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Home My WebLink About1000-62.-3-4 TOWN OF SOUTHOLD Rental Permit 1216 Owner John & Laurie Lane Occupied as Single Family Dwelling Located at 150 Hobart Road Southold 62-3-4 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. 10/18/2024 Code nfc iment O cial This Notice must be posted by the main entrance at all times w5p 10 TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O_ Box 1179 Southold, IVY 11971-0959 ., Fax 631 765-9502 � � r. xi °r: : n� � lily r ' . w .m Telephone (631) 765-1802 ( ) i_.. .. �ow RENTAI. PERMIT APPLICATION Rental Permit Fee 300 (Application must be renewed every two yearst°'nNI w1' Section A. Property Information: Rental Property Address: rv�,. 1 Tax Map Number: 1000 SECTION 6 -BLOCK -LOT SECTION B. OWNER INFORMATION: Al Leje Property Owner Na Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) Telephone Number (s): Daytime 1e7`/0-elf Evening.Emergency Property Owner Email Address: 1- �'�� °`r ` co-P, Page 1 of 4 �b i Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent (no P.O. Boxes): !0 a 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); 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: For each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier (for example, Unit 1, Unit 2, Unit 3 or Apt A, B, C); 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: Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: Use and Di ensions of each room in Rental Dwelling Unit: 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 ❑ lam 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 3,04V 2 N• 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: J'Cv Property Owner's Signature:_5,°w � "� Sworn to before me thisi�D day of �jo b 20 Official tatar ublic Signature a d t 1 °a ' ot� Stamp— C.MASON w.;" " ,+ My Canntisston Expires Page 4 of 4 l'af SO TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 &a - 3- INSPECTION [ ] FOUNDATION 1 ST 1 REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING I STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI AL) [ ] CODE VIOLATION [ PRE CIO [ RENTAL REMARKS: O - DATE ��6'� INSPECTOR > Town Hall Annex Town of Southold 54375 Main Road o Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 �e. � ._�,.�. �.,.._ �_... � w...w.._. .w,.... w ., . .___.m..___mm_... . _..._. ..rv.._ . .., .. ,,.... SCTM# Date !Owner Phone Address.. . . .... _.__�.__ .. _........ _. . _...__ _. _...... _..... ..,Visible.. . _ ... ... ...___.., ..,.� .._ � ...,.._._.._........_ ... .. ..........,_...., ....._M.._. _.. . Inspector Hamlet _ ... ._ ....._.: ...... .__.. _.......'. Level Quantities Sub _ 1 j 2 3 .Floor.�._ ,.... .,...�._. _...._. . _.._....... ._._._...... . ... .. . ........._µ._M_ ._._.. .___. .. ......._ _. .... . A Smoke Detectors (not located in bedrooms) C j Carbon Monoxide Detectors �....�_.�._ _. Fire Extinguishers f Exits _ .. _..�.. � m 4 5 ✓ Z 3��_..... _. Smoke D 6 w Bedrooms Detectors Egress Occupant Count Building Systems Maintained &Operational Condition of Property Heating � Buiiding interior e Hot water Budding exterior ....._ _ ...... _ .w.... .... ..... . _w.. _..... , . . _ ...ry.. Electrical .� __.____ ,. _ a.._ �•�-�-�� -�� Property maintained Mech.anicsI 'Handrails clean,guards installed &secure .T.. Pool Safety Pool an Site IM. Surface water alarm l Date of CO issuance ., ..._._w�......