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Home My WebLink About1000-54.-5-45.5 TOWN OF SOUTHOLD g Rental Permit 1182 Owner Carter & Sara Griffin Occupied as Single Family Dwelling Located at 11925 Soundview Ave Southold 54.-5-45.5 Maximum Permitted Occupancy 10 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. 8/6/2024 Cod o ce ent Official This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O.Box 1179 Southold,NY I 1 ; E I V E Telephone(631) 765-1802 Fax(631)765-9502 litt s://Nv�NfNv southoldto vnn J U N 2 0 2024 Building Department RENTAL PERMIT APPLICATION Town of Southold Rental Permit Fee$300(Application must be renewed every two years) Section A. Property Information: Rental Property Address: 11925 Soundview Ave Southold NY 11201 Tax Map Number: 1000 SECTION #54. -BLOCK --& - -LOT -4& — - #54.-5-45.5 SECTION B. OWNER INFORMATION: Property Owner Name: Carter Griffin Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 25 Joralemon St Apt 3 Brooklyn NY 11201 25 Joralemon St Apt 3 Brooklyn NY 11201 Telephone Number(s): Daytime646-263-2118 Evening646-263-2118Emergency212-920-5720 Property Owner Email Address: cartergriffin02@grnaiI.corn Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: N/A 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: N/A 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: N/A 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: One 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." �..a Rental Dwelling Unit Identifier: 1 Requested Maximum number of persons allowed to occupy Dwelling it: 10 Number of rooms in Rental Dwelling Unit: 15 counting bathrooms and entry s Use and Dimensions of each room in Rental Dwelling Unit: Side entry foyer 19ftx6ft. Kitchen 19ftx20ft. Dining 19ftx9ft. Living room 20ftx20ft. front entry foyer 20ftx 17ft bedrooml 16ftxl3ft. Bedroom216xl3ft. Bathrooml 5x9. Bedroom318x21. Bathroom218ftx9ft Bedroom4 15ftxl3ft Bedroom5 15ftx14ft. Bathroom3 5x9ft bathroom4 5x9ft. Powder room 5x5. 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. 50 1 am requesting afire 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 from a licensed architect or a licensed professional engineer. Page 3 of y o �y ran 1 a L c i f �u� l,he -iv C o ;AC A � � y9 p SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFOLK) Carter Griffin 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: Carter Griffin .. i Property Owner's Signature: Sworn to before me this ra�day of 20 a-" KAMAL R SONI Official Notary Public Signature Vhd Original Notary Stamp Notary PuWio,State of New York No,Ot r0 a089949 Qualified in Kings County Commission Expires March 31.2027 Page 4 of 4 F sours ��"4� �j(3Vr�(yt/�CJ✓ 1�rQ.` k, TOWN OF SOUTHOLD B 1LDINO DE PT. 631-765-1802 INSPECTION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] F" L [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F AL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: -vt b DATE -yl 1RSPECT RF)lgaj: - 50# LIGHT BOXES REQUIRED q,o3NyO,, a a v^U FAN EXHAUST OUTLETS WILL BE THRU ROOF R m Q ------------------------ € € -- -- _ ON,J -------------------- t £a t� sIfV i Is. BEDROOM 43 a oil a S a t a I SI z° s` _ £ - 7€ a € v � ! - - 1• " I N N !M ur s s o mw® c r I , t p i p I p ro pg LLJ z I 10.12(A) 0VEWNG'UNITS. ALL 11O''VOLT, SINGLE PHASE.15- AND '20-AMPER BRANCH SUPPLYING OUTLETS INSTALLED IN DINFLUNG UNITS FAMILY RONS. CORNING ROOMS. UVING ROWS,S, PARLOF S. LIBRARIES, DENS, BEDROOMS, SUNROOMS, RE17EATJON ROOMS, CLOSETS, HALLWAYS, OR SIMILAR ROWS OR AREAS SHALL BE PROTECTED BY A LISTED ARC-FAULT CIRCUIT ' IEWOWTEE C BINA€, ;--TYPE INS`A€, O TO O Cs PROTECTION T4E BRANCH CIRCUIT. 