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Home My WebLink About1000-64.-2-54 � 3 = TOWN OF SOUTHOLD -V Rental Permit 1172 Owner Barbara Kellc Occupied as Single Family Dwelling Located at 680 Locust Ln Southold 64.-2-54 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. I 7/18/2024 ode n e t Official This Notice must be posted by the main entrance at all times 5Inl'�H 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 h L,// ww.s+ utlioldtowiiti .g ov d "Y RENTAL PERMIT APPLICATION M AY 1 6 2024 Rental Permit Fee $300(Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION -BLOCK � -LOT - I I . Prc-CO I ci`1�f y • I , SECTION B. 3 - OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 3 ( !� , f Cotes Telephone Number(s): Daytime Evening Emergency Property Owner Email Address: � � t'" v, o-(bo CAiRt rc, oore 63( - �!^ �f�'3o eC M0C)re @fitoore0N� - Page 1 of 4 Section C. Authorized Agent Information: I , Name of Authorized Agent of dwelling unit, if any: �T✓ r+ b. C W6 0 Address of Authorized Agent (no P.O. Boxes). i � \Y��= . C 1 Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening Emergency Email Address: 0 C2Q rc : °� � � um 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 Emergency Email Address: SECTION E. SITE MANAGER INFORMATION:(required for rental properties containing 8 or more rental units) Name of Managing Agent of dwelling unit, if any: Address of Managing Agent(no P.O. Boxes): Mailing Address of Managing Agent: Telephone Number(s): Daytime Evening 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, 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'(11 Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: -0 02 .c�, Ftoo 2 , ronrh� 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. 2le 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) ) COUNTY OF SUFFOLK) 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: . L.M Property Owner's Signature: 'rt Sworn to before me this Itday of Q L 202_4 Official Notary Public Sign Lure and Original Notary Stamp KYLEE S DEFRESE NOTARY PUBLIC-STATE OF NEW YORK No.01 DE6420156 Qualified in Suffolk County Page 4 of 4 My Commission Expires 08-02-2025 C a (' CfA CY 1-7 r I-I .. :11A, Ar6 r L o c�, r �- " ' TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 H INSPELACkTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I ULATION/CAULKING [ ] FRAMING / STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F AL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: _. e l )ol0 � A-Y- JIS L3 y RATE — INSPECTOR Y "y p ✓p �y b .o...,....�,.,m-..,.,...... .. .. "4 4 ,G " 4 Z rid Wall D Cc i _ t 4 a TOWN OF SOUTHOLD PROPERTY RI 9 RD ,v OWNER ' STREET VILLAGE DISTRICT SUB. LOT � I RMER OWNER = N I A� EAG1 isW TYPE OF BUILDING RES. SEAS. VL. FARM COMM. IND. CB. MISC. ! Est. Mkt. Value _o E LAND IMP TOTAL DAT REMARKS Y AGE BUILDING CONDITION c NEW NORMAL ' BELOW ABOVE FRONTAGE ON WATER Farm Acre I Value Per Acre Value 1 FRONTAGE ON ROAD �x Tillable 1 BULKHEAD Tillable 2 DOCK Tillable 3 Woodland I i Swampland Brushland f House Plot 1 Toto i a V ems,, R ix j s l� f a -- - - - _ f i ..- t 64.-2-54 3/06 M. Bld -`, F of Foundation Bath Extension # `:, Basement i Floors Extension Ext. Walls Interior Finish . _ w -- - - - - Neot Fire Place Extension a Prci Roof Type - - - -- - - _ = Y Porch Rooms 1st Floor -re ze o 41 Patio Rooms 2nd Floor garage Driveway Dormer mer i FORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No W . . . . . . . Date . . . . . . . . . . . . . .23 . . . . . . .. 1974. . THIS CERTIFIES that the building located at Locust. A VROM01110U. L* Street Map No. %%ck No. . . . . . . . . . .Lot No. . 1�7.&g8 Southold. N..I. conforms substantially to that r t dJVLAVOLANAW IC cods Juellt .before April 23 19 57. pursuant to whicilul �o Z "M dated . . .J . .a3. . . . . . . . . . . .. 174. ., 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 Privato. me .Family. duelling .&. Ace7. Bldg. . . . . . . . . . , . . . . . . . . . The certificate is issued to Roboo.U44. A .3dith.Libita. . . . . rs. . . . . . • . . • • • • . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .�. o� � n . . . . . . . . • . • . UNDERWRITERS CERTIFICATE No.PrO.r. AX40AX9. . . . . . . . . . . . . . • . . • • . • • • . • • . HOUSE NUMBER . . . . .575 . . . . . Street .L!H0010diM 14. . . . . . . . . . . . . . . . . . . . . . • . 68o Locust La ,A, � � � Building Inspector HOUSING CODE INSPECTION January 23 , 1974 #575 L'Hommedieu Lane & #680 Locust Lane R-1 Southold, New York Subdivision: Founders Estates #1178 Lots - 1/2 57-58 Tax Roll: Sebastian R. Labita & Wf Upon request of the Southold Town Building Department, I made inspection of this two story framed dwelling and found the following violations of Chapter 52 , Housing Code, Town of Southold. I was admitted to the south side entrance by Mr. Labita who accompanied me during inspection beginning at approximately 9 :10 A.M. ..,_. .. , . consist of itchsu ....� uvng First floor' rooms„ m Efi!resdud ahoom. Second � e�ckbtw.armm':.....ir " oP to...... �ll ii� .. 1 furnace located in partial cellar of building. Kitchen: Gas range, no shutoff valve at unit. Art. V, Sec. 52-52 B-2 . Living Room: Outside entrance: No electrical switch or means of controlling light in room on entry. Art. V - Sec.52-56 B-2 . Accessory Building: One car garage. Exterior of buildings and yard area in good condition. Inspection completed at approximately 9 :40 A.M. �*spectfully submitted, Edward Hindermann EH:mm Building Inspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z19162 Date JUNE 21 1990 THIS CERTIFIES that the building ALTERATION Location of Property 680 LOCUST LANE SOUTHOLDD House No. Street Hamlet County Tax Map No. 1000 Section 64 Block 02 Lot 5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEB. 1.5 1989 _______pursuant to which Building Permit No. 17852Z dated FEB. 16 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 RENOVATE ROOM OF EXISTING ONE FAMILY DWELLING. The certificate is issued to MS. JOAN ARNSTEIN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N0947: 8 SEPT. 29t 1989 PLUMBERS CERTIFICATION DATED THOMAS MC SHANE Ma 24 1989 Building Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31249 Date: 10/28 05 THIS CERTIFIES that the building ACCESSORY OUTDOOR SHOWER Location of Property: 680 LOCUST LA SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 64 Block 2 Lot 54 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 2 2005 pursuant to which Building Permit No. 31193-Z dated JUNE 9 2005 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 ACCESSORY OUTDOOR SHOWER IN THE REWIRED REAR YARD AS APPLIED FOR. The certificate is issued to BARBARA RELLC (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A /Ytho zed tignature Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-32109 Date: 12 29 06 THIS CERTIFIES that the building ADDITION Location of Property: 680 LOCUST LA SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 64 Block 2 Lot 54 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 6 2006 pursuant to which Building Permit No. 32355-Z dated SEPTEMBER 12, 2006 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 BUILT" DECK, ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to BARBARA KELLC (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N A ELECTRICAL CERTIFICATE NO. _ NZA PLUMBERS CERTIFICATION DATED NIA 4 /Aut Signature Rev. 1/81