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Home My WebLink About1000-26.-2-39.1 1o�yUFFu( RESOLUTION 2024-410 ADOPTED DOC ID: 20222 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2024-410 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON MAY 7,2024: RESOLVED that the Town Board of the Town of Southold hereby authorizes a refund of $300.00 to Anne Wyden, 1145 Majors Path, Orient NY 11957 for payment of a Rental Permit that was Requested in Error. Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Brian O. Mealy, Councilman SECONDER:Jill Doherty, Councilwoman AYES: Doroski, Mealy, Smith, Krupski Jr, Doherty, Evans O e • cL VK LL'V- sks E C Er, 3 . h ; 'fl TOWN OF SOUTHOLD-BUILDING DEPARTM E NY'11071V,�� Town Hall Annex 54375 Main Road P. O. Box 1179 Southold 4 Telephone (631) 765-1802 Fax (631) 765-9502 https://ww-w.southoldtownny.gP,, spe:qi b RENTAL PERMIT APPLICATION P t sot) Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: JN5 mAxODA RObb ROAD r6V,'e"-T. t'" "45-1 Tax Map Number: 1000 SECTION -2-(P-.1-3q—1-BLOCK -LOT SECTION B. OWNER INFORMATION: Property Owner Name: AmAr_ Wvw:m Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) Telephone Number (s): Daytime W 0-2S5-aq&&ning '.sAr4C Emergencye Property Owner Email Address:--Tf ee-+&ac AZ aa 1. C-n M Page 1 of 4 193 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: Telephone Number (s): Daytime Evening Emergency Email Address: 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: VAO L45 E 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: 1 6RE�T QOCM ( ICITCNfI) Rot'. LWIMa; 0.boH - 13ft a.00 M t L PET M S 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) I At4rie VJ�'DETI , 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: AM MC LD-i-byrA Property Owner's Signature: W !,O== I `` CONNIE D.BUNCH Sf 3 day of �Gh�") Notary Public,State of New York Sworn to before me thi , 20� No.01BU618505b Qualified in Suffolk County Commission Expires April 14,2j2aq Official Notary Public Signature and Original Notary Stamp Page 4 of 4 61�t5 M Asa 2S e>N T'-0 o Q -t4.rt -1, 'L'4--I (Lt ' lt"TAL �PaH1-r APPtcAT1vr► VL.00a- Pt�HS ao e IVIPAC; SZ60H } O` r 'Dl ppF� r baN► A% �Aiur loft I 3 lbo Qoon r 0%A L�- Ma1N �N'PAArIG£ U 0 CIL T£GrIEc Too. TOWN ®f S UTH LD OFFICE OF BUILDING INSPECTOR Town Hall Annex Receipt No. 10 6 6 7 6 Southold, New York 11971 Date a 13 I Received of 1- A, chi'-.4- "1OODollars For Fee for ❑ Fee for ❑ Fee for ❑ Fee for ❑ Fee for ❑ Fee for Rental Disapprovals Building Permit Certificate Electrical ql(,, of Occupancy Inspection e Check# $ Go/� ❑ Credit Card � — ❑ 'Cash Building Department L —(duJn / C (evk- I'�fueS{�Hp A YG1'u.4tGi 'F+N k. C} v�lfs{ed ih QVrv✓ APR 3 0 2024 d 41trA-r- r-A -i t1�S� S.outh°ld Town C�pr 43� • �.SS ay � `' �(.aa a�► T'D CA Sold re ule,s+ 2 cA 'r`c4 0 -� `t'In e C r c tom• s�ahG�s p �, M a��► '�3, -z o Z '-1 u A-s Cow-1a ram -A-- Ao� 8'rw '►tk S , 3dd C reG _,r " 1 a .�� roG�5 `�5 � �� I �l�rec�-cQ `e G S t v%CJQ- CL SO c Less A ri off' 1 �b lam. w � � As �3Ud . f N Y TOWN ®f SOUTHOLD : OFFICE OF BUILDING INSPECTOR Town Hall Annex Receipt No. 106876 Southold, New York 11971 Date Received of .Gyn 100 Dollars For Flo S �7tcrp a- LJh✓ CE�Fee ❑ Fee for ❑ Fee for ❑ Fee For ❑ Fee for Fee For Rental Disappiovals Building Permit Certificate Electrical of Occupancy Inspection ' L_I Check# 6?l N'' $ �/t�� ❑ Credit Card �/ ❑ Cash Building Department A �� '��' pp�� C JP 1�,�r��;� Q (�lt�►T� l� LOL5- APR 3 0 2024 A D Southold Town Cier'a 4 31 . 2.S 5 , b y 6 Ib -1-9 feG��e,s} Q rt--�'(�''`� c -� l exr►^ U a `('tie c►r cc,�• s�a-�c�s w e,,+-+ 4-o k 5 0 ' GpinlGl 4�r-' AOto 7g, �SS 1 �a��- �,30 d o� r• c� � � ��„� s ► �cam- 1 �"�rec�-� � t� 0.S 1 air �,n-�-� �,,,ti.�,�►.� .l ra ilcd A cc-esso Y As � a.,M. r•o � ,� ,S ,►ale 03v6 .�. TOWN ®f SOUTHOLD : OFFICE OF BUILDING INSPECTOR Town Hall Annex Receipt No. 10 6 8 7 6 Southold, New York 11971 Date-8 I is Received of444 . —?100Dollars For / Mo S vx, a- EP Fee for ❑ Fee for ❑ Fee for ❑ Fee for ❑ Fee for ❑ Fee for Rental Disapp'�ovals Building Permit Certificate Electrical ql( ,, of Occupancy Inspection L'J Check# ❑ Credit Card ❑ Cash Building Department I i Noncarrow, Denis From: Verity, Mike Sent: Wednesday, May 1, 2024 8:59 AM To: Noncarrow, Denis Subject: RE: Refund Denis, OK to process. Thank you, Mike From: Noncarrow, Denis<denisn@southoldtownny.gov> Sent:Tuesday,April 30, 2024 11:26 AM To:Verity, Mike<Mike.Verity@town.southold.ny.us> Subject: Refund Hi Mike, We had a Anne Wyden here looking for a refund for a rental permit. 300.00. Is that correct and good to process? Thank you Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownny.gov denisn@southoldtownny.gov 631-765-1800 CONFIDENTIALITY NOTICE: This communication with its contents may contain confidential and/or legally privileged information. It is solely for the use of the intended recipient(s). Unauthorized interception, review, use or disclosure is prohibited and may violate applicable laws including the Electronic Communications Privacy Act. If you are not the intended recipient, please contact the sender and destroy all copies of the communication. 1