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Home My WebLink About1000-54.-5-33 $, TOWN OF SOUTHOLD Rental Permit 1104 Owner Poor Soul Inc. Occupied as Single Family Dwelling Located at 825 Dogwood Lane Southold 54.-5-33 Maximum Permitted Occupancy 3 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. 3/26/2024 1`1-�p Code Eon eneot offico This Notice must be posted by the main entrance at all times � ,.. / 40 a Town Hall Annex x Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 � Southold,NY 1 1 97 1-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD J U L 1 1 2023 RENTAL PERMIT APPLICATION BLTUVING DFPT. Rental Permit Fee $200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: �` Tax Map Number: 1000 SECTION S Ll -BLOCK SECTION B. OWNER INFORMATION: Property Owner Name: L. , "� � Property Owner Legal Address: Property Owner Mailing Address: ., F Im 14-C z.O 3 a ' '7-. ' G Telephone Number(s): Daytime Evening Emergency Property Owner Email Address: "" L) L 't.,Liz L C Page 1 of 5 Torun Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 m'X BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime Evening _ Emergency 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." 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: Page 3 of 5 Town Hall Annex , Telephone(631)765-1802 i 54375 Main Roadl Fax(631)765-9502 ckr P.O.Box 1179 Southold,NY 1 1 97 1-0959 ' n d, 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 the laws adopted by the New York State Fire Prevention and Building Code Council. ❑ 1 am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ 1 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 SUFFOLK) 1 , 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 S ifif SO e` TOWN OF SOUTHOLD BUILDING DI 631 -765-1802 5y- 5 INSPEC 10 [ ] FOUNDATION 1ST [ ] ROUGH PL13G. j ] FOUNDATION 2ND [ ] INSULATION/CAl [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN%f j ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII [ ] CODE VIOLATION [ ] PRE C/O [ el REMARKS: hem ltq t I ex-,ul k lwxm ok- 41"c 3 &DATEALSO/? �'- '/ S � 011 Town Nall Annex " Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 ` ry 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. 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 as to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager. Property Owner's Name: rro Property Owner's Signature: Sworn to before me thisl /-�ay of : " 20 a Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.01 BU6185050 Qualified in Suffolk County Z) Lf Commission Expires April 14,2 Page 5 of 5 Town Hall Annex Town of Southold 54375 Main Road Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 �Owl Tel: 631-765-1802 AL _ ... .m. n..._ _......m .... .. ..�.. .. .� Date...M SCTM # Phone ,,Owner �o�S .. .........� �. ...._ �. ...� .. � Address (Visible 1. _i ..Hamlet. .�_..a......�,..... __.�.��!� � ..__... _.... �.ne. .. .._�.._.a..�. ..._. .�...... ........ ._._m,, Inspector�.�.�. .. �....... � ...._�..�.... �. ..�u._. ,.Floor Level q......�.... .......... �...�... ...�._..... �,._ uantities Sub 1 2 3 Smoke Detectors not located in b �.__. i . .._.... �... .... . .. ...._m _.. ..edrooms) ... .. e ,._.. .. . .w._ ....ro__ ._.. Carbon Monoxide Detectors Fire Extinguishers Exits . Bedrooms 1 2 3 4 5 6 Smoke Detectors E gress J �. Occupant Count Building Systems Maintained &Operational Condition of Property Heating Building interior Hot water Building exterior Electrical Property clean, maintained &safe ........ .. ....a.... _ cur Mechanical Handrails &guards installed &see Pool Safety Pool on Site Surface water alarm Date of CO issuance Door alarms - __ - Pool completely enclosed Self closingI , .. fence to code t requirements ,�a_atchinggates Pool,.., . ..._,�... _.�_ __.... CO's for all items resent Prior a p r Rental _. _.. . . _ CComments �.._� ...... .. ..�._.. d � .. m _ . .....�.._. __..._.. �. w.�_ _ ... _. r' Town EaII Angie.. ,roX N r Teieprone (631)765-i 902 54.37r �✓taitt Road �631 755-9502 � � Pax 7 P.D.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY TY CERTIFICATION Form is to be completed by a license architect, licensed engineer or licensed home inspector Separate farm Is required far each individual Rental Dwelling Unit Professional,seal re utred for Architect or Engineer, licensed Home ins ector rrrustprovide co o valld current cerfti lcation Rental Property SCTM Number: L>Qo - Rental Property Address:; � Owner/Name: Rental Dwelling Unit Identifier: Number &Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 —100 sq., Bedroom��#2-90 sq., etc.) CI:/k�f.LY.d'S fYV. L Property Description (Include all improvements indicated on survey) 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, and the Energy Conservation Construction Code of New York State. 17 411 " aTM " Ori inal i tore _. 4 Print Name � � �� ° g 1 Wrµ iN .,AuV M r M !..