The URL can be used to link to this page

Home My WebLink About1000-70.-2-19.11 `OWN OF SOUTHOLD AN Rental Permit Nk 1211 Owner Alexander Morgenroth Occupied as Single Family Dwelling Located at 1505 Jockey Creek Dr Southold 70-2-19.11 Maximum Permitted Occupancy 4 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 Code nfor ent OffiC This Notice must be posted by the main entrance at all times a W 'F TOWN OF SO i'Ft�[t LD—BUILDING DEPARTME r,,,-, ti'� "„ Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971 0959 Telephone (631) 765-1802 Fax(631) 765-9502 ttp ://r vvvv sotitllit.)l�dto� w,�, RENTAL PERMIT APPLICATION Rental Permit Fee $300(Application must be renewed every two years) 1 o-�-��I �6 A?� vtCi 1� 5 Section A. Property Information: Rental Property Address: 1505 Jockey Creek Drive, Southold, NY 11971 Tax Map Number: 1000 SECTION 473889 -BLOCK 70. -LOT2 -19.11 SECTION B. OWNER INFORMATION: Property Owner Name: Alexander Clemens Morgenroth Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) iA RA,6 6 w 720 Lone Pine Road ( 3 ( g , -�- Bloomfield Hills, MI 48304 Telephone Number(s): Daytime+491609827876Evening 49160982789fi7ergency+4916098278767 Property Owner Email Address: cmorgenroth@gmail.com Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Ken Poliwoda Address of Authorized Agent(no P.O. Boxes):124 FRONT STREET, GREENPORT, NY 11944 Mailing Address of Authorized Agent: 124 FRONT STREET, GREENPORT, NY 11944 Telephone Number(s): Daytime 31- 79- 046 Even ingb l- 79- 0 ergency Email Address: Kenneth.Poliwoda@elliman.com 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): 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: 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: Unit 1 Requested Maximum number of persons allowed to occupy Dwelling Unit:4 Number of rooms in Rental Dwelling Unit: 6 Use and Dimensions of each room in Rental Dwelling Unit: Bedroom 1 (13'4" x 12'8"), Bedroom 2 (11' x 12'), Bathroom 1 (5' x 5'), Bathroom 2 (5'x 9'), Kitchen (9'x 10'), Living Room (20' x 16') 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 afire safety inspection to be performed by a Code Enforcement Official from the Town of Southold V 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 h L°. � 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: Y Owner's Property Owner' Signature: p GERMAtNY MY OF EBrt,14LBN SS CONSULAR SERSYOE OF THE &kWIEV 'VA ES OF: AMERIOA A� Sworn to before me i day of J ly Official Neta-W-Rt cc Si ature and Original Notary Stamp David Puntel Notarizing Officer Page 4 of 4 TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 70-a -/9 INSPECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. - [ ] FOUNDATION 2ND [ j INSULATION/CAULKING [ ] FRAMING /STRAPPING [ j FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ j FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ j PRE C/O [ �ENTAL REMARKS: OIL Sod ocGv � DATE INSPECTOR PEC'" OR � � Town Hall Annex Telephone(631)765-1802 54375 Main Road ;' Fax(631)765-9502 P.O.Box 1179 Southold,NY 1 1971-0959 w � lj" '° BUILDING DEPARTMENT TOWN OF SOiU'THOLD 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 Professional seal required Lor Architect or Engineer licensed Florae inspector mu t ovrde co01 of valid current certification Rental Property SCTM Number: Rental Property Address: i ' Creek Dr.,, OL,Iti10u NY 11971 Owner/Name: ak k O�Jl Rental Dwelling Unit Identifier: 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 #1 130 s ft Bedroom #2 170 sqft Property Description (Include all improvements indicated on survey) 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 York State. Victor CorneNiu,; -eX Print Name and Title „��,E,,, ;�. ', �. � Original Signa r Please place professional seal: TOWN OF SOUTHOLD PROPERTY RECORD CARD X0- 121 /d .�!� OWNER STREET VILLAGE DIST. SUB. LOT ht, n f VA 0 f-01 erl A-e rp s --EORMER OWNER N E ACR. 7 0— Ic S W CODE DATE OF CONSTRUCTION 1,6,ne A LAND IMP. TOTAL DATE REMARKS -A zzr�4 LJ At p r) 6 3po 6 1124, ;F A i re,T L 4-6 Mu n i / (a 66 cob L4 pla ff t, of E Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD J _7'2- Meadowland DEPTH House Plot BULKHEAD Total u \O t�.. , M. Bld - - Foundation Bath Extension — = Basement Floors _ v Extension Ext. Walls Interior Finish Extension Fire Place � Heat Porch Pool Attic a Deck - Patio Rooms 1st Floor Breezeway Driveway Rooms 2nd Floor Garage 7 s O. B. _ f C FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. Z.13509. . . .. . . . . . Date .. . . June. .1.1 . . . . . . . . .. . , . . . . . 1985 . THIS CERTIFIES that the building . . . .One family ,dwe�l I i n . . y . . . . . . . . . . . . . . . Location of Property . . . . .?5p5. ,Jockey, Creek ➢rive. . . , . , ,Southold . HOuse/Vo. Street Hamlet County Tax Map No. 1000 Section . . .9 T fl . . . . .Block . .. .9?. . . . . . . . .Lot . . .d 19. .E 1 . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. .. . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . .JupA .?$ . . . . . . , 19$?. pursuant to which Building Permit No. 1 17 9 5 Z. . . . . .. . . . . . . . dated . . . . . . . . July. J,a .. . . . .. . . . . . 198.2 . ,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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . . . . Herbert 5,.. ,Arm . . . . . . . . * . . of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . ?.-S 9-7 5 . . . . . . . . . . . . . . .. . . . . .. . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ♦ ♦ . . . . . . . . . . . . . • .. . . . . . . . . . . . • . . . . . Building Inspector Rev.1/81 �oy J-C)CKf-Y 6'Ree DR, q4 Z) ta P SY �a � o� 3 , E 06{ 1 >UG 1 C T C v e i . � w .n LU T rONT, Til wexx � 1 J a�`y�wr rl.ao�uvq ;r d WWO FI/y2.ilyCj ;� f __ .... N�.. WFIL I4VD RIIIP ✓ e KITLHGhI �'N��KC1 6 VV p r rc 1 k r LG r I, � , I 1 kill vlEIR5T"FLOUR-AN r w •rnw,w«, «NHS v xa iT i j r I i _,,,n «.�.•.». a�R,,,� �..:�,,..,�. I kv � I IIi 4 "' t...� �a tiI i F« _. 1H .r• � rW 1 srd. � � � 'Il � ' I F A Imo' i rw ua7N jj Y^�li}Y`YI M.M•99N am,mr D ¢ ,,..._..J':�. _..._...":'._.. ......_••. :., uNb u.7a'+.nwvm our eey a 111 z � � 1 1 ARM RESIDENCE I I { 9OUTHOLD,NEW YORK I pE6 6a.OBHpO I , f 6 WEHL 2liTN eTP '� t3A5EMENT t 11>T FI..R - ,}yr rroF fit.. PLANS