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Home My WebLink About1000-102.-6-4 x = � TOWN OF SOUTHOLD V11 Rental Permit ate_ Al 1115 Owner Mark Williamson (Trustee) Occupied as Single Family Dwelling Located at 410 New Suffolk Rd Cutchogue 102,E-4 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. 4/22/2024 Code n r ement off` a This Notice must be posted by the main entrance at all times r Town Hall Annex Telephone(631)765-1802 54375 Main Road ' Fax(631)765-9502 P.O.Box 1179 �` Southold,NY 11971-0959 e0UNI(I BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200 (Application must be renewed every two years) Section A. Property Information: Rental Property Address;* w RAI 0 Tax Map Number: 1000 SECTION W)_. &&,-BLOCK -LOT SECTION B. OWNER INFORMATION: Property Owner Name: CX Property Owner Legal Address: Property Owner Mailing Address: `r Telephone Number (s): Daytime 4, 47 tMing Emergency Property Owner Email Address: ► Page 1 of S o i 000 �A . Town Hall Annexe Telephone(631)765-1802 54375 Main Road r �; Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 . w BUILDING DEPARTMENT TOWN OF SOUTHOLD 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: To mm ft Address of Authorized Agent no P.O. Boxes : t . '�U a!�J � ��` �.1 g ( ) Mailing Address of Authorized Agent: Telephone Number s : DaYtim nin Emergency. Email Address: M Cis ! 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): Page 2 of 5 fl " " Town Hall Annex �' ��. Telephone(631)765-1802 54375 Main Road ; � ti` Fax (631)765-9502 P.O.Box 1 179 r; Southold,NY 11971-0959 'Z of RAF BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: �` . Q o Telephone Number (s): Daytime Evening Emergency Email Address:' A�00306 r 0D eM i go" co 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: u�5� 4 Sc Requested Maximum number of persons allows 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 54375 Main Road t Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 C, 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. Q1**-I 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) I e ify under penalty of perjury,the following: 1. I 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 5 4 s ��':, Town Hall Annex ( Telephone(631)765-1802 54375 Main Road _ Fax(631)765-9502 P.O.Box 1179 l Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTOLD 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: wu 45 Property Owner's Signature: Sworn to before me this.4 day of OCA r , 2023 O icial Notary Public Signature and Original Notary Stamp JORDAN MEEKINS Notary Public State of Washington Commission#2 02145 2027 My Comm.Expires Aug Page 5 of 5 TOWN OF SOUTHOLD BUILDING D 631 765 180►E INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAI [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INI [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FIl L l CODE VIOLATION [ ] PRE C/O [ REMARKSIK pun T)OO(Z ' ju miow 4,tplaa C KK DATE 1 INSPECTOR TOWN OF SOUTHOLD BUILDING N f i31 -?8E 1802 tol • 6 INSPEC ION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAI [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INc% [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII [ ] CODE VIOLATION [ ] PR C [ I a O r EE 1) INSPECTOR Town Hall Annex Town of Southold 54375 Main Road CD t Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 SCTM# ;Date .. ..,� Phone Owner d /. . ._...,r i Address Visible t �h , Inspector .�.�...... ...... _ . _........ .._.... .�. _.,......., ....___�.. -. ...._ ._.,_ � u Ham e __..,.. Level Quantities ... �w....... __..� _ .�..��. �.. ..... ._...._..... � ..�. Sub..... 1.... ..1 _...,. 2... Floor. . 3..