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Home My WebLink About1000-63.-3-17.3 TOWN OF SOUTHOLD } Rental Permit E 0490 NN Owner 56863 Main Rd LLC Occupied as Single Family Dwelling Located at 56863 Route 25 Southold 63-3-17.3 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 de V e e Official This Notice must be posted by the main entrance at all times () �s IG� s mY� cam Telephone(631)765-1802Telc Town 1-[all Annex P 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 1 1971-0959 BUILDING DEPARTMENT TOVIN OF SOUTHO11,D RENTAL PERMIT APPLICATION Rental Permit Fee $200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: l '' Tax Map Number: 1000 SECTION -BLOCK a -LOT r' _ 3 SECTION B. OWNER INFORMATION: Property Owner Name: ME.;; UGG Property Owner Legal Address: Property Owner Mailing Address: Ro Telephone Number(s): Daytime �EV ning�Emergenacy AV Property Owner Email Address: l" N�+, Page 2 of 5 m� Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O. Box 1 179 Southold,NY 11971-0959 aW BUILDING DEPARTMENT TO OF 80UTHOL ► 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: Address of Managing Agent(no P.O. Boxes): Page 2 of 5 Town Hail Annex Telephone(631)765 1802 54375 Main Road pax(631)765-9502 P.O.Box 1 179 Southold.NY l 1971-0959 BUILDING DEPARTMENT TOWN OF SOUT HOLD Mailing Address of Managing Agent: Telephone Number (s): Daytime Evening Emergency Email Address: SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: 1 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: w Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: t Use and Dimensions of each room in Rental Dwelling Unit: . _ ♦ u l N i �I �` tt . y MAID ' ( t� ♦ `` SOP-' G--'t V f t 4» 1 !)e r a , t ? LOU Page 3 of 5 Town Hail Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY I1971-0959 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. Il I 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. 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. 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 Page 4 of 5 Town Hall Annex AL AL Telephone(631)765-1802 54375 Main Road ir Pax(631)765-9502 P.O.Box 1179 Southold,NY If 97 1-0959 eel BUILDING DEPARTMENT TOWN OF SOUMOLD 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 Manager. Property Owner's Name: T `tbt+''}' Property Owner's Signature: Sworn to before me this 3 ay of� � 20 7-) "*Y�LL lal Notary Public Signature an riginal Notary Stamp JAIME H, GAYNOR NOTARY PUBUC-STATE Of NEW YORK No.01 GA6151068 Ouslified in Nassau County My Commission Expires 08-07-2022 Page S of S TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ FINA "lI [ ] FIREPLACE & CHIMNEY ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: IAA dt& �, �1r f r E DATE INSPECTOR Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 1 1971-0959 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 Er—okm1mL seal re lred Lot architect a En laser licensed&MS Ifim.94—OLv d my t► +v d magnt cortiftagga Rental Property SCTM Number: Rental Property Address: Owner/Name: ffQr23 8AId RP Rental Dwelling Unit Identifier: WW Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1-100 sq., Bedroom #2-90 sq., etc.) l •' J 2.4D Property Description (include all improvements indicated on survey) ? 0--smpe�w 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 Constructi Code of New York State. „ p* .1-1111, - - lie Print Name and Title AR01/+ ' O 1g al Signature IT Please place professional seal: � � OF JOWN OF SOUTHOLD PROPERTY"RECORD CARD J ,OWNr'7R ! STREET C7 VILLAGE DIST. SUB. LOT —FORMER OWNERV-40 flipf i E ACR. -T S W TYPE OF BUILDING 6 RES. SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. 1 TOTAL DATE REMARKS AL F, 12 6 27/70 /14 '2 ---------- JiJ' m c i�41 Tn 1�— �7 171 1 c j -2-00 V-1 A q Di Tillable I FRONYAGE ON WATER t" -7 L /Z 2 --------T— Woodland FRONTAGE ON ROAD, Meadowl,and DEPTH House Plot Total J SCTM # 1 � 1- -7, TOWN OF SOUTHOLD PROPERTY RECORD CARD I OWNER ' 0 3 Ij STREETlc'D VILLAGE DIST. SUB - LOT r ACR. REMARKS f _-TYPE OF BLD, c- PROP. CLASS s41 � LAND IMP, TOTAL DATE ? C.�. Ix r �5 7 - Z 21, , h FRONTAGE ON WATER HOUSE/LOT BULKHEAD I TOTAL m FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N-Y. CERTIFICATE OF OCCUPANCY No: Z-34078 Date: 11/17/09 THIS CERTIFIES that the building AS-BLT DECK ADDITIONm mmmmmm wwvwvwp Location of Property: 56863 MAIN RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 63 Block 3 Lot 17.3 Subdivision Filed Map No- Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 17, 2009 pursuant to which Building Permit No. 3 4 7 94-Z dated www ww JUNE 17,_ 2009 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 "AS BUILT" DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ANTHONY FORGIONE _.......... (OWNER) of the aforesaid building. r? �A SIIFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL _ .. ,w ................... _ .........._. ET,SCTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED 3 uth I ed Signature � ._... Rev. 1/81 .......... . ..... ....... Town of Southold Annex 1/31/2012 54375 Main Road Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 35421 Date: 1/31/2012 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 56863 MAIN RD SOUTHOLD, SCTM#: 473889 Sec/Block/Lot: 63.