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Home My WebLink About1000-78.-1-10.23 TOWN OF SOUTHOLD Rental Permit 1109 Owner The Old Town Farm LLC Occupied as Single Family Dwelling Located at 2355 Main Bayview Rd Southold 78.-1-10.23 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. 4/15/2024 omk. o e ; This Notice must be posted by the main entrance at all times Enf ce e t fficial ��SOfFeltCp ®,�,�`� TOWN OF SOUTHOLD-BUILDING DEPART MEN. .., 1. - ;� � Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 1�1_ 5 Telephone (631) 765-1802 Fax(631) 765-9502 https://www.southoldtownnj-.g MAR 2 8 2024 8 BIJ ,DTI TG DEPT. RENTAL PERMIT APPLICATION TOV'1N. �c3P Lsouni41zu)' Rental Permit Fee $300(Application must be renewed every two years) Section A. Property Information: Rental Property Address:- i jc( Tax Map Number: 1000 SECTION �� -BLOCK -LOT - 2 SECTION B. OWNER INFORMATION: Property Owner Name: -I —ke Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) ltgs lteis Telephone Number(s): Daytime Evening Emergency Property Owner Email Address: e- cwc"1 6/ YYI '• coma Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: C—duM id TkL r Address of Authorized Agent (no P.O. Boxes): 7"[3d y�b.,. ' `c CK Mailing Address of Authorized Agent: 1•0 17eto n LL JA Telephone Number (s): Daytime v ing Emergency Email Address: ecUar+ Vv4Z4.1 • LO 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 re ts) 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 f 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: 2�1d �� J )C V&1n1 _ 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: I)'y" , 0 I la`g" )t 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 ❑ lam 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 SUFFOL"K)) I O000C rd 4 h� , 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. 1 Property Owner's Name: F.; ctv I-T f Old 1 Fa I W iL L Property Owner's Signature: IAA A Sworn to before Dip,thiX day of % ty 20 Z/ OZyc 'Zed l' Signature and Original Notary Stamp §NTH G BANK lttake of New YorkGggNK W. A6d31183 tate 4i i d fH 5uffalk County i 64 ofNewY° ^ d 's� xoir�es )ar�3,aozb ff 277g3 F-vi� oun es Jan 3,ty 2016 Page 4 of 4 ho�aoe souryO� 'I jy� �i/� hv=AoTOWN O SO BU ING DEPT. courmN�'', 631-765-1802 �t ,--- I _ I ry.1- INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] AL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION ] ELECTRICAL (ROUGH) [ ] ELECTRICAL NAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL RE 0ARK �; r, o n DATE INSPECTOR SCTM # - f TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET -��'i>„:d�" VILLAGE DIST. _ .... LU }`e�:�;s+°'dy',1 �'°'°d�'++'ef ��t..� +Y�a 1xa Lei•1.. 2.y:`c :y `:' _ I ACR. REMARKS j a v, lt C Tb i a TYPE OF BLD. 4.-y /-7 . PROP. CLASS LAND IMP. TOTAL DATE 1 I i f 1 FRONTAGE ON WATER HOUSE/LOT BULKHEAD TOTAL "s'I "s xw, , Y, OT F, s 7-4, 'XI vl� ig, _0 al 'p "Al f Z' -V 6, --Ai! #�ta%,'-1,44P "Alm "I�ijl ir ME 'J pq A All uagg" "M R SAM M, 4z,� 4N "OR Zw" "a Z�6.'Y,A� -M Rx"O" V- R, IN RA" '04 R, Jii,� n, ,,,, !", , % -.5 711`1�— A i 4 J", ftw- V, 4,1 4- Z"i . .I.... AW, a 4,M, �il�_-llll Mll� ww"40�4,14- WW� Ay"; NJ E,'Nd2- MOWN, I "i"l-16 11 R Oil 4; "Wg o'4 V'4 Ai 'a 4,-i R E` Owl Ilk" i "M n o TOWN OF SOUTHOLD PROPERTY RECORD CARd OWNER STREET '3 ; VILLAGE DIST_ SUB. LOTS ,,.>. ^L g ,. _ .j4 f" p •,. S �,., M1 i °?;.s� f ✓ma's f"` wf,.. ^:.. 'g , - t ACR. } ,} REMARKS h r�}I•it fist Vg1. ! ., a p ,? _ TYPE OF BLD. �` `.G`t/L•;J�t.f�. i�rrd P r ~ e'4.+`„".� i.-... '��f �i `r `A`_.•'•"�`' r»1 .�'�i f W j{'e.;�:., •.. ,'''a< M'� r� 1.r PROP. CLASS - }w, i $ �%r•.: r4•~i�� 7 i .r"�y .'