__.. ors (not located in bedrooms) Smoke Detect Carbon Monoxide Detectors / Fire Extinguishers Exits , .. a Bedrooms 1 2 3 4 5 6 „ . Smoke Detectors _ .. Egress Occupant Count � _._ m m. .., p _ _ Building Systems Maintained &Operational Condition of Property Heating Building interior Hot water Building exterior Electrical Property clean, m p y _a maintained &safe Mechanical _ ......ry ._. p _..aHand.. . ..p._. guards......... . ... .µ........ ..ry. Handrails& uards installed &secure Pool Safety Pool on Site ,Surface water alarm Date of CO issuance f M 'Door alarms Pool completely enclosed j t Self closing/ latching gates Pool fence to code requirements CO's for all items present Prior Rental Comments: w {r,. i i I i i a. ax 1 r i I 1 i ti 1 J,ww.�'°� �"a� Q 4r ti SIX! v. .............. TOWN OF Ptt'OPERTY RECORD CARD 4 OWNER STREET I VILLAGE DISTRICT SUB, ; LOT T s F ER OWNER i ACREAGE _ d/ ff W� TYPE OF BUILDING s RES. SEAS. VL. FARM COMM IND. ! CB. MISC. Est. Mkt. Value LAND IMP. TOTAL I DATE 1 REMARKS Fes_ f e .7 _2�-/,y_LL1 AV or e a AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FRONTAGE ON WATER Farm ? Acre Value Per Acre Value FRONTAGE ON ROAD Tillable 1 BULKHEAD = ` ; Tillable 2 _I DOCK I - - — Tillable 3 Woodland - Swampland Brushlanc&,. I House Plot Tota I E u Ck) r je e- s r e a E Bath M. Bldg, Foundation Extension , Basement Floors 4C. r Extension r Ex . Walls Interior F nis_h � Extension - , Fire Place / Heat j• - $ �' I Porch Roof Type Porch Rooms 1st Floor B Rooms 2nd Floor reezeway Patio Dormer Driveway Garage Z 7 '/ O. B. E e11 Town of Southold 4/20/2024 53095 Main Rd r rq Southold New York 11971 Ap IIIE EXISTING CERTIFICATE OF OCCUPANCY No: 45135 Date: 4/20/2024 THIS CERTIFIES that the structure(s) located at: 410 New Suffolk Rd, Cutchogue SCTM#: 473889 Sec/Block/Lot: 102.-6-4 Subdivision: Filed Map No. Lot No. ... ................. conforms substantially to the requirements for a built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 45135 dated 4/20/2024 was issued and conforms to all the requriements of the applicable provisions of the law. The occupancy for which this certificate is issued is: wood t IT l vS:11gje f`ar ly.4�ve1.1 11g. ^ith covered fiont_pptgjl, ll�lo el_ c�� 1�.It�a�clmta<al�l�a ��(�a�ca)I�c��I N 11A�,c�s 1pon1 and cccrncla>ci fight gage::. The certificate is issued to Williamson Joyce Liv Trt (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. Autho izei, ignatUro BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 410 New Suffolk Rd,Cutchogue ........ ... ........ ........................................... ......... ..... ...... SUFF. CO. TAX MAP NO.: 102.-6-4 SUBDIVISION: ......... NAME OF OWNER(S): Williamson Joyce Liv Trt OCCUPANCY: .._._._.. ._....._ ........., .. ......... ... ADMITTED BY: Mark Williamson .... ... ....... SOURCE OF REQUEST: Williamson Joyce Liv Trt DATE: 4/20/2024 DWELLING: #STORIES: 1.5 #EXITS: 3 FOUNDATION: block CELLAR: partial CRAWL SPACE: yes BATHROOM(S): I TOILET ROOM(S): I UTILITY ROOM(S): in basement ----------------- PORCH TYPE: 1 cov,2 enc. DECK TYPE: PATIO TYPE: _... .. �...... ..... .. .... .. ....__....... BREEZEWAY: FIREPLACE: GARAGE: .......................................... DOMESTIC HOTWATER: HWH/oil TYPE HEATER: furnace AIR CONDITIONING: TYPE HEAT: baseboard WARM AIR: HOT WATER: ..... . ......... _..,..,. #BEDROOMS: 4 #KITCHENS: I BASEMENT TYPE: ........ . ................ .... OTHER: ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: wood frame STORAGE,TYPE OF CONST: SWIMMING POOL: GUEST,TYPE OF CONST: OTHER: ........ ..... VIOLATIONS: .... ...................... ......... .... REMARKS: INSPECTED BY: NANCYD DATE OF INSPECTION: 11/14/2023 TIME START: 11:32am END: 12:1Opm