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HomeMy WebLinkAbout1000-53.-6-35 TOIAIN W SOUTHOLD F Rental Permit 1231 Owner Kelly & Brian Kotliar Occupied as Single Family y Dwelling Located at 3650 Bay Shore Rd Greenport 53.-6-35 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 County of Suffolk and by the laws adopted by the New York State Fire Prevention and Building Code Council EXpiration is two (2) regulations of the years from date of issue. The operator is responsible for arranging for the bi-annual inspection. 11/19/2024 This Notice must be posted by the main entrance at all times Cod n ' ,e g ent Officialx Town Hall Annex µ , 54375 Main Road , P.O.Box 1179 Telephone(631 7 5-1802 lx Southold,NY 11971-0959 i 'BUILDING DEPARTMENT 'EI' "AL PEIt'IVIIT�PP'LICATIC1I11 Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: .... 3(e5 v P,)lW S 1-fn tZk�- P..0 c Tax Map Number:1000 SECTION 6 -J ,FLOCK SECTION B. 9WRkll INFQR IATit l ; o a-nl t Owner Name: k'XV PP? Owner Le al Address: � �.�rt� mm T Leptgn Number(s a times �- �-Id. - � vening &T� -�Emerge Prle�®caner Email Address: Pagel of S w Town Hall Annex 54375 Main Road > P.O.Box 1174 % Telephone(631)765-1802 h`Y outhold,IVY 11971-0959 "a Fax 631 765-9502 ( ) 'WILDING EPAR'I'MIENT ,rOWN OFO OLD 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 g or mor e rental units) Name of Managing Agent of dwelling unit, if any: Address of Managing Agent(no P.O. Boxes): Page 2 of 5 it M 'sc�"vn-Hail Annex °^ F� s 34375 Main Road I P.0.Box 1 179 Telephone(6311765-1802 rr g � � l Southold,NY 1 1971-0959 Fax(631)765-9502 r, BUILDING 1 P RTMI-NT" 'OWN OF 80"L7"'rHO Mailing Address of Managing Agent: Telephone Number(s):Daytime Evening--_ Emergency mail Address: ' SECTION F. 'PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: .. Far each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier(for exam le 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: 3, O r�ru G(o D k-bllj, Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: � . 2-, � 'Irk� P'age 3 of s Town Hail Annex 54375 Main Road + P.O.Box 1179 jotJ'' j eiephone(631)765-1802 NY 1197]-0959 " Southold, �� Fax(631)765-9502 rf T i7O BUILDING jOFtS0JJT CI`LD SECTION G. INSPECTION: Pursuant to the Town Code of the Town of Southold Chapter 207(Rental Properties a =nspection by Code Enforcement Official is required. If the owner chooses not to have said bnspection per 'ormed by the Town, a certification from a licensed �� safety icense Professional engineer or a home inspector who has a valid New York StatetUniform Fiirre 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 Town of Southold,,the laws and sanitary and housing regulations of the County of Suffol the by the laws adopted by the New York State Fire Prevention and Building Code Coun • k and cil. ❑ 1 am requesting a fire safety inspection to be performed by a Code Enforcement Offi ' from the Town of Southold cial ❑ 1 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 dwe lling unit. .11V fY OF N k-- �i�rderpenalty of pLrfuq`,the fall owing; ,. awner of tl roperty ideritgfred in ection this application. 2. The property owner's le gal address set forth in ""Section B"of this application is my legal lddr,..; rill"t i�drsti�d ., the 12 n w ll use tth ad�lr s fR service pursuant to all Page 4 of 5 r ✓, Town Hall Annex , 54375 Main Road j P.Q?.Box 1179 Telephone(631)765-1802 '� ��� � Fax(631)765-9502 Southold,NY If 971-0959 ' `A, BUILDING i t>E?PAR°tMENT OWN F SOUTHOLD 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. Proper j)y2y ner's Name: C 'ro? Owner's iglature„ ' be Official N `crtIy Public Signature and O riginal No#ar 4� . 1J�A KY PVHLI+C',,STATE O N,EW Yt�RK Registration l`o OI S06435838 ualir d in Ai1�W VOXI I Count �""'ommission Expires 3Tt1Y 05,202 Page 5 of 5 -77 OUT TOWN 0 THOLD Bu LDIAll EPT. 631-765-1802 INSPECTION [ ] ,FOUNDATION 1ST/REBAR [ ] ROUGH PL [ ] FOUNDATION 2ND BG. [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING 14 6 [ ] FIREPLACE & CHIMNEY [ FIRE SAFE [ ] FIRE RESISTANT CONSTRUCTION SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL [ ] CODE VIOLATION [F ' L) [ l PRE C/O [ RENTAL RE RS. l 10c./ DATE INSPECTOR � 11 Town of Southold Town Hall Annex Rental Inspection Report 54375 Main Road CIP PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 SCTM# ��r Owner— ------ Date Address Phone HamletXdef Visible Floor Level Quantities _ Inspector 1 Smoke Detectors(not located in bedrooms) Sub 2 3_ _ Carbon Monoxide Detectors Fire Extinguishers Exits Bedrooms Smoke Detectors 1 2 3 Egress Occupant Count Building Systems Maintained& Operational Heating Condition of Property Hot water Building interior Electrical Building exterior Mechanical Property clean, maintained & safe Handrails&,guards installed & secure Pool Safety ___--------_....