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Home My WebLink About1000-91.-1-3.2 TOWN OF SOUTHOLD Rental Permit 1166 Owner John Lapolla Jr Occupied as Single Family Dwelling Located at 2850 Cedar Beach Rd Southold 91.-1-3.2 Maximum Permitted Occupancy 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. 7/5/2024 1� PA This Notice must be posted by the main entrance at all times ode nfArr,7t(5fficia1 SCENE JUL 2024 F� 6P TOWN OF SOUTHOLD-BUILDING DEPARTMENT ell 44375 Main Road P. 0. Box 1179 Southold,NY 11971-0959 .southoldtowlif V -Z4 Telephone (631) 765-1802 Fax(631) 765-9502 h XIM90- -7 RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address* _7 ( 4AA 4 C,)jc��A_ Tax Map Number: 1000 SECTION ---,,,-,-BLOCK �_LOT S 01 SECTION B. OWNER INFORMATION: Property Owner Name: -S 14t V CA 1-10 L A F6 i-L A Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) I - I (Z.o.cj _24$ A"!� S�Io6t:sc�IA Telephone Number (s): Daytime Property Owner Email Address: e(�I_L Co Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: If L�,) L—AlAfA—L 6 Address of Authorized Agent (no P.O. Boxes): 111/f-7( Mailing Address of Authorized Agent: Telephone Number (s): Daytime Sit-3S�G—',1>-VjEvening Emergency 3L-V-1-2961 Email Address: AJ2 6 ty'l A j 4-. CO C20 Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent (no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number (s): Daytime Evening Emergenc Email Address: SECTION E. SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units) ly. Name of Managing Agent of dwelling unit, if ar Address of Managing Agent (no P.O. Boxes): Mailing Address of Managing Agent: Telephone Number (s): Daytime Evenin 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 U 69 Number of rooms in Rental Dwelling Unit: vexim Use and Dimensions of each room in Rental Dwelling Unit: low" ......... I-C 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. 0 1 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 frorn 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) C.Ae6L,�Ljq 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: —:::00 V� Y,-N L,A Eg L L A- Property Owner's Signature:< Sworn to befor this X day ME 202,4 SILVIA CRISTOVAO LNotary Public-State of New York Official Notary Public Signature and briginal Notary Stamp No.01 CR0002946 Qualified in Suffolk County M v Co., > 2 Comm,Expires Mar.20,2.027 Page 4 of 4 i &w"l if000e �0" PC[ TOWN OF' SOUTHOLD BUILDING D Ito, 631 -765-1802 qk . . �, 2 .0 IBM Awmft& I Nzo mC ION FOUNDATION 1 ST / REBAR ROUGH PL13G. FOUNDATION 2ND INSULATION/CAl FRAMING / STRAPPING FINAL FIREPLACE & CHIMNEY FIRE SAFETY IN! FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PE ELECTRICAL (ROUGH) ELECTRICAL (Fl CODE VIOLATION PRE .C/0 REMARKS: t A,-fjAb- c 40 Ar rl A DATE INSPECTOR Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.0. 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 reaulred for Architect or Engineer, Licensed Home Inspector mus provide cogy of valid current certification Rental Property SCTIVI Number: It)()C) — Rental Property Address: 0 CAL:M Owner/Name: Rental Dwelling Unit Identifier: Kmvk Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 — 100 sqft., Bedroom#2—90 sqft., etc.) a Property Description (include all improvements indicated on survey) 15 t �91 �6,�,ele Fmv, '1-,v co lywoxv� I certify that I have done a physical inspection of the subject rental dwelling unit and find that it Ily rental dwelling un i s t and fi nd that it u"y complies with all the provisions of the Code of the Town of Southold, the R idential Code of w York of w tat u State, the Building Code of New York State,the Plumbing Code of New tate, the Fuel s Code of New York State, the Fire Code of New York State, the Propertyinte n ode of New rk State, and the Energy Conservation Construction Code �ew York Print Name and Title A.M Original 6nature V Please place Profession z 16 0. 0!551 4 m NOW 6. R C/Irs s NN/A CoTikz 0 - SRO LE co ALA(?lM 72 I S�U :1 34r, Gal 06 iFu 00f. OF IV 7=4; sc, UACE. Zzi -Vol cmw rs o - sn OK E ,�- CO Iq LfEYY\ of TOWN OF SOUTHOLD PROPERTY REC OWNER�a VILLAGE DISI LOT 1�72a I STREET - 0 7�17 6 FORMER OWNER E ACR. Al,eq W TYPE OF BUILDING 7�Elv 77, R E S. SEAS. VL. LAND 1 MP, TOTAL DATE REMARKS 2;-a-i�" j ae, 4 7 73 J S A; A�-L 0 Y /r3., - �z C-C-d /7 V' 4xe 0& B ,41�DIT/COND T)P(N, c,----eel 9's NEW NORMAL BELOW A60VE 91/6, Z�7 Z- 4�vf FARM Acre Value Per Value od Acre Tillable I C, r") art',!QUD- 1 0 n- Tillable 2 Tillable 3 Woodland FRONTAGE ON WATER Swampland Brushland FRONTAGE ON ROAD House Plot DEPTH -T- ! BULKHEAD Total DOCK —T T7 F -T--T COLOR jt N4' V TRIM N 7 t 6A —T 117 11 4�A I M. Bldg. ��pfoundotion Both Dinette .2* Floors I K. 1 OAA Extensi -74 asement T Extension I Ext. Walls Interior Finish LR- I Ife WIG 6 t JX/p Fire PI Extension ace Heat DR. Rooms Ist Floor BR. pe Roof `Ty z FIN, 13.1 Porch Recreation Roo Rooms 2nd Flooll Dorme r P.eae+T Breeze"y Driveway I Garage 1 6 X J Patio 0. B. Total FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold,N.Y. Certificate Of Occupancy 7 r562 No. !-.9 . . . . . . . . . . . Date . . . . ,S.eptember. 4 . . . . . . . . . . . . . .. 19 -7.9 THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 'Rv.�kD Location of Property 2850 Cedar Beach Prl�re . . . . . . * ' ' * * ' ' * * ' ' ' ' . . . — — * — Vtr�4i Hamlet County Tax Map No. 1000 Section �91 Block . . . . . . . . . .Lot . . . . . .3/P.t. . . . . . Subdivision . ?4rk. . . . . . . . . . .Filed Map No. -Lot NO. . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . .Dec.ember' .4 . . . . . 19 7P�pursuant to which Building Permit No, . . . . . . . . . . dated . .December. 6. . . . . . . . . . . . . . . 1979. ,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 . . . . . . . . . . . . . . . . . . 0 F.Ml-foY. n1T1E;jvL1X1G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to Inc. 11 KWO of the aforesaid building. Suffolk County Department of Health Approval . . . PnqcQ—. 11-3 . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. X403A9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Building Inspector Rev 4179