No preview available
HomeMy WebLinkAbout1000-18.-6-21.7 fill TOWN OF SOUTHOLD } Rental Permit 1128 Owner Linda Fargo Occupied as Single Family Dwelling Located at 27840 Rt 25 Orient 18.-6-21.7 Maximum Permitted Occupancy 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. 5/13/2024 Code Erg or eon Officia This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD—BUILDING DEPARTMENT ro y 1o�a� 3 Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959'Ve C Telephone (631) 765-1802 Fax(631) 765-9502 e�� w otitti,o Idto N,nn (a RENTAL PERMIT APPLICATION ,1 ! ..o bar , Rental Permit Fee $300 (Application must be renewed every two years) APR 1 "'024 Section A. Property Information: Rental Property Address: 2T840 ffiAW RD. ORtF-NT' Tax Map Number: 1000 SECTION � " SECTION B. OWNER INFORMATION: Property Owner Name: 4--INDA Pik KG 0 Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 4 IVD 22 Telephone Number(s): DayfimeJf'*5-�JAE 1ening 5&femergency 45k- 40- Property Owner Email Address: ' Page 1 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: Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: R �Kww':`" 'c7l ON) fzr" . Use and Dimensions of each room in Rental Dwelling Unit: I I=t" `- MEOIA RM IS��Y2x�lo�-' "iy ' ;0Wt*'- KrA. l�c 4,0-4#1/1 Vt"' 0P ra`17Y2,' c f . rM . r - a .it►-44 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. ❑ lam requesting afire 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 SUFF{OOLLK) .. -, 1ri c -�� 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 (S) business days s to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager. .. Property Owner's Name: �....... ...��...�� . m����.�.........� . ......._ �........ ,. Property Owner's Signatures . � ����" Sworn to before me this day of .... .__. .... .... ._..� 20.�N ._..._.., GE 0�5'15g--`n-li:—ture N TILOfficial ary a°sic N otary PubCic-Sfate and Original Notary Stamp ORGE E ATIL York No. o1AN6340144 Qualified in Kings County My Commission Expires April 11,2028 Page 4 of 4 Town Hall Annex - Telephone(631�765-1802 W75 Main Road --D Fax(631)765-9502 P.O.Box 1179 X Southold,NY 11971-0959 MAY ')024 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 rSgulred for Architect or Engineer, Licensed Horne Inspector rnust provide copy of valid current certification toov, Rental Property SCTM Number. Rental Property Address: " 2 84C) MA-v AJ Owner/Name: I-tNflA- 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.) eM *t— Its 41 ?WED• 9'M - Sg zeQ2.n1 .01 —24� 19 4+f- eotk tZeK. -3'L' r tte t� Property Description (Include all improvements indicated on survey) `PO w l nti l 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+Pode of New York State:,the Fire Code of New York State,the Property Main nance Code of Ne " and the Energy Conservation Construction Code of New York St " .... + a Print Name and Title Original Signature Please place Professional Seal: , lnl e " Town Hall Annex 1 efah one 51 71 1902 54375 Main Road � � 7 �50 A P. O. Box 1179 Southold, NY 11971-0959 ` R 2024. 7 � BUILDING DEPARTMENT TOWN OF SOUTHOLD ` J `� 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 re uired for Architect or Engineer, Licensed Lorne Ins ecltor roust provide copy of valid current certification Rental Property SCTM'.Number: — Rental Property Address: 7 O M f-t t�J P ' 09 -T Owner/Name: L t N oIr- Rental Dwelling Unit Identifier: Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 -100 sqft., Bedroom#2-90 sgft., etc.) $ATttRnl4t l (1.2 pWn KrA 28,s 1ft 15Eo p4v�- #► sv.. 4- ''-' • R"� .Z th ttt-�A**J _� ►4.8cb vtN - R,rt.— III kvv�03 RK — d ! rn — Property Description (Include all improvements indicated on survey) clwggm w- .T-. 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 Y rk State,the Fuel Gas Code of New York State,the Fire Code of Nc�rr�York State,the Property Maint ce Code of New York State and the I rgy Conservation Cotlructior ,Cade o 1ew Y' rk Stat W, Print Name and Title P Original Signature Please place Professional 1P /� � * , TOWN OF SOUTHOLD BUILDING qf so awa ra 631 7651802 INSPEC ION [ ] FOUNDATION 1ST [ ] ROUGH PLTG. [ ] FOUNDATION 2ND j ] INSULATION/CAL [ ] FRAMING / STRAPPING [ ] FINAL j ) FIREPLACE & CHIMNEY j ] FIRE SAFETY INS [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (Fit [ ] CODE VIOLATION [ ] PRE C/Oko—.s.a j DATE , INSPECTOR TOWN OF SOUTHOLD PROPERTY REC . , )WNER _ STREET ;� `7 VILLAGE DIST,' SUB. LOT ' _ a ORMER OWNER �_+J �iS N E ACR _ } W TYPE OF BUILDING .S. SEAS, VL. FARM COMM. CB. MISC. Mkt. Value i LAND IMP. TOTAL DATE REMARKS N I A� _ CO 1 ' _ NORMAL 1 BELOW BQVE _ , ) x , ,. _ - _ ARM I Acre Value Per Value O Acre I Ilable 1 Ilable 2 Ilable 3 I :)odland arpfand 4 = FRONTAGE ON WATER ashland FRONTAGE ON ROAD ruse Plot DEPTH� r BULKHEAD ta) ., DOCK : LJR 6lX TRIM Af I -77 a.. 3 ✓ > 1 18.