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Home My WebLink About1000-128.-4-26 s.F- #£ � Rat � TOWN OF SOUTHOLD Rental Permit 1154 Owner Elizabeth Dwyer Occupied as Single Family Dwelling Located at 4170 Peconic Bay Blvd Laurel 128.4-26 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. 6/24/2024 Code fo � ent off l This Notice must be posted by the main entrance at all times ,. ., „ � t TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 11 fw °.sou Clio]dtow y 0 " RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: 4170 PECONIC BAY BLV LAUREL 11948 Tax Map Number: 1000 SECTION 128 BLOCK4 -LOT26 SECTION B. OWNER INFORMATION: Property Owner Name: ELIZABETH DWYER Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 1107 Broadwa New York NY 10001 1107 Broadway, New York, NY 10001 Telephone Number(s): Daytime 516-317-8312 Evening Emergency Property Owner Email Address: Idwyer1117@aol.com Page 1 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: 1 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: 1 � Requested Maximum number of persons allowed to occupy Dwelling Unit: 8 Number of rooms in Rental Dwelling Unit: 4 Use and Dimensions of each room in Rental Dwelling Unit: Bedroom #1- 132sgft., Bedroom #2- 326sgft., Bedroom #3- 150sgft., Bedroom#4- 240sgft., Study- 243sgft., Kitchen- 238sgft., Great Room- 822sgft. 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. ❑ 1 am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold 5� 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 SUFFOLK) ELIZABETH DWYER , 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:_ELIZABETH DWYER Property Owner's Signature: Sworn to before me this-6—day of JO , 024 DARCEE AUFENANCx`R NOTARY PUBLIC,STATE OF NIIEW PORK Official Notary Public Si a r �ndOr�iginalNotary Stamp Registration No. 01 AuOIC'19644 Qualified in S! .f.-4 County Commission Expir,. ^�f iry 9, 2028 Page 4 of 4 TOWN OF SOUTHOLD BUILDING DENT. 631-765-1802 df- INSPECTION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ liENTAL DATE INSPECTOR A. Town Hall Annex 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 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 Home Inspector must provide copy of valid current certification Rental Property SCTM Number: 1000-128.-4-26 Rental Property Address:, 4170 PECONIC BAY BLV LAUREL 11948 Owner/Name: ELIZABETH DWYER Rental Dwelling Unit Identifier: 1 Number& Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 —100 sgft., Bedroom#2—90 sgft., etc.) Bedroom#1-132sgft., Bedroom#2-326sgft., Bedroom#3-150sgft., Bedroom#4-240sgft Property Description (Include all improvements indicated on survey) 2 Story frame house,wood deck(2),frame shed(2), outdoor kitchen, frame garage,wood steps&landing, wood bulkhead,glass room, hot tub, stone driveway 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 p� y of New York State New York State, the Fire Code of New York State, the Pro ert le"na ce Code and the Energy Conservation Construction Code of New Yor tate. Anthony Portillo, RA ' Print Name and Title ' Ori in l Signature Please place Professional Seal: TOWN OF SOUTHOLD PROPERTY REC OWNER STREET VILLAGE 1 _ .. SUB, LOT 1 FORMER O `NE-R N ACR._ = - �' � � � a W s TYPE OF BUILDING s � F R S SEAS, VL. FARM COMMA CB, MISC. Mkt. Value LAND i IMP TOTAL DATE REMARKS F z 3 f AGE BUILDING CONDITION NEW( NORMAL BELOW ABOVE - FARP Acre Value Per Value f Acre Tillable 1 Y Tillable 2 Tillable 3 l — Woodland i Swampland f ' FRONTAGE ON WATER Brushland FRONTAGE ON ROAD House Plot DEPTH BULKHEAD Total DOCK i ' -- - Elk BI — I i 1 s 9 4 P I k f = z ki } zs e = 128.4-26 10 2014 - _ ; 3 i M. BldgU i n a Dinette _ Fo �ndat'c Extunsin r - hs- Basement tF lao s Extension !Ext. Wails Interior Finish Extension € `Fire Noce Neo - I--,,?Pe R--of Rooms - Porch _ Recreation Isom Rooms 2nd Floor �� N. E L_ - •DOrr2C JrE G I t'4vtf +x, QrUC i E { c Total a = x FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z5880. . . . . . . Date . . . . . . . . . . .4T. . . . 2 . . . . . . . ., 197.4 . THIS CERTIFIES that the building located at Rk0*W.*. .Pecouic. Bity.