Loading...
HomeMy WebLinkAbout1000-122.-5-25 TOWN OF SOUTHOLD Rental Permit 0908 Owner William Gremler Sr. & Maryanne Gremler Occupied as Single Family Dwelling Located at 3905 Ole Jule Lane Mattituck 122.-5-25 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. 5/19/2023 e Official This Notice must be posted by the main entrance at all times $ � ' Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 "„ 1 BUILDING DEPARTMENT TOWN OF SOUTHOLD MAY 18 9023 LD RENTAL PERMIT APPLICATION duiwlr4bulin TOWNOFSOt► 40LD Rental Permit Fee $200 (Application must be renewed every two years) Section A. Property Information: Address Renta Property : . L het /1? Tax Map Number: 1000 SECTION -BLOCK -LOT - SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: Telephone Number (s): Dayti me 1 E renin , I' ,a . Emergencys p 1� �� g�.�� Property Owner Email Address: )''Y), C�W-v\)L12, L 661 �l7� g- )3 etc- DSI J�� Page 1 of 5 lv sw. 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 C. V/ Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: ::� Address of Authorized Agent (no P.O. Boxes); O Mailing Address of Authorized Agent: ✓' \I- Emerenc Telephone Number(s): Daytime Z.-Evening ,� ,gam y ._._. . Email Address:" 04 117" �'0) 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 Evng _ Emergency Email Address: ' SECTION E. SITE MANAGER INFORMATION: (required ntal properties containing 8 or more rental units) Name of Managing Agent of dwelling t, if any: Address of Managing Agent (no P Boxes): Page 2 of 5 ', JZ22 " Town Hall Annex b Telephone(631)765-1802 54375 Main Road Fax (631)765-9502 P.O. Box 1 179 Southold,NY 1 1971-0959 IOU BUILDING DEPARTMENT TOWN OF M SLLD MailingAddress of Managing Agent: O Telephone Number (s): Daytime Evening mer 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." r Rental Dwelling Unit Identifier: J N Requested Maximum number of persons allowed to occupy Dwelling � ng Un ' Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: Page 3 of 5 s' •, oll AR Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 a 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. L-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 "._ 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 r' Soot, Town Hall Annex Telephone(631)765-1802 54375 Main RoadFax(631)765-9502 P.O.Box 1 179 CA" � Southold,NY 11971-0959 eco 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: c- 11' w Property Owner's Signature: Sworn to a are me this 'day of Official Notary Public Signature and Original Notary Stamp ,p4YYklip Ppy,f ,,.v,,... cy h? t?R a* Public.SW, 41`1wi1G°w YOTk NoiAFn :*5 No.61 PUBM Q0AjHWjnSufWkCou0tY Page 5 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 �� Southold,NY 11971-0959 �`� o 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 Professional seat re auiredcar Architect or En ineer, licensed home Inspector must provide copy of valid current cerci catlon Rental Property SCTM Number. Rental Property Address: 2,, 0 Lrw Owner/Name: Rental Dwelling Unit Identifier: Number & Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 -100 sq., Bedroom #2-90 sq., etc.) scri Include II&imrovem X Property (Include improvements indicated survey 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 Conservation Construction Code of New York State. Print Name and Title Original Signature Please place professional seal: TOWN OF SOUTHOLD BUILDING I 631 -765-1802 INSPEC ION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSU TION/CAI [ ] FRAMING / STRAPPING [ ] EAL [ ] FIREPLACE & CHIMNEY EIRE SAFETY IN! [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII [ ] CODE VIOLATION [ ] PR [ I TOWN OF SOUTHOLD PROPERTY RE c OWNER STREET VILLAGE , DISTRICT LOT _ y 3 > e �F FORMER OWNERS i N _ E ACREAGE lo 3 E - SW TYPE OF BUILDING _ E � E - _ e RES_ SEAS. 'VL i FARM COMM. IND. CB. MISC. ! Est. Mkt. Value 3 s , LAND IMP. TOTAL DATE REMARKS IJL t z n s t 5 0 t - . NEW I NORMAL BELOW l ABOVE FRONTAGE ON WATER Farm Acre I Value Per Acre Value FRONTAGE ON ROAD Tillable 1 _ BULKHEAD -DOCK Tillable 2 Tillable 3 e Woodland - - s Aft- r, Swampland -AMI e= Brushland House Plot Tata I s f Iff - - ti s Y _F ro w- i a f a-- 122.-5-25 3/19/2021 MkIfi m Extension ; Rcsernent Cloors Extension F_xt, Walls nterior i° i=h Extension Fhe Piece « ` Porch np 4- PorchRDf-, ns s- 00 ' s = KG MS 2nd Flour Pot G Gaarac _ � - DriVewoy _ e„ ,-me— �A S. e �-b t r IV R Two it. SA 7 �I • � G�of� .� �� i d x 3 .. - raw '" } -` oc$i - c+n , NAS: $aw z � _k t tJ 1 E t t 'aly# tf Z© <{ f, f 3T¢- `,• ♦ a €•? r $C g� E� ,� ui`. f.`! + � Fk+:#it `a f?�3 =a t - - rT' t+ivt e an - } -K-N, r YSAW oil 5 oaf 0 oil t�?Iie-'Y 'M .� u I�Fr-�- Ivi6K savN ' y _. �' !1 � -E'F �' •`� �I .t�,,,...+ a„A . -ax e s�f�E s.�:a� WON ®� t` -- 11 � AMOCO., t.srdc %€,o- >ti - - r!>i:.s � e�.u� I �� r��^x etAj ��. _ r.. tea. I. ll LO- .' PLAN, l- . ,. 11 3 I � i - - - ----- -- --- �;I II• �w —I Arl 3:. 5 _ _ --_- - x I �n� FOUN AT'Ok f .P�Y` '"-• Az�;7 X001? ,--,.gid -'NEMSCHICK SILVERMAN/ARCHITECTS MA I «eo�a�n srase,su�rF� �� -_. _-�. :�,s.� o•n - • PhersY Git 563 F13G Fax:.1—'e13P -