_ ._..�.._ .... .. m_.._.... .�.. ..w... _.._ . �.. ,, ..�. ..µ�,_._._.... .. ...�..._.�_ .... .. ._ .�.a_.,..um._.w �. ...!....w__.��._....... arms {Pool completely enclosed Door alarms .�..�.�W. ,...__.W_.. �. .. P y � r A o c ._....._. .__.. � _. _ ....m.W, .. ....Y�W ..... Self closing/latching gates i �Pool fence to code requirements Co's for all items present ! Prior Rental _.._.._._ _...... ...... _. ... . .. . W.. .. ... ... ..... W .._... _.._. .. ............... Comments ... .....o. ,...., _w SCTM# l 111 0C)b � � - - �� TOWN OF SOUTHOLD PROPERTY REC-_ . OWNER STREET VILLAGE DIST. SUB. LOT C Lam . ACR. REMARKS00 TYPE OF BLD. If 5- L ►z-go 59-Todj vtU �o Ma ry 410 O s 1 PROP. CLAS LAND YMP, TOTAL DATE i i FRONTAGE ON WATER HOUSE/LOT BULKHEAD TOTAL q 141�141:t I TOWN OF SOUTHOLD PROPEWE ny -----.-D CARD STREET i VILLAGE DIST.j SUB. LOT -y P,C) FORMER OWNEW11-n�41f N) E,_,/ ACR. I 0 W TYPE OF BUILDING ki y I e, RES. SEAS. I VL. FARM comm. CB. MICS. Mkt. Value LAND i imp. TOTAL DATE REMARKS gg A - A -777-- 1;2 42 6 j4 ti 17' c7,I I AGE BUILDING CONDITION r NEW NORMAL BELOW ABOVE ARM Acre e Value Per Value Acre Tillable FRONTAGE ON WATER Woodland I FRONTAGE ON ROAD Meadowland DEPTH House Plot BULKHEAD Total DOCK , Tr C �� < -^ TRIM e 1 s 4 t _ { l ci E € � 3d U. Bldg., _ E l 3 Extension - 7 -Z s o g� p � s i Extension I I foundation Tath t Dineite f - s Porch ;Basement p/o Floors K. Patch Ext. Walls _ !Interior Finish LR. Breezeway Fire Place ;Heat r DR. Garage _ Type Roof !Rooms 1st Floor BR. i Patio !Recreation Room ; Rooms2nd Floor I ' FIN B I 5�� 1 �/ � �- `Dormer I 'Driveway , Total z . i FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDATED CERTIFICATE OF OCCUPANCY No: Z-29149 Date: 12/27/02 THIS CERTIFIES that the building ADDITION Location of Property: 150 HOBART ROAD �wv.w.m SOUTHOLD (HOUSE NO.) _ (STREET) _...e .....(HAMLET)� County Tax Map No. 473889 Section 62 Block 3 Lot 4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ---MARCH 6, 1992 pursuant to which Building Permit No. 20477-Z dated MARCH 12,_ 1992m 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 TWO STORY ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. THIS CERTIFICATE OF OCCUPANCY REPLACES C/O# Z-22762 ISSUED 12/2/93 ., The certificate is issued to THOMAS K TALBOT _& ELLEN E KRUDOP m.w.-......., .__wwwww(OWNER) ............ww.....M_..,...w_..._..._.w. of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. H 037268 03/30/93 PLUMBERS CERTIFICATION DATED 11/30/93 THOMAS TALBOT Si ature Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPART-NIENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. U592 . . . . . . Date THIS CERTIFIES that the building located at .wig. -Hobart-Road. Street Map No. . z7[ . " o . Block No. . . = _ . . . .Lot No. . .XX.XX . . . 6,outhiold. , X.1 conforms substantially to the r' ws► ing Codo Curti2. ion H o P ri:1 . .23. . . , 19- .57 pursuant to which No. . 4 pancy dated . . . . . . . . .Karch . 23 , , 19. .,72, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . . . .Pori ts. -Me. -family 1wol-1- ng. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . .pobert .&. Su,jan Conlon ch.•ncxrs (owner, lessee or tenant) of the aforesaid building. NOTEi Housing insvecticn Mar 23, 1972 Suffolk County Department of Health Approval . prior. construction. & -pudic.water House . _.,... Building Inspector re - L ; - 4 / —T a