__----__-.-- Surface water alarm Pool on Site Door alarms Date of CO issuance Self closing/latchingPool completely enclosed gates Pool fence to code requirements CO's for all items present _ Comments: Prior Rental Town Hall Annex ""� Ulllllui���i 54375 Main Road P.O.Box 1179 � Telephone(631)765-1802 n Southold,NY 11971-0959 Fax(631)765-9502 � i N BUILDING I EPARTMEXT TOWN OF SOMI10 RENTAL PROPERTY CERTIFICATION Form/s to be completed by a license architect, licensed engineer or lice Separate form is required for each individual Rental Dwelling unitnsed licensed inspector P"rlonal seal rMec uired ror Architect ar n irrr llcrsd Poe/ns oval/d current cart/ can - - actor° ld _- �� _Ms pr ..__. Rental Property SCTM Number: 1 oDu Rental Property Address: 3(0�-, 3 _ _ m.__... ... ... Owner/Name: "��% ..m Rental Dwelling ...., .._, � ��.. .. Rent " g Unit identi 1 Number&Square footage of each ch bedroom as depicted in the attached floor plan: Ae. Bedroom#1 -100 sq., Bedroom#2-90 sq., F etc.) SF- Property Description (Include all improvements indicated on survey) ---------------- certify that I have done a physical inspection of the subject...._...,�,.�,.�._.,� fully complies with all the provisions of the Code of the Town Of Southold, rental dwelling unit and find that it of New York State, the Building Code of New York State, the PlumbingCode the Residential Code the Fuel Gas Code of New York State, and the Energy Conservation ode of New York State, York State, Construction Code of New dOA u s. FEXlew- Print Name and Titlee-01��, ����� W� Or in I Signature Please place professional seal: 15861 OF NEW C 1,tj ul ry, � n �w r O , LL o f w ' "w ,, t. �. u w V) w't f LY w U �� O O .. �. Q [� J O 0 U cisLU Lu LL a, cty LLJI Ln O ,.N NN jr w ") 00 r " f ce j Al°e F i p bpi a a CL o �. '•LLI Z w a 3 F- F- m �o 0 F- v — HU L'Art SCTE=-- � TOWN OF SOUTHOLD PROPERTY FEG DIST- SUB_ LOT 10 VILLAGE STREET ; OWNER a qz5 coo c KS } R [BAR � � � � ►� I -� ACR. 2�� tI -Liz� � TYPE OF BLD_ s € PROPP CLASS II TOTAL DATE IMP,LAND � I j i HOUSE/LOT FRONTAGE ON WATER _ BULKHEAD TOTAL � f OWN p pV�'HOLD PROS � OWNER PROPERTYRECORD BARD iSTREET V[LLAGE DIST. � �� SUB. LOT FORMER OWNER 10 F I . E ACR. alc'0� `ac gill € S W i TYPE OF BUILDING RES. SEAS. VL LAND FARM COMM. CB. - MICS. Mkt. Value IMP. TOTAL n ATE REMARKS 3„ LeT/y0 �Sfit3 ,PPRAI: frT SIRS t�f a Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland House Plot _ DEPTH BULKHEAD ------------------ Tota Y � - OLOR I RIM Ti- 1 , I 204 1/30/2019 3 1 'Bldg. _ I ij M. . t F 1 , e d Founation Six �i Bath Dinette I lei ., � Basement E'rS€ort , ' `Floors l f;�Yn i v I s i ; Interior Finish i 1 Fit F a _ I Wallsi _ Fire Place i _ LR. _ 3 T � s ; Meat , �. , Porch YPe Roof - - ; Rooms 1st Floor BR 1 lRecreation Room i ' I 1 1 Rooms 2nd FI fr - FIN. B, -7 Ll �e (F Dormer : Br p� S Cb Garage 416� O £Driveway O Y. S � Total t �9001$ - itr TOWS O- SOUTHOLD GE PROP'ERTYa � DIST. SUB, LOT VILLA jStREET OWNER ��GOtI I 4 ACR N FORMER OWNERg TYPE OF BUILDING W a - -. MISC. Mkt. Valu e COMM. CB FRM a SEAS. ,VL, RES. ,o DATE I REMARKS �� �`_ = x s IMP TOTAL �.. r L LAND l ,'` r2 � dv " f,rrSiAS �p 3 ; INC � RpDa�dyil�Lv- r I y© 3 I T ti BUILDING CONDITION o_ AGE BELOW ABOVE NORMAL NEW Value I { Value Per I FARM Acre Acre E Tillable 1 i l Tillable 2 Tillable 3 Woodland FRONTAGE ON WATER Swampland 'FRONTAGE ON ROAD *' y ; Brushland a DEPTH a House Plot BULKHEAD I i DOCK Total DAYS Mesa - t h it pi \ a [C € - !! �• - G '�# t. -�� '.-.-�.�_ ��� � i .gip -. -. �+� � �LltSN it !! � R Ube Tc� ft 1p— Attic Room. .. f .�7�$is - 7 t.a_ s —7- i uyr `r�'• z ff z -mom�!I ,� � ��, U C O i_ Phone 47 J-0400 ~� •� IY[N�h J n i?'.. - �- r�- __ - �� t If 441 ri rl - - H E r 4 _ - - t�•� kit;+ cci4,��r:av«t�• _ � { �4���i r - � !s oc�c�a �t - 7" t AKP,i k _ }'_� ti �� .f r,,=.jg} Li Phone 477-0400 Main i k' f l j j l ; _ {a tii CREFNPQRT-NY 11944