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HomeMy WebLinkAbout1000-78.-2-15.2 cia 1'OWN OF SOUTHOLD Rental Permit 4£ 1176 Owner Mary Kirby Occupied as Single Family Dwelling Located at 3795 Main Bayview Rd Southold 78.-2-15.2 Maximum Permitted Occupancy 6 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. 7/23/2024 Code E- orce of Official 41 This Notice must be posted by the main entrance at all times D M a TOWN OF SOUTHOLD —131JILDING DEPARTMENT T" JUL 1 1 ''9 4 Town Hall Annex 54375 Main Road P. ©. Box 1179 Southold,NY 11971- G DEfyT. 1 6ro P � ,F'1° N�,A�,�6 Telephone (631 765-180 Fax (f 31 7 5-95t 11 1���/,w��� .����������lcl���r���:�� � " ft C-'JP 1 0.7 9 03 RENTAL PERMIT APPLICATION N/CT/ ­1 Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: SITS, 'erevedr4_01 Tax Map Number: 1000 SECTION -BLOCK O Z -LOT /.I- - Z SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 6 �/- W .5OL-7is �v Ae.-Ot 0 L y�. Ats. yraY Telephone Number (s): Daytime Evening Emergency Property Owner Email Address: f�'`f��G '`r7/�• Go Page 1 of 4 Section C. Authorized 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 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, 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: x, . ""+e» 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: 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 XI 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) I er 4 4.c.k'P40 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: too9' K--POO Property Owner's Signature: Sworn to before me th day of V _ _ , 20 2 Official Io ary Pub ignature and Original Notary Stamp JOANNA CONDOLUCI Notary Public, State of New York No, OICO6279481 Qualified in Westchester County Commission Expires April 8, 20 Page 4 of 4 TOWN OF SOUTHOLD BUILDING DBPT� 631-765-1802 7� - o?-/S,d- IN SPEC TION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI AL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL Town Hall Annexe Telephone (631)765-1802 631 54375 Main Road �, � Fax( ) 765-9502 P. O. Box 1179 , Southold, NY 11971-0959 wr v 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 wired for Architect or Engineer, Licensed Home Inspector must provide copy of valid current certification Rental Property SCTM Number: ��� ` 0-7— — Rental Property Address: �i J3KNVttw PO,+o �d�J DL-b /V1/ Owner/Name: M J Y k)IZ[3\d + Y?M QZT PALUM[t p Rental Dwelling Unit Identifier: S5//✓Gile 140HE Number& Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 — 100 sgft., Bedroom#2—90 sgft., etc.) 130000 'F0(7. ®ri �-2 -2 S, I,1FO000m -it :r I'JC SF Property Description (include all improvements indicated on survey)) /Nast: f Jil l l.'Y (�wG.�.� �1�4 01�l •�f:l;IVG Fwv 4, yo b l 1 a 5�I M 'r�APti2?Iv� �{ni0 IlUO�j�Dl�, oich IL� lic4f &IMif.p�oa- °to zg5.rll✓(a so-r.O, AS Du,uT- 5tF(<,;v FEW'- [5CD t ,4.410 '�3�tihhbon i n i&n S DP6 5)VULt r'F►�^i�_ �� *r.W�ING O�lI � r� -4�0g4 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 New York State, t�e Rore ode of New York State, the Property Maintenance Code of New York State and the En ns66-06 onstruchon Code of New York State. b Print Na ,e �Tj(tt '� Original Signature Please p � r04 µ " "� , qq _,,,• ice, �. r_4. TOWN OF S UTHOLD PROPERTY M. ORK 3f a.d a3 � VNE STREET _ - VILLAGE DIST] SUB. LOT FORMER OWNER 'LY.r y N E ACR. S W TYPE OF BUILDING RES. �� SEAS VL. FARM COMM. CB. MILS. Mkt. Value f LAND IMP. TOTAL DATE s REMARKS �'t4 I LO 14 f m s �. a D4 • �i -_ ' /VAL— L4 � c - 7, � - Tillable FRONTAGE ON WATER , Woodland FRONTAGE ON ROAD Meadowl.and DEPTH } House Plot I BULKHEAD Total l _ i AT a 3_ DLOR _ F" TRIM 11 - -e€ z ' JL 1 L l t , i i # , f - e — — — — �� • I f 1 78.