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Home My WebLink About1000-3.-7-5 TOWN OF SOUTHOLD Rental Permit 1119 Owner 375 East End Rd Rlty Trt Occupied as Single Family Dwelling Located at Off East End Road Fishers Island 3.-7-5 Maximum Permitted Occupancy 16 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. 5/6/2024 Code Enforc ent Officia This Notice must be posted by the main entrance at all times 1%11411,milt,, ,,, k Town Hall Annex °"�"' ' "'Ju,° Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION .... w... _... _.w.... IL( CK.....ww.._� -LOT_.....�.. SECTION B. OWNER INFORMATION: Property Owner Name: ......vv w. . . ..... ._ ._. ..., .. . _. Property Owner Legal Address: Property Owner Mailing Address: ............. ...w.. w .w_. _: u . ...._. .W_. : _ ..... _... _ ...... Telephone Number r(s): Daytime ." `° ..... � � ............... .._.W Emergency..........., _....... Property Owner Email Address: ......,� "0 ,.M ...�. ._.��..� �..........�... ....� Page 1 of 5 Pi h Town Hall Annex If Telephone(631)765-1802 54375 Main Road ` Fax(631)765-9502 P.O.Box 1179 �� Southold,NY 11971-0959 �� 'F i 2./ r H v„ BUILDING DEPARTMENT TOWN OF SOU . OLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if an Address of Authorized Agent (no P.O. Mailing Address of Authorized Agent: . ............................. ......... ..... . ...www. ....__.kwµµ....._._... .. .......... .a ...._ Telephone Number (s): Daytime_ ...........�.�._.� Evening _.....-..,_..... Emergency Email Address:-.._........_..w.w...��w.............. .....�..............- �.....- .... .. ..........�w_...._..wvw..._..._._...__........._.........w. ..__ .. ...._..........�...__...... ..._ Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if anY: ._...�.w... U �� .�,,..ww... _......_.....,.,. ,. ....w........_......�..��.�.�.�....��.� Address of Authorized Agent(no P.O. Boxes :_ www_.._.......-.._.....�.w� __ _� ..m.__w.............��..__..._.... _........._.._.. .........._. Mailing Address of Authorized Agent: _.... .� �__....._.._..._. ....... ..__...m.�ww�_...... ..__. ....... _._..M.._......� . �� _,..... . Telephone Number (s): Daytime...�........... _.,_,.......... Evening EmergencY�_~......�,u.�....._.M...��...M.._ Email Address: ......_ _._....m...,..... . _ ........_..... ._ .........._ SECTION E. SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units) Name of Managing Agent of dwelling unit, if any: _._...............A-,........,...............�................... ........... �.... ,...................,..w............ Address of Managing Agent (no P.O. Boxes): Page 2 of 5 V � ore , Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax (631)765-9502 P.O.Box 1 179 Southold,NY 1 1 971-0959 ° �a 4011/ BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime _--Evening Emergency___...... , Email Address: 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: ..._ .,. .......... ,� if Requested Maximum number of persons allowed to occupy Dwelling Unit: /M l9 _wwwww. 3g'-7 x�'g Number of rooms in Rental Dwelling Unit:. w �ww._... „-_..w.----,......... .� Use and Dimensions of each room in Rental D ell ng Unit: w ,�_. ,,,, _ ,rl-1WM 3 �rll 1 � 22'' fl x t�J1'��1 r('�1� 27�-2' X�y�2 Itrl ," I ` 1�' `f � `� � a ,' 6-¢I' X �� '�` . t'��2� �o -�rtx 1"� n "l I lag 3 o�5 r� ., r7 fSNx IZ't71f t -, it 1�rr i rlT �S VI�% l I3'�n I( 3 P ► 4Or,x Got, it S,N� — 11 I 7"X I1 --�" l I' r' (7 Town Hall Annex � � Telephone(631)765-1802 54375 Main Road r` Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD 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. 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. 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 Page 4 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road rr Fax(631)765-9502 J P.O.Box 1179 ma Southold,NY 11971-0959 ,� N 0 'w � y`F'9rry d BUILDING DEPARTMENT TOWN OF SO HOLD 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 as to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager. Property Owner's Name: Property Owner's Signature: �L 9 Sworn to b fofe me this Q day of a' , 20( Official Not Public'` ignatur," nd Original Notary Stamp EDWYN HYSSONG -- NOTARY PUBLIC, MAINE MY COMMISSION EXPIRES FEBRUARY 09,2021 °' INi41111 `� Page 5 of 5 E 4 Town Hall Annex w, TelelShone( 31)71502 � �� „� 54375 Main Road rax(63f)766 502 P.O.Box 1179 Southold,NY 11971-0959 k 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 ;seat required for Architect or Engineer, Licensed Horne Inspector must provide copy of valid current certification Rental Property SCTM Number: — — Rental Property Address: 33 Owner/Name: Is w 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.) r Property Description (Include all improvements indicated on survey) 7 q a. & �uwv SAY V' 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 aintenance Code of New York State