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Home My WebLink About1000-15.-9-1.13 TOWN OF SOUTHOLD Rental Permit IN 0250 s Owner Jeremy Barth Occupied as Single Family Dwelling Located at 120 Lands End Road Orient 15.-9-1.13 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. 2/27/2024 Coden e�)e t Official This Notice must be posted by the main entrance at all times A Co(p 0 V1 610 2120124 TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O.Box 1179 Southold,NY 11,9,7l`-',00, 59,,` L) Telephone(631) 765-1802 Fax(631) 765-9502 F E[3 2024 RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: I;to 1.CuA .5 en R QA10 Tax Map Number: 1000 SECTION /157 -BLOCK_--q--LOT SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) talvic- - -Po Oox Tn �ir�,,JIJ4'tC &Y-f Gilo )Cj Vao'd'tc.4_ Telephone Number (s): Daytime 666— Evening SAW: Emergency Property Owner Email Address: fa" Page 1 of 4 Town Hall Annex ' Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 i Southold,NY 11971-0959r a�� BUILDING DEPARTMENT TONM OF SOUTHOLD Section C. Authorized 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 Evening Emergency Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: NIIA- 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: A Address of Managing Agent (no P.O. Boxes): Page 2 of 5 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: I ( ovie 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 Uri" Number of rooms in Rental Dwelling Unit: V 'Jklt Dimensions of each room in Rental Dwelling g tL _, . ., Use and Dimens' g Unit: �. a�� 3 13L 10 ` %- 336ylo ' 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 from the Town of Southold ❑ I 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) 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 applicable laws and rules. 1 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: V,\,Z Property Owner's Signature: th Sworn to before me this day of Fi , 2024 Official Notarylic Signature and 06jinal Notary Stamp TRACEY L. DWYER NOTARY PUBLIC,ST:4T E OF NEW YORK NO.01 DW6,06900 QUALIFIED IN SIJFF""L (,0UNTY Page 4 of 4 COMldNSsION EXPsRES Town Hall Annex Telephone(631)765-1802 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: 12Z 1000 1, k 3 Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: 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: 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: TOWN OF SOUTHOLD BUILDING DEPT, 631 -765-1802 113 INSPEC ION ON 1ST [ ] ROUGH PL13G. ON 2ND [ ] INSULATION/CAULKING STRAPPING [ ] FINAL E & CHIMNEY [ ] FIRE SAFETY INSPECTION !ANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION AL (ROUGH) [ ] ELECTRICAL7RENTAL L) LATION [ ] PRE C/O [ Town Hall Annex Town of Southold 54375 Main Road Rental Inspection Report PO Box 1179 P Southold, NY 11971-1179 Tel: 631-765-1802 �SCTM# 1 Date Phone Owner .. .. address 3visible ... ns�, pector Hamlet Floor Level QuantitiesSub 1 m _ _. ( I �.. n Smoke Detectors not located in bedrooms} Carbon Monoxide Detectors r Fire Extmguishers Exits I J ... ......_ . _ ,m.._ .... Bedrooms [ 4 5 6 Smoke Detectors m Egress ✓ �. .. ... _._�..... _ ......,� _. Occupant Count . .. ... ...._n.W .._. _ , . — Building SystemsMaintained & Operational ?mCondition of Property HeatingBuilding interior _. ., Hot water Building exterior ..... . Property clean, maintained&safeElectrica .. . ., , - guards installed &secure f Mechanical a;Handrails& , w Pool SaifetyPool on Site m.,.r alarm�,,,..a.w�....,�ww�..�.n. .�,„,,.��..........�.... ...w.,...w.._�.. � ....._......_. ..._��D.,�a, t a.��of CO issuance ._. Door alarms Pool completely enclosed � , . Self closing lathing gates .;Pool fence to code requirements—,,..��. � . �... c /latching _m�,....., ,_. ..,. .. _ .. .mm_._.. .. _ re _... .._. .._...w.,.. . ......M,o-.., � COs for all items present � � Prior Rental �� m �� e _ . TOWN OF SOUTHOLD PROPERTY R! OWNER,,--,,:- -STREET VILLAGE SUB. LOT I J FORMER OWNER v N ACR. _0 � S 1 TYPEOF AG RES, SEAS. VL. FARM COMM. CB. mics. Mkt. Value X K LAND Imp. TOTAL DATE REMARKS '2 Coo OD o Tillable FRONTAGE ON WATER 1 Woodland FRONTAGE ON ROAD ' Meadowkxid DEPTH i House Plot BULKHEAD Total G v C} OR I t � e o= _ E ` e 4 P 3 � � B - - 15.-9-1.13 1/13/2022 L1 orl ! € I l a a s Extension i 4 3 3 s Z /,tension Both Dinette�Foandat3an ` `B 'F _ � asement , _, i l�rs r-h ti gn, _q Interior Ext Walls nish LR.forch �• �� _ ' Breezeway IFire Place Neat I I 1Type Roof Rooms 1st Floor BR. Garage Patio = Recreation Room 'Rooms 2nd Floor ,� F I N. B - _ £Dormer Driveway O. B. - = TQtal I - FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28646 Date: 08/02/02 THIS CERTIFIES that the building NEW DWELLING Location of Property: 120 LANDS END RD ORIENT (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 15 Block 9 Lot 1.13 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 12, 2001 pursuant to which Building Permit No. 27900-Z dated NOVEMBER 14, 2001 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 WITH COVERED PORCH AND FIRST AND SECOND FLOOR DECKS AS APPLIED FOR. The certificate is issued to DANIEL F NICKOLA & ORS (OWNER) -� of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-01-0096 07/24 02 ELECTRICAL CERTIFICATE NO. 1044059 06/10/02 PLUMBERS CERTIFICATION DATED 07/10/02 KING PLUMBING & HEATING f Authorized gnature Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28645 Date: 08/02/02 THIS CERTIFIES that the building ACCESSORY Location of Property: 120 ... _LANDS END RDORIENT W, (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 15 Block 9 Lot 1.13 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL11, 2002 pursuant to which Building Permit No. 28270-Z dated APRIL 15, 2002 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 INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. The certificate is issued to DANIEL F NICKOLA & ORS (OWNER)MM of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL _m N/A_ ELECTRICAL CERTIFICATE NO. 1044059 06. 10 02 PLUMBERS CERTIFICATION DATED -_,„,NLA.... Authorized S'" aature Rev. 1/81 A 1�ITCH E r� k .w_ PL- ROOM PocKc-T, Doo (3�Lo w Liv , QG R M 1 I SDS if - 1 ` ` D CYO �f SD (10 W i sv co - n ` F� �i STo R..-