HomeMy WebLinkAbout1000-117.-8-7 41
TOWN OF SOUTHOLD
Rental Permit
1204
Owner Cottage on Third LLC
Occupied as Single Family Dwelling
Located at 850 Third Street New Suffolk 117.-8-7
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.
ki
9/30/2024
€ arcs t icial
This Notice must be posted by the main entrance at all times
Town.Ha11 Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
x
P.O.Bo1179 � EV' LS � U �.x
Southold,NY 11971-0959
BUILDING DEPARTMENT If
TOWN OF SOUTHOLD
BOding Deparlt�rent
RENTAL PERMIT APPLICATION Town
Rental Permit Fee$200(Application must be renewed every two years)
Section A.
Property Information:
Rental PrertyA�dd�r�,ess: �,(
Number: 1000 SECTION -RM ► `� -LOT
Tax Map Nu f
--
SECTION B.
OWNER INFORMATION:
Proper
ty Owner Name:
Property Owner Legal Address: Property Owner Mailing Address:
,g Jam_ ... �. +�► �.......�,
le one NN r"er O j K. E nin ,✓ EmergenTe p
Property Owner Email Address: ._.
Page 1 of 5
Town Hall Annex Telephone(631)765-1802
54375 Maim Road Fax(631)765-9502
P.O.Box 1179 1b
Southold,NY 1 197 1-0959 �E
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
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: Q f
Telephone Number(s): Daytime, ani Emergency
Email Address: A 6MAI -
6��t
Section D.
Managing Agent Information:
Name of Authorized Agent of dwelling unit, if any:
Address of Authorized Agent(no P.O. Boxes): lit
1
Mailing Address of Authorized Agent- Zal
Telephone Numbers : Dayt im Ev"el 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):
Page 2of5
Town Hall Annex Telephone(631)765-1802
54375 Main Roast Fax(631)765-9502
P.O.Box 1179
Southold,NY 1 1 97 1-0954
k�0^ '
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent:
Telephone Number(s):Daytime Evening Emergency
Email Address:
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."
� m
-000
Rental Dwelling Unit Identifier:
. LIAR
Requested Maximum number of persons allowed to occupy Dwelling U it:
Number of rooms in Rental Dwelling Unit:
Use and Dimensions of each room in Rental Dwe Cing Unit:
K 4?01 1-,Pr Mir-
0141146 j.94eo
Page 3 of 5
o
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
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.
❑ lam requesting afire safety inspection to be performed by a Code Enforcement Official
from the Town of Southold
V11 am submitting a completed Town of Southold certification form from a licensed
architect or a licensed professional engineer.
SECTION H.
DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit
STATE OF NEW YORK)
COUNTY OF SUFFOLK)
1_4) 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
Page 4 of 5
16f so
Town Hall Annex Telephone(631)765-1802
�i11 "
54375 Main Road Fax(631)765-9502
P.O_Box 1179
Southold,NY 11971-0959
All
BUILDING DEPARTMENT
TOWN OF SOUTHOL 3
applicable laws and rules. [further acknowledge that I will notifythe 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 as to any change to the information
regarding Authorized Agent, Managing Agent, or Site Manager.
Property Owner's Dame
Property Owner's Signatur `
b �
Swor o before me d y f 2
clal Notary ignat re and Original Notary Stamp
SETSY&POW1114.
f Public,S 01 N
lu llfi9d in Sufi 100
commisslor,evin"July 11194.
Page 5of5
0 72(Jv Sv n
TOWN OF SOUTHOLD BUILDING DEPT.
