HomeMy WebLinkAbout1000-18.-5-18.4 -AV. TOWN OF S UTHOLD
Rental Permit
{ 1073
Owner Thomas & Roseanne Reddy
Occupied as Single Family Dwelling
Located at 140 Platt Road Orient 18.-5-18.4
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.
2/20/2024` )Vw,"l)-
Code :nte ent o .'
This Notice must be posted by the main entrance at all times
E C E W E
DEC 5 2023
TOWN OF SOUTHOLD–BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-09169vil ofSoulif-goid
Telephone (631) 765-1802 Fax(631) 765-9502
RENTAL PERMIT APPLICATION
Rental Permit Fee $300(Application must be renewed every two years)
Section A.
Property Information:
Rental Property Addr
1 ,10 FrjS +- R04
Tax Map Number: 1000 SECTION --BLOCK—15 -LOT
SECTION B.
OWNER INFORMATION:
1---1–1
Property Owner Name:
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
Belmor Au-(-
Jo't)V�c� L
116o3
Sz2 7SA) -?12,'5Z9,7
Telephone Number (s): Daytime Evening Emergency
01
Property Owner Email Address: 6
4� 300
Page 1 of 4
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any: t A ��S J clee � m
Address of Authorized Agent (no P.O. Boxes): J�t'�1`'°�'� ``� I"rJsU{�' N/>
Mailing Address of Authorized Agent:
Telephone Number (s): Daytime Evening Emergency_ ���3 o47
Email Address:
Section D.
Managing Agent Information:
Name of Authorized Agent of dwelling unit, if any: � n �'
Address of Authorized Agent (no P.O. Boxes):
Mailing Address of Authorized Agent:
Telephone Number (s): Daytime Evening Emergency
Email Address:
SECTION E.
SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units)
Name of Managing Agent of dwelling unit, if any:
Address of Managing Agent(no P.O. Boxes):
Mailing Address of Managing Agent:
Telephone Number (s): Daytime Evening Emergency
Email Address:
Page 2 of 4
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on property: y
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 Unit:
rb
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.
0 1 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.
-f 11 : (51�) - - -,5ZZ?
Page 3 of 4 "
9 � V- -
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Town Hall Annex o � '+ Telephone(631)765-1802
54375 Main Road "
P. O. Box 1179 cra
Southold, NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION ADDENDUM
Rental Dwelling Unit Identifier: HOVs�
Requested maximum number of persons allowed to d cupy each dwelling unit:
Number of Rooms in Rental Dwelling Unit:
Use and Dimensio of each room:.
a q
Rental Dwelling Unit Identifier:
Requested maximum number of persons lowe to oc py each dwelling unit: _
q
Number of Rooms in Rental Dwelling Unit: "
te nd Dimelon of each
room-
KILT-
n i
C` , 4 1 ' P oe-,11IMS,. 3
Pf '°. r
Rental Dwelling Unit Identifier:
Requested maximum number of persons allowed to occupy each dwelling unit:
Number of Rooms in Rental Dwelling Unit:
Use and Dimension of each room:
SECTION H.
DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit.
STATE OF NEW YORK)
COUNTY OF SUFFOLK)
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, Managing Agent, or Site Manager.
Property Owner's Name:
Property Owner's Signature:
Sworn to be re mefs"- day of A(1)VfY1 b-G✓ , 20-13
Officialt� is Signa re d Original Notary Stamp
ANNE MARY SIGNA
W7rARY iU".MTt of NEWYM
No.05SI6443M
OualUbd in SUft k CaW
Odobr z�
Page 4of4
st sou,
TOWN OF SOUTHOLD BUILDING D
631 -765-1802
INSPEC ION
[ ] FOUNDATION 1ST [ ] ROUGH PL13G.
[ ] FOUNDATION TND [ ] INSULATION/CAI
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN!
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FIN
[ ] CODE VIOLATION [ ] PRE C/O [
REMARKS:
DATEINSPECTOR
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,, *: Telephone(631)765-1802
Town Hall Annex e a.. r' Fax(631)765-9502
54375 Main Road "
P,O.Box 1179 W r
Southold, NY 11971-0959 wt 4F
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PROPERTY CERTIFICATION
Form is to be completed by a licensed architect, licensed engineer or licensed home inspector
Separate form is required for each individual Rental Dwelling Unit
Professional seal required for,Architect or En inset Licensed I-ome lns ig or must
reavide ccr of valid current certification
Rental Property SCTM Number: "n rvw
p
Rental Pro ertY Address: k r /It Ail,
Owner/Name:
SZZ
Rental Dwelling Unit Identifier:
Number&Square footage of each bedroom as depicted in the attached floor plan:
(i.e. Bedroom#1 —100 sqft., Bedroom#2—90 sqft.,etc.)
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Property Description (Include all improvements indicated on survey)
iA 1C
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,the Fire Code of New York State,the Property Maintenance Code of New York State
and the Energy Conservation Constructio Code of Iew York State.
" ` d Cy Original Signature
Print Name and Title ,
Please place Profession "
r�1056 4
SICJ
-7/311 ab 18
� - TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER STREET pa VILLAGE DIST, SUB. LOT
ACR. REMARKS
3
TYPE OF BLD.
PROP_ CLAS-
LAND
LAS LAND IMP TOTAL DATE
- z
1zc
_4 r_ � 141
Akm -
9 ! -
foro, . b f7vka
F
i
i
-FRONTAGE ON WATER - - T,L LABLE
�e
I FRONTAGE ON FRN
WOODLAND
DEPTH MEADOWLAND
BULKHEAD HOUSE/LOT
= E E
TOTAL
m
MAY 12 2022
COLOR
f
21 1: -Naa
4 i
x_
= TRIM
18.-5-18.4 1/21/2022
18-5-18.4 02/02
M. Bldg. Foundation Ge Bath Dinette
FULL -. --- - -__ --
Ete slop °° Basement Floors Kit.
Extension Ext. Walls *47 Interior Finish L.R. fir'
Extension Fire Place -t :Heat D.R.
V%
Patio Woodstove BR.
Porch { ��� �� Dormer Fin. B.
Deck Attic
Breezeway � sl Rooms 1st Floor
Driveway Rooms 2nd Floort
Garag 3 Q o 150
3
u
33
Pool
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31810 Date: 09 14 06
THIS CERTIFIES that the building NEW DWELLING
Location of Property: 140 PLATT RD ORIENT
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 18 Block 5 Lot 18.4
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 19 2006 pursuant to which
Building Permit No. 32127-Z dated JUNE 192006
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 SINGLE FAMILY DWELLING WITH COVERED FRONT PORCH AS APPLIED FOR.
The certificate is issued to THOMAS & ROSANNE REDDY
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-00-0195 08 01 06
ELECTRICAL CERTIFICATE NO. 101478 12 L IQ1.
PLUMBERS CERTIFICATION DATED 2. 30 06 THOMAS REDDY
/'V�""'L
i
A <' e uign re
Rev. 1/81