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Home My WebLink About1000-17.-1-2.2 TOWN OF SOUTHOLD Rental Permit t 1135 Owner John & Carrie Mullins Occupied as Single Family Dwelling Located at 905 Stephensons Rd Orient 17.-1-2.2 Maximum Permitted Occupancy 8 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. 5/24/2024 ` Co E o e entOfficiral This Notice must be posted by the main entrance at all times 1,J) C TOWN OF SOUTHOLD—BUILDING DFPA wfLN'� 2De"? Town Hall Annex 54375 Main Road P. O. Box 1.179 Southold,NYJ,!j,,9 Telephone (631) 765-1802 Fax(631) 765-95021A) ANyw.southol t I lre l 6-7 (-f-(, RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: 905 Stephensons Road, Orient, NY 11957 Tax Map Number: 1000 SECTION 017 -BLOCK 01 -LOT 002 _ 002 SECTION B. OWNER INFORMATION: Property Owner Name: John and Carrie Mullins Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) i Kl i 1 Telephone Number (s): Daytime-AA —00 Evening Emergency Property Owner Email Address: J_ 1i1 ' MU-1 tin 0 Com Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: F--e,it _M, _..__..._.._ . Address of Authorized Agent (no P.O. Boxes):_ Z . Mailing Address of Authorized Agent: ��_7- tjj_g57 d... Telephone Number (s): Daytime— -0j'Uvening.__..__� Emergency Email Address: L m FPSey , Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: ►1 r� „_, ___ _ __. 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: Lmi' 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 ni Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: _ ' 270 11 5_ i 9 y & 4W'111 - &nroom 4 x 7=* IZ q0 X j 3 121 SECTION G. 5ecbrtJ FIK 15t4Th & f3 '78' 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. ❑ 1 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. 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 JAL day of _, 2.0A 4A JP1 tA,,,14 WHITLEY ZETINA Notary Public-State of New York Official Nota Pub ' Signature and Original Notary Stamp No.OIZE0015483 Qualified in Kings County My Commission Expires 1110312027 Page 4 of 4 9 TOWN UTTH BuiLDING DI 831 T8T-1802 ,.. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PTBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAl [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] TIRE SAFETY IN! [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI [ ] CODE VIOLATION [ ] PRE C ' [ I -_0 DATE INSPECTOR i i i ' E u I 7 E u i a � 3 4 � s LU En Luzoz - �zz a } IREE ui Ui PN MN co i v g i � p <—_ t f A l.0 PROGRESS PRINT NFC _ - _ a LU I }� s l Z a t+z Z u Ln t _ ;= s ' m 102 9 - Jv— — x k IL f x _ 3`. [ r_. O r PN - - - - FN = { fit 1.4V r Tom._ _ s g� PROGRESS PRZNF NFC All [ i i - 4- r j aIt z z _ • s. _ __ .< _ L N WcnN _ aO 41 t CL ce s, s' Z £ e_ CL r � PN MN g � U w s PROGRESS PRINT NFC A1.2 SOWN OF SOUTHOLD PROPERTY RECORD CARD STREET VILLAGE SUB. LOT I e A- L FORMER OWNER,� N E ACR. S V1/ CODE DATE OF CONSTRUCTION - �. — kJ LLam` j � . LAND IMP. TOTAL DATE REMARKSI lad, - 4- ;, 3 f t t _ 3 gg p f } r � 3 � 4i -- Lc a _ y f i Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH I House Plot BULKHEAD Total -47 PS I .3 M. Bldg. sx ► ' t -1� Foundation Bath Extension Basement Floors Floors3 v � Extension ` oA - -7 ` Ext. Walls Interior Finish 4 Extension Fire Place Heat 13cLf 4 s 1 S4 D - l-XZA 0 V t?Porch Q Q ( Gt t 01 Pool Attic ¢�, H1-1 Deck Patio Rooms 1st Floor �� `� �t>f TR Breezeway Driveway Rooms 2nd Floor Garage I �: � . to' = Town of Southold 5/4/2024 m P.O.Box 1179 1 53095 Main Rd 00 Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45162 Date: 5/4/2024 THIS CERTIFIES that the building SINGLE FAMILY DWELLING Location of Property: 905 Stephensons Rd.,Orient SCTM#: 473889 Sec/Block/Lot: 17.-1-2.2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 2/11/2022 pursuant to which Building Permit No. 47654 dated 4/7/2022 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: sin,le famih_dwelling with finisl ed,,bWm pt_Kr ) d porch and deckas )plied fo.rw,. The certificate is issued to Mullins,John&Came of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-20-1134 4/26/2024 ELECTRICAL CERTIFICATE NO. 47654 3/21/2024 PLUMBERS CERTIFICATION DATED 3/19/2024 ((--"Nlat itc 1 Plumbi utl wri �r ture