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Home My WebLink About1000-79.-5-20.12 TOWN OF SOUTHOLD Rental Permit �R 1210 Owner Peconic Land Trust Occupied as Single Family Dwelling Located at 10273 N. Bayview Rd Southold 79-5-20.12 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. 10/9/2024 ��—P Code f ce _ Offi it This Notice must be posted by the main entrance at all times Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 1 1971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD a s.. RENTAL PERMIT APPLICATION � � Rental Permit Fee $200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: 10273 North Bayview Road. Southold NY 11971 Tax Map Number: 1000 SECTION 79 -BLOCK 5 LOT 20 - 12 SECTION B. OWNER INFORMATION: Property Owner Name: Peconic Land Trust ...""..�, Property Owner Legal Address: Property Owner Mailing Address: Peconic Land Trust Peconic Land Trust 296 Hampton Rd. 296 Hampton R . Southampton, NY 11968 _ Southampton, NY 11968 Telephone Number(s): Daytime 63128"3-"3195ext 14 Evening 631-506-1210 Emergency,,__,_,... Property Owner Email Address:�w��coniclandtrust.or dheston@agconiclan dtruLst car Page 1 of 5 Town Hall Annex �, Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O. Box 1 179 Southold,NY 1 1971-0959 � � BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: ton j Jacqueline Wilson Darnel Hes.......�........ ..... .�......�......�._-.�.._ Address of Authorized Agent(no P.O. Boxes): 296 Hampton Road, Southampton, NY 11968 Mailing Address of Authorized Agent: _ p a p Y 119 2966 Hampton Road, Southampton,ton, 11968 Telephone 516 381-4489 Evening Emergency_.___ Telephone Number (s): Daytime -, _..._www..._.-.. g/J . .... Email Address: dheston@peconlclandtrust.or 'wl son@ pecan'1c an trust-.org Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: Dance! Heston Jacqueline Wilson Address of Authorized Agent(no P.O. Boxes): 296 Hampton Road, Southampton, NY 11968 ._.._.,Southampton, ..w...._.. Mailing Address of Authorized Agent: p NY 11968 296 Hampton Road, Southampton, Telephone Number(s): Daytime 516-381-4489 Evening__Emergency _ Email Address: _.._hes g dtrust.org dheston@peconiclandtrust.or /jwilson@peconiciandtrust.org 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);_ _._ .. __ _ w_........................ Page 2 of 5 Town Hall Annex f Telephone(631)765-1802 54375 Main Road Fax (631) 765-9502 P.O. Box 1 179 Southold,NY 1 1971-0959 � BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: .,,, .. .- Telephone Number(s): Daytime _Fvpni 1 Emergency _y 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." Rental Dwelling Unit Identifier: House Requested Maximum number of persons allowed to occupy Dwelling Unit. .,, ,, Number of rooms in Rental Dwelling Unit: - _.w__......... _...._. ..... ............_. __ Use and Dimensions of each room in Rental Dwelling Unit: �ft•, First Floor Guest Room 1�ftxl2 Bathroom - 8ft.x5ft, Kitchen- 15ft.x13ft., Living Room - 16ft.xI3ft., Dining Room- 13ft.12ft., Second Floor- Bedroom 1 -22ft.x13ft., Bedroom 2 -22ft.xl6ft. Page 3 of 5 Town Hall Annex Telephone(631)765-1902 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 1 1971-0959 � 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. I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ 1 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) .�. .w..a-I 1, ,"� certify under penalty of perjury, the following: 1. I 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 i Page 4 of 5 I o R Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 a BUILDING DEPARTMENT TOWN OF SOUTHOLD 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 as to any change to the information regarding Authorized Agent, Managing Agent, or Site Man ger. pMe,lGvLi.- C;,�.