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HomeMy WebLinkAbout1000-17.-3-3.1 TOWN OF SOUTHOLD Rental Permit 1223 Owner Gordy Slack Occupied as Single Family Dwelling Located at 100 Maple Lane Orient 17-3-3.1 Maximum Permitted Occupancy 10 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. 11/1/2024 Code E for et Offigal This Notice must be posted by the main entrance at all times 08w 0 qV4 G�* -4. 51 TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. ©. Box 1179 Southold, _V 1 7 fbOt9 Lr. Telephone(631) 765-1802 Fax(631) 765-9502 RENTAL PERMIT APPLICATION 1301ding Department Town c"."Scuff-mid Rental Permit Fee$300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: -04 1 r= 1 Tax Map Number: 1000 SECTION - � r_-BLOCK 3 .... -LOT .�1 SECTION B. OWNER INFORMATION: \\ Property Owner Name: 60 C� Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) neXK \r"A44 (-A Telephone Number(s): Daytime Sio5ojfta Evening Emergency seµ� Property Owner Email Address: �\--C ke Ci �`'�a` "�O M Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: W l.1 a 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): 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: 0 Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: 9 Use and Dimensions of each room in Rental Dwelling Unit: O.' A 1 '.. '► ` '� L 13;2 'X } ray, 'T-V 1 a� ` 13 a 1 rov. Iv' ft '� ,-r - 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. M'1 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. 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 d ld`C- , 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: o ram. Property Owner's Signature: -}h Sworn to before me this]L day of Ce-'+0bC V- . 2024 4�wet! (A- ,* SE-AApi-v4 Official Notary 1lic Signature an ginal Notary Stamp TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YO:?X NO.01 DW61.06800 QUALIFIED IN SUFFOLK OOkkITI' COMMISSION EXRRE'S,1UN- 0„2 02(v Page 4 of 4 of SOC p, TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 17- - / INSPECTION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [RENTAL REMARKS: (� rz_4-6 0IP145orl �v RATE /0 a 5` INSPECTOR Town Hall Annex Town of Southold 54375 Main Road Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 " Tel: 631-765-1802 :SCTM # Date d 2 i Owner ;Addy.__..._. M .... .�,.._..,..W..� ....,.° ; �. ....�� ....._a. ..�_..�....� .�........__. w...�._w.�...��. _�. Phone. ...m..e ,,,Address,,,, �d7�. .._ ... �...... .... ....m.__. . .. _ ...�. .p..�.,... t ess Visible � Hamlet jai Inspector Y Floor__.. . ., es . Sub 1 2n 3 Level Quant !.��� .._....�..__�. .. m�..._. ...._.. . . �. .__ - _.. . w. . ..,_� ...�m...�_.� ...._ . ..�._ � ,, ... „ ... Smoke Detectors (not located in bedrooms) ( �µ Carbon Monoxide Detectors Fire Extinguishers Exits Bedrooms 1 2 3 Smoke Detectors Egress Occupant Count , rcw BuildingSystems Maintained &Operational Condition P m... ..... y p Condition of Property ' Heating. Building interior ti Hot water Building e�.�__....__._ . xterior _...._. ..._.ro ... ._..... ._...._ . ...._.m.. .._... _........�.. . .. .. Electrical Property clean, maintained &safe Mechanical Handrails &guards installed & secure { Pool Safety Pool on Site Surface water alarm Date of CO issuance .Door alarms ......_.. ._rv.,.a ........