytime, „__.._. _.. Evening Emergen _m__- Email Address: - Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit; if any Address of Authorized Agent(no P.O. Boxes): -� -- I i4 Mailing Address of Authorized Agent: l�-0 7172 7 Telephone Number(s): Daytime Evening Emergency- Email Address: - (mf�i )c-'� �lcfirrlCL!Po) F �vl SECTION E. SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units) Name of Managing Agent of dwelling unit, it any: Address of Managing Agent (no P.O. Boxes): Page 2 of 5 p� d �ryz M phi, Town Hall Annex � d '(:,P��< f�c z.;il r 54375 Main Road Fax (631)765-95112 a n," P.O.Box 1 179 5oulhold,NY 119/1-0959 � m h '. w, BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailine Address of Managing Agent: Telephone Number (s): Daytime Evening__.._.,,, Emergency_- EY' ai Address: �...._ � .. SECTION Fa 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: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unri: �,aee 3 of 5 Teiephane(63 1)765-1802 Town Half Annex F, 54375 Main Road Fax(63 i)'765-9502 P.0_ Box 1179 Southold,NY 11971-0959 "afire h; 1BUILDING DEPARTMENT TOWN OF SOU OLD 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. am requesting a fire safety inspection to be performed by a Code Enforcement Official from 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) 1 Ct ncertify 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 Telephone(631)765-1802 54375 Main Road F Fax(63I)765-9502 P.O.Box It 79 Southold,NY 11971-0959 ; 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. : . i 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: r Property Owner's Signature- Sworn to before day of �A 202 Official Notary P I Si e and Original Notary Stamp LEROY RIVERS A Notary Public.State of New York NO.01R16357788 Qualified In Suffolk County My commission Expires Apr 24, 2025 Page 5 of 5 To OF%' OUTHOLD BUILD NG DI 831 ?85 1802 0 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAI [ ] FRAMING / STRAPPING AL [ ] FIREPLACE & CHIMNEY FIRE SAFETY IN; [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F1 [ ] CODE VIOLATION [ ] PRE C/O I / r,;iv r ,,, ,,,. 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A1;6— ? . . . . 19 THIS CERTIFIES that the building located at . A,&O*W.t -9/8. 10VAIS Rftd Street Map No.XG. . . . . . . . . Block No. �[. . . . . .Lot No. . A - -0l401. -*44t . . . . . . , . . , . , conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . fty. . .6 . . . ., 19.74. pursuant to which Building Permit No. dated . . . . . . . . .Ate. a . . .6. . . ., 197�. ., was issued, and conforms to all of the require- ments of the app.icable provisions of the law.The occupancy for which this certificate is issued is Tr. rate. onip. exIly. .dvolling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued toMrs. . . . Elbert .Luc*. . . . . . . . . . . . . yrs (owner, lessee or tenant) of the aforesaid building. ��- 15,7y �' VAA, Suffolk County Department of Health Approval ( . . . . . . . . . . . . . . . • . . . . . UNDERWRITERS CERTIFICATE No. a177931 . . . . .4US . .?I. . .t9?* . . . . . . . . . . . . . . HOUSE NUMBER . . .944. . . . . . . . Street . . . X�r . .�!�:" . . . . . . . . . . . . . . . . . . . . . . . , . �w � � � � Biding Inspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23401 Date—DECEMBER 12, 1994 THIS CERTIFIES that the building ACCESSORY Location of Property_ 944 YOUNGS ROAD ORIENT NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 18 Block 2 Lot 14 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in tlis office dated JUNE 1, 1994 pursuant to which Building Permit No. 22132-Z dated— JUNE 16, 1994 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 STORAGE SHED "AS BUILT" & AS PER ZBA #4285. The certificate is issued to ELBERT E. & CAROLE LUCE (owners) of the aforesaid building. r SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO.— N/A PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 • `� TTT FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23402 Date DECEMBER 12 1994 THIS CERTIFIES that the building ADDITION Location of Property 944 YOUNGS ROAD ORIENT NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 18 Block 2 Lot 14 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in thVs office dated41M 1 1994 pursuant to which Building Permit No. 22132-2 dated JUNE 16, 1994 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 OPEN DECK ADDITION TO EXISTING ONE FAMILY DWELLING "AS BUILT" & AS PER ZBA #4285. The certificate is issued to ELBERT E. & CAROLE LUCE (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A 41eZ Building Inspeo or Rev. 1/81 V FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23816 Date AUGUST 15 1995 THIS CERTIFIES that the building S Y Location of 'Property 944 YO1UNGS ROAD ORIENT, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 18 Block 2 Lot 16.19 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in thVs office dated JANUARY 9 1995 ursuant to which Building Permit No. 22566-Z dated JANUARY 17 1995 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 INSTALLATION OF WOOD BURNING STOVE IN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to GAIL COHAN & NANCY R. GOLDSTEIN (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building Insp ctor Rev. 1/81 _ -71 All N OF SOUTHOLD P dPERTY 72 OWNER ST i VILLAGE I DISTRICT SUBS LOT i FORMER OWNER � N� fly � E � v S W TYPE OF BUILDING '; k-* 0 Let— — a RES. SFAS. j VL. AF RM COMM. IND. CB, Misc. Est. Mkt Value - _ 4 YEuyr LAND 1AAP. TOTAL ! DATE REMARKS � , 7; '_. we - 4 ? �- 404 1 - -- — ILI t1 lb_ �} 4- - 2zgoI t^ r a r L 1701 1 IteCF,f Fit. AGE � B l DING CCflI �O - _ -, F U� _ b NEW �t} MAL EL OW ABOVE_t [ F,RONTAGE ON WATEt _ _ ;A _ Y Farm i Acres Value Per Acre Value FRONTAGE ON ROAD Tillable i i BULKHEAD t — Tillable 2 DOCK Tillable 3 I Woodland ? i 3 Swampland Brus and House Blot _ a I Total gra, s _ 1&,-2-16.19 1112 E i Foundation Stith A Bldg. - -. ;- __ - Z--� - ------ Extension -1 Basement ;Floors e - --- Lfft_ Extension `� - ; Ext. Walls t Interior Finish Extension Fire Place a, Heat Porch Roof iyPe e c Porch Rooms 1st Floor Breezeway Patio Rooms 2nd Floor Garage Driveway Dormer O. B. �� P