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Home My WebLink About1000-83.-1-19 -4TOWN OF SOUTHOLD Rental Permit - 1233 Owner Catherine Dunn Occupied as Single Family Dwelling Located at 340 Vista Place Cutchogue 83-1-19 Maximum Permitted Occupancy 5 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. 11/20/2024 rC7 nt ffcial This Notice must be posted by the main entrance at all times ?C e a TOWN OF SOUTHOLD—BUILDING DEPARTMENT wi ( Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone(631) 765-1802 Fax(631)765-9502 https:/A �w oj►tho1dto% nn 6v 4 A q RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: ental Property Address- 5V e- v C o Tax Map Number: 1000 SECTION , LOCK -LOT �- SECTION B. OWNER INFORMATION: Property Owner Name: ) " ° ',°lae t n "'- Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) c .. )- ,,. L2 -2a c1f GIB "v : `2 I Vlbwdrik t Telephone Number(s): Daytime`" i � - ~ "vening Emergent ,. F � -. -°553� Property Owner Email Address i Q�� w - 't�� " :'>'( „0 Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: D Address of Authorized Agent(no P.O. Boxes): .. Mailing Address of Authorized Agent: �� 0 0 Telephone Number(s): Daytime Evening _ Emergency a Email Address: r (C a CCe)-t 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 all ITcupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: li Use and Dimensions of each room in Rental Dwelling Unit: kddew t� .. � c , �, � �,. �o x 20 SECTION G. o ) 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 � �mmw MI w Town Hall Annex Telephone(631)765-1802 54375 Main Road `,: Fax(631)765-9502 P. O. Box 1179 Southold, NY 11971-0959 � N. �m.Ny BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a licensed architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Professional seal re aired for Architect or Engineer. Licensed Home Inspector must rovide copy of valid current certification Q Rental Property SCTM Number: I D DO - - ( -r Rental Property Address (-, d ✓i "� " 6U I *t Owner/Name: 0 Rental Dwelling Unit Identifier: Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 -100 sqft., Bedroom#2-90 sgft., etc.) Property Description (Include all improvements indicated on survey) 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,the Fire Code of New York State,the Property Maintenance Code of New York State and the Energy Conservation Construction Code of New York State. Print Name and Title Original Signature Please place Professional Seal: SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFO'LLK))� 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 Sig nature:3 .,.,�. ° �........... Sworn to before me this 4 day of 20 7 Off ici "" otary Public Signature and Original Notary Stamp Notary Pubfi , tate of New York QuaG ied pn Niagara County Rag, No. ojtj ; 4 70 MY C'OMMi par:Expire ' g I,.- Page 4 of 4 V, 1�t, �to TOWN OF SOUTHOLD BUIL. ING DEPT. 631-765-1802 g 4. l 9 INSPECTION [ ] .FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] AL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F/ L) [. ] CODE VIOLATION ` ] PRE C/O ( RENTAL REMARKSh wtL-,-;.- �v L , DATE 111 '� INSPECTOR TOWN OF S UTH LD PROPERTY RECORD CARD - OWNER .` - BEET = '` VILLAGE DIST�' SUB. LOT I . FORMER OWNER i N E ACR ` vot 3 � , � nCl�,�, S W Y TYPE { BUILDING RES. SEAS. VL, FARM I COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE : REMARKS e e E O J� � Q 1S0 a 03 // /y !O S o L i✓c ' t �Y f :or [ fti�f�`- i } y AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre Tillable FRONTAGE ON WATER Woodland m FRONTAGE ON ROAD Meadowland DEPTH --T House Plot BULKHEAD Total-, ' DOCK E 1000 I i COLOR TRIM ' _ _ r E - I 1 I � - ti 4-I y( � at 4 c =� ; r j_ e E } M. Bldg. Extension E Extension ' E Extension i i 3 Foundation Bath Dinette Porch _ r i semenfi °Floors I<. a - 300 !Ext. Walls ! 'Interior Finish ` " LR. Breezewayr = Fire Place ; Herat DR. - Garage ype Roof ! _ ! Rooms 1st Floor BR. r Patio Recreation Room Rooms 2nd Floor FIN. - O. B. Dormer riveway Total _: 5 7- 31 I 3 FORM No. L TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. $3 . . . . . Date . . . . . . . . .r1•l . . .6. . . . . . . . . . ., 19 . THIS CERTIFIES that the building located at It19t . .n. & 0,10M.Ct . . . . Street Map No.Vlgt&•jWgBlock No. . . . . . . . . . .Lot No. I* . .� thorn•. . . .A.�., . . . I . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . Aug. . . . .�3 ., 19.69� pursuant to which Building Permit No. .1111417 . dated . . . . . . . . . Avg. . . . .1� . ., 19. 69, 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 PT000 0. ZAI ,11Y .4V0.11 . . . . . . . . . . . , „ . . . . . . . . . . . . . . . . „ . . . . . . . . The certificate is issued to Adolp •Ugolba4 . . . . . . Owwr. . . . . . . . . . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .ji. . . .by-I Si 11JU. . . . . . Ruil- g Inspector • 0 6W alo 0% s � .. _ e� 4 e 4 t v OL - SW - d F co oL n ��l t E E E 3 r 1.4 4. 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