HomeMy WebLinkAbout1000-109.-1-36 T WN OF SOUTHOLD
Rental Permit
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Owner 25425 Main Rd LLC
Occupied as Single Family Dwelling
Located at 25425 Rt 25 Cutchogue 109.-1-36
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.
5/22/2024
Code t
rc nt Official
This Notice must be posted by the main entrance at all times
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TOWN OF SOUTHOLD—BUILDING DEPARTMENT
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41, Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 tltq dLoa vp iyzov
RENTAL PERMIT APPLICATION
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Rental Permit Fee $300(Application must be renewed every two'years R 3? 0 202
Section A.
Property Information: »► +
Rental Property ddress:
� : / 11 1 l� t I i 1� ( � "' A/
Tax Map Number: 1000 SECTION -BLOCK �C -LOT -
SECTION B.
OWNER INFORMATION:
Property Owner Name:
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
( � 1 � W " "
31 �i3 Cygtenin / ��m
Telephone Number(s): Daytime vergency
Property Owner Email Address: �'l 1°l ' *`"n1AA' "
Page 1 of 4
Section C.
Authorized Agent Information: j��jj��
Name of Authorized Agent of dwelling unit, if any: 1/Y'r9V
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: L
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: PO P'�
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, C);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: 3
Number of rooms in Rental Dwelling Unit:
Use and Dimensions of each room in Rental Dwelling Unit: (sQ �
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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.
IKT I am requesting afire 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.
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)
"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 this 0' ay of
6
Official Notary Public Signature and Original Notary Stamp
C ONNIE D.BUNCH
Notary Public.State of Now York
No.OIBU6185050 Page 4 of 4
Ouelifl d in Suffolk County
commission Expires April 1 .°.
Town Hall Annex Telephone(631)765-1802
54375 Main Road
P. O. Box 1179
Southold, NY 11971-0959 : P°
i
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION ADDENDUM
Rental Dwelling Unit Identifier:
Requested maximum number of persons allowed to occupy each dwelling unit:
Number of Rooms in Rental Dwelling Unit:
Use and Dimension of each room:
Rental Dwelling Unit Identifier:
Requested maximum number of persons allowed to occupy each dwelling unit:
Number of Rooms in Rental Dwelling Unit:
Use and Dimension of each room:
Rental Dwelling Unit Identifier:
Requested maximum number of persons allowed to occupy each dwelling unit:
Number of Rooms in Rental Dwelling Unit:
Use and Dimension of each room:
FIX
Town Hall Annex Telephone(631)765-1802
54375 Main Roads a`F Fax(631)765-9502
P. O. Box 1179 ;e `;'
Southold, NY 11971-0959 w°
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PROPERTY CERTIFICATION
Form is to be completed by a licensed architect, licensed engineer or licensed home inspector
Separate form is required for each individual Rental Dwelling Unit
Professional seal required for Architect or Engineer, Licensed Home Inspector must
provide copy of valid current certification
Rental Property SCTM Number: //—Y .- 10-40 no e--
Rental Property Address: +` U�� IN33
Owner/Name: S q, ?i A l�v` R L L r
Rental Dwelling Unit Identifier:
Number&Square footage of each bedroom as depicted in the attached floor plan:
(i.e. Bedroom#1 - 100 sgft., Bedroom#2-90 sgft., etc.)
"lit
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,the Fire Code of New York State, the Property Maintenance C de of New York State
and the Energy Conservation Construction Code of New York State.
Z 141
✓
Print Name and Title Original Signature
Please place Professional Seal:
so
* , TOWN OF SOUTHOLD BUILDING I
631 -785-1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PL13G.
[ ] FOUNDATION 2ND [ ] INSUTATION/CAl
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN:
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (TII
[ ] CODE VIOLATION [ ] PRE C/O [1,,Tl
REMARKS: Ok— 3 oc,G we!
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� � •, Town Hall Annex
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Town of Southold 54375 Main Road
c Rental Inspection Report PO Box 1179
Southold, NY 11971-1179
` Tel: 631-765-1802
�SCTM# _ Date � w
Phone
Owners C �..._� ..... ..M ...._._
Address a Visible
,Hamlet I.Inspector
b 1 2�. 3
Floor Level Quantities Su
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Smoke Detectors(not located in bedrooms)
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Carbon Monoxide Detectors
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Fire Extinguishers
Exits
Bedrooms 1 2 3 ...4. .,.. ,-_...... ,5 6J
Smoke Detectors
ss 1
rOccupant Count
:BuildingSystems.-�..�.Maintained
ed &Operational Condition of Property
Heating Building interior
Hot water Building exterior
;Electrical Property clean, maintained &safe
_.....a.. . _ s
,Mechanical Handrails&guards installed & secure �
Pool Safety f Pool on Site
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'Surface water alarm Date of CO issuance
_r.....,....water alarm _
Door alarms Pool completely enclosed
Self closing/ latching gates _ Pool f
ements 1
CO s for all
..items present Prior Rental
..omments .. . „
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TOWN OF SOUTHOLD PROPERTY RECORD ala \CA �
y LLAGE bISTY SUB LOT
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OWNER STREET
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FORMER OWNER N E ACR.�
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w p S W TYPE OF BUILDING
RES. SEAS. VL. FARM COMM CB, MISC. Mkt Value
LAND IMP, TOTAL DATE REMARKS
R
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r �ING CONDITION
BELOW ABOVE
NEW NORMAL y�
FARM Acre Value Per Value
. ..,,,,.., .._,.,. Acre r a
Tillable...,,,I
Tillable 2
Tillable „3...
y
Woodland _.
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FRONTAGE ON WATER
Brushland 'FRONTAGE ON ROAD X
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House Plot DEPTH
BULKHEAD
Total
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Town of Southold Annex 3/6/2012
,.
