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HomeMy WebLinkAbout1000-67.-6-4.1 TOWN OF SOUTHOLD �E Rental Permit 1050 Owner Jason S. Graves Occupied as Single Family Dwelling Located at 555 Fasbender Avenue Peconic 67.-6-4.1 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. c 1/16/2024 e of r ment Official This Notice must be posted by the main entrance at all times 1& ?x'6 P'5"p TOWN OF SOUTHOLD–BUILDING DEPARTMENT 9 Town Hall Annex 54375 Main Road P. O. Box 117 Southold, NY 11 x'°11�-0.� O Telephone (631) 765-1802 Fax (631) 765-9502t s:af �Vv stl c Itltn r al >v RENTAL PERMIT APPLICATION D E C 2 R 2023 ±^ a^ Rental Permit Fee $300 (Application must be renewed every two years) T-1 Section A. Property Information: Rental Pro arty Address: M �Y s' � N G VL _P�COQ �- ti's- 1 Tax Map Number: 1000 SECTION G l --BLOCK—, -LOT ( - SECTION B. OWNER INFORMATION: Property Owner Name: v `5 0 Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) I�Aky_ I0 -3 '1 Telephone Number (s): DaytimeVA" Evenin�'� Emergency. �`'3ty' Property Owner Email Address: 04 Page 1 of 4 r SECTION F. IuktvV I'll d v� �i"I ,J PROPERTY DESCRIPTION: �� STS'\�5�3��� ria .... �. 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 Uni Number of rooms in Rental Dwelling Unit: i,r :5h".�wons of e h room in Rental Dw Wl e and D" nit: � . �� 1 .wi,Vi ) , K o 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. >C 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. Page 3 of 4 SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) ) COUNTY OF SUFFOLK) 1 K a I-V 1., , 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 s to any change to the information regarding Authorized Agent, Managi Agent, or Site Manager. �7 Property Owner's Name: Property Owner's Signature: Y�v Sworn to before me this�!� day of 20 23 �AAQLW ,� . Official NcOry Public Signat and Original Notary Stamp -FURY PUBLIC,3c TATS E "leo R NO.�) > k OVALIFIED IN SUFFOLK LK ONTY COMSMON Page 4 of 4 o �� veoll-OWA k C TOWN OF SOUTHOLD B�LDIING D 631 -765-1802 INSPEC ION [ ] FOUNDATION 1ST [ ROUGH PLBG. ] FOUNDATION 2ND [ ] INSULATIOWCAI 1100, [ ] FRAMING / STRAPPING [ rFIRE A' FIREPLACE & CHIMNEY [ SAFETY INI [ ) FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE ELECTRICAL (ROUGH) [ ELECTRICAL (FII CODE VIOEATIO w [ PRE C/O [ "w REMARKS: AW- I t07 N000r 0,0 "tt % Aw% o vv DATE INSPECTOR TOWN OF SOUTHOLD PROPERTY RIEC ER STREETVILLAGE DIST. SUB, ,I;, LOT r_ _--, ,r DORMER OWNER Vr 11'e,I',fir' N E ACR. S W TYPE OF BUILDING RES. SEAS VL. FARM COMM. CB. MISC. Mkt. Value LAND IMP, TOTAL DATE REMARKS F t a 10 � NO C 3 t e = e, F Tillable } _ Tillable 2 Tillable 3 Woodland Swampland FRONTAGE ON WATER Brushland FRONTAGE ON ROAD House Plot DEPTH BULKHEAD Total DOCK o I _ COLOR l F f TRIM z 9 s x 33 E e = 3 F t c a s 4 M Bld _ o c� FoundationBath G Dinette Extension Basement �`� , Floors i �rK. - - - Extension Ext. Walls �f��z�� as,4 e' Interior Finish LR. Extension Fire Place Head ,<� >r D P Type Roof Rooms 1st Floor BR. r_ Porch F Recreation Roo Rooms 2nd Flood 2FlN. B.; E «n r , Dormer Breezeway i Driveway I I Garage i Patio O. B Total i i FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18960 Date APRIL 10 1990 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 550 FASBENDER AVE. PECONIC N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 67 Block 06 Lot 04 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 4, 1989 pursuant to which Building Permit No. 18367-Z dated AUGUST 10 1989 i 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 ONE FAMILY DWELLING AS APPLIED FOR & TO CONDITIONS OF THE ZONING BOARD OF APPEALS #3452. The certificate is issued to RENEE T. PE141ZTIER (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL MAR. 26 1990 - 88-SO-155 UNDERWRITERS CERTIFICATE NO. N-109544-JANUARY 5 1990 PLUMBERS CERTIFICATION DATED MAY 5 1990-BERTSAND PLUMBING & HEATING li Building Inspector Rev_ 1/81 ot FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23792 Date JULY 25 1995 THIS CERTIFIES that the building ADDITION Location of Property 555 T AVENUE PECONIC NY House No. Street Hamlet County Tax Map No. 1000 Section 67 Block 6 Lot 4 Subdivision Filed Map No. Lot No.� conforms substantially to the Application for Building Permit heretofore e filed in this office dated JULY 130, 1992 pursuant to which Building Permit No. 20837-2 dated JULY 17f._1992 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 A DECK ADDITION TO A SINGLE FAMILY DWELLING As APPLIED FOR AND TO ZBA APPEAL #4107. The certificate is issued to RENEE PPL IRR (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A B ding Inspector Rev. 1/81 ............. i ii u m u , I i,1 , \ 111 i t. 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