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HomeMy WebLinkAbout1000-14.-3-2 TOWN OF SOUTHOLD a rr^ w- Rental Permit 1102 Owner Michael & Teresa Smith Occupied as Single Family Dwelling Located at 1405 Terry Lane Orient 14.-3-2 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. 3/25/2024 _ Co n r( grit Official This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD—BUILDING DEPARTMENT Ar Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 ieiephone (631) 765-1802 Fax(631) 765-9502 l'€' w.southoi lto -nn . o ° E C E WE RENTAL PERMIT APPLICATION .I Rental Permit Fee $300(Application must be renewed every two _ ;3 Section A. Property Information: Rental Property Address: Lanz, � �� 11) Tax Map Number: 1000 SECTION ' -BLOCK -LOT SECTION B. OWNER INFORMATION: Property Owner Name: � � lecess,., Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 5 Telephone Number(s): Daytime Evening Emergency Property Owner Email Address: 0.p,' CC''r"�- -YZe- d, 13 Page 1 of 4 3 t , �` I Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: A9 I' _ Aq' Address of Authorized Agent (no P.O. Boxes): Mailing Address of Authorized Agent: � — © 5 Telephone Number(s): [daytimeJ-JS� -ta� 7Evening Emergency / l l� Email Address: a' `e K an � � �-x r\6 'etVt#iosvl - CGv v . fl" 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 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: 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 Mom. 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 Un Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: b4ckeo " 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 OfficiaP 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) I i - X- 11n 17a 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: �f Property Owner's Sig aturw--/ff-V�l Sworn to before me this day of agrc.4 20 Z9 Pu of New Yofk Officiloriffary Public � re and Original Notary Stamp No.01 ��ln M t 4, Page 4 of 4 TOWN - BUILDING j il 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. I ] FOUNDATION 2ND [ ] INSULATIOWCAt [ ] FRAMING / STRAPPING [ ] F AL [ ] FIREPLACE C - INEY [ FIRE SAFETY IN [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL {F C l CODE VIOLATION [ ] PRE CIO [ 1 REMARKS: DATE 3 g 1ok INSPECTOR • poi = c v yRK�-�h►�w ,�QLod M� Too M-� 1�` LI Se�so.,(\ oo w\ cxk At _ 03 13e��`DoM.� � 5t TOWN OF SOUTHOLD PRbPERT RECORD CAM- OWNER STREET D FORMER OWNER N E ACR. ts CODE DATE OF CONSTRUCTION `2 �— fl ILL- -——------ --------------------------------------------I LAND lmp� TOTAL DATE REMARKS ,, 3P, .............. 5, Jf J, 0 cz 9 q'7Y f"1111111111 2 - --------- Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH House Plot BULKHEAD Total F FORM NO 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N Y. Certificate Of Occupancy No Z 1 645 1 Date December 1 , 1987 THIS CERTIFIES that the building . One f am i 1 y_ .dwe 11.ing. . , . , , . , . . , . . . . Location of Property R..0:W. off Main Road O r i e n t House No. Street .Ham/ei County Tax Map No 1000 Section . . 0.20 . Block .0 1. . . . . . . Lot . . . p./.o Subdivision L.1 o y d T e r r y Minor Sub ,Filed Map No . . . . . .Lot No . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore fled in this office dated 19.86 pursuant to which Building Permit No. .15 4 7 I Z . dated .Nov,., 8 ,, ,1 9 8 6 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 famzly_ ,dwelling garage and rear deck. The certificate is issued to V�LAI`IK R. ,IiELMIN B I of the aforesaid building. Suffolk County Department of Health Approval 8 6-S 0-.1.6 3. 8./ I 0/8,7 UNDERWRITERS CERTIFICATE NO. . N 8 2 7 3 3 3 8/ 17/8.7 { # .. . . . . . . . . PLUMBERS CERTIFICATION DATED: MATTITUCK PLUMBING & HEATING CORP. ecem er � , ly . . „ Building Inspector Rev 1181 t = Town of Southold 3/16/2024 P.O. Box 1179 CAA 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45051 Date: 3/16/2024 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 1405 Terry Ln, Orient SCTM#: 473889 Sec/Block/Lot: 14.-3-2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 7/1/2020 pursuant to which Building Permit No. 44975 dated 7/13/2020 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: "as built"accessory in ground swimmin pool fenced to code as a plied for oer ZBA 47282.dated 7/3/2019. The certificate is issued to Smith, Michael &Teresa of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 44975 7/21/2020 PLUMBERS CERTIFICATION DATED 4 fA6o red nature a Town of Southold 11/16/2023 P.O.Box 1179 53095 Main Rd ' 3 Southold,New York 11971 CERTWICATE OF OCCUPANCY No: 44737 Date: 11/16/2023 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 1405 Terry Ln., Orient SCTM#: 473889 Sec/Block/Lot: 14.-3-2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 2/15/2022 pursuant to which Building Permit No. 47625 dated 3/31/2022 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: sunroom addition to existing inIc-Tamil}d #elfin as a�licd for. The certificate is issued to Smith,Michael&Teresa of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 1 Town of Southold Annex 1/24/2013 P.O.Box 1179 54375 Main Road ► Southold,New York 11971 0ERTIFICATE OF OCCUPANCY No: 36120 Date: 1/24/2013 THIS CERTIFIES that the building ALTERATION Location of Property: 1405 TERRY LANE ORIENT, N.Y. 11957, SCTM#: 473889 Sec/Block/Lot: 14.-3-2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 4/15/2011 pursuant to which Building Permit No. 36327 dated 4/15/2011 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: alterations and rgola addition to an existing one family d elling�as a lied fc�r. The certificate is issued to MICHAEL&TERRY SMITH (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 36327 1/23/13 PLUMBERS CERTIFICATION DATED 1/15/13 Michael Smith tSi tune i V t` r r OF //� t Ad I;,