54375 Main Road
Southold,New York 11971
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: 35472 Date: 3/6/2012
THIS CERTIFIES that the structure(s)located at: 25425 Route 25,Cutchogue
SCTM#: 473889 Sec/Block/Lot: 109.-1-36
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- 35472
dated 3/6/2012 was issued and conforms to all the requriements of the applicable provisions of the law.
The occupancy for which this certificate is issued is:
m—nd fr4r [rst floor c,pl inge—i ffice ^it(t;ttt hq„gara c az1 „u tlrl s p aps)flc r.« ar�r to t�yrt at rc tclr rg
and acccssory Mora e buildilµl
NOTE. BP 146,28 fire repairs C .15741; BBP 25w114.E cc°atastruct„fropt o__rch C 261„67
The certificate is issued to Grathwohl James F Trust& Victoria Emil
_ . ...._
(OWNER,)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
A hoticd Signature
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 25425 Route 25,Cutchogue
. ... ................................... ... ....SUFF.CO.TAX MAP NO.: 109.-1-36 SUBDIVISION:
NAME OF OWNER(S): Grathwohl James F Trust&Victoria Emily G Trust
OCCUPANCY:
........................ADMITTED BY: Emily Victoria
SOURCE OF REQUEST. "diathw" o'll James F Trust&Victoria Emily G Trust DATE: 3/6/2012
DWELLING:
TYPE OF CONSTRUCTION: #STORIES: 2 #EXITS: 3
FOUNDATION: stone CELLAR: CRAWL SPACE:
..................TOTAL ROOMS: 1ST FLR.: 2ND FLR.: 3RD FLR.:
BATHROOM(S): 1 TOILET ROOM(S): I UTILITY ROOM(S):
PORCH TYPE: front DECK TYPE: PATIO TYPE:
...... ...........
BREEZEWAY: FIREPLACE: GARAGE: yes
............DOMESTIC HOTWATER: x TYPE HEATER:ga. boiler&electric AIR CONDITIONING:
................................
TYPE HEAT: Gas&Electri WARM AIR: HOT WATER: baseboard
#BEDROOMS: 2 #KITCHENS: I BASEMENT TYPE: 1/2 unfinished
OTHER:
............
AC'°CLF_SS0RYSTRVCTtWES'
GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: wood frame
SWIMMING POOL: GUEST,TYPE OF CONST:
OTHER:
VIOLATIONS:
............
REMARKS:
....................... . ................. .....................
........ .... .......... . ....................... ...... ....................
INSPECTED BY: DATE OF INSPECTION-
TIME START: END:
FORM NO.4
TOWN OF SOUTHOLD N POO
BUILDING DEPARTMENT
Office of the Building inspector
Town Hail
Southold, N.Y.
Certificate Of Occupancy
No. . .z 15 74 1. . . . . . . . . Date . . . M. y. �.l.s. . 198.7. . . . . . . . „ . . . . .
THIS CERTIFIES that the building . . , . .R e n.o v a t i o n due , t o, f ire . . . . .
Location of Property 25425MMain Rd . & 55 Alvahs Lane Cutchogue
/louse IUo. Sneer Hamlet
36
County Tax Map No. 1000 Section . . . . .. . . . . . .Block . . . . .1. . . . . . . . .Lot . . . . . . . . . . . . . . « . .
Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
J an... 12 8,„1«9 8 6` « „ pursuant to which Building Permit No. . . .14.6.28Z. . w . « « «
dated ,March 8 , .19 8.6. 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 . . . . . . . . .
Renovate existing buiidin because of fire damage :
The certificate is issued to . , ,Mrs . Corwin G r a t h w o h 1 + 5 * « « x
(owner,l ��r�tif��tl
of the aforesaid building.
Suffolk County Department of Health Approval . . . .N/A . . . . . . . . . . . . . . .
UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . .N 7.?5 Q 1.1 0 c t . 17 ,«1186« « „ « « . . « « . . « «
PLUMBERS CERTIFICATION DATED:-- NIA
C.
Building Inspector
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-26167 Date: 12/11/98
THIS CERTIFIES that the building ADDITION
Location of Property: 25425 MAIN RD CUTCHOGUE
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 109 Block 1 Lot 36
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 26 1998 pursuant to which
Building Permit No. 25114-Z dated AUGUST 18f 1998
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 RECONSTRUCT FRONT PORCH ON COMMERCIAL DWELLING AS APPLIED FOR.
The certificate is issued to JAMES F GRATHWOHL
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A -_�
u ding fnapector
Rev. 1/81
� ...........................Town of Southold......._�....�_.._....�__._w.....�.....�._.._......__...........�...._.._.. _..-......__-----------_..�......
6 7/21/20.1.9......._._.....�................_._..�.M_.�_
F11t��
P.O.Box 1179
53095 Main Rd
*1 Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 40524 Date: 7/21/2019
THIS CERTIFIES that the building ACCESSORY ALTERATION
Location of Property: 25425 Route 25, Cutchogue �Fµ __ m �µ ...vw......n.
SCTM#: 473889 Sec/Block/Lot: 109.-1-36
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
12/19/2018 pursuant to which Building Permit No. 43333 dated 12/19/201.8
........
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:
.I,TERA'rj N .'I'tjNQ'I j.JQ I.I1 I'lNt I f S"TI D+ TDRAI CI1Al llC ES'l f'11 E- "l ll a.
) 1 C ( _w _ ( GI S aQj1K flLLjLL)ING AS APPLIED FOR
The certificate is issued to 25425 Main Rd LLC
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 43333 05-16-2019
PLUMBERS CERTIFICATION DATED
Au raw. Signature