HomeMy WebLinkAbout1000-15.-6-21 t o TOWN OF SOUTHOLD
Rental Permit
�$ 4 1100
�4 Owner Hania 3 LLC
Occupied as Single Family Dwelling
Located at 990 Three Waters Ln. Orient 15.-6-21
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 or
Code Evq)—ment Ofe` l
This Notice must be posted by the main entrance at all times
TOWN OF SOUTHOLD—BUILDING DEPARTM" -
Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 1 1 97 1-0959
P 1 11n tiry "ent
Telephone (631) 765-1802 Fax (631) 765-9502 tt)s://w w' s)gtholdt0 wnn v Tow4 o "�'�'oui °o�d
RENTAL PERMIT APPLICATION
Rental Permit Fee $300 (Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
Tax Map Number: 1000 SECTION BLOCK -LOT -
oe
L0 2 I
SECTION B.
OWNER INFORMATION:
Property Owner
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
923 -96ss
Telephone Number (s): Daytime Evening _ Emergency
Property Owner Email Address: AGL. e-oAf
Page 1 of 4
c
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:
Address of Authorized Agent(no P.O. Boxes):.__.
Mailing Address of Authorized Agent: L ,/ V' ✓� ___per/ //2a 4
Telephone Number (s): Daytime. Evening Emergency
Email Address: 156� �,#4 • Ga�1 q_
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, 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."
Rental Dwelling Unit Identifier:
Requested Maximum number of persons allowed to occupy Dwelling Unit:—461 ._.._,—
Number of rooms in Rental Dwelling Unit: e
Use and Dimensions of each room in Rental Dwelling Unit:
2
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)
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 before me tHi 4-'Z�day of 20 7—
Offici!?al Notary Public Signature an Original Notary Stamp
PAUL M.DECHANCE
NOTARY PUBLIC,STATE OF NEW YORK
(qualified in Suffolk County
Registration No.02DE6415194
Cornrnission Expires March 8,20
Page 4 of 4
f4f so
TOWN OF SOUTHOLD BUILDING DI
Cool 631 765 1802 �
INSPECmT� 10N
[ ] FOUNDATION 1ST [ ] ROUGH PLTG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAll
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] TIRE SAFETY IN;
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII
[ ] CODE VIOLATION [ ] PRE C/O [ ,]"I
REMARKS:
DATE
f 107 Town Hall Annex
Town Of Southold 54375 Main Road
'' Rental Inspection Report PO Box 1179
Southold, NY 11971-1179
Tel: 631-765-1802
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Owner ��C. ,� L �- !Phone
Address � O Gnu-f S f 1t— Visible
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Hamlet Inspector-._ .... .. .... ........ ._ .. .. ......., mm ._ .._.. �. . .w.. .
��a .......
Floor Level Quantities Sub 1 2 3
..W. ..,. ,,.. ..,,,,,... µ. , ,,,, , ,,,,, ,,, m, .,..a
Smoke�M Detectors(not located in bedrooms),........�,.._..,W,,. ..��.a.a .w.�.a....�.,�-, ,a w.,�a,v , ..a. �. ....�w�.....a,,...,� ... ..f ...w� �. ...����_ .... . .._....__. ........
Carbon Monoxide Detectors
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Fire Extinguishers
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�.. Exits.. . ....... ... . ..... . ._,..., .�.��. �.. .. .. . �.,.�..., ... .,...,,.�.... . .. _- . .......__ ... !..rv._ w ...._.. ....
Bedrooms t �1 2 3 4 } 5 6
M�. Smoke �,,... �.,._ . �„ ,.,.. , e..�.l. . .__ ... . . ......... _ ...._ . . � ..� ....w_ .,..t. ........ _�rc
�..e � �..__ � � i
e Detectors �
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Egress
Occupant Count
�... �
Building Systems Maintained &Operational (Condition of Property
,... .. __ ... m. .. �,........... �.. ......
Heating Building interior
Hot water Buildingexterior
Electrical Property clean, maintained &safe
.�„ ...,...� �..�m� a.,� . ....,. ... �� ��.,.� . . � ��._..-� .............;,Handrails& wards installed &���„� � �,. ,,.. �w... .........�.
M ical �w ... ....... ..�.. .. ..... . .. guards ........... ..secure �. .......
m echan ..,...m. ..e�..,...... a..,. � � .�.�a
Pool Safety Pool on Site
P „
Su
rface water alarm Date of CO issuance
Door alarms Pool completely enclosed
Self closing/latching gates Pool ���� � s �
..... ....R. .... .. ...m
� � requirements
E.�n. .. .........��..�. .b._...,�., .®. .._..fence to code .m. ,,rc.�e . ...w, _, _.�.a,....,.._�... .. .... ..... .
�.� .11 ............ ,j �:" �.....,. �...,,, .. .,
1C0's for all items present [Prior Rental
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Comments
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Floor �/ate
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h"ems
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TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER STREET VILLAGE DIST. SUB, LOT
3
ACR. REMARKS
TYPE OF BLD.
a
R
Z a kov 05 eOeC3,A PROP. CLASS
9 p
LAND IMP. TOTAL DATE 4
i
FRONTAGE ON WATER HOUSE/LOT
BULKHEAD
TOTAL
-7/ 3O
I X1
/ea o "OWN F SOUTHOLD PROPERTY
W� R �� ` VILLAGE DISTRICT SUB. LOT
FORMER OWNER N E ACREAGE -,
iS W TYPE OF BUILDING
IN
RES. SEAS. VL. _ FARM COMM. IND. CB. MISC. Est. Mkt. Value
LAND IMP. TOTAL DATE REMARKS ea
i 6--
-� �
� s _
Q /
a 7—O
300
v i D - - `
v _ �
6AGE �S o o # L 6I f`�G -N
...
— + �
NEW NORMAL BELOW ABO FN T SWAT
4 O )�ESN
Form Acre Value Per Afre � Value_ FR 1�1T�� R A
_ _ — _ v ks
L
Tillable 1 BULKHEAD47
SSG
Tillable 2 DOCK
Tillable 3
Woodland
Swampland
Brushland I
House Plot
3
Total
�a
_ I
II)OD DJ
Gam, R(M - LO
- - i
E
-- 15:6-21 6/11 1
IF
MEN
tvV. Bldg. Bath !�`
Foundation
-
Extension 1 Basement �� Floors
r t 41
Extension Ext. Walls Interior Finish
a
Extension Fire Place Neat
at `E7
Xa _ _ Porch Roof Type -
t Porch Rooms 1 st Floor
Breezeway -- Patio Rooms 2nd Floor
s
i Drivewayi
I GarageDormer
�,' ( / _ / D D __ _. —
O. B.
FORM W0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERKS OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
.......... Date .............................I..........4........ 19.3.6.
THIS CERTIFIES that the building located at -19/8....Threavatera..:�: ..................... Street
OrPnt by the 901cl .......... Ix.... Lot No. 3,11............Ori- entp ......
Map 0. 0 No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
—11 ..............I.............kwust—Ax........ 19.66... pursuant to which Building Permit No. ...2044-A
dated .............................AUZU01;....V.., 19.65.,was Issued, and conforms to all of the requirements
of the applicable provisions of the low. The occupancy for which this certificate is issued is ........
............................I.....,............................................ ......
The certificate is issued to ....WIllian2ree.dy...................Qmex...............................................
(owner, lessee or tenant)
of the aforesaid building.
R.D,Approval April 26t 1%6 by R. Villa
.........
guiM.; Inspector