� µ...a.... .... wPool..completely enclosed Self closing/ latching gates Pool fence to code requirements . _., CO's for all items present Prior Rental I Comments: 7' 211411 rn 10' 8" in Dining Kitchen . ~ w �0 �r I �1 13� 11 1r 45 qos,e LO Bathroom - Porch c� - � Living cv f , Living .� Co Sf H a I I w a 5' 10" n 131 24t 9 F- 39' 3" o N M T 3" Toilet 10, 101, Bedroom Bedroom J- • T- it t CIA.ei losvIt alas t Cl set'' Bathroom cv o CIO r 9� w Bedroom T N 3 lose Ci t r 12' 10" T �j1 1r r L 6 * r los N ose� 00 & edroom 2' Bedroom Hallway s 0� i �_� TOWN OF SOUTH OLD' PROPERTY6ECORD CAND YJ 1-7-OWNER STREET VILLAGE DIST. SUB. LOT: 9f OR1 ER O -NER E � ACR. IvesNI���� W TYPE OF BUILDING N RE5 { SEAS. VL. FARM 1COMM. CB. MISC. t,'%kt. Value LAND t IMP, TOTAL DATE REMARKS 1 f r L1 o 51 vL Wan } o € } e s AGE BUILDING CONDITION01 NEW NORMAL ! BELOW ABOVE FARM Acre Value Per Value Ac re f Tillable 1 Tillable 2 Tillable 3 Woodland. ... . FRONTAGE ON WATER 1 1 2-7 Swampland I FRONTAGE ON ROAD E e —m-�'— Brushland E DEPTH House Plot .._ BULKHEAD - - I I Total DOCK _ E , LORME . t er IM ( i I i I I --17.-3-3.1 6/11 I , Foundation rTF- M. Bldg Both i g / y Dinette! _ ; Extension Basement �' Floors K. Extension _ i Ext. Walls Interior Finish �� I LR. e Extension Fire Place Heat - DR. Type Roof Rooms 1st Floor BR. - ; Recreation Roanr"Roo ms 2nd Floo Porch SIN B. Porch / A"O Z Dormer ff Driveway Breezeway Garc:ge i Pr do i O. B. - i Total ; v / 1 � A c -I T- 3 -3- 1 -4 COLOR i a_ I I t i r t� i _ TRIM s i 1 � � i 5 s t i I s 3 s t s . 4 � E 4 M. Bldg Foundation I Bath Dinette - Extension Basement c Floors K. F t _ - I a 1Ext. Walls Interior Finish LR. 1 Extension 1 Extension 1 lFire Place Heat I DR. Type Roof € Rooms lst Floor BR. i Porch 1Recreation Room Rooms 2nd Floor I FIN. B. 1 Porch s Dormer 3 t Breezeway ]Driveway t Ge-rag e 1 o B- �3�L ousfi 17X3a-S�o . '� 27�" Total I 1(� 7S s z } TOWN OF SOUTNOLD- PROPERTY RIECORD LAW OWNER STREET VILLAGE DIST. SUB. LOT FORMER OWNER N E ACRE I S WTYPE OF BUILDING t �_ RES. `� SEAS, IVL. FARM COMM. CB. MISC. Mkt. Value G LAND IMP. TOTAL DATE REMARKS I I - Af o--� l d i AGE i BUILDING CONDITION NEW i NORMAL BELOW ABOVE i FARM Acre ! Value Per Value hl=_ ' Ac re , Tillable 1 3 Tillable 2 Tillable 3 i Woodland Swampland _ FRONTAGE ON WATER FRONTAGE ON ROAD Brushland I g £ a DEPTH House Plot IBULKHEAD ? Total DOCK i 1 fFot . Town of Southold 10/30/2023 411OC 53095 Main Rd C Southold,New York 11971 PRE EXISTING CERTIFICATE OF OCCUPANCY No: 44703 Date: 10/27/2023 THIS CERTIFIES that the structure(s)located at: 100 Maple Ln,Orient SCTM#: 473889 Sec/Block/Lot: 17.-3-3.1 Subdivision: Filed Map No. Lot No. conforms substantially to the requirements for a built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 44703 dated 10/27/2023 was issued and conforms to all the requriements of the applicable provisions of the law. The occupancy for which this certificate is issued is: d f c in plc Tamil dwellin with woad dec lr cov r .. p arouard aorc l covcrcd rirch sac car ara�_ c1,cier porctL4rjd.gS _woqd A - -cV The certificate is issued to Raeside Frances (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. ut o ' Signature BUILDING DEPARTMENT TOWN OF SOUTHOLD DOUSING CODE INSPECTION R POR LOCATION: 100 Maple Ln,Orient SUFF.CO.TAX MAP NO.: 17.-3-3.1SUBDIVISION: .............. ....... _...... _.............. ........ .................. .�_.....�.............vw_. .....,m„_.mm. _._ ..,.._ SUBDIVISI�w ON: .�. _.�....�.�.. .................