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Home My WebLink About1000-17.-3-10 TOWN OF SOUTHOLD 3 Dental Permit 1228 Owner Andrew Zarnett & Lindsay Pollock Occupied as Single Family Dwelling Located at 20615 Route 25 Orient 17-3-10 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 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 Code fore ent Offici This Notice must be posted by the main entrance at all times 3ri TOWN OF SOUTHOLD—BUILDIN G DE:PA i ME NT �c Town Hall Annex 54375 Main Road P. O. Box 1179 South �old,' 1'1.97 PO959 Telephone (631) 765-1802 Fax(631) 765-95021"tyrrvcr;tlrld1. i RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address• o V l➢ ( l Tax Map Number: 1000 SECTION.. __ BLOCK 3 -LOT I D - SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) t i� O Z Y Telephone Number (s): Daytime L t ' Evening Emergency Property Owner Email Address: I �,� Cz--) 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: Use and Dimensions of each room in Rental Dwelling Uni°:��a,��°� v LQ- r- q x1610,1 Ll� poi x t�� l� X t� �LjSt��) 13 2 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. I am requesting a fire safety inspection to be performed by a Code Enforc from the Town of Southold ement Official ❑ 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 S 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 7Lager. Property Owner's Name: p Y Property Owner's Signature: Sworn to before me th day of . 20_al� � L _1 Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.01 BU6185050 Qualified in Suffolk County Commission Expires April 14,2 �e Page 4 of 4 TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 / _ INS' PECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FIN L) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: vt je s®� w DAME -�, a 1N5► "EC' "CMR FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ....*20.......... Date .....................b.tob*11'.All"t............. 19...59 THIS CERTIFIES that the building located of 1 *..juL&.2d...(RURD:• .A.• :` aS Map No. .X=............. Block No. .....X=........Lot No. . . :.........94 '.+o—R.Oxt................... conforms substantially ..:�a ..Wic>Ir... ., 1 ......... dated ........x=1B1 M 11�....................... 19........, the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is.............. ............................ ..t ........I......,,........ .................... ................. This certificate is issued to Saver . .F...O r.•.................................. (owner, lessee or tenant) of the aforesaid building. � .....,�...... .......... Building Inspector 110WAM fito TMY -k 3A 3 UP i . vO &rJ-h - . 4-j llpint-t�A $tr 03 . N 'PIN x �