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HomeMy WebLinkAbout1000-70.-8-15 g€ s TOWN OF SOUTHOLD } Rental Permit f 1188 Owner John Lacey Occupied as Single Family Dwelling Located at 440 Pine Neck Rd Southold 70-8-15 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. 8/29/2024 )& Code de ent Officia This Notice must be posted by the main entrance at all times n or ,af so ' TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 lo- �- Ir INSPECTION [ ] 'FOUNDATION 1 ST/REBAR [ ] ROUGH PLBG. [ I FOUNDATION 2ND [ ] INSULATION/CAULKING [ I FRAMING /STRAPPING [ ] FINAL [ I FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ I CODE VIOLATION [ ] PRE C/O [ �46NTAL REMARKS: Ptt� vt � � SA �'�3• � � � � sods. _ DATE INSPECTOR Town Hall Annex Town Of Southold 54375 Main Road w Rental Inspection Report PO Box 1179 =' Southold, NY 11971-1179 Tel: 631-765-1802 �.. .. Owner �Phone _ ..... .. ...... Address �{Q Irl�, � Visible , ..... .� Ins ���...� ... � .. .. .. .... ... ._. __... pector Hamletv.T..M''v..� �. Floor Level Quantities ,,.. ......_..Sub._ 1. .. 2 . 3 Carbon Monoxide� oo in bedrooms) Smoke Detectors®nt lcated e. .e. .e. ............ ..m_���, .��..- ........�. �_.�. ,. ... .� �d.... ... tectors Fire Extinguishers Exits .._.... . .... .. ..� ......... .......�._ .�_. _�_....�... �.� .... ...m....��...�� .� .......... ... . .... ... ... . _.. .. Bedrooms 1 2 3 4 5 6 dl .. Egress Detectors....... .....mom ...�... .... .. _ a .. �_.,. Occupant Count.._ �..�... aaa.._.. .... ...... .I_...... �..... '__...... �m „ , .�� .�.._..�__. . .a � ....._ . �...... ........ Building Y uildin Systems _ Conditon of Proper ty. m e�. ...,�.ste, ... ...ee.�s Maintaineda &Operational.., . .. ... �. Aa..... HeatingBuilding interior Hot water `Building exterior ....- .... ... ...a, _�.n. ._..._. .. . .....� e� safe .Electrical_ Property�._._.....� . ..�..� _....�. ,,._... .... .. ,.,_� .�... ........��.._.���.... . clean, maintained &saf..e _. . ,,,,,, ..w... ... ...�...��. Mechanical l Handrails&guards installed &secure .m mm. ..... ------ I .. ..w.... _. . .... .. ... .. ...... Pool Safety...rv...._ .. .. ..:.�:: ........��... ..:: ...._ Pool . .,. ..w�.�....w..�..�..M.�._. .�...� . �..�.v.... ..._ .. on Site Surface water alarm j Date of CO issuance �.. �.. �..�. m ..... .....m .. _... a , ,..,... ,w .� Door alarms Pool completely enclosed Self closing latching gates Pool fence to code requirements CO's for all items present Prior Rental ...... ...all - -_ .� .. ... e.. C omments �.. . . ....... .. ..�......... ..............�.w... ._. m Pk�k�^�mH 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 lit�p�.L/f yw�so� tholdtown �, RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed ev ry f y rst s Section A. Property Information: d ' Rental Property Address: 440 Pin C 0 eCX Ind OC Tax Map Number: 1000 SECTION -BLOCK -LOT_L5__- SECTION B. OWNER INFORMATION: Property Owner Name: a c Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 2-000 L wson1 1 3311 c, Telephone Number (s): Daytime 631 g53-566&ning Emergency Property Owner Email Address: C, O VA OVA t i.