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Home My WebLink About1000-110.-4-8 s5 i A. tj . TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971M591 9 2024 Telephone (631`) 765-180 Fax (631) 765-9502 F 5 v-, C w0 RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: 0 5 vex C; n® i l S Tax Map Number: 1000 SECTION -BLOCK -LOT 9 SECTION B. OWNER INFORMATION: Property Owner Name: �i-jo- LTLLe. CPic� s Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) v Number Telephone s time �. Evening_ Emergency p : Daytime Property Owner Email Address: JVR ST.yy F s i !^ AOTMRT L. C J M +,3ob e& C Page 1 of 4 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: Requested Maximum number of persons allowed to occupy Dwelling Ut t: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: 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 SU�FFOLK) I AKi S .�1"`rl� ',' 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 ,fore me s day f 20 off ici u c Signatu a and p#Wtary Stamp NOTARY PUBLIC,STATE OF NEWYORK Eieglstration No.05FR6288691 Qualified in Suffolk County My Commission Eow September 09,2t1� Page 4 of 4 <q V*A 4�� I> TOWN so T S TT T T TD T INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLRG. [ ] FOUNDATION 2ND [ ] INSULATION/CAI [ ] FRAMING / STRAPPING AL [ ] FIREPLACE & CHIMNEY [ % FIRE SAFETY IN! [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL [ CODE VIOLATION [ ] P C/DATE t/�oo>q [Y(F -- INSPECTOR WINDOW WELL R3102 LADDER a STEPS R31021 `- ' �y � WINDOW WELLS WITH A VER-ICAL DEPTH GREATER THAN 44 514ALL BE EQUIPPED UUTH PERMANENTLY AFFIXED 1 LADDER OR STEPS USAB E WITH THE WINDOW IN THE U� FULL OPEN POSITION, 65 SHALL HAVE AN INSIDE P {,2¢ T .9 E 3p'_7 1!2" STUDS a 16"OG RI.N WIDTH OF AT LEAST 12"AND SHALL PROJECT AT LEAST _ m i f INSULATION(2"J ^ , dz 6= 3 FROM THE WALL AND SHALL BE SPACED NOT MORE Q I THAN 18"OG.VERTICALLY FOR THE RILL HEIGHT OF t Q 5 THE WINDOW WELL 1 g �4REAISC E= i X @8 z U 59 FT ALLOW '+1 E "E 05 5Q FT PROVIDED PROVIDE' "TYPE 'X GYP `' ROD t SHELF _' BOARD OVER EXISTING O`er € m �e A €E r I MECHANICAL EQUIPMENT AS a m-€ k Zd 4OA ' @ RCODE IC 5 Sa FT $: 3j U i " 30 D !OOR W _-C, 12"XIS"VENT n LEGEND NEW GONSTRUCTION € RELOCATEv U `ST.E g*_,ATE ExIST, 1 STEEL �d O S:E=COLUMN EXIST.CONSTRUCTION [ " ' ` E Tt � : . 314► ` [ EXIST.GONST.to be REMOVED : ,�= U" 16'-8 I!2' 0 8 " GE NCs NTH -- _ 'T ' IL ' 3 -+- t rl t REMOVE EXIST 1 IN �' 1 STEEL COLUMN - cd 50CFM E 4.A- 1 [ _ F XAN7E T°E O EQUAL EQUAL EQ` EQ E RIOR Al w�� PER CODE I 4 FLOOR P --- --_ jj CAL _- PLANS ' - - T T FTC. Da a g o"w�sue: M AREA t 124 'T .; =2/21124 AS NOTED 3 g 74 X -5,52 5Q FT.AI l LO91 L�XI3FIlf Basement Plan T I I0.5 SQ,FT PROVIDED �'T`_ o.w"By. [cn"a"e By. ! A-3 SCALE: 1J4"=1'-0, 6 ; _ A cCa.AeLG� eOT : S rT z S J" PROVIDE SMOKE d CARBON MONOXIDE 3ROOM AREA�314 SQ SET E D' lqN., I DETECTORS AS PER NEW YORK STATE i94 X 04-4,6 S%FT,4L 1-0-1- CODE S M 105 5Q.FT PROVIDED( � 3 i ' h'i l / � /�� \ / / �' ^_- ~_- 1C)C)-- Ito . -' a 121, e _ ti 110.4-8 9/11 —— - _ el m- 1 . Bldg. Foundation Both x�o ion=_ f Basement F1 _ Y, Floors xtension 3 Ext. Walls Interior Finish Atension � � Fire Place Neat , P ;. �' r Porch Roof Type 117�1Z� t� F Porch Rooms 1 st Floor j 3reezeway Patio Rooms 2nd Floor garage f ! Driveway u €' Dormer 3. B. FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 34780 Date: 01/07/11 THIS CERTIFIES that the building DWELLING AND ACCESSORY Location of Property 5405 PEQUASH AVE CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 110 Block 0004 Lot 008 Subdivision Filed Map No_ Lot No_ conforms substantially to the Requirements for a ONE FAMILY DWELLING built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 34780 dated JANUARY 7, 2011 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 ONE FAMILY DWELLING WITH GLASS ENCLOSED PORCHES AND ACCESSORY TWO CAR GARAGE (ROOF OF GARAGE NEEDS TO BE REPLACED) .* The certificate is issued to STANLEY W & BARBARA J ENGLAND (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A EI,ECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. C Autl orie Si .ature Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: µ540„5 PEQ, IAS,,,H„ AYE CUTCHOGUE S[RfIIIVISION: MAP NO.: LOT (S) HAMS OF OWNER (S): STANLEYe W e&e SA .........J ENGL.AND OCCUPANCY: ONE FAMILY DWELLING STANLEY W & BARBARA J ENGLAND AIIKIIITED BY: ACCOMPANIED BY: KEY AVAILABLE: � SUFF. CO. TAX MAP NO_: 110_-4„ 8 .,. ... ... ....DATR; 01 07/11 ..... SOURCE OF REQUEST ... .......... .,,,..,.,..,. M „ ORTHINGTON OLSEN,...A'I'I'�'........................DAVID W,,,,,.. DWELLING: TYPE OF COIIRMOC"C"ON: WOOD FRAME ...........� # STORIES: 1.0 # E LITS: 2 FOURM71ON: CEMENT BLOCK CELLAR: FULL CRAWL SPACE: .ROOK S: . _.... 3RD FLR.: -0TOTALTOROOKS: 1ST FLR.: 9 � FLR.- 0 RA (S): 1.0 TOILET ROOM(S): 0.0 UTILITY ROOM(S): PORCH TYPE: DECK TYPE: WOOD FRAME P .. ..... —.... ....,... ........,.,. I HS a Y: FIREPLACE: 1 GARAGE: DCW�4TIC CATER: YES TYPE HRRTRR: GAS KEYSPAN ATRCONDITIECHTN;: TYPE HEAT: GAS MARK AIR: X HOTWha!ER: OTHER: 2. GLASS ENCLOSED PORCHES ..,.,... ._,_ ___. ,.... . ... ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST.: 2 CAR WOOD FRAME ., .,...M_ STORAGE, TYPE CONST.: SH73OCIM POOL: GUEST, TYPE CONST.: OTHER: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION � .._..__,_.._VML�:CCfiC S�C�N� _.... ��w....�T.,:.....� ... SEC,.,M GARAGE ROOF NEEDS TO BE REPLACED ¢ pl { Y � � � M d � REKARKS: BP-31 1. .5...DE CO 47r5_._ __.._,.,._. ... ......... .........,_.. .. r INSPECTED BY: DATE ON INSPECTION: 12/13/10 GARY J F,' TIlOi START: 10 00AM END: .1„0 30AM m FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34779 Date: 1107/11 THIS CERTIFIES that the building DECK Location of Property: 5405 PE{UASH AVE .� CUTCHOGUE (HOUSE NO.) (STREET} (HAMLET) County Tax Map No. 473889 Section 110 Block 4 Lot 8 Subdivision Filed Map No_ Lot No_ conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 28, 2010 pursuant to which Building Permit No_ 36125-Z dated. DECEMBER 28, 2010 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 "AS BUILT" DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to STANLEY W & BARBARA J ENGLAND (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N A _ ....... ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ......._._._......� _... ut riAdature Rev. 1/81