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HomeMy WebLinkAbout1000-126.-6-6 _x TOWN OF SOUTHOLD Rental Permit 1150 Owner Ronald S chwalb Occupied as Single Family Dwelling Located at 3105 Sigsbee Road Laurel 126.-6-6 Maximum Permitted Occupancy 5 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. 6/10/2024 de t r r rr Official This Notice must be posted by the main entrance at all times ( I � boo ►�� �I-�a-ay � re TOWN OF 50UTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone(631) 765-1802 Fax(631) 765-9502 l t '://www.soqt ldtt rnl y RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two yea ' ��r 1 " .� tiro PR � 2 Section A. Property Information: Rental Property Address: SI &SIESFEnn�-rT�Tuc Tax Map Number: 1000 SECTION 12 (0 -BLOCK 06 -LOT 0b - SECTION B. OWNER INFORMATION: Property Owner Name: ONJ SC KWAL6 Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 444 E'. 6 Sr. E F t sbl- 70 5 Telephone Number(s): Daytime Evening Emergency Property Owner Email Address: ri S C �wo l9 .2 (a `G(OU4( . CO 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: ���� B�� el'T to cc'�,," Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: KmetEN-- bkTKFM :t#1 -f-o')c ,�-orr C " 5'� `-4� ►•G r ti. f�'� 18'._4 y :SeMm �I" `- Ir ; . - , seoam3 ►o�k",<t8'--5-' 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. yf I 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) �Y ) COUNTY OF Sef-tTMC) i ),16- / Ur �� ,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: / ` �h u �e 4,fl-17 Property Owner's Signature: IN- Sworn a re me this attl y of �, 20 2 �1 SOi kcial Notary Public Signature and Original Nota mp � otory Pi,"rrbic,State of New York No. fro 1 J oia'i in N rk Cora i ,ior�k ire Nov Page 4 of 4 � Town Hall Annex Telephone(631)765-1802 54375 Main Road JV, � ,�` Fax(631)765-9502 P.O.Box 1179 # " Southold, NY 11971-0959 , 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 re aired for Architect.or Engineer, Licensed Home [napector roust rovide coDv of valid current certification Rental Property SCTM Number: (2— 12 G. Rental Property Address: 31 v5 c5 l &TT77VCJr1- Owner/Name: P-O& sS C lA/ALIS 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.) spores f l I -7-6 Sftaw, it 2 0,2- 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 Ne York State, the Fuel Gas Code of New York State, the Fire Code of New York State,the Property Mai e a e de of New Y' tate and the Energy Conservation Construction Code ew York44;,e_ 41, t . Print Name and Title I Signature Please place Professional Seal: : „h ipqf so &L000e � BUILDING 631 765-1802 ��►,.�j� .. INSPEC ION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. FOUNDATION 2ND INSU ATIOH "CAI FRAMING STRAPPING INAT FIREPLACE CHIMNEY TIRE SAFETY IN; [ FIRE RESISTANT CONSTRUCTION [ FIRE RESISTANT PE [ ELECTRICAL (ROUGH) j ELECTRICAL (F [ CODE VIOLATION [ PRE CO [ I T ARK V4,;�I 1`6 . TOWN OF S U HOLD PROPERTY RECORD CAr*w - - )WNER ! STREET : PILLAGE DIST. SUB. LOT s _ =ORMER OWNER N E ACR. S W TYPE OF BUILDING s SEAS, `VL. 'FARM COMMe CB. MISC. Mkt. Value LAND IMP, TOTAL DATE REMARKS .> ft , _f � a .r r AGE i BUILDING CONDITION ,IEW NORMAL BELOW ABOVE ARM Acre Value Per Value � Q I Ac re liable 1 liable 2 liable 3 oodland FRONTAGE ON WATER ,ampl•and ushland FRONTAGE ON ROAD �7 ruse Plot DEPTH ' r !BULKHEAD tal DOCK $_ COLOR a 3 i a TRIM3 Tj s t w i I � A } f 1 126.-6-6 10/04/2017 s c n Dinette _ E Foy dation , - , K. Kee store 1 d'w a rTient i, iaars xtension xg. Walls Interior Finish LR, xtension Fire Place 'Heat =. DR. C - r-� IRooms 1st Floor , w i Type Roof ._ �R orch e�reation Room[, :Roams 2nd Floor= FI N orch Dormer °' . I Driveway a forage r < atio i ). B. r Town of Southold 10/11/2016 53095 Main Rd Southold,New York 11971 W � PRE EXISTING CERTIFICATE OF OCCUPANCY No: 38571 Date: 10/11/2016 THIS CERTIFIES that the structure(s)located at: 3105 Sigsbee Rd, Laurel SCTM#: 473889 Sec/BloddLot: 126.-6-6 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- 38571 dated 10/11/2016 was issued and conforms to all the requrien=ts of the appheable provisions of the law. The occupancy for which this certificate is issued is: Agod_ 4pgg,que. welli� with ce t ati ao* N te:BP 41 7 "as hViL"deck with outdoor sow Mall "lion tJ-YSllin -3 -7 The ceM carte is issued to O'connell,Patricia Treder,Elinor (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. nt l� Siatuc BUILDING DEPARTMENT TOWN OF SOUTHOLD HOE SING CODE INSPE(7FION LtEEOK1' LOCATION: 3105 Sigsbee Rd,Laurel .......... .......... SUFF.CO.TAX MAP Pi SUBDIVISION: . ... ................................................................................... NAME OF OWNER(S): O'con................................nell,Patricia&Tredor,Elmor ............ ......... ......... —-------- ................................................... ...... OCCUPANCY: ADMITTED BY: SOURCE OF REQUEST. .................................. ........................DATE:- -10/1"1-/20l6 ............. ............................... .................... DWELLING: #STORIES: 1.5 #EXITS: 3 FOUNDATION: cement block CELLAR: 3/4 CRAWL SPACE: ........ ..i . . (S)-. ... ......................I..... I UTILITY ROOM(S):BATHROOM(S): TO .. ROOM ............. ......... PORCH TYPE: DECK TYPE: PATIO TYPE: cement .. ................................ ... ...... BREEZEWAY: FIREPLACE: 1 GARAGE: ........... DOMESTIC 116-T—Wifili....................y'—es TYPE HEATER: Natl.Grid AIR CONDITIONING: #BEDROOMS: I WARM AS: I BASE : �n........... --- - # MCIEN ........... NT TYPE .........---- -----TYPE HEAT: N t x T WATER: i .................. OTHER: ................................................................ ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: SWIMMING POOL: GUEST,TYPE OF CONST: ............. .... OTHER: .......... ........ VIOLATIONS: ........... .................................... ................................... .................. ...... ............ ................................ ........... ............ ...... ............... INSPECTED BY: JOHNJ DATE OF INSPECTION: 9/13/2016 .......... ................. TIME START: END: 11t1t � Town of Southold 10/11/2016 ' P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY CUPANCY No: 38570 Date: 10/11/2016 THIS CERTIFIES that the building AS BUILT DECK Location of Property: 3105 Sigsbee Rd,Laurel SCTM#: 473889 Sec/Block/Lot: 126.-6-6 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/30/2016 pursuant to which Building Permit No. 41067 dated 9/30/2016 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: "a uilt`" nt deck and h �sti 11 additlen t are e .i t o � rye fhn�il dwellin a a lid for. The certificate is issued to O'connell,Patricia&Treder,Elinor of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 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