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Home My WebLink About1000-55.-3-30 TOWN fait OF SOUTHOLD t � Rental Permit 1175 Owner Willow Haven LLC Occupied as Single Family Dwelling Located at 1345 Long Creek Dr Southold 55.-3-30 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. 7/23/2024 Code Eta ctt nt Official This Notice must be posted by the main entrance at all times ' TOWN OF SOUTHOLD—BUILDING DEPA►RT1 ID� e, Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, C 1. 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 Litt s-�/ sogtliold o it, &JVN 2 0 202 " BUILDING DEPT. 0NN'N ovn'tt 1 RENTAL PERMIT APPLICATION (0 (b(2. � *' Rental Permit Fee $300 (Application must be renewed every two years)�'t C* r -7-710 Section A. Property Information: Rental Property Address: 13Lf S LOK C b7 OJE Tax Map Number: 1000 SECTION --p%-3O-BLOCK d 3 -LOT I�- 2�o 55 -3 -3o SECTION B. OWNER INFORMATION: Property Owner Name: \tJ l L-L01 9AU --t4 LC-C- i�i -r,T-A ?XI—C,4V W S k Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) $O 2.-I FAiZt LA E $-o 221, ?ARK LA JC Telephone Number (s): Daytime Evening Emergency Property Owner Email Address: V- YY1 @.i • CsO� 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: L- 41�3�. �� W`t I l'{ Telephone Number (s): Daytime Evening Emergency Email Address: Y . 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: Requested Maximum number of persons allowed to occupy Dwelling Uni . Number of rooms in Rental Dwelling Unit: 'u{ MR_00 S Use and Dimensions of each room in Rental Dwelling Unit: 136t Q,0DAA 1 Iz` k I,(' 2" cwIN4 "0r-i t b' 3`rx 'LV 1 " E`57 �7lt� it Z 1�' ' 24 �`1Y-41' 0OA Z` k 1 3' 'a1oIN q P,00&4 ILI, InktA it er 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 hmm 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) I . �' "' "'` � �� 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: KA-r:3 A AIZ 0\/'�S P Property Owner's Signature: Sworn to before me this A day of ukt 20 Of '�Otary Public Signature and Original Notary Stamp Offi JOSHUA L.WHALLEY NOTARY PUBLIC,STATE OF NEW YORK Registration No. O1 WH6440404 Qualified in Suffolk County My Commission Expires �� Page 4 of 4 TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 S - 3-30 1 N Shok P E�T10 N [ ] 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 [ 41RENTAL OF lit Town Hall Annex Town of Southold 54375 Main Road Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 Date 7 SCTM # _ 4f - Owner _.�uI��O�/ "r� « / Phone _ Address 3 � _ _ Visible Hamlet Inspector Floor Level Quantities Sub 1 2 3 Smoke Detectors (not located in bedrooms) Carbon Monoxide Detectors Fire Extinguishers p Exits Bedrooms 1 2 3 f° 4,� 5 6 Smoke Detectors � + p�r��` °" Egress Occupant Count - , Building Systems Maintained &Operational Condition of Property Heating Building interior Hot water Building exterior Electrical Property clean, maintained & safe Mechanical Handrails &guards installed &secure Pool Safety ;Pool on Site Surface water alarm Date of CO issuance Door alarms Pool completely enclosed Self closing/latching gates Pool fence to code requirements CO's for all items present Prior Rental Comments: f . O� F STREET VILLAGE DfST.� SUB `LOT FORMER OWNER", .r ,,cn N E ACR. S W TYPE OF BUILDING RES. SEAS. ; VL. I FARM COMM. CB, MICS. Mkt. Value .., 6 `A LAND IMP. TOTAL DATE REMARKS t I r , 4 r r -- - _ U 2 L AGE BUILDING CONDITION _ NEW NORMAL F BELOW ABOVE s® FARM Acre Value Per Vclue Acre Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD l Meadowland DEPTH House Plot BULKHEAD Total DOCK I _ _ r i - - QLC�R TRIM t > _ - -- -- — r 'i ¢. 