__w .................................................. NAME OF OWNER(S): Raeside,Frances .., .._......... _..............._. OCCUPANCY: ......._ ADMITTEDBY. ,,..�. ................ ...._.._.,........ _... _ .w ✓.__...W......w SOURCE OF REQUEST: Raeside,Frances _w............ _. .........._... . ._...,_... .._ DATE: 10/27/2023 .._.._ _w.ww._. �_�_.�...........� . ._.. w _. _..__....._....vw._.._....._.............................. DWELLING: #STORIES: 3 #EXITS: 6 FOUNDATION: brick CELLAR: full CRAWL SPACE: .._..........._..___w _._.........._._........... BATHROOM(S): 3 TOILET ROOM(S): 1 UTILITY ROOM(S): in basement ......_.._.... PORCH TYPE: covered/ mm�������wrapped DECK TYPE: wood PATIO TYPE: ..._._.www__-..,.�. ..................................................... _.._.._ _mm_.... _... BREEZEWAY: FIREPLACE: 1 GARAGE: under porch 1 car DOMESTIC HO ...... -..."""""J". _ _._..._._._._._._._.._._..._..._. ... TWATER: well TYPE HEATER: furnace AIR CONDITIONING: TYPE HEAT: baseboard WARM ............._........._._..,._,-........_.._..�.._._ _w.w.w�..___. ARM AIR: HOT WATER: super stor #BEDROOMS: 5-6-.........._ #KITCHENS: 8....__ BASEMENT TYPE: unfinished OTHER: ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: wood frame SWIMMING POOL: CO11538 GUEST,TYPE OF CONST: OTHER: pool house CO11538 VIOLATIONS: REMARKS: INSPECTED BY: NANCYD DATE OF INSPECTION: 10/24/2023 TIME START: 11:15am END: 12:1Opm FORM NO.4 TOWN OF SOUTHOL.D BUILDING DEPARTMENT_ Office of the Building Inspector Town Hall _Southold,N.Y. Certificate Of Occupancy No Z.1.1538. . . . . . . . . . . Date . . . . . . . Mares.. . . . . . . . . . . . . . . . . . .. 1983. THIS CERTIFIES that the building . . . .Accessary , . . . . 4 . Location of Property . . 450 Birdse .a �.e (Private Road'.#2) . . . . . » Orient House)Vo, Street Hamlet County Tax Map No. 1000 Section . . .�7 . . . . . .Block . . . . . . . . . . . . . .Lot . . . . � . . . . . . . . . . . Subdivision W . . « . . . . . . . . . . . . . » _ . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated September 2'f 19 .77. pursuant to which Building Permit No. . . . }46;1 Z. , . . . . . . . . . . dated . ,September, . .. , • , , , , , , , , . 19 .77,was issued, and conforms to all of the requirements of the applicable provisions of the Iaw. The occupancy for which this certificate is issued is . . . . . . . . . Ingxound swimming pool ;� Fencing; ,Pool house &, Acce,ssarys The certificate is issued to . . .Reiff ,A,• Ma)p'f._�y,& 'Wif e. . . . . . . . . . . . . . . . . . . . . . . . . . . . (owner,lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . . . . /A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . .40�35�. . . . . . . . . . . . . . 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-19429 Date OCTOBER 10 1990 THIS CERTIFIES that the building ACCESSORY Location of Property 100 MAPLE LANE & 450 BIRDSEYE LANE ORIENT N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 17 Block 3 Lot 3.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 3 1987' ______pursuant to which Building Permit No. 16717-Z dated'. JANUARY 26 1988 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 BUILDING AS APPLIED FOR. The certificate is issued to REM A. MAE1AFFY (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N A UNDERWRITERS CERTIFICATE NO. N-101625 - NOVEMBER 10 1989 PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81