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Home My WebLink About1000-61.-4-20 C) .0 = c u O — v O O X O N cv LU ' L � 00 0 q r cn =3 (1) �--� O Q L C) cf) C ) ca (O U = O C c U .E 1 cu bb � M m f -a L co ca 4-- cu c co wcn O 4-- cc 66 Op 0 t v L yVl OO Q O z v 1M�irr�r N pO Q' +� 0- o >, N o Q- z E Oc CD -cn FMX D 3 p c �> CUao LCD -0 o a) E O a in p O U C \ 110 � ry •CL O O � U Town Hall Annex �d . x; Telephone(631)765-1802 Jot 54375 Main Road Fax(631)765-9502 P.O.Box 1179 " Southold,NY 11971-0959 � + BUILDING DEPARTMENT 1 TOWN OF SOUTHOLD 'nOCT 1 2020 RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application roust be renewed every two yearn z , Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION __, -BLOCK -LOT Z� - SECTION B. OWNER INFORMATION: Property Owner Name: -__w__ ,""%� Property Owner Legal Address: Property Owner Mailing Address: Telephone Number(s): Dayti 1—---.------ Venin --_,__,, ,, En1er ental Property Owner Email Address: 4 2)bb Page 1 of s Town Hall Annex Telephone(631)765-1802 54375 Main Road , . Fax(631)765-9502 P.O.Box 1179 i b 4": f Southold,NY 11971-0959 pgre, fy� N1 F BUILDING DEPARTMENT TOWN 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: ww_ �, Telephone Number(s): Daytime_µ ening,_ Emergency _, Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: ,..,�w_.... _ Address of Authorized Agent(no P.O. Boxes):.,.,,,,_ Mailing Address of Authorized Agent: ....._...ww_ Telephone Number(s): Daytimes Evening Emergency ___a 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):mµ„mM.,_., �? S_ww., ........ ...... . C _�. _ �'i g3S Page 2 of 5 ono � Town Hall Annex 101 Telephone(631)765-1802 -54375 Main Road f Fax (63!)765-9502 P.O. Box 1 l79 Southold,NY 11971-0959 w BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: �,rJ a Telephone Number(s): Daytlme 3i � w r ng,__,,_...�. , .,,Emergency b 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, Q 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." " g Cans 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: i ._..` __ _..... _... ....w m._ . .. . _... _.._--._.._- Page 3 of 5 Town Hall Annex „ , Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 i N 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 t e 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. SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) ) COUNTY OF SUFFO K) 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 Town Hall Annex fi Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179a Southold,NY 11971-0959 q 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. 1 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: "t Property Owner's Signature:YX Swor 6 before m this day of 0 Offici I No ary Publi Signature and Original Notary Stamp LORMA Il" 001 LA617NO awfifled in Suffolk CMUMY 1,20 Page 5 of 5 qf so TOWN OF SU TH LT BUILDING DI 831 »785*1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAl [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY FIRE SAFETY IN! [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII [ ] CGDE VIOLATION [ ] PRE C/O [ I REMARKS: c��✓ pK\-( Lek t TE "� INSPECTOR 4 0 ti u 21 'x 2,91 f 3 Y.2 IJ I t I 1 _............... t f � 1 ...w..........._. ..w.w......... _.�.._.. ... ............ f v r r .. i �a 1 f r j 10VI WOO*) n� 6 3 N, 4 IV r' n , u � i d � . i � .� Z Zcr cn — 4r. LL LLJ r, Rl l usi Min � y vt 0� !a e, e k 7 � L !► J � ,� C LU CL J V LU LL m ■ Q \ m a LL n 1 um W > �.. �ti. c: z' — — " .fid,Q �- w pop �� VJ rn, 9 co uj q i , c uiv LLI LLJ °� o a Z V' m v o o — — a 3 u cn m 0 �° i � m � m r o, LJL r N m LL. Z V 77 ,— ,. ......,_ ...... www. .__..u..�_ .. ._...._..... _ ._ ...... .......� N �I > O p, tY_ c E y 7v al CL LL_ ,A. �- Ay� Irtt N, o01V V ry j 1 r F �Yj N v�' ..1•' f 7 00 AQ r f � „ C71ImO - .� .N •� N Q1 m m mw � a m m +�, 00 x w 0 m O 1-- `L w u a i µ � Town of Southold 6/11/2020 53095 Main Rd Southold,New York 11971 PRE EXIS"T"ING CER TI ICAA OF OCCUPANCY ANCY No: 41170 Date: 6/10/2020 THIS CERTIFIES that the structure(s)located at:, 54100 Route 25, Southold SCTM#: 473889 Sec/Block/Lot: 61.4-20 Subdivision: Filed Map No. Lot No. conforms substantially to the requirements for a built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 41170 dated 6/10/2020 was issued and conforms to all the requriements of the applicable provisions of the law. The occupancy for which this certificate is issued is: wood fr ine one fhn-&dwefldi gµwith wa k p. on-babitall p.attic attdwe>��rsagr�c ),e eap z�ci axad aaa acc eery g rime% t ara ryr ck h itl zulua sl ,le t. 11t : I 'w1 50 addition f,'C) -640° 1 F! 3 62 alteration office) QZ,33456°B 44565 El�tric _� - � .w The certificate is issued to Rothman R H Cred Shel Trust _._..................� (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED JON *PLEASE SEE ATTACHED INSPECTION REPORT. -.-..� mm ...........ut tov.. ... ..Signature ry BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 54100 Route 25,Southold SUFF.CO.TAX MAP NO.:......�61 4-20 mm..___......�..�_..._.._....�.�.�.SUBD.��.IVIS,......,.�_.m.,_.................... .._�_.�......_..�_..w_._._�.......... ..,...�..._.............._... ... ION: NAME OF OWNER(S): Rothman R H Cred Shel Trust ...� _ � .....—w.............. ..... ......—__...--- �...� ._ � _.�._.._.. �.._,_.......__..__.,_.............._ OCCUPANCY: ADMITTEDBY:_._.�....___.�..__...w._.._.._.__........ ....____....�www_.._...... ............�._.__...�,..., __..,�.._...,.. ..w .www...._. SOURCE OF REQUEST: Rothman R H Cred Shel Trust _ DATE: 6/10/20�.... 20 DWELLING: #STORIES: 2 #EXITS: 2 FOUNDATION: stone/block/brick CELLAR: partial CRAWL SPACE: BATHROOM(S): 2 TOILET ROOM(S): m UTILITY ROOM(S): PORCH TYPE: DECK TYPE: PATIO TYPE: _www...... _ _. ._.._.. BREEZEWAY: FIREPLACE: GARAGE: DOMESTIC HOTWATER: x TYPE HEM._,._._,. �._w_._._._..� �. _ .....,..... ATER: AIR CONDITIONING: TYPE HEAT: oil WARM AIR: HOT.W.._.._._..._ ATER: steam #BEDROOMS: 4 _ #KITCHENS: 1 BASEMENT TYPE: unfinished ........................ OTHER: ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: wood frame garage STORAGE,TYPE OF CONST: SWIMMING POOL: GUEST,TYPE OF CONST: OTHER: VIOLATIONS: REMARKS: INSPECTED BY: JOHNJ DATE OF INSPECTION: 2/27/2020 TIME START: 3:45pm END: 5:30pm y � II�IIIII��II IIIIII� Illlll�/�� /�� ....................... uuuuuuumiuouuuuuuuii �� i/ a��il�u'� Ili �b 1 ' ��IuuiIIIIIIIIIIINIIIIIIIIHIIIIIIIIIIIIIIII 0 V 1 a 1 / f JAM, `110 M N�F