$3.vd Street Map No. .xx. . . . . . . . . Block No. . . . . . . . .Lot No. . . 1,^uro , . .If•y t . . . . . . . . . . . . conforms substantially to the on e� +ctin dv it " code (&wt r fi too oecu ancr Before- -April •23. 1957. . pursuant to which �O.Z589a . . dated . . . . . . . . . . .May. . . .2. . . ., 1974. -, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .Privet to. ono. fully .dx*!IUic. . . . . . . . . . . . . . . . . . . . . . . . . . . „ . . . . . . . . . . . The certificate is issued to . .Do"ld• H, .Clark. and.vif'e. .0=*rs. . . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval pre-, sxixt4z . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE No. .proi.. .exiating . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSE NUMBER . .1070. . . . . . . . Street . . Paaonie -Bey Blvd . . . . . . . . . . . . . . . . . . . . Building In or HOUSING CODE INSPECTION April 25, 1974 #4170 Great Peconic Bay Blvd. Laurel, New York Tax Roll: Donald H. & R. C. Clark Occupied Owner Upon request of the Southold Town Building Department I made inspection of this one family framed dwelling and the accessory buildings on premises and found no violations of Chapter 52, Housing Code, Town of Southold. I was admitted by Mr. Clark who accompanied me during inspection which began at approximately 10:30 A.M. Dwelling consists of three bedrooms, two full bathrooms, living room, kitchen, with heat supplied to each room from oil fired hot water furnace in partial cellar. Accessory Buildings are a one room guest cottage (sleeping only) , and two car garage with workshop. Inspection completed at approximately 11:00 A.M. Res p ctfully sub. tted, Edward Hisrdermann EH:mm FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Fall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18594 Date NOVEMBER 27 1989 THIS CERTIFIES that the building, ADDITION Location of Property 4170 PECONIC BAY BLVD. LAUREL W YORK House No. Street Hamlet County Tax Map No. 1000 Section 128 Block_ 04-Lot 26 Subdivision Filed Map No. Lot No.. conforms substantially to the Application for Building Permit heretofore filed in this office dated KARC11 201 198 -----Pursuant to which Building Permit No. 17943-Z dated MARCH 23 1989 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 2ND STORY ADDITION TO EXISTING ONE FAMILY DWELLING. The certificate is issued to DONALD McALLISTER (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-102416 - NOVEMBER 10 1989. PLUMBERS CERTIFICATION DATED NOVEMFR 6 1989 DONALD McALLISTER -01 Building Inspector Rev. 1/51 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33876 Date: 08/05/09 THIS CERTIFIES that the building RENOVATION Location of Property: 4170w GREAT PECONIC BAY BLVD LAUREL (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 128 Block 4 Lot 26 Subdivision Filed Map No_ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated pursuant to which Building Permit No_ 16830 X dated MARCH 17, 1988 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 RENOVATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to JOSEPH G & JOAN R CHISHOLM ...,., (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL. ELECTRICAL CERTIFICATE NO. 3958-H 07/29/09 PLUMBERS CERTIFICATION DATED N/A t h rued rt ure Rev. 1/81 , t Town of Southold Annex 9/24/2014 P.O.Box 1179 54375 Main Road Southold, New York 11971 CERTIFICATE E OF OCCUPANCY No: 37174 Date: 9/24/2014 TIIIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 4170 Great Peconic Bay Blvd, Laurel, SCTM#: 473889 See/Block/Lot: 128.-4-26 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 9/17/2014 pursuant to which Building Permit No. 39192 dated 9/17/2014 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: solariUln�addit n Co exishpZ-qLL f n w.cl llll g «111�iqtfi2L. The certificate is issued to Chisholm,Joseph&Chisholm, Joan (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 39192 9/24/2014 PLUMBERS CERTIFICATION DATED Autl Sid I lure 1 . 1 r If j —^ I 27 I� __...i uxz arri � 1 1 r k ° s+ �1 sy J Zdy.a r,�v r,w r v� y rs / 1 y N II 1 i � wt � > p x iY. v r I� Oil I h �$ mt r, ...... e ....... ^w � ry r