Loading...
HomeMy WebLinkAbout1000-55.-6-15.6 lei TOWN OF SOUTHOLD �g Rental Permit AV 1232 Owner Elena Palencia Occupied as Single Family Dwelling Located at 755 Oriole Dr Southold 55.-6-15.6 Maximum Permitted Occupancy 2 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. 11/19/2024 ` )dreyfojrMrn7f dal This Notice must be posted by the main entrance at all times ark � TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, N Y` 19t- 5t 1 Telephone (631) 765-1802 Fax(631) 765-9502 htt s://www,so th ld t�ow Yov RENTAL PERMIT APPLICATION Ptiin � pn �nnl T '°onof�' O Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION CL�- "�L► -BLOCK -LOT - SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) te— Y ©_ - � • Telephone Number (s): Daytime Z55-0 Evening Emergency Property Owner Email Address: k 5eci. tD Page 1 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, 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: Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: 1 Use and Dimensions of each room in Rental Dwelling Unit: V Ia,0 1,- � 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. ❑ lam 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. 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 ) , 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: '" . & ,, Property Owner's Signature: Sworn to before me thitsl ay of "_n:y , 20a7 Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.0 1 BU6186050 ®ualifldd In Suffolk County Page 4 of 4 Commission 1=xpires April 14,=V TOWN OF SOUTHOLD BUILDING DEPT. af 631-765-1802 . I N IS` P E C T 10" N [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING- [ ] FRAMING / STRAPPING [ rFIRE AL FIREPLACE & CHIMNEY [ SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI ) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: c DATE tog INSPECTOR _ Y TOWN OF S UTHOLD PROPERTY RECORD CARD 77 OWNER STREET � ILLAGE DIST SR LOT ACR. REMARKS jt TYPE OF BLD. PROP. CLASS LAND IMP_ TOTAL DATE e 1 I s s� F a x i °s j S � t � ` . - — u — r a � s [ y[ s FRONTAGE ON WATER TILLABLE a FRONTAGE ON ROAD WOODLAND s DEPTH MEADOWLAND BULKHEAD HOUSE/LOT - TOTAL teat' 4t4 � COLOR TRIM ti I 7 i f _ / � - 5 Foundation Bath Dinette M Bga � 7 ?� - �- .� a, �' 1� _ �� -�s FULL � Extension. � � <Ma � r °'�. Basement CRAWL Floors Kit. a�hG.}` 1 .. SLAB Extension Ext. Walls Interior Finish L.R. Extension > Fire Place ,°r Heat _ <. D.R- i Patio Woodstove BR, Dormer -Ww. B Deck Attic ---------------------- Breezeway Rooms 1st Floor I Garage Driveway Rooms 2nd Floor O.B. Pool FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NoZ19772 Date MARCH 5P 1991 THIS CERTIFIES that the building ALTERATION Location of Property 755 ORIOLE DRIVE SOUTHOLD House No. Street Hamlet County Tax Map No. 1000 Section 55 Block 06 Lot 15.6 Subdivision HIGHPOINT MEADOWS Filed Map No. Lot No. 4 conforms substantially to the Application for Building Permit heretofore filed in this office dated JAN. 3, 1991 pursuant to which Building Permit No. 19617Z dated JAN. 4 1991 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 ALTERATION TO BASEMENT OF EXISTING ONE FAMILY DWELLING. The certificate is issued to DBM CO. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N174691 FEB. 19t 1991 PLUMBERS CERTIFICATION DATED K & K PLUMBING MARCH 5 1991 Building Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.X. CERTIFICATE OF OCCUPANCY No Z-22564 Date SE"PTEMBER 1 1993 THIS CERTIFIES that the building ADDITION Location of Property 755 ORIOLE DRIVE SOUTHOLD N.Y. House No. Street Hamlet County Tax Map- No. 1000 Section 55 Block 6 Lot 15.6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 28, 199pursuant to which Building Permit No. 146 Z dated JUNE 7 1993 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to JOSEPH & MARIE LIBERTELLI (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N A PLUMBERS CERTIFICATION DATED N/A ilding 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 Z19573 Date DECEMBER 27 1990 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 755 ORIOLE DRIVE SOUTHOLD House No. Street Hamlet County Tax Map No. 1000 Section 55 Block 06 Lot 15.6 SECTION ONE Subdivision HIGHPOINT MEADOWS Filed Map No. 8910 Lot No. 4 conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 16 1990. ______pursuant to which Building Permit No. 18971Z dated APRIL 23, 1990 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 The certificate is issued to DBM CO. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 90-SO-25--NOV. 14 1990 UNDERWRITERS CERTIFICATE NO. N158570 NOVEMBER 1, 1990 PLUMBERS CERTIFICATION DATED K & K PLUMBING-JULY 17 1990 Village of Greenport Water Service 11/8/90 Planning Board Approval 12/27/90 vtl� 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-25133 Date JULY 110 1997 THIS CERTIFIES that the building ACCESSORY Location of Property 755 ORIOLB DRIVE SOUTHOLD N.X. House No. Street Hamlet County Tax Map No. 1000 Section 55 Block 6 Lot—15.6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 30 1997 pursuant to which Building Permit No. 24136-Z dated MAY 19 1997 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 INGROUND SWIMMING POOL WITH FENCE TO CODE IN REAR YARD OF EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JOSEPH & ROSEMARIE LIBERTELLI (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL INSPECTION CERT. DATED JUNE 18 1997- #16659 PLUMBERS CERTIFICATION DATED N/A -2Z Buil g Inspectof Rev. 1/81 lR l 2 :- 21- �� ---` Ezcisr 1�t CNnt-/'� `le3�o-Z t !L 20 JCX F v Ile Up it LIN A/lri w 4Ae@ ol Cam" r e— REQWRED2' £' � r,J4U �rrx4 i wAtl _ :s` F ^f 2a3�a 2 Z83�o�Z Ion N1�Eki i `�o2 �o�. �'!4►JC� a�H =,cam ��`�- i-o LO�� LAN c � _