+.31 Please plac N" rfe orr t seatt i °f` 0eD tZi l 1 77 $3 ,_ _ Q IL yv Id TOWN OF SOUTHOLD PROPERTY R ZI 'STREET VILLAGE DIST. LOT SUB. Y) FOWER OWNERL-1 I 'a AV E ACR. S W TYPE OF BUILDING RES r,� ; �<.; � SEAS. I VL. , FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS -0 91i Q f7 vc A0 n AGE BUILDING CONDITION NEW NUKM,4,L BELOW ABOVE YC4P— FARM Acre Value Per VGlue T Acre Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH House Plot BULKHEAD Total DOCK �9 COLORTRIM 2 s e a I a F e _ ! t a m� i s 2 1 - x a x € i x t� f i i t 3 � � ' e x 54:5-33 4/07 — a M. Bldg. Extension 77 Extension 1 � I F s Extension . oundao n Gth -ietteDt orcn !Basement ;Floors K Parc xt, alls �N _ Anterior Finish E LR y Fire Place Breezeway - w _ lHeat DR. a, Garage Type Roof Rooms 1st Floor F BR. Patio ;Recreation Room Rooms 2nd Floor FIN. B 0. B. !Dormer :Driveway Total FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. Z 112.42 . . . . . . . . . Date . . . . . .0 F t Q t a r. .4 . . . . . . . . . . . .THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . » . . . . . . . Location of Property t,t5 Dogwood Lane Southold Mouses . . . . . . . . §treat . . . . . . . . . . . . . . . . . . . . . . .Muir%si County Tax Map No. 1000 Section . .0 5 '. . . . . . .Block . .0 . . . . . . . . . . .Lot . , . . . . . . . . . . . Subdivision . . . . . X . . . . . . . . . Filed Map No. X. . . . .Lot No. X llequireeenta for a private one—faeily dwelling built prior to conforms substantially to the he , �. { .office h— Certificate of Occupancy . . . . . . . . . . 19 .5 7 pursuant to which iMilding iPerntitNo. . . Z.t.i?4 3. . . . . . . . . . . . dated . . . . .Gc t p.har. 6. . . . . . . . . . . . . 19 .a2,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 . . . . . . . . . . .a .pra,uate. .aoe-.f •. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . » . . . . The certificate is issued to . , , „ Varna P, Fitzpatrick . .(owrrar tor`. . . . . . . . . . . . . . . . . . . . » . of the aforesaid building. Suffolk County Department of Health Approval . . . . . .A/4L. . . . . . . . . . . . . . . . . . . . . . . . » , . , , UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . .n/,a, , '. . . . . . . . . . . . .. Building Inspector Rev.1/81 BUILDI`IG DEP_ARTI"IENT TOl OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT Location (nun, o r°ees kejunicypalityy Subdivision i4far) No. Lot(s) Name of Owner(s) Occupancy type owner-'tenn t Admitted by: Accompanied by: Key available I ` Suffolk Co, Tax No.� Source of request � �" :1. a'te _tol� D?1ELLING: Type of construction 00, stories_ ` Foundation elIar011ii& Crawl spac e Total rooms, 1st. F'1 2nd, Fl_ __Ord. ' Bathroom(s) Toilet room(s) Porch, type Deck, type Patio, type Breeze,aay Garage Utility room Type Heat `arm Air Hotwater Fireplace(a)�No. Exits Air anditionan , Domestic ho twat er Type heater, Other ACCESSORY STRUCTURES: Garage, type const. Storage, type const. Swimming pool Guest, type const. Other VIOLATIONS: Housing Code, Chapter 52 Looation Descr"iration Art» 1 Sec. -14 Remarks: Inspected by: Date of Insp.-fa_._ .Time star r end ' FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34361 /10 Date: 05 20 THIS CERTIFIES that the building ELECTRIC UPGRADE Location of Property: 825 DOGWOOD LA SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 54 Block 5 Lot 33 Subdivision Filed Map NO_ Lot NO. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY... 5 2010pursuant to which Building Permit No. 35533-Z dated MAY 61 2010 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 ELECTRIC UPGRADE FOR AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to VIRGINIA & KEVIN COTTON _...m.__ (OWNER) of the aforesaid building. Su MOLK COUNTY DEPARITCOM OF BEALTH APPROVAL ... ..... ELECTRICAL CERTIFICATE NO. 35533 05 07/10 PLUMBERS CERTIFICATION DATED Authorized Signature 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-32659 Date: 1q 2.5 0°7 THIS CERTIFIES that the building ADDITIONS/ALTERATIONS Location of Property: 825 DOGWOOD LA SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 47889 Section 54 Block 5 Lot 33 Subdivisionw Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 2006 pursuant to which Building Permit No. 32298-Z dated AUGUST 18. 2006 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 FRONT ENTRY & REAR SCREEN PORCH ADDITION TO AN EXISTING SINGLE FAMILY MDWHLLING AS APPLIED FOR. The certificate is issued to KEVIN & VIRGINIA COTTON of the aforesaid building. (OWNER) SUFFOLK COUNTY DEPARTHMTOF HEALTH APPROVAL ---NIA ELECTRICAL CERTIFICATE NO. 3045422w 09/7.207 PLUMBERS CERTIFICATION DATED N/A �7th/iz4edSignature Rev. 1/81 �y 1(Y f / 1f4 1�111151j1{I �I.� I u I�°i lioi '�i�ii � �ii�. V�in� i 4111�I IIIIO� m� 1i ri jl fj ii I If I G lit 1 rig/i %, N r, 1 i �i�i iY� �pl �Irll'I "s i°i uyi"III� jilYuy ' if „6 , v VV 0 it r r✓�ir�s/d�narmNdt^�� d, /t, �G/l�� ✓�u�,�w �l is 4 v '� „a u e �w akx II�IG wdyjl c"A � d 41 r r i J rid / r / r �,. i„ �,n.,.% ro,,, oo ,. i i, „" ✓; �/ r, ,,. / r 5, r r.� � � !' r� °f -/ / „a//Gig„//r / // ;„/r! „ ,�i,,, r /L, „/%fir szo nz r Dr r // / Ip r ' / Nl lr,, r r ,r"„� r /,�</ � g l,'�%y, r ✓ r / // / r% l� i i ,�, rr r % I r� 1 1 r �� v rr rr,/ ,/irr „ .✓., r o, / // / ��/ � � 1, ,/ /� u N I� S ,77 77"TZA /0 y r i IIII�I�II i i�� l q �/1 // r rr a uc�r6^^wUrro/ofrf F� ,wrr rf ri far r irr✓�rF�r r Qjj i/ / � 1 P. y, %I � r�rrt Ili o i i i o- o ! ( % r`/-