- IF 4 3o� Pd ef y C_ l tq o 1 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: Iv 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: 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 Unit: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: �f nl Au, X) i �i,�"1P1 29' ► Ea ,,� v) 1+ ",( 13` .w IS i, 1`� �I�vbedroom - I `x 14 ' p' x 12' 1C) ° ►,e-vtl 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 ❑ 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: Lace, Property Owner's Signature: a-<, Sworn to before me this day of f! 20_ Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.01 BU6185050 Qualified In Suffolk County Commission Expires April 14,2©a' Page 4 of 4 � V TOWN OF SOUTHOLD PROPERTY RECORI i a I loj ac/ l OWNER STREEt VILLAGE DIST SUB LOT FORMER OWNER � I`I mmf ACR d6,o S W TYPE OF BUILDING v MICS. II�IrS, r dr�S�5.._� � � ° VL. � '�_ ...FARM COMM. CB.� � r �,w,•�. _,,..... ,_... .ry_A_-�. m. � .: ..,..e ..e..__. _...__ �.��,���. f Mkt. Value .,....., LAND.__ .. ..�,,.�..._. .,. .... _.,,....,._.... _ ..._.._......_ ..,,,.ww, .,,,_,....._.,...__�._k,., .,_,..._.w�,,_,a.a_„_._......M,m,_......,..,�......._.,..,_ ��...,..._ __..,m......, ._._.,_,.,,.. ..._ ..,,,,._...... IMP, TOTAL DATE REMARKS m �. _ _2. r AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE v FARM Acre Value Per Value Acre Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD 4 i Meadowland DEPTH _................. _......_ .__.. ..... _. .....,__ L. .. .. .. House Plot � BULKHEAD ......,., .� .�.. Total DOCK _ ... . .,,, .. ............ . .......... _.._..,._.....,.L _.. . _... ._... _.... ..... ._. ..._._. ..... . .._ ..... .. .. w,... w � I r Y Bug' _... w ....... Extension w �_. . .. .. Extension Extension .....___......, .m.,,,,,_....�M.,._.,__�.... ...._...,,,....��.,...._,.,.,_._ ,�_.,_.... _w . Foundation .,I,,,.._..,,,, ..._,..., w.......,.,, .._�.,,,.......��.�_ww._,..„.„. Both D4'iett it .,� .,... .... .. ..,_ Porch Basement Floors K Perch _.l Ext. Walls rInterior Finish LR. .....Breezeway .,. ..Fire Place..... .w ....,�,. _mm...�.,:. .�..�� _.,...._...,. ....�.�.,.. _..._. ___.�.._..M. ..,.__.,...�._... Float DR. Garage Type Roof Rooms Ist Floor mm BR Patio Recreation Room Rooms 2nd Floor `= �� d B O. B. Dormer ;Driveway Total 1 1 t FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. . .Z 1481.6. . . . . . . . Date . . . . . .August 20... . . . . . . . . . . . . . .. 19 .86 One family dwelling THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . » . . » . . . . . . . . . .. . . . . . . « . . Location of Property . 440 .Pine Neck Road . ; . , , Southol.d , kN* Y.M . House No. Street �"amtor County Tax Map No. 1000 Section . . . . . . . .Block . . . . , . 8» . . . . . . .Lot 01 5 . . » » Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated Jan u a r y 9 1. 1 19,85 pursuant to which Building Permit No. . 13,6 9 2 Z µ January 30 , dated . , , . 85 . . . . . . . . . . 19 . . . ,was issued,and conforms to alI of the requirements of the applicable provisions of the law.The occupancy for which this certificate is issued is . .. . . . . . . . , . . . . One family dwelling. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to , , , , Andrew C . Kehl Jr .. & Janet M. Kehl g ^ µ » . . . of the aforesaid building. Suffolk County Department of Health Approval » . . . . . . . . . . . . . . » * . » w . . µ . . » UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . , , .. . . . » , . . . . . . . I . » . . . . . .. » Plumbers Certification dated January 31 1986 THIS CO INCLUDES 14x22 DECK AS INDICATED ON SURVEY DATED 5/15/86 BY R. VAN ..-, .�,�...._�.............-.�., ��,.�, �� �r Building Inspector» » F Rev.1/a1 r Mc„ - r _ j �7' -- z a ! a 3 rt LINtI`! 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