-3-17.3 Subdivision: Filed Map No. Lot No. ....................................................... ............................... conforms substantially to the Application for Building Permit heretofore filed in this officed dated 6/17/2009 pursuant to which Building Permit No. 34795 dated 6/17/2009 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: g �c, or in ,Yround swumning,pootwith fence to cA)dc as a lied for, ff9Rn9-T= The certificate is issued to ANTHONY FORGIONE (OWNER) of the aforesaid building, SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ................... ELECTRICAL CERTIFICATE NO. 34795 5/16/11 ................... ... PLUMBERS CERTIFICATION DATED .... .. ..... 'cd Si Atlitl n FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20742 Date MAY 19 1992 THIS CERTIFIES that the building ACCESSORY Location of Property 56863 MAIN ROAD SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 63 Bloch 3 Lot 17.34 Subdivision Filed Map No._ Lot No. conforms substantially to the Application for Building Permit heretofore filed im this office dated APRIL 24 1992 ____pursuant to which Building Permit No. 20584--Z dated APRIL 24 1992 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 ACCESSORY STORAGE SEED AS APPLIED FOR The certificate is issued to WALTER & CAMILLE RO ' (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A "'Building Inspector Rev. 1/81 FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. . . ,Z- 1 b,5.05. . . . . . Date . . December 16 1 987 . . . . . THIS CERTIFIES that the building .�onstruct One Family dwelling with attached garage Location of Property 56755 Main Road Southold , New York House No. . Street /erar%et County Tax Map No. 1000 Section . ,0 6 3 Block . . .0 3. . . . . . . . „ .Lot . , . . l.7.•.3 . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated March 16 , I 9 7 pursuant to which Building Permit No. 1 5 7 8 0 . . . 987 dated •March 19 ,,. . 1 . . . . ` + . . 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 . . . . . . . . . ONE FAMILY DWELLING WITH ATTACHED GARAGE AS APPLIED FOR The certificate is issued to „ , , JOHN & KATHLEEN BOWNE S ° (owner,A9U1;Xty; of the aforesaid building. Suffolk County Department of Health Approval . . . . .8 7_S 0—3 3 . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . 8�`4,�`?a . . . . . . . . . . PLUMBERS CERTIFICATION DATED: Innovations YPlumbing 12/ I / 1987 r z-7 . . M . . . . . . . . . . . . . . . . . Building Inspector Rev.1181 FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. . . wZ- 16505 w w Date . Decemberw 16 ,w 1987w . . THIS CERTIFIES that the building ,Construct One,Family dwelling with wattachedM garage Location of Property 567SS .Main . Road . . . Southold, New York House No. . . . Sty .i • « Hamlet County Tax Map No. 1000 Section . . .063 .Block 0 3 . . . ,Lot . . . . l..'. . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated March 16 , 1987 15780 Z . . . . . . . . . . . . . . . . . . . . . pursuant to which Building Permit No. . . . . . . . . . . . . . I . . w . w . . March 19 1987 dated . . . . . . . , . . .�. . . . . . . . . . . . . . . . . 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 . . . . . . . . . ONE FAMILY DWELLING WITH ATTACHED GARAGE AS FOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . * X The certificate is issued to . . , , , JOHN & KATHLEEN BOWNE S ° roner,i w b X . . . . , , . . . « . . . . . . . . .. of the aforesaid building. Suffolk County Department of Health Approval . . . . .8 7-,S O-3 3 . . . . y . * . Y . . UNDERWRITERS CERTIFICATE NO. . . . . N844420 . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . PLUMBERS CERTIFICATION DATED: Innovations Plumbing - 12/ 1 / 1987 Building Inspector Rev.1181 I LotAG ;_ � Tax A 1 12 ! ; AREA .1283 acr<a 1 49.p5S ad 1I. v� 1 I o,a -_--- lz 1 rr�vP Nrw r a ".'oxl,nE S8034'00"W no,b 172.05'.][ry"'l, TAxt0T1Ya M. m..m wnwxc.ra r+x+ REF I TL n RENCES: f !J E REPORT PREPARED aY FIRST AMERICAN TITLE INSURANCE COMPANY ! Or ayN� TITLE NP-3019-1045219 EFFECTIVE DATE:12/01/2020 ! ' lK JERRYP.LaQUE bS A NOR HERN 9000EVARD 2O]t-DD) +al-� VRCFESOONAL LA D WRWkOR '�'^"-'T EAST NORwCH,NEW YORM 11737 cacxry (877)7792122 Phone/1Px .rt 42 25a.. p m l7.L1 63 a SURVEY OF PROPERTY -0C1111QN 56863 MAIN ROAD,INC MLLAGE OE SWiNOLD. PA44, -....- COUNTY OF 9 FFOLK.STATE OF„NEW YORK MAIN ROAD LLC MAIN ROAD CERTIFiEp T0:56663 M........._ _ -. .................... FIRST AMERICAN 1111,E ENSURANCE COMPANY pME GCMIMUNTtt BANK ITS SUCCESSORS AND/Qfl AS"dCNS PDF Created with deskPDF POF Miter-Trial::httpWwww,docudesk.com rac G ANDREW V. GIAM13ERTONE &ASSOCIATES Ep A fT -ARCHITECTS T 62 Fla,saga NY 11743 T&0—631367.0050 Fa 631.367-6636 0 0 02080k OF 56863 Main Road LLC N—York 00-000 bi z Not For Construction Now First Floor Plan First Floor Plus A2.2