�`n Vise �wes i c�eA&+ ......,r. �--a vj �t1 S f I Y1Ce3✓ a e c� Property Owners Name: Property Owner's Signature: ..,.,.,...m.__....,,�._..., �— ...............�._._� Sworn to before me this 8 day of JJ P42, ..„ 20 22 Official NotaryPublic Signature .._�...._ ....__...,.w....._ g and Original Notary Stamp MLHAMIS ft#01HA642o775 Oudled In Suffolk County August 16,202 Page 5 of 5 ��cXF SOCtI,y�� e�� (�( � t�rj//► / �C3 r OUv� �/ * ' TOWN OF SOU HOLD BUILDING DEPT. u� 631-765-1802 INSPECTION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. o [ ] FOUNDATION 2ND [XFIRE TION/CAULKING [ ] FRAMING /STRAPPING [ [ ] FIREPLACE & CHIMNEY FETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F AL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: OK �~''` fit/ TOWN OF SO I`I~ICIL D BUILDING DEPT. Coo 631.765-1802 S Of ook OEM C T 10 N [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING / STRAPPING [ ] F NAL [ ] FIREPLACE & CHIMNEY [V FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI ) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: lM� 6bMN� I v1 el vir t ✓ t1 tj �lze_6�:s PC,-ei ts t e c DATE INSPECTOR boo TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER VILLAGE DIST. i SUB. LOT je FORMER OWNF JR N E ACR. rray! S4 S �w 7-- TYPE OF BUILDING RES. SEAS. VL. FARM COW4,1 CB. MICS. Mkt, Value LAND IMP. TOTAL DATE l REMARKS jo Ai 7 -1 - 4w �7 77 LILA Ile Pic,—L-,d J-7 Qj 711 FRONTAGE ON WAT ER Woodland FRONTAGE ON ROAD MeodawkwW DEPTH House Plot oo BULKHEAD P Total vv 'TOWN OF SOUTHOLD PjkOPERTY RECORD CARD — ' OWNER - ! STREET _ 1 STREET - _ VILLAGE DISTRICT SUB. LOT E z OWNER•-- N I E - - _ . CR Y ...E 1 a _ EAE TYPE O BUILDING - F ILD - _ RES. ; SEAS. VL. FARM COMM, IND. CB. M[SC. - — LA N D IMP_ TOTAL -- - -- -- - - _ -= DATE REMARKS E 7 J 1- - _ - r — ——_ F R AGELDING CONDITION NEW = LW ABOVE - v 6 � . -" G Farm Acre Value Per Acre Value Tillable 1 a ; . �� ra (D �7 Tillable 2 - - billable, 3 vVcodland h1 T — } °�C - �2 l�r ru la a� F_ — — — - _�'__� t House PION - —ti- -- h_ - sl� �' 1 G c% J � a a - " u .a i � b 79-5-20.12 10/00 � - o-27 - i � M. 8 y Foundation rF" Bath r Extension _. _ .Basement Floors Extension 2. _ U Ext. Walls `� Interior Finish Fire Place Heat r fit a `u F Pore —_ Attic Parch Rooms }st Floor — -- - - _ Breezeway! ,'i Patio Rooms 2rtdFloor, F 74 } _ 3 7 Garage Driveway Q. B. r w e rn r � r n z : y: 3 � �4 p. _ e 414 f a III r 79.-5-20.12 10/08 ¢ �s.-s-2o.12 loos 79:5-20.12 uc*lgm -771 wlu 3 } 3 e Z E . s ° i I a f 4A REMARKS \ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-32804 Date: 12/27/07 THIS CERTIFIES that the building ACCESSORY Location of Property: 10273 NORTH BAYVIEW RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 79 Block 5 Lot 20.12 Subdivision Filed Map NO. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 3�2007 pursuant to which Building Permit No. 33491-Z dated OCTOBER 24 2007 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 RECONSTRUCTION OF AN EXISTING ACCESSORY BUILDING AS APPLIED FOR.. The certificate is issued to PECONIC LAND TRUST (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED f f4 Au horized Signature Rev. 1/81 1 '1'k. 16ft, 1�1t, 12ft. 1M Oft. n.. '.. ..tip. or 'CO p r _...,. 1111 ., . .. .. Daft. 15ft. loft. ^^ 51"t. 12ft. 13ft 11ftw Oft. 5ft. 151t. i 16ft. 22ft. 1 16ft 2 22ft. . .. ........... 6ft. RBI tk 6% 13ft. loft. (2nd Floor) Wz &Yov.g L d S�arvvyorsser g' p tarevary Rv ; \�\ \ i trert �-13 s �.•�i... �=.<:�� '�� r � �3s-- �F€$fit 1 _ >, � h Q i z t o ` ( -49 §g n � e � '"� 41 `` ff/t ✓P � � Ft ��. ue,. se.a..e sip �� 'k._ f v- DATA 1 € w�t 1.TOTAL AREA z.;T}� RES _ �h8�L, sse -A�3 4C3 `e TOTAL AQ.QF LDTS 5 3.ZONNNG USE D1STR CT7 R_SICENTAL LOWDEtiSt 'AA' v tji 1 i P of ReYrtan Shvr¢. " 1j -.See"Sn<faS E=-'vie Fide Yv.63t � '� � — .' 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