��`�-�` ��„�� .M.. � �'""..�d.if.r'.Y 'p �u"..9i�f"y'q .�� ,,}�E a✓��.. .4:f ofr, w,�,C.{,• }1 f��t AWN LAND IMP. TOTAQf,V :DATE t !t f .� s'r 34 f tf '`t \ x}sw.. 3m;,- ».. A h afro°'-'g 4' €P`------' � -'-- —z *3, r•�, . -.E._ 1`•i '� L All t.,� �� .�j I r''-" Y< F �r^ mm. ,�A �'•' s .`^° :eJ �t ------�d — ^"c�� ;'~4 ., 1/ji/ —�t� .-,•` .a-..d'`t. ..:. a ) ,.;.,....r:-� r ,:w'�,•�v=":j v .r�, y a A '"-. f(,:- (e ,r L.3a`3 , IV, --- r .ir"{ r ° .�P f`rt'! �.f. ..� t�r°A rf-f-;d;x}d�. 7 i' ��J �,�; t ,p L✓f,•.f.•'j{^u 37 /d rr g,dc •�,•yp. ga. ,p - r'c'u� n < 1 ?�> l ......................... r, ,+ cx, j ' *� 'Yy'akit.i4V � ' iv 4a 7 k V�E. tY{ � :'• Efg "f e�6 2m., FRONTAGE ON WATER 1 t J� d A� BLE .__ = ` . . �z tt. gipp, FRONTAGE ON ROAD WOODLAND — DEPTH MEADOWLAND i BULKHEAD HOUSE/LOT TOTAL ;• -- - '---- :: ■N■■■N■■■■NrN ■■�■ .e ■ ■■■rN■srrrr■■■ ■■r�i�i . � . . . .., .. . ■� NOMNMi�ii�iNM M■r■��ii � N�iO■iNiN■i��i��ii�i � i�i�i . ■■N■■■ ■ ■■ ■ on ■■■■■■ �■ NO■NN■am No ONE ON r �- � :R:.^ ■■ ■Orr O�■.■ ■■e�■■■■■�iN ..; ENO■NNN■■■UM ■■N■■■ ■ _ MONO■ ■■■ 10101 'I momr ■ ■■■■■■■■■■:H mom■■ ■o ■ ■M■■■■■■O■■M■NNN■■N■■ ■■ ■■N■■■■■■■O■■ ■■M■■■ ■■N■O■■■■M■■IM ■ MONO rOr■M■ INIMMEMINIMMEMIN■ ■N ■MN N ■■N■NM■NNN■M■N■■N■■ ■Or■NNNNNrMMrrr■■rrrrrNr Foundation Dinette Exte 104 Basement •• Extension • Extension • • ••• • •. • Dormer Deck Attic I R Rooms 1st Floor Driveway Rooms 2nd Floor s i s i FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, -N.Y. CERTIFICATE OF OCCUPANCY No: Z-29231 Date: 02/04/03 THIS CERTIFIES that the building ALTERATION Location of Property: 2355 MAIN BAYVIEW RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No_ 473889 Section 78 Block 1 Lot 10.23 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 9, 2002 pursuant to which Building Permit No_ 28343-Z dated MAY 1, 2002 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 REPAIRS TO AN EXISTING AGRICULTURAL BUILDING AS APPLIED FOR. The certificate is issued to EDWARD DART AS TRUSTEE (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A /Aonyed Si nature Rev. 1/81 F.':-n(.. _.,—..faP"s,r^,*o-=�r^,�+^r— .1; _I_^"^+Arn _ _- •- ` - ,. - t FORM NO. 4 TOWN`OF 50UTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall s 's. Southold, N.Y. CERTIFICATE OF OCCUPANCY No':. Z-_3.0005 Date: 04/06/04 TSIS,CERTIFIES that the_-building NEW. DWELLING Lo c ton of Property: 2355 ' '` j MAIN BAYVIEW RD SOUTHOLD County,:Tax;Map No 473889 , Section 78 " Block 1 Lot '10.23 Subdivision Filed Map No. Lot No. conforms 'substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 21, 2001 pursuant to which Building Permit No. 27459-Z dated JANUARY . 2., 2002. 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 NEW SINGLE FAMILY DWELLING WITH ATTACHED PORCH, & THREE CAR GARAGE UNDER DWELLING AS.APPLIED FOR & AS PER ZBA #4925 & AS PER 'STATE PETITION #2001-1029. The certificate is issued to EDWARD DART, AS TRUSTEE Of the'4foresaid building:. su TOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-00-0273 01/16/04 ELECTRICAL CERTIFICATE NO. 115075 01/07/04 PLUMBERS CERTIFICATION DATED 02 04/04 BURTS RELIABLE Y K //�uti,Zrized,,"Signature Rev. 1/81 �o�gu6FOt,i-�0 Town of Southold 5/24/2019 a P.O.Box 1179 0 C* m 53095 Main Rd oy� �op4 Southold,New York 11971 ' 6 CERTIFICATE OF OCCUPANCY No: 40409 Date: 5/24/2019 THIS CERTIFIES that the building FARM STAND Location of Property: 2355 Main Bayview Rd., Southold SCTM#: 473889 Sec/Block/Lot: 78.4-10.23 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated " 1/9/2019 pursuant to which Building Permit No. 43411 dated 1/22/2019 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: FARMSTAND AS APPLIED FOR The certificate is issued to Old Town Farm LLC The of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED uth ed Signature f Town of Southold Annex 6/2/2014 A-44 P.O.Box 1179 41 00 - 54375 Main Road "F, Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 36947 Date: 6/2/2014 THIS CERTIFIES that the building ELECTRICAL Location of Property: 2355 Main Bayview Rd, Southold, SCTM#: 473889 Sec/Block/Lot: 78.4-10.23 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 4/25/2014 pursuant to which Building Permit No. 38823 dated 4/28/2014 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: 200 Amp Underground Electric Service The certificate is issued to Old Town Farm LLC The (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 38823 05-29-2014 PLUMBERS CERTIFICATION DATED Authorized Signature SITFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES CERTIFICATE OF CARBON MONOXIDE ALARM INSTALLATION I Electrical Ins ecrion A ency l Town Electrical Ir s ector Business:Name&Address: Na of InSpecto . Lcng Island Electrical Inspection SV ► �� 1,070 Middle Country Rd. Telephone: (Saint James, N.Y. 11780 631 -265-3075 Health Department Reference Number: ]- 7--- Tax =lap Nunflher: District Section Blocks) Lot(s) , ao-� 1 Vv o v s O��'neri.l<<er;t Printed Name: Owner/Agent Signature&Date: No.of Alarons installed: Rough in Pass (Date/Init. /03 Final Pass(Date/(nit.): /3 1 i U I CERTIFY THAT ALL OF THE FOLLOWING ARE TRUE: ® Carbon'Monoxide Alarms have been installed on each level where sleeping quarters are located,AND All alarms have been installed in accordance with Article 10 of the Suffolk County Sanitary Code and the Carbon Monoxide Alarn; Standards,including: All alarms are UL2034 listed (Latest Edition), have a digital display, have a reset button,and have a feature to display the maximum carbon monoxide concentration recorded since the feature was last reset,AND All alarms have been directly connected to the lighting circuit with no intervening switches,AND All alarms have been tested and found to be operational,AND I am employed by an agency that is currently approved to perform electrical inspections in the Town/Village having jurisdiction. • If this certificate is for a MULTIPLE DWELLING,Carbon Monoxide Alarms have been installed: In all sleepin ooms served by a centralized sy supplying air for cooling,heating,or ventilation,AND In ea sice tng oom containing a fuel appliance,AND In all wel ing nits and sleje ' b units sharing a common wall with, or located directly above or below, a roilm c itai i o cen alized - tred appliance,AND 1 In acrid r se vi t welling units or sleeping areas within forty(40) feet of all doors to those units and the serve ro in ontaining a fuel-fired appliance. l s �. (. tgnat of Inspector) (Date) V (Printed Name) (License Number) Falsest- ments made herein are punishable as a Class A misdemeanor ursuant to Section 210.45 of the New York State Penal Law EffiEffaza • 'I'm 1OXACQUIl • • • • ' ' a 1 I CERTIFY THAT THIS DWELLING IS EXEMPT FROM THE REQUIREMENT TO INST.-uLL C.- !mN N10NOXIDE ALARMS BECAUSE ALL OF THE FOLLOWING ARE TRUE: ■ There are no fuel burning appliances installed,AND • There are no garaves attached to the dwelling,AND • The duelling uses an electrical heating system. {r f •Inspector ) (Date) (Printed Name)False;tsterneuts made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the New yor-L. ct +(•T'r TIIF ORIGINAL SIGNED COPY OF THIS FORM MUST BE SUBMITTED TO THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES IN ORDER TO RECEIVE FINAL APPROV F,I._ , i- '`•(Rev. 10/01)