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HomeMy WebLinkAbout1000-143.-2-22.1 $� TOWN OF SOUTHOLD Rental Permit 1165 �F Owner Stephanie Romer Occupied as Single Family Dwelling Located at 550 Marlene Lane Laurel 143.-2-22.1 Maximum Permitted Occupancy 3 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. 14 7/5/2024 �Official This Notice must be posted by the main entrance at all times jdrjc TOWN OF SOUTHOLD—BUILDING DEPARTMENT 49 Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 Fax(631) 765-9502 Ljqp,s-,/ANyLvsquthold /1 E RENTAL PERMIT APPLICATION V 1)) [ E I I, Rental Permit Fee $300 (Application must be renewed every1`Wo years) JUL, BUM'DING DE PT. Section A. TOWN YS0171101 Property information: Rental Property Address: .5550 MPLENE LONE ATEIALL ZVY 10-5a Tax Map Number: 1000 SECTION -BLOCK _-LOT :n:A SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) Q Telephone Number (s): Daytime lll�)Al—'5tavening S&VVIP- Emergency(40-181--5-9-03 Property Owner Email Address: Page 1 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: c For each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier(for example, Unit 1, Unit 2, Unit 3 or Apt A, B, C); 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 U i . ' Number of rooms in Rental Dwelling Unit: ' Use and Dimensions of each room in Rental Dwelling Unit: Y 511 loll�4 10� 1 w5rhamm � `�I" ` " � 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 1, 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 StfFf6tK 1 5 i 9jD A4 e r 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: nnnA Sworn to before me this o day of , 20-aq SIUX MORALES Notary �b��i i Ne vY k 06226413 Ousg in Nassau county Official Notary Public Signature and Origina otary Stamp . Co i n ir"81091 Page 4 of 4 Town Hall Annex � Telephone(631)765-1802 54375 Main Road "r Fax(631)765-9502 P. O. Box 1179 Southold, NY 11971-0959 a 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 required for Architect or Engineer, Licensed Home Inspector must rovide copy of valid current certification Rental Property SCTM Number: 473889 Rental Property Address: 550 Marlene La. Mattituck, NY 11952 Owner/Name: Stephanie Romer 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.) Bedroom#1-114 sqft. Bedroom#2-112sgft. Bedroom#3-92sgft. Property Description (Include all improvements indicated on survey) 2 story one family dwelling with covered front porch,font deck, rear deck and attached one car garage. 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 Yor '" 1 " el Gas Code of New York State, the Fire Code of New York State, the Property Maintentc k State and the Energy Conservation Construction Code of New York State" " ► K� / r- Print Name and Title OrJg al Sig Please place Professional Seal: 20 TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 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) [ ] ELECTRICALI , ) [ ] CODE VIOLATION [ ] PRE C/O [ (F RENTAL REMARK cw DATE INSPECTOR SCTM # �8-6.