631-765-1802 q,
I ti r m(4o"T 10 N
[ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PEN TRATION
[ ] ELECTRICAL (ROUGH) [ ) ELECTRICAL (F AL)
[ ] CODE VIOLATION [ ] PRE C/O [ RENTAL
REMA RS►:
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t
DATE INSPECTOR
pa der. ,
-town Hall Annex Telephone(631)765-1902
54375 Main Road Fax(631)765-9502
P.O. Box 1 179 �o
Southold,NY 1 1971-0959 !, 7 '
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PROPERTY CERTIFICATION
Form is to be completed by a license architect, licensed engineer or licensed home inspector
Separate form is required for each individual Rental Dwelling Unit
"r a� s an rl s t rewired wear c wi t err��fr e rlicensed Home Ig
.ApecLormtrstp ty
Copy of valid current certi tcatifr l
Rental Property SCTM Number: 1 -117-8-7
Rental Property rasa; _ .. 9f r! t. Ner,, ��....I�Y..1..1,9,5 _._... W. .... ........
Owner/Name: Cone Qn
Rental Dwelling Unit Identifier: �� �..,. . m ..._...... , � _w.—. �...__... ...•...•
Number & Square footage of each bedroom as depicted in the attached floor plan:
(i.e. Bedroom #1 -100 sq., Bedroom #2-90 sq., etc.)
Bedroom 1 = 136 SF Bedroom 2 1 ....SF..W ........... ...._w _..... . �.— _ ._..__
Bedroom 3 = 184 SF Master Bedroom = 154
Property Description (Include all improvements indicated on survev)
Single Familyl3eidence with
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, and the Energy Conservation Construction Code of New
"'fork State.
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�ttde Town of Southold 6/22/2024
P.O. Box 1179
53095 Main Rd
�� Southold.New York 11971
CERTIFICATT OF OCCUPANCY
No: 45300 Date: 6/22/2024
THIS CERTIFIES that the building SINGLE FAMILY DWELLING
Location of Property: 850 Third St. New Suffolk
SCTM #: 473889 Sec/Block/Lot: 11 T-8-7
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
9/6/2019 pursuant to which Building Permit No. 44406 dated 1 1/13/2019
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:
Ip t,c l ttt rf c1 ro l �mt ��ith finished basement andtront,entrN d�,c. a.�tp.11!ie fo pgr e"II �t7191 �latc�1 �)�'Cl/2C�
The certificate is issued to Cottage on Third LLC
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-19-0024 6/25/2024
ELECTRICAL CERTIFICATE NO. 44406 10/13/2021
PLUMBERS CERTIFICATION DATED 10-5-2021 Xc's P w H Inc.
Aral ,ri-, ttttttC
ttt Town of Southold 6/25/2024
P.O. Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 45 308 Date: 6/25/2024
THIS CERTIFIES that the building POOL FIOUSC/CABANA
Location of Property: 850 Third St..New Suffolk
SCTM #: 473889 Sec/Block/Lot: 1 17.-8-7
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
7/21/2022 pursuant to which Building Permit No. 48499 dated 1 1/16/2022
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:
air m ��r tars 1 bruise wwitll 6�� la�tt��.� �,�l��tr tap���l ��t�l� at��,���...�t�t�l ��attcic����,�ho�w�r
Supreme Court.
The certificate is issued to Cotta-e on Third UX
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-19-0024 6/5/2024
ELECTRICAL CERTIFICATE NO. 48499 6/12/2024
PLUMBERS CERTIFICATION DATED 6/5/2024 J. Zee's P mbing& caring Inc
uth °i ,ed Signature
Town of Southold 6/22/2024
P.O. Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 45301 Date: 6/22/20214
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 850 Third St.. New Suffolk
SCTM#: 473889 Sec/Block/Lot: 1 17.-8-7
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
3/5/2020 pursuant to which Building Permit No. 44794 dated 3/13/2020
was issued. and confonns to all of the requirements of the applicable provisions of the law. The occupancy for
which this certificate is issued is:
access(t�y.1q_g�����r�,�lw�y�Fq�f�,t��in pool t'Oic d to c.o�d s..�.t.Rplia d I�m%
The certificate is issued to Cottage on Third LLC
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 44794 1/6/2021
PLUMBERS CERTIFICATION DATED
A h( rize i nature