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HomeMy WebLinkAbout1000-62.-1-18 a TOWN OF SOUTHOLD Rental Permit 1242 Owner 275 Boisseau Ave LLC Occupied as Single Family Dwelling Located at 275 Boisseau Ave Southold 62.4-18 Maximum Permitted Occupancy 4 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. 12/17/2024 , of me- t Official IL- This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD—BUILDING DEPARTMENT 'a 2 el Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631)765-1802 Fax (631) 765-9502 htl ://-www,soLitholdtowiinv,Lyov RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Propert Ad ress: Tax Map Number: 1000 SECTION -4-f 13 0b4 -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) 7� � JU Telephone Number(s): Daytime X Evening x Emergency Property Owner Email Address: O 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: Telephone Number(s): Daytime Evening; Emergency Email Address: u 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: w Telephone Number(s): Daytime Evening Emergency Email Address: CA) Page 2 of 4 " SECTION F. PROPERTY DESCRIPTION: � Number of Rental Dwelling Units onproperty: ' 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 ofrooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: SECTION G. INSPECTION: Pursuant to the Town Code of the Town of Southold Chapter 207 (Rental Properties), a safety inspection by Code Enforcement Official |srequired. |f the owner chooses not to have said inspection performed by the Town, a certification from a licensed architect, alicensed 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 bV the laws adopted by the New York State Fire Prevention and Building Code Counci| | anmreque«tingafiresafetyinopectimntobeperformnedbymCmdeEnforcmnmentOfOcia| � ^ from the Town of Southold 0 | ann submitting a completed Town mf Southold certification form from a licensed architect ora licensed professional engineer. Page 3of4 SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFOLK) i vV7 4CA 4WD 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: �- �/" ;A/ Property Owner's Signature: .. Sworn t before me his day� - 20d --C fficial o ary Public ignature and Original Notary Stamp A LAMB olery Public,Stata of New York *01 LA6179883 Oualifted in SulfOIX 0ount, " Term Expires D Page 4 of 4 fat Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O. Box 1179 aLw Southold, NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use d Dimenio of each room; p Z ! 2m " `X l M Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: cFk Town Hall Annex one(631)765-1802 Telephone 54375 Main Road (631) P.O. Box 1179 Fax 765-9502 Southold, NY 11971-0959 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 f* fessi III a ch`ert car Izn ineer Licensed Home I s e tr must n e tI Rental Property SCTM Number: Rental Property Address: t, Owner/Name: Rental Dwelling Unit Identifier: Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 —100 sgft., Bedroom#2—90 sgft., etc.) Property Description (Include all improvements indicated on survey) I 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: 91 - 5 v TOWN OF SOUTHOLD BUILDING DEPT. * � 631-765-1802 INSPECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND ( ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] AL [. ] FIREPLACE & CHIMNEY ( FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI L [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS:r*%. to. DATE 1 NSPE TOR _ TOWN OF SOUTHOLD PROPERTY RE L✓ STREET I VILLAGE SUB. LOT c ^ . - FORMER OWNER , N E ACR, W^ TYPE OF BUILDING RES. SEAS. VL. FARM . COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE € REMARKS E £ - � I a I € i 7 AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Ac re Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD s Meadowland DEPTH i F House Plot BULKHEAD Total DOCK /000 C,� - - DLOR TRIM „F _ t I a E F { I I! } I - _ f € s f 3 62:1-18 2/10 - M. Bldg. - f E Extension � - -77 t , € i E Extension /© x 2 z = I I C Extension 1 Foundation Bath f =Dinette Porch i � 7 1� I tO = r t _ Basement ;Floors K.: Porch Ext. Walls Interior Finish M Fire Place U� 5 Heat J DR Garage :Type Roof i Rooms 1st Floor BR r E tli Patio Recreation Room Rooms 2nd Floor FIN B 0. B. Dormer Driveway Total � o77 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No 8-25380 Date NOVEMBER 24 1997 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 275 BOISSEAU AVENUE SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 62 Block 1 Lot 18 Subdivision Filed Map No. Lot No. conforms substantially to the Requirements for a One Family Dwelling built Prior to: APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z-25380 dated NOVEM ER 24 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 ONE FAMILY NOW-HABITAMA DWELLING & ACCESSORY BUILDING The certificate is issued to MAUREEN NORA TURNER (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. ,r B iding Inspector Rev. 1/81 mr[LDINr. DEPnui;D;r+T TOWN OF SOU771OLD IrOUSING CODE INSPECTION REPORT LOCATION: 72 _. _............ ...._,........ .,.�........».. (. (mutiLe a paI t.ty SUBDIVISION No. LOT (::) NAME OF OWNER (s) OCCUPANCY type (ta �uata4) ADMITTED ACCOM['ANIED RY: KEY AVAILABLE SUPF. CO. TAX MAP NO_ �. . SOURc, OF REQUEST: M_q_4 -........--.�.... �.......e. .:._........._ DA"I'R; �.................,......... �������,�. DWELLING: NG: TYPE OF CONSTRUCTION ION �.. 0 STORIES d7!Q� EXITS _ o� FOUNDATION CELLAR �'�/�j CRAWL SPACE TOTAL ROOMS: I ST PLR. 2ND FLR. JRD PLR... __m. BATl1RO0M (s) TOILET ROOPI (s) `' UTILITY RoOM PORCII TYPE� Q DECK, TYPEPATIO, TYPE _.._,.._.........._..� BREEZCWAY FIREPLACE GARAGE DOMESTIC HOTWATCR TYPE 1[EATER v., _ ATRCONDITIONING TYPE 11 AT --- -� OTHER: � �_ WARM AIR BOT14ATER ACCESSORi STRUCTURES': GARAGE, TYPE OF CONST._ Y • _ STORAGE, TYPE. CONST. SHL`L'fINC POOL_ q M GUEST,,TYPE CONST. OTHER: ` VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM -FIRE PREVENTION & BUILDING CODE LOG1PIOr[ DCSCRIPTIOrI �' �"""�""�"""""""'"`" """" _ SEC. w .. .........,w;;,,s,: ...»..u�,..„ ......�... ..............,.,............ ._ __ .. _. 1 REMARKS: .. , . .. IIrSI'ECTED BY: DA'1'1; ON INSI'I-_CTION /} TIlfE START a:�0 .... IF;II) .rl= Idl Town of Southold 5/5/2019 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40360 Date: 5/5/2019 THIS CERTIFIES that the building ADDITION/ALTER.ATION Location of Property: 275 Boisseau Avenue, Southold SCTM#: 473889 Sec/Block/Lot: 62.4-18 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/15/1998 pursuant to which Building Permit No. 35027 dated 9/25/2009 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: front stoon. central air conditioning.heating-systeTq,4j d Iteration to an existing.p4e f mt d rellin as a lied for. The certificate is issued to P&G Holding Corp. of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 35027 4/17/19 PLUMBERS CERTIFICATION DATED 5/3/2019 S eha robing Heat. FORM NO. 4 i TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy . . . . Date , . . . . . . . . . Al, ftary . . 9. . . ., 19 76 . THIS CERTIFIES that the building located at VAS.SAIN O 44.4 . . . . . . . . . Street Map No. .X . . . . . . . Block No. x=. . . . . .Lot No. XX3M. • Soulkold. . N.Y.. . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . . . . Its► . .24., 19.74. pursuant to which Building Permit No. 2 . dated . . . . . . . .Xa. . . 27. . . . .. 19.74., 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 .Private►. .C40. ftally. A voUing.xith.mAdition.do sit.. . . . . . . . . . . . . . The certificate is issued to . AAry .$t*pUVA . . . . . or. . . . . . . . . . . . . . . . „ . . . . , , . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval I*R.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE No. A.!0'55 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSE NUMBER . . . 27$. . . . . . . Street . .&Ass**; •Av* • • . . . . . . . . . . . , . . . . . . Building Inspector s k� 3 S� 4 � s U � Srn X elf