- -��. , TOWN OF SOUTHOLD PROPERTY RECORD CARD I �� �C OWNER STREET r�s VILLAGE DIST_ SUB, LOT ACR. REMARKS TYPE OF BLD. PROP. CLASS LAND IMP, TOTAL DATE CA FRONTAGE ON WATER HOUSE/LOT BULKHEAD TOTAL T OW N OF S UTH LD PROPERTY RECORD} MCA OWNERic STREET VILLAGE DISTRICT SUB. LOT FORMER � O.,W�i�N�7E z.t.G tM3b 3 rSa��€_�u� N E �S ACREAGE ! tom� 1 i 2 �.� a'1 -. is W YPEOFBUILDING r e _ J RES. SEAS. VL. FARM ? COMM. IND. CB. MISC. Est. Mkt. Value _ LAND IMP. TOTAL DATE RE ARKS r:• diw p, L11r _ P _ AGE BUILDIG DI�I � J C� - a NEW ORMAL ELOV/ ABOVE FRONTAGE ON WATER Farm Acre Value Per Acre Value FRONTAGE ON ROADS fix, Tillable 1 I BULKHEAD _3Q RP- e v- 57 Tillable 2 DOC & '¢_ Tillable 3 715/1/, 11 1 .. .N s Woodland i Swampland Brushland i House Plot Total 3 r e \s t - t Li- m L � 4 - 143-2-22.1 2/02 M. Bldg, X lc .2k d 3 T% q©� Foundation Bath Extension Basement Floors tersion Ext. Walls vim. Interior Finish 7L Extension r�2'� - Fire Place �S Heat �l k l Porch Roof Type _ 2�t Porch Rooms 1st Floor .� Breezeway Patio =Rooms 2nd Floor 8� Garage �� X 2 2-q Driveway ' Dormer 0. B. Ae_ �f hr ��F`� E 13 0 r e w 8 - 1 ° FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29271 Date: 02 18'/03 THIS CERTIFIES that the building _NEW DWELLING Location of Property: 550 MARLENE LA _ LAUREL (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 4789 Section 143 Block 2 Lot 22 .1 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_ 29134-Z dated JANUARY 30, 2003 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 COVERED FRONT PORCH, FRONT DECK, REAR DECK AND ATTACHED ONE CAR GARAGE AS APPLIED FOR. The certificate is issued to SPRINGHILL CUSTOM HOMES INC (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-99-0228 01/25/03 ELECTRICAL CERTIFICATE NO. 1054924 12/02/02 PLUMBERS CERTIFICATION DATED 02/12/03 RUSSELL WILLIAMSON -4 /Zut i ed ignature Rev. 1/81 GENERAL NOTES: CONSTRUCTION LEGEND: ELECTRICAL LEGEND: WINDOW LEGEND: INSULATION NOTES: s a 47 uj U}A s Q s Fn J v Q 1 DOOR LEGEND: o � UJ b9P�� ALL aF ,F�a. �FaN _�C nw nA u n� W Nor PRGCFmWITH FRMING UNTIL LL B GFPoUh64T14N iGCARGN < a HAS BEEN APPROVED. -a er a . a — /-d 31�@Os �F ..�r�F.y ncwGnS PRpetDE580Y.[-4EiEP,fiNB AlAell @MC6 uap IS Ul� crs RmEaMwoc f - - 00 i,..,:�; n, [ `3 �.- S - GONG. QN ULF-0DCOMFMBFKtRF 1 - t PRQRFPF OPENINGS FOR CFRRftG2FOfOCCFWANCY e11'0 zb ESCAPE AS SOtO£R(tSFOlA"M3AT&4 (�,} SUPPLY SYST£MCANxO^ Z-, LPIRGMI. G'E_ �L Qj € I - - 24#RNiuiE .RAH G R LLI tt a� .,J.,�. 1 a } 1 ^ PRJl w 1.1.vt LL I } i -___. ---_ LLI _ E .kbRlD -- ___ __ a'W i t 4U Iz� mf L "Qx �, ;..=,1 PWN@F dR@SLAt@HOAR C J Ii � � THERYAF 5p0."A PF{4pFtp6 22'-3 �:� Lk`, '[' � •' "'�* � �. -- - RRYICE$AS?@PdRf.4M.G} �{ ircaa .' _ _ 3. - .. �4L->•. flT.SiaiE Eu wds tGN. 219^ PRO'dIPEp NR flRE EN _ AM SEPh IL FIE A �A PApi.'1�3(fl PJ@F G.-'—R I, G 3 .a*tcOw.(TrP..aLL .s•.st ' GIEAR 5 IL0E :.=.,. —BLE _x wet n ..5C A O s a- E c C ES I Fg -------------- @m _ Al FOUNDATION PLAN .ts�3� GENERAL NOTES: CONSTRUCTION LEGEND: ELECTRICAL LEGEND: WINDOW LEGEND: INSULATION NOTES: TI oi% _jj PLUMBING LEGEND: 01 DOOR LEGEND: ZM' ui < L2 Lu vo 7i f X 0-" ;jp GRE T ROO-1 ---------- SEC.Nl SECOND FLOOR PLAN 73 -4]