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HomeMy WebLinkAbout1000-63.1-1-19 TOWN OF SOUTHOLD kl"- Rental Permit 1106 Owner Peter Tast Occupied as Single Family Dwelling (Unit 4D) Located at 2555 Youngs Avenue Southold 63.1-1-19 Maximum Permitted Occupancy 4 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. 4/5/2024 Code n orc ent Offici This Notice must be posted by the main entrance at all times - f a TOWN OF SOUTHOLD—BUILDING DEPA"xrMENT x 54375 Main Road P. O. Box 1179 Southold NY 119�7f;;695 Town Hall Anne �'( v9 )24 Telephone (631) 765-1802 Fax(631) 765-9502 pittps:/,fi rww.sot�ittiofdt('.) inn .iov RENTAL PERMIT APPLICATION Rental Permit Fee $300(Application must be renewed every two years) Section A. Property Information: Rental-Prope y A ress: Tax Map Number: 1000 SECTION •Q{ -BLOCK 01' O D -LOT - OW SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) a TO bo 91 Telephone Number( ): Daytime time r Evening Emergency �r 6 7ZII� ,T Y Property Owner Email Address: Page 1 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property:I� 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: 4D 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: pt � R 2V X KIT - IYA X 14 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 JIOn- _FSUFFOLK) �`T� I T�5t 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 thiga day of m Out 0 , 20,� y Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.0 1 BU6185050 Qualified in Suffoltt County Commission Expires April 14„2,C:1 y Page 4 of 4 so 631 76E 1802 6 3— 1 INSPEC I 11,1, 10N [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAl [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY W [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI [ ] CODE VIOLATION [ ] PRE C/O [ REMARKS: 04 INSPECTOR Town Hall Annex � w-M Town Of Southold 54375 Main Road Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 „T Te1: 631-765-1802 SCTM# '. Date .a .. !Owner Phone Address ' Visible ...,..... ��..� ���w. e s .. ._._�� ............. ... Hamlet _..... .......... _.. �' , .._. ..... ...... .. ....�. . .. . ..... Inspector^ .�.... ..�.. .... _ . ...._., _ ... ... ..� ... . _........ ..w......_......... ... _ ._.. .a .. .....-.. Floor Level Quantities Sub 1 2 3 �a ( � .�.. Smoke Detectors(not located in bedrooms) .,..,.. .. ..�R�...�, ��� ... . , .. .............w...... .. ......... ..... ....... _....... Carbon Monoxide Detectors Fire Extinguishers M....,. EXItS.. ....,,, ,,.,..-. .. .__.. ,........ . . .. .. .. w.._�.....,,.....,,... .. _.. ..,.,,... ...........,, }Bedrooms 1 2 . ... .. 3..._._-w �_..4 _...... 5 ..� J.......��6 Smoke Detectors � Egress 1 ...� ..OccuantCoun.t.. ......�.�_ �....��....w.. . . . ... ._......� .....�.� .. ......._ ......� m.._.�.....�._,....... _...��. . ......._.. �...�_. ........... . ..� p lB �........ti ..� . ��.� e �Condition� rProperty uildm Systems Maintained &Operational Building of g Y P Heating g interior �.e ...a .. ......... .... ��w..� ..�...�� ,... - . �_...,. .� a ��� �, � .. .... . m..�, Hot water Building exterior _ ...... ..... .. .. N,.,m ..,.,, .. _... .... ,, Electrical Property clean, maintained &safe m� ...... , ...� ... ... �m��..,. �.�... . .....,,e �� _ . �A, M ,wo . �H.�. -. a ���„ ,v,� .��. .,.. �.. ..��_ ...... .... . .-...�.�..... ... . g installed cure Meehan' �.�. .,.,�. �.ical...,�..� w..�.-. .. ....._..... .:Handrails&guards i tailed secure ww_� PoolSafe ,.�� ... ..., ..._.,_ _... ,Pool on Site Safety Surface water alarm Date of CO issuance Door alarms Pool completely enclosed Self closing latching ac p ... �..�_..,.��......g�. ...g. ates_....... . .. ..�.....�. . �_......... P ....._.,,.ryry... .-.Pool fence to code requirements ....,.....�..�. ................ � ..,,,,. .,,< Prior Rental p O's for all items present.y Comments ..... .�.... �. .......� . ...._.._.........�� ......... _...._.. ......... ......� .. ..._. -.. . ....... .. ......... .. ...... W�.. . , .......... I L ... ... ...... __... ............ ....... .... . ......... ........ _ ..... .... ._.w......� 1� .. ....... _.. .. _.... 'PATIO BED ROO11 11-0/10-8 ,18 AT LIVING ROOM cl Z Z-6/13-0 Gi) F R CI Ifnt BED ROOM NJ ICKITCHEII 17-0/11-4 4/9-4 MATH c Of 0 O O lei FLOOR PLAN MODEL B FOUNDERS VILLAGE TOWNHOUSES C UTHOLD. HFW YORIC � D TOWN OF SOUTHOLD PROPERTY REC OWNERS—iREET VILLAGE I DIST. I COUNTY TAX MAP NO, t � _ LAND IMP. TOTAL ' DATE REMARKS: I f , _. t526 I i _ leg F i t i g 3 i LAND DATE PST t r N x0 { E a FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. .Z 136123 ... . . . . .. Date . , JulY. .1.0.. . . . . . . .. . . .. . . . . .. .. 105. THIS CERTIFIES that the building . . . .tUJI f I FLE.VWk44INA . . . .. . .. . . ... .... . . . .. Location of Property 5. 5 XPAN05. AVr:,NJJA.. . . . . QVTRQ4V. .. . . . . .. .. . . . . .. . . . Haum Na stmer Hanger County Tax Map No. 1000 Section . . OhA . . . . ..Block . .P P?. . . ... . . . .Lot .. .28. .?9 . . .. . Subdivision... .F.QTJVPM4. Y-I.44ME . . . . . ..Filed Map No. . . ... . . .Lot No. .... .. .... . . . conforms substantially to the Application for Building Permit heretofore filed In this office dated . .. . .... . , 1984.pursuant to wlfich Building Permit No. . . .. . . .. 284 oZ.. dated . . .. . .4 @'A•. .17. . . . . .. . . .. . . . 19$4 . ,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 ... . . . . .. . . . .Zv;L14iog.A4. Xpt. . 64-A.Vni4 .7A MVl.kjPI-P. PWg1�.�rlg. . .. . . . . .. .. . .. .. . . . The certificate is issued to . . ... .4IZPA . -JLhTX. LT.P . . . .. ... . .. . . . . .. . of the aforesaid building. Suffolk County Department of Health Approval .. .. . .. 4 . , , m . . . . . . . . . .... .. ...... . UNDERWRITERS CERTIFICATE NO. . .. . . . . . ... . .. .NO9.7935. .. . . .. . . . . .. .. ... .. . . Plumbers Certification 713/85 .. . . . »C . » . . . . .. . . . . . . .. .. . ... . Building Inspector Rev.1/a1