and the Energy Conservation Cotaftfctton p, Hof New York S te. Print Name and Title @ �a b Origin Signature Please place Profession S at, �- q 9� t �nxum.nmmm,,„tea Town Hall Annex Telephone(631)765-1802 °= (631 54375 Main Road f � ,r Fax )765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOU OLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a license architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Pro essional seai re aired or Architect or Fn ineer licensed Rome ins ector r1�lxsrovide ;9py o valid current certi .cation Rental Property SCTM Number: Rental Property Address: Owner/Name: Rental Dwelling Unit Identifier: Number & Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom #1 -100 sq., Bedroom#2-90 sq., etc.) Property Description (include all improvements indicated on survey) •3 WE 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, and the Energy ConservatiokS ion Code of New York State. l ' Print Na �'t a + lour Origin Please pl Sio POYY15 i p Mks teveoopi — 4s3 sf # 1 — 'G8 o Sf �y¢mm * 2 — I SS Sf Bc-� rywM # 3 — q 65 Sf �nftoam44 — 19 S sF . t _ `SOWN UTHOL PROI �� M CARD OWNER STREET VILLAGE ST.; SUB. LOT FORMER OWNER,= N a E — .r ACR_ = a .. W TYPE OF BUILDING t RES. SEAS, VL. FARM 'COMM, CB. MISC. Mkt. Value f= I LAND IMP, TOTAL DATE REMARKS tyu e . ue e e a r ,_ [ - 1 n AGE BUILDING CONDITION , NEW NORMAL BELOW ABOVE FARM €� Acre x Value Per Value Acre Tillable 1 Tillable 2 Tillable 3 1 Woodland E. — 1 - -- Swampland l FRONTAGE ON WATER i Brushland FRONTAGE ON ROAD House Plot DEPTH — - BULKHEAD Total DOCK �.r y. a COLOR1-4 � 1 9 E _ t ItV1 f t } - - T> -. _ IT- -ITT, - - _- - - - zf' .P e 3.-7-5 11/2016 M. Bldg Fou��cation _ Bath Dinette; Extension Basement _ Floors K, E ' " t x_ Ext. Wa11s Y. interior Finish Extension xir Fire Place Heat e Type Roof Roams 1 st Float F Porch Recreation Roam K.oms 2nd Floor, Porch z 3 Dormer Breezeway L- y , Dr've,ay Garag Patio l ` _ 0- B. - I l Total = l E _ x r< va t � Town of Southold 1/16/2020 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE IFICA"TE OF OCCUPANCY No: 41007 Date: 1/16/2020 THIS CERTIFIES that the budding ADDITION/ALTERATION Location of Property: Off East End Rd,Fishers Island SCTM#: 473889 Sec/Block/Lot: 3,7-5 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/3/2019 pursuant to which Building Permit No. 43999 dated 7/19/2019 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: "as bu" t"additions an alterations includinI kitchen rf k A&d old _lwr t n ea:istizt one fly drvej' a a-pp1�1° f r. The certificate is issued to 375 East End Rd Rlty Trt 4 k ' of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43999 8/13/2019 PLUMBERS CERTIFICATION DATED ........ .. ..._�.-.Authca 5i:._ ter ?EFllt; Town of Southold 2/9/2016 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 38087 Date: 2/9/2016 THIS CERTIFIES that the building ELECTRICAL Location of Property: Off East End Rd,Fishers Island SCTM#: 473889 Sec/Block/Lot: 3.-7-5 Subdivision: Filed Map No. Lot No. ,conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/21/2016 pursuant to which Building Permit No. 40420 dated 1/21/2016 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: Electri a r L gr r The certificate is issued to 375 East End Road Realty Trt of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 40420 01-21-2016 PLUMBERS CERTIFICATION DATED _.................. �_........__ -w.: _..._....Authurtzed Signature � 17,k P =O W 0 O �l 2 OP w H A Ln CM --------- I � O 1 BASEMENT (987 sgfl) r / ; FAU CRAWL SPACE r O L� -————————————————— b w v E a l J SMOKE DETECTOR BASEMENT PLAN CO CARBON MONOXIDE DETECTOR SCALE.1/8*-,'-0' REf. �REF. F O _ e I I PANTRY 00 {75 sgft) F w O E O s KITCHEN o (325 sgfL) 0 MUD ROOM 2 0 S (123 sgft.) ig W r 8 v f I 1 COVERED ENTRY I CLOSET _ j i M t f � s STUDY BUTLERS KITCHEN e MUG R0069 DECK BAT._-_ (157 sgft.) {231 sgft.) {100 sgtt) its ) FOYER {10A sgft.) a CLOSET CLOSET 1 i CLOSET C:ASET r POOLROOM (288 sgft.) � s ! LIVING ROOM DININGROOM € (517 sgft) (280 sgit) .. I Li I o � E SUN ROOT 9 (365 sgft) ' COVERED PORCH 1 I W /1 Q� I j S SMOKE DETECTOR LLLLiN FIRST FLOOR PLAN CO CARBON MONOXIDE DETECTOR W SCALE:1/8'-1'-0' a 2 a Z2g \ BATH�l (56 sqft)_ cv) BED ROOM#4 BED ROOM#5 sqft.) (254 sqft.) /1911 HAL t 14 1 sqft) On CLOS. IF _4 L, BATH#4_,ft) i CLOS. hLLL G s ft BATH#2 CLOS. k300 sqk) (62 sqft.) (5o sqfy) S_LO _LOS CLO& CLOS. CLOS. GLO& CLO& G \ >� * BED ROOM#1 BED ROOM 11 MASTER BED (280 sqft.) 7sqfL) BED ROOM#1 ROOM 7 sqft.) AA cil (54 sqft CLOS am fE= b K\ � $/ LU ul 0 SMOKE DETECTOR CARBON MONOXIDE DETECTOR SECOND FLOOR PLAN ulg SCALE.1/8'-l'-O' !p a: E- a w �L o Lv& 0 �2 0 W P M BED ROOM#6 (255 sgft.) PLAYROOM (15%sgft.) G BATH#7 (70 sqft.) � co ATTIC CUBBY CUBBY (522 sgft.) BED ROOM#7 (187 sqf,) u E P SMOKE DETECTOR va LL a CO CARBON MONOXIDE DETECTOR THIRD FLOOR PLAN SCALE:1/8'-7'-0'