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Home My WebLink About1000-70.-3-22.9 TOWN OF SOUTHOLD Rental Permit 1199 Owner Adam Lefkowitz & Deborah Mason Occupied as Single Family Dwelling Located at 2570 Wells Avenue 70.-3-22.9 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. 1 9/16/2024 / ^'r?kzl Code E ore ent o fiei This Notice must be posted by the main entrance at all times �5r TOWN OF SOUTHOLD—BUILDING DEPARTMENT ka" Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax(631) 765-9502 h1t s://ww'w.southoldtojy n . )y RENTAL PERMIT APPLICATION 1In1' � w,i m.k4 M Y Rental Permit Fee $300 (Application must be renewed every Ar; Section A. Building Department Property Information: Town of Southold Rental Property Address: 2570 Wells Ave, Southold NY 11971 Tax Map Number: 1000 SECTION 70 --BLOCK 3 -LOT 22 _ 9 SECTION B. OWNER INFORMATION: Property Owner Name: Adam Lefkowitz and Deborah Mason Lefkowitz (nee Deborah Mason) Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 112 3rd Place, Apt1 112 3rd Place, Apt1 Brooklyn, NY 11231 Brooklyn, NY 11231 Telephone Number (s): Daytime 631-786-5079 Evening631-786-5079Emergency 631-786-5079 Property Owner Email Address: Adam DLefkowitz@ mail.com #30O r211 01 to�- C) S.-I Page 1 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: Whole House / Unit 1 Requested Maximum number of persons allowed to occupy Dwelling Unit: 10 Number of rooms in Rental Dwelling Unit: 10 Use and Dimensions of each room in Rental Dwelling Unit: Kitchen 13.5 x 12 / Living Room 13 x 18.5 / Half Bath 5x6 /sitting room 13x13 Bedroom 1 11 x 10.5 / Bedroom 2 14 x 12.5 /hall bathroom 5x9 / primary bedroom 16.5 x 13.5 Primary bathroom 7.5 x 10 /dining room 8 x 11 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. l�l 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 PtDR*t Lt,e"wim X Db�b , 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: Lr W-DW ttZZ 1> I-) `L�ZTz- Property Owner's Signature: Sworn to before me th4 day of 20_31-'Y Official Notary Public Signature and Original otary Stamp —10 to � � MARIA PRIKAS GANLEY Notary Public-State of New York NO.OIPR5003206 Qualified in Suffolk County My Commission Expires Oct 19, 2026 Page 4 of 4 of soar,° TOWN OF SOUTHOLD BUILDING DEFT. 631-765-1802 '7 p — 3 , d2 --2_j INSPECTION [ ] 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 [ ENTAL REMARKS: (o PZ4,5o n DATE INSPECTOR OFFOtk Town Hall Annex Town Of Southold 54375 Main Road C= Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 SCTM # — Date .... w. - Z� __.. , ... . � -,.�_ �a.a�. . _, w. .�...,... �wa... P Owner µ �� .... s N '.,., Phone ;Address ) Visible Hamlet ._ ...... .. ._., ..... .. "v. .� . .. _..... _._. Inspector.. :Floor Level Quantities j Sub 1 2 ; 3 Smoke Detectors (not located in bedrooms) 0 � .. _ . .. ......... m _ Carbon Monoxide Detectors Fire Extinguishers .. Exits . ;Bedrooms 1 2 3 4 5 6 Smoke Detectors Egress Occupant Count �✓` BuildingS Maintained &Operational stems y Condition of Property Heating Building interior Hot water Building exterior Electrical P e. .rw.P.. ._Y.� .c .� i...,.a Mechanical I- - Handrails guards installed &secure &a ". .�y... e f Pool Safety Pool on Site ..N�.. ._...._Surface Ovate..... Door alarms r alarm � Date of CO issuance Pool completely enclosed Self closing/ latching gates Pool fence to code requirements .. Prior ..present__ Rental CO s for allll items Comments: 2570 Wells Ave, Southold - SECOND FLOOR Smoke Detector BATHROOM CM Carbon Monoxide Detector BEDROOM 14t x12-112tt CLOSET X stt CLOSET CLOSET C BEDROOM 16-112ft x13-1J2fl -BEDROOM 11ft x10 112ft' Mba 17 �L , 2570 Wells Ave, Southold - FIRST FLOOR Smoke Detector C Carbon Monoxide Detector SITTING ROOM ,aft x l3 f, 00 e TA Garage fP �. 2570 Wells Ave, Southold - BASEMENT el Smoke Detector CM Carbon Monoxide Detector La CM BASEMENT 451I2ftX301//2f TOWN F SOUTHOLD _ REC-0-ORD CARD fo�mkn, STREETVILLAGE ilk _ ACC REMARKS TYPE OF BLS. z zt- y� � ee; LAN" IMP � TOTAL DATE �.r ti e s. y � s s FRONTAGE ON WATER _AB FRONTAGE ON ROAD WOODLAND DEPTH _ _ 1 IL N :. gK L) u-- NO "I M-0 alp u . \, e 6: v voAllIli t may. I jig, vv� yy 70-3-22.9 3/03 ; M_ BI - Foundation Bath Dinette - �_, FUCK Extension = , Basement Floors - Kit t r ( — e F SCAB -- Etenior _ Ext. Walls Interior Finish € L-R. Extension Fire Place Heat D.R. Patio Woodstove BR. Porch r Dormer Deck Attic Breezeway Rooms 1st Floor Gara a Driveway Rooms 2nd Floor 1 9 -- 0-B a f, - - _57 ,ram Pool P _" FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-20667 Date: 08 q9 02 THIS CBRTIFIBS that the building NEW DWELLING Location of Property: 2570 WSLLS AVENU S OLD (HOUSE NO.) (STREET) (HAMLET) County Tax Nap No. 473889 Section 70 Block 3 Lot 22.9 Subdivision Filed Nap No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated CH 11 2002 pursuant to which Building Permit No. 28275-Z dated MARCH 14 2002 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued isOggFAMILY LLI G WITH COvERED FRONT PORCH pjM DECK AND ATTACHED TWO CAR GARAGE AS APPLIED FOR. The certificate is issued to ZO`UM kCTING CORP & AND« (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-02-0011 08 09102, ELECTRICAL CERTIFICATE NO. 63912 07 29 02 PLUMBERS CERTIFICATION DATHD 07 31 02 HI- PL ING Authorized Si ature Rev. 1/81