-2-15.2 10/20/2020 ` ` ' ` t gg v 3 _ M. Bl 70i 5 G — 4 x xtension � �� � z��o �� �, _ i 2 t- - - _ - - iensr I Foundation Bath IDinetteE Porch Basement Floors 1 /V p Porch Ext. Walls i��y� Interior Finish LR. Breezeway - Fire Place Heat Garage - fr ' DR. Type Roof r Rcoms lst Floor I BR. Raft _. .fa 6 R= �A -Y NCO Recreation Room I Rooms 2nd Floor I FIN. B i -e- _ ; Dormer Driveway Total - - T_ - i i - 4 44 �' FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31111 Date: 08 16 05 TSIS (fit MMS that the building NEW DW Location of Property: 3795 MAIN BAYVIEW RD SOU OLD (HOUSE NO.) (STRMET) (HAMLET) County Tax Map No. 473889 Section 78 Block 2 Lot 15. Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 20 2005 pursuant to rhich Buil,di it No. 31209-Z dated JUNE 20, 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 -SINGLE FAMILY DWELLING ON EXISTING FOUNDATION AS APPLIED FOR. The certificate is issued to 213 F POSTER (OWNER) of the aforesaid building. SUFPOLK CGUMTr D8PA M OF HIMMS APPROVAL �LR/A _ Rf.Z CrPT `(RL 1P FICA= NO. N-47060 11 06 98 PLUMBIM CSttMIMMOB DMED 06 22 05 GREENPORT PLC, ATING r Authorized Signature Rev. 1/81 �tto, Town of Southold 5/18/2022 4 `� P.O.Box 1179 4 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43082 Date: 5/18/2022 THIS CERTIFIES that the building AS BUILT ALTERATION p rty: , Southold Location of Property: 3795 M e ..._...... Main Bayview Rd v.._.�__.... _ww ..._..._.. __ ....��.... ....�-.. __..-�.....-_.._..........._...M.......�...........-............_� ...._....... SCTM#: 473889 Sec/Block/Lot: 78.-2-15.2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated _ry....._3/8/2022 pursuant to which Building Permit No. 47700 dated 4/19/2022_ _.�....._.... __.. -_... 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 l uiltp secottd k oc r bcdro an and batltroozn to existira sin awt ily dwelrtn&asAM1ied facer. The certificate is issued to PGA Capital LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 47700 5/11/2022 PLUMBERS CERTIFICATION DATED ..... .. . At o ized nature ftit� Town of Southold 11/10/2020 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41588 Date: 11/10/2020 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 3795 Main Bayview Rd, Southold SCTM#: 473889 Sec/Block/Lot: 78.-2-15.2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 2/24/2020 pursuant to which Building Permit No. 44755 dated 3/3/2020 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: alterations and addit o ir�cludir deck as t eat.c entral ajiL.q pdt(jpWU to aq.p s g sjn c fan&cik!&, as gpplitl or. The certificate is issued to PGA Capital LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 44755 10/2/2020 PLUMBERS CERTIFICATION DATED Ate __........ .t � ....................... ............. ature EX 5ECONIQ FLOOR CLAN LEGEND F!R6T FLOOR f-AN 1 22 TIE--oFS­T­,D. ILD,­T PAUT A LOMBARDO ARCHITECT ',9-9 n.l N-,Y-1 Me Se.f.-d, 11- V,,JN7A`,EXIST NG APPLO'`ON TO R-SDENCE LoIc. Al ­S!vN r­1 P—Z I