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Home My WebLink About1000-22.-1-15 TOWN OF SOUTHOLD Rental Permit g ; 1230 Owner Jennifer Proulx & Jordan Silbert Occupied as Single Family Dwelling Located at 840 Southern Blvd East Marion 22.4-15 Maximum Permitted Occupancy 12 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 Co En nt Official This Notice must be posted by the main entrance at all times Ott SYiy TOWN OF SOUTHOLD—BUILDING DEPARTMENT �U w � tw a11 Annex 54375 Main 'loadP. O. 1� ox 1179 Southold,'�N" 1 - 5'Annex Telephone ( 1.) 765-1 02 Fax ( 31) 765-9502 0 C RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: t �� 3q RLin • ��.� i o 1 Tax Map Number: 1000 SECTION -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) � y_ etu6 4 �. dd2� �( � 2gColCa Telephone Number (s): Daytimes Evening Emergency Property Owner Email Address: Mai Page 1 of 4 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: -77 Telephone Number (s): Daytime "'—Evening Emergency 7 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 Age . Telephone Number (s): Da 'me 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 Un 2t: Number of rooms in Rental Dwellin nit: �� ; Use and Dimensions of each,r�m in Rental Dwelling Unit: o A 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. Vo"I am requesting a fire 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 . ��. „ r ��.,. 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: 1 4 Property Owner's Signature: Sworn to before me his day of �jn , 204—' JAIME FUEST Official Nota blic Signature and Original Notary Stamp NotaryPu.01F 0016ate fNewYork rY g g� Y p No.01 F00016755 Qualified in New York County My Commission Expires 11/21/2027 Page 4 of 4 TOWN OF SOUTHOL.Dt BUILDING DEFT. INSPECTION [ ] FOUNDATION 1 ST/ REBAR [ j ROUGH PLBG. [ ] FOUNDATION 2ND [ j INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] F AL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ j ELECTRICAL (FI L) [ ] CODE VIOLATION [ j PRE C/O [ RENTAL REMARKS: 1 ° DATE INSPECTOR :TOR)q)� .�77 TOWN OF SOUTHOLD PROPERTY RE CON 4 �STREET VILLAGE Dl ]. SUB. LOT FORMER OWNER N s E ACR. is E W TYPE OF BUILDING RES. VL.' FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS J; 5 7/ 10'"Dri --A 0 7 Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowkpmd DEPTH BULKHEAD House Plot J-1 iTotal I _OR TRIM Ak € 3 i , f 3 _ i _ s € el s { 14 r 22.4-1s 09/05/2011 - 4 tA E i y - t Extension z C On i € ray, GP , Extension Foundation !Beth Dinette , Porch . a Basement � Floors ;K. v _er I xt'. lAVsalls t -� ;Interior Finish �._. LR. r, DR. Breezeway w Fire Place ;meat �� R rs Ist Fly Rs Type Roof Patio ' ; t Recrection "RooM F Rooms end 1 Flip. O. B. Dormer :Driveway Total . n "1 0 F s { \ j ; a r � Fbt,f Town of Southold 12/5/2017 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CE TIFICATE OF OCCUPANCY No: 39377 Date: 12/5/2017 µM� THIS CERTIFIES that the building SINGLE FAMILY DWELLING......_..... ...w. ._...... .. . ............... ... .._.._..�w Location of Property: 840 Southern Blvd,East Marion SCTM#: 473889 Sec/Block/Lot: 22.-1-15 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/30/2016 pursuant to which Building Permit No. 41150 dated 11/9/2016 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 11WI LLl 1 a_)K TI1 ?Q0D O" '"1"l Galt R SH0' Q2NQR1j-L '1 CANT El'r1 Y A'l I `1�111 1 C' PORT AND UNFINISHED BAST m__. w " 1,I1 D FOR The certificate is issued to Schuman,Gary&Cori of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-16-0067 11-14-2017 ELECTRICAL CERT ICATE NO. ) 41150 � � �u 08-16-2017 PLUMBERS CURTW41CATION DATED / 06-08-2017 Brad Piecuch A l orized. Signature Town of Southold 12/5/2017 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39378 7 Date: 12/5 201..............m........... THIS CERTIFIES that the building IN GROUND POOL Location of Property: 840 Southern Blvd., Marion _ W ............. SCTM#: 473889 Sec/Block/Lot: 22.4-15 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/8/2017 pursuant to which Building Permit No. 41435 dated 3/17/2017 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: AQ '1iSS01 IN-GRO S 4 l ll T( 1?