2 ALL RECEPTACLES WIL BE TAMPER-RESISTANT, s - = EL2 3 Al ".EXTERN RECEPTACLE C WPS L€ BE U PROTECTED, - 50# GHT BOXES REQUIRED W� -MMUSB� 1 K CMRd W.aflll.Q.fl X lVpY1f.X WIH NEED LOCATION: me�n,a a>ewxa mrrciawsue ❑�3 O -PANEL BOX DROP r_ --a.- _-____s___--_____a____a____---_-a_____--_.-- -..-_----_ -.-- -.----- v_-_.-__----_---- -(1)TV JACK ce oa. C FAN EXHAUST OU -ETS WILL BE THRU ROOF s -(4)DIMMER SWITCHES m qx2,cp�RR� Ap ______________________ --------------- gg „ . E _a_ _ ,_ __a_—__-L_____________ _____ d --------- � s € € I�r NI s ice, y� LISM _ ap.pK i ® wa lATliB;emu `T" g�^ � 3� NOW- 5- I a9 %'8U -------------- 111+++444 a�lii.ttl� 1 � ; a— t € I I _ i x e __ ®__ wJ t o € u it 1-- - - --- a _ ------------- w ------------- i 1. 210.12(A) DWELLING UNITS. ALL 120-VOLT, SINGLE PHASE,15- AND 20-AMPER BRANCH SUPPLYING OUTLETS INSTALLED 3 IN DWELLING UNITS FAMILY ROOMS, DINING ROOMS, LIVING ROOMS, PARLORS, LIBRARIES, DENS, BEDROOMS, SUNROOMS, RECREATION ROOMS, CLOSETS, HALLWAYS, OR SIMILAR ROOMS OR AREAS SHALL BE PROTECTED BY A LISTED ARC-FAULT CIRCUIT srsmavnECT�cKww INTERRUPTER, COMBINATION-TYPE, INSTALLED TO PROVIDE PROTECTION OF THE BRANCH CIRCUIT, 2. ALL RECEPTACLES WILL BE TAMPER-RESISTANT. 0#109$1 EL1 3. ALL EXTERIOR RECEPTACLE COVERS WILL BE (UV PROTECTED) N 09 SOUTHOLD V-20PE 10 CARD - O _z ILL E DISTRICT SUB. Lo B C =A E T a c � w S g TYPE OF BUILDING » . - x, r -, A� s a d a � 6 Lo 4 BUILDING CONDITION e N NORMAL BELOW ) ABOVE R - 3. r _ I Form Ac-e Value Per acre Value o a ble s r ic __mc—' F x t 4 �. House Po F Y& TOH OF SOUTHOLD PROPERTY R a 3 � OWNER STREET ' ' VILLAGE DIST ; SUB. LOT ACR REMARKS _ TYPE OF BLD r� PROP. CLASS s e � f 4 LAND IMP_ TOTAL DATE F 4 i e.e r a � - a _ _ ea � t _3 3 s i I i FRONTAGE ON WATER TILLABLE I FRONTAGE ON ROAD WOODLAND I DEPTH MEADOWLAND 3 BULKHEAD HOUSE/LOT TOTAL I COLOR F1 TRIM 412 I Bath j Dinette M. Bldg F Foundation co Basement Floors € . �. � K t I Extension �. � �. � , �� ,LAB r Ext. Walls _ Interior Finish L.R Extension __ Extension Fire Place ' Heat D. BR �m £ .- Wood stove 3 Porch Dormer Deck -��, Attic Breezeway Rooms 1st Floor Garage - Driveway - Rooms 2nd Floor [ ' i Poole v m 54-5-45.5 2/02 Pit. Bldg �, Foundation bath Ext si r k Basement ours e r Fxtnar - Ext. Walls Interior Finish E,<tension Fire Place a Heo Porch, Attic-. ' - P&C Rooms ist Floor; Breezeway Patio Rooms 2nd Floor Garage Driveway i � I i , tltgp � Town of Southold P.O. Box 1179 8/6/2024 " o 53095 Main Rd + Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45427 Date: 8/6/2024 THIS CERTIFIES that the building SINGLE FAMILY DWELLING __..... .......... .._�.-- .._------- Location of Property: 11925 Soundview Ave, Southold SCTM#: 473889 Sec/Block/Lot: 54.-5-45.5 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 12620 22 pursuant to which Building Permit No. 48857 dated 2/3/2023 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for P Y which this certificate is issued is: .....1,l...I- lc xn y cl yr l lwi,l w z la 1 � Ii L, l c d„1115 pt a r rttr , r . c ?1 ci fl sr r ka I La13 1.c a r_l l With in,g!L0q—q l s wimrn;iQ&) pgojf ,c1 tc�rode as„ �jj�q(f far. The certificate is issued to Griffin, Carter&Sara of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-22-0945 6/24/2024 ELECTRICAL CERTIFICATE NO. 48857 6/11/2024 PLUMBERS CERTIFICATION DATED 1/11/2024 zara Plumbing Y E . ...._... Aft .�C�C ... . ....., ....... _...._ " ' nature