1 175 04/04/2019 I n� i M. Bldg r. E Extensions o- f-- i Extension j, Extension {` i > `Founder*ion >°��.c.... t� �'r Bath r Dinette -x , Basement Floors K. ;Interior Finish LR Porch Ext, Walls Breezeway Fire Pierce eat s C'R I Garage =Type Roof Rooms 1st Floor EAR � Patio Recreation Room' =Rooms 2nd Floor 1 FIN. B - - —� Driveway D B Dormer 1 sCO Total ; j FORM No. 4 TORN OF SOUTHOLD: BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 790 . . . . . Date . . . . . . . . . .April • . . . .24. . . . .. 19 70 THIS CERTIFIES that the building located at . . .Do;lg- Creek .Drive. . . . . . Street Map No- .,yenneoott Wck No. . . . . . . . . , .Lot No. . g4 . . . . . •Elautheld • . •X•.b.y conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . .Jtuse. . 3 . . . 19. .69 pursuant to which Building Permit No. 1+33-1- .Z dated . .une 19. . 69 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 . . PriveLt 'o 'f fa ;�'diet 1. 3�t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to � ; o P 'i8 . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval -vov. . .7. . . . .1969 , Building Inspector 1 House # 1345 Town of Southold 2/1/2018 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39484 Date: 2/l/2018 THIS CERTIFIES that the building DECK Location of Property: 1345 Long Creek Dr., Southold SCTM#: 473889 Sec/Block/Lot: 55.-3-30 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated .. 8/4/2017 pursuant to which Budding Permit No. 4189897 dated 8/22/2017 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: PECK ADQ1LtQNrQ AN EXlaj"ll +C1(711E FAMILYRW . JAAlPll FtC g l The certificate is issued to Price Jr,William of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED uth Signature 6/12/2024 Town of Southold M P.O.Box 1179 53095 Main Rd Southold,New York 11.971. CERTIFICATE OF OCCUPANCY No: 45274 Date: 6/12/2024 THIS CERTIFIES that the building I VAC Location of Property: 1345 Long Creek Dr, Southold SCTM#: 473889 Sec/Block/Lot: 55.-3-30 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/28/2024 pursuant to which Building Permit No. 50655 dated 5/10/2024 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" 11VAC to exist �t .,:i` nil \yi lliiMa5_�,��i ., r� The certificate is issued to 1345 Long Creek Dr LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 50655 6/12/2024 PLUMBERS CERTIFICATION DATED ... .. . ...__ 1l air` d..� ..nuture.._ ry.... ........... vd ,t TY E. LE mecca �s�pRoO;• i 3 tom, I � # N=NCS t2oo�4 i f3hTH � � EL!] - _ _- `' STOua 4a 8E'Lc'I�v6�.Hpt __ 73�0�;actl M. E - Eti r3 caorv:. !a'4!z �� 'i'ax Yx r•4u.� .� y_h:; 7—L. l�'�A nlE54ta ONCE 01� M Lg DECKJPORCH LEDGER CONNECTION }-,E f iTij s e i ro z rimAfflik ij pla- Lu I � W W U t - A ca, c O„ O USEI5U ,` _ '1 VATHCUTGERTIF_4 raE4�F.ePres...eaT�4;^s cocas 07 OCCUPANCY - PEO Fhp CJEC. Ch S JF 1 a z I OWNER \ WILLOW HAVEN t£C \ 1345 LONG CREEK m ( SOUTHOLD,NY nm cy PATCHOWSKY m a e! � � OWNER&AUTHORIZED w mmP,\am z . � \ REAR DECK P«c SITE ; LONG CREEK 1345 LONG CREEK m SOUTHOLD,NlY !m! BEDROOM, : Rw: � , « Smv . mmP ROOM § TAX m,» = , » ® a»w= vS m » ,m« To TIE a ,wz ' z RESIDENTIAL m , . � ` ^^ BATHROOMCLOSET DATE&REVISIONS. : LIVING 16JUNF 2024 ROOM m * B-ATIIROO-XIU mL AY | x � { ~ � \ mom, mm. 7 � ( � | ��a��mr • �w>c=s" /em(CO)DETECTORs : SHEET. L-4 a ROOM LAYOUT PLAN SHEET SIZE: HX17