()4 T, F COI ,_AS APPLIEQ FOR. The certificate is issued to Schuman,Gary of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 41436 08-16-2017 PLUMBERS CERTIFICATION DATED Signature QtEttt Town of Southold 10/20/2022 P.O.Box 1179 53095 Main Rd Southold,New York 11971 ...... ...... CERTIFICATE OF OCCUPANCY No: 43509 Date: 10/20/2022 ................... ..........----.............. THIS CERTIFIES that the building AS BUILT ALTERATION Location of Property: 840 Southern Blvd.,East Marion .......... ....... ........... SCTM#: 473889 Sec/Block/Lot: 22.-1-15 .............................. ....... Subdivision: Filed Map No, Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/28/2021 pursuant to which Building Permit No. 45788 dated 2/5/2021 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: "as built,"'alterations'Cor finished hasr nont to ea istin sin ale fhanil d velliaagA%.4pp-Liqd fi2j:.. The certificate is issued to Proulx,Jennifer&Sibert,Jordan .......... ............ ......... of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF]HEALTH APPROVAL ................ ELECTRICAL CERTIFICATE NO. 45788 7/13/202 r\ .......... PLUMBERS CERTIFICATION DATED 10/19/2022 J c 'ismond tat ori- 'ignature W W 9 Z NEW. !ELEGRCAL LEGEND DWELLING i Q'? QUPUR RECEP[A."r'UR? ® SNORE DETECTOR i UNDER TREELICJI i1V SEE%RECE TAM 040 ® CO DIRECTOR Ov WAIER PW RECEFUM DITLET L IDEMN'E GM,)FAUIT IN;ERAiIPICR WILET[III TREASON ME DRIVEWAY _ 41RFACE NIX:NT:e CEiUNG FIXIEAE aB1R5 Fkh 1 SURFACE OUTTED V"�'�PXItLA= 10CR R.CEP(A�E WIIEi SWITCH eaawT a WHIN GRAVED DWI SWITCH LID SERF UGHTS H41 HAT FA'RfiiE ;r EXLw LICHT S-6:I4 34 Sly_ ,.� RESIDENCE --_ J BLUE STONE • C CONi HEADER 124x1 Its PSL _ FAST MARION, NY SORT fi �1 840 SQUNERN BLVD. i 1 SMOOTH EVENT aw ! N3 I Tx. ; FRONT PORCH BAD W.LCLOS7L ARCHITECT BLUE STX I ``' 9 •' � g FRANK JEIJ.EIM 1 _ 123 CEVRAL ATINUE PALTRY':, FOYER,- nc 2iP.O.BOK 316 Lug - J GREENPORT,NY 11944, BR 3 n I N 12)2x4 POSTA TEL 631-+1?8624 IMP ' 26 . 7 a PSL yEwGR OWNERS 2 GAR IBILCG - �.' y hN�,� fl � � CODE SCHUhtAN DOOR 267A STATE STREET `l� S TEL 2O2-7f4-BXh3 KDT ® DO 13 IT BR 2 c I ,,. t -�- r 41 OF !k Jg 'mot rOS < =� d, iers� I"t7 2XIL CJ 0 18`U. _) `_ i 6 1 R a wrH BRIDGING ent A01" rrt8" # a itI' + GJT' R �' W Hcf)E ,2,2N8,;P. SHEER a ER r cEe IJ l5"x14 4 r T 5°O.C. C I_ kl "a' += N BRI.vE�WG 1=n �s I 1` a- e=msrT` n 5'sIff _ ) r, , nK ,pr1 [ LR ® SF I, o I I CLG.HUT.:'4'-C I WOOD DECK (IFF) ® x� r` cot 676 SF AWNINGS ATO(l C o: ;. x14 PK RARAUM° 3 CCNL HEADER: TRT'0'.7-x1 7t6 1 I FLYING BsN r - HEADER 526' 1 E[ 3 I — — — — WOOD DECK(IPE) s 99 SF � s` '� �� ,Y-e` ,.6• #__'lt :,�_g %'-,T ,e._� �A�Sri w126120=6 Gj N-CROP O POOL FLOOR PLAN' 20 A X,=G' DEPTH 3 5 TO fi ELECTRIC GOUER 2,52R SF `C oa NAME BLUE STONE SEPARATE PERMIT APPLICATION) BLUE STONE I 1 PP,TiO _ - -= PATIO LJOR-PLAN A-4 s - ; scA 1(a" a" 9RG NO - - --- - T�, ."+OGv'JTENT BEFORE NOTES: - ---- 1. HVAC Use existing system and provide outlet and return duct work to each area.HVAC contractor to finalize locations. C - 2. ELECTRICAL-Use existing service and provide new branch circuits for basement.Provide switch 'a=»,=.rA. =r==UKr„.•. ,o -_ --- controlled overhead lighting and ceiling fans in each area.Provide outlets in each area spaced per code. PEPim[ieR WALLS[CnOn 3. BATHROOM VENTILATION-Provide switch control direct mechanical ventilation to exterior. N.J.MAZZAFE�P.E.4. FIRE,SMOKE,and CO ALARMS-Provide devices in each area per code. , _. ..._.... . - PROFEssaoNAP O.90X 5r GRKN iN Ul wau sEcnou .rxE�fl�mo FINAL BASEMENT PLAN sRscr Noo. _ 84050LTHRN BLVO 4 9T MAR V 31939