-6-21.7 6/11 t Bldg ` o G Fo , - t Bare .� tension i r A sement r � _ y , 3 Floo s ��� K :tension _ Ext. Walls Interior Finish LP.. I Aension # Fire Place �` � = Heat � " s DR. Type Roof 6 R. Rooms 1 st Floor _ = I Recreation Room Rooms 2nd Floo ' i=1N. BA )rch "l I CO Lii' Dormer s e eeaewo 1 Driveway I zirage B. l otol I t J _ 4, - MAY Z � 212 3_ COLOR _ r_ Chi F � TRIM 18.-6-21.7 1/21/2022 Jl±tj I Lj SQ. FT. Fin "B° 1 st Floor 2nd Floor TOTAL M. Bldg. :&S X I-IS � �P.p( 5 vV Foundation Pc OTHER Bath `d Dinette 1.15 I' IFI 4 q f COMBO Extension &_(3 = C O O 3 O p Basement � PARTIAL Floors Kit. Extension Finished B. Interior Finish L.R. V v Extension FP/WBS Heat ©1�Vj D.R. Garage Ext. Walls BR, I Porch _ Dormer Baths Rm. . ✓ Roof Fam Deck/Patio a v1 � kal - Pool 5?0� $ O O Solar Foyer A:C./GEN Laundry Library/ O.B. Study Dock eo FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy No.Z 13300. . . . . . . . . . Date . . . . . . .APRIL . .1 » . , . . . . „ . . . . . . .1 19'35 . THIS CERTIFIES that the building . ,N F W D W E L L I NWG w » . , . „ , . , . . . Location of Property .27840 MAIN ROAD ORIENT w „ County Tax Map No. 1000 Section . . Q 1 g. . „ . . .Block . . . .G6 . . . . . . . . .Lot . . . .?1 . , . . . . Subdivision . . . . . . . „ , „ . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY„? . . . . . . . . . . . . . 19 8 3.pursuant to which Building Permit No. . , .1?3 8 6 Z. . . . . . . w dated . . J U N E 1 6 . » µ , . , » _ . . , . . . . 10 3, ,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 . . . . . . . A NEW ONE FAMILY DWELL„ING. . . . , . . . . „ . . » . » . . . . . . , . . . » » , . . . . , » . . , . . . . . . . » , The certificate is issued to J O S E P H & E D W I N A H A T A T E R (owner,lessee�or�tenaotl of the aforesaid building. Suffolk County Department of Health Approval . . . . . . .13-S 0-41. , , , , , , , „ , , , , , , , , , , , , , , , UNDERWRITERS CERTIFICATE NO. . . .N 6 6 0 C b 3 . , „ „ . „ . . . . . . . . . . . . „ . . . . . . Building Inspector Rev. 1181 Town of Southold 10/9/2021 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42422 Date: 10/9/2021 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 27840 Route 25,Orient SCTM#: 473889 See/Block/Lot: 18.-6-21.7 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated p g 44 dated 11/20/2019 11/12/2019 pursuant to which Building Permit No. 44 mmmm,0 _ M.WYYYY WWIT 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: accessory g[ouqd,swirnmin )9Q f aced to odde as a a lied for. The certificate is issued to Fargo,Linda of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 44440 1/26/2021 PLUMBERS CERTIFICATION DATED m.. . ~ A h riz_ igatu:re.....vw_._._.,�...__. .. Town of Southold 6/16/2021 P.O.Box 1179 .� 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42096 Date: 6/16/2021 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 27840 Route 25,Orient SCTM#: 473889 Sec/Block/Lot: 18.-6-21.7 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/23/2019 pursuant to which Building Permit No. 44236 dated 9/30/2019 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: additions and a ter t(?ji i acludln outd r.to addition t g la: le-fasr it dwellLq as as i d t�r2r The certificate is issued to Fargo,Linda of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 44236 1/26/2021 PLUMBERS CERTIFICATION DATED 6/2/2021 rad Piecit �... ....._._. .__._.....v_._.....� ._.M..._. .. ho ` Signature PA7H.R M #1 �l PWD. RM. 0 1 KITCHEN DINING ROOM0 a CLOSET I & CO2 C?DSET r Al L LIVING ROOM BEDRM #1 L II E T-� -NT111 2ND FLOOR PLAN STEP FARGO RESIDENCE 7 E� 8- 27840 MAIN RD. 1 iiS S ORIENT N.Y. SCT.M# 1000-75-02-14 Cs,& co z BEDRM #3 I y ,=� BATHRM #2 LAUNDRY MECNAN€CA= RhA.- -1 d� Lj ----------------------- ------------------------------ :S& CO2 1 i BEDRM #2 - _ MEDIA RM. _ RECREATION RM. ? CLOSET 25x45 I I) OUTDOOR STORAGE SLAB ON GRADP 1 ST FLOOR PLAN G- k FARGO RESIDENCE t ~ 27840 MAIN RD. cr �c l 2 � i ORIENT N.Y. SCTM# 1000-75-02-14 I I