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Home My WebLink About1000-54.-9-3 #x TORN OF SOUTHOLD e3 Rental Permit 1243 F Owner Ari & Jennifer M Paul Occupied as Single Family Dwelling Located at 485 Pine Rd Southold 54.-9-3 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. TIN XX 12/18/2024 XX ode nfo rat Official This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD—BUILDING DEPARTMENT ' Town Hall Annex 54375 Main Road.P. O. Box 1179 Southold,NY 11971-0959 Telephone(631)765-1802 Fax(631)765-9502 l t, 5.ZL c>IdLO—W, 9. RENTAL PERMIT APPLICATION Rental Permit Fee$300(Application must be renewed every t OW ago �u DEC Section A. Property Information: Rental Property Address: 485 Pine Rd,Southold NY 11971 Tax Map Number: 1000 SECTION 054 -BLOCK 09 SECTION B. OWNER INFORMATION: Property Owner Name: Ad and Jennifer M Lurie Paul Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 89 Forest Ave 89 Forest Ave New Rochelle,NY 10804 New Rochelle, NY 10804 Telephone Number (s): Daytime 91719-7250 Evening 917-3i9-7250 Emergency 917-319-7250 Property Owner Email Address: jennyluriepaul@gmail.com 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: TelepZe 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 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 x ry SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: 1 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: 485 Pine Rd Requested Maximum number of persons allowed to occupy Dwelling Uni . 10 Number of rooms in Rental Dwelling Unit: 7 Use and Dimensions of each room in Rental Dwelling Unit: Primary Bedroom 14.1'x13.6', Bedroom 14.1'x 11',Bedroom 9.7'x 10.4',Dining Room 13'x 13.6',Kitchen 12'x 13.6' Living Room 19.2'x 13.9',Den/Guest Bedroom 19.6'x 20.2' -------------- 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. ❑ 1 am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold 0 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 ML!ST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUF,FOLK) 1 Jennifer M Lurie Paul 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 i 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: Jennifer M Lurie Paul 1 Property Owner's Signature: 4 Sworn to before me this day of 20 2i 7Nota. tate JOHNSON Official No Public nature and Original Notary Stamp 5 New York g g ry p 06421540 Bronx County xpires Sep 7,2025 Page 4 of 4 qf so �gs �le, �oag gav4k� TOWN OF SOUTHOLD BUILDING DEPT. a� 631-765-1802INSPECTION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL FI L) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL RED RKIsUfl 8� tl DATE 11fibIkkY 11IMSPECoMORA; ►� l Telephone(631)765-1802 Town Hall Annex 54375 Main Road Fax(631)765 9502 P.O.Box 1179 ;N Southold, NY 11971-0959 ' wP 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 sell re faired for Architect or Engineer,Licensed Horne Inspector rrrtalst provide copy of vapid-current certification Rental Property SCTM Number: 1000-54-9-3 Rental Property Address: 485 Pine Rd,Southold 11971 Owner/Name: Ari and Jennifer M Paul Rental Dwelling Unit Identifier: 485 Pine Rd Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 —100 sqft., Bedroom#2—90 sqft.,etc.) Bedroom#1 -191.76 sqft,Bedroom#2155.1 sqft,Bedroom#3-100.88 sqft, Den drd'° � Z92 sqft 11w Property Description (Include all improvements indicated on survey) Orte story frame house with gffa a under, frame dock stone atio in- round uniteopool frame shed outdoor shower and asphalt driveway. 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 F061 New York State,the Fire Code of New York State,the Property Mainten C +e of N or t a µ. and the Energy C�tservation Construction Code of New Yor ,State. Print Name and Title Original Signature Please place Professional Seal: r NF TOWN OF SOUTHOLD PROPERTY RECOR D R �' � }L�Se—+n, t`I ,N� , STREET VILLAGE DISTRICT 1 SUB. LOT M L 7, -F0 OWNER N E ACREAGE ln/Aa S W 1 TYPEOF BUILDING '! RES. 6 SEAS. VL. FARM Est,Comm. IND. CB. misc. Mkt. Value p" LAND IMP. TOTAL DATE REMARKS 47 477 Z 60 � 0 '7z5)� C�) b AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FRONTAGE ON WATER Form ri I Acre Value Per Acre Value FRONTAGE ON ROAD 0 0 Tillable 1 —aWj4HEA-D Tillable 2 u DOCK I 2-0 32 Tillable 3 Woodland Swampland IJ Brushland�r House Plot Total s s � � 77 - I Of �a i t _ k ,. _ 2 m� f_ V 54:9-3 1/22/2021 j { M. Bldg. �� ' Foundation �=bath"` i t , Extension �rj .l asement � �� Floors rfo Extension Ext. Walls t��' �� i � _ � t Interior Finish Extension Fire Place Heat Porch -Roof Type =f �tG � �} Porch Rooms st Flo or oor BTe=eW C"A Patio Rooms 2nd Floor Garage � `� �� ' Driveway � -Dormer e _ «7. FORM NO 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT :OWN CLERWS OFFICE SOUTHOLD. N. Y. CERTIFICATE OF OCCUPANCY No. .. .,1029....— Date .... ...... ............ 11.1Y................1 19.4)), THIS CERTIFIES that the building located at Piffie.A..H.l.OkW?Y. ROa4ja........... Street Map No. .............. Block No. ........................i,ot I�Io. .. t "Ri �.. s �............... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..............7-$mb�.....�.. -.,, 19 bC3 pursuant to which Building Permit No. 3127.7...... dated ............ .... ga ...._5...... 190.., 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 .....PEA. iRto...om.Xaxil,y. AWMlUmg....................... ..... .................................................. This certificate is issued to 401M.A c—Enar.... .............0MOT................................ .... ... ..,. (owner, lessee or tenant) of the aforesaid building. Building Inspector FORM NO. 2 TOWN OF SOUTHOLD B U I LDi NG-DEIPARTMENT TOWN CLERWS.OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK"AUTHORIZED) N? 1277 Z DeeeMbOX.....5.......... 19...60 Date .............o.... Permission is hereby granted to: Or:Lginal..$vaffOlk..Rid lderS..A/C.....Zohn..Rller ......rkadwol aa...................................... .......... .......»......................................... ...............................__.................................. .,,.,....,.. at premises located at ..,...PJLne.,&..H:Lokor-y..Soads...................................................................... ....................................Nest1and).....;,,0 dy.....1L.Y.. .............,,.....................,............ pursuant to application dated .........................DIS.Ce er.....5...........19...60, and approved by the Building Inspector Fee $..10.#.00......... Building Inspector* FORK M06 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWNCLERWS OFFICE SOUTHOLD, N. Y. Examined ....Ae6gz(' Application No. ..... ........... Approved .... tz 19,6,! ..Permit No. ....... Disapproved a/c ------------- ....................... .............. ...... "I. X-1-1-.1......... (Building Inspector) APPLICATION FOR BUILDING PERMIT /IN Date..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on promises, relationship to adjoining premises or public streets or areas,and giving a detailed description of layout of property must be drown on the diagram which is port of this location, c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises ovoiloble for inspection throughout the progress of the work. e. No building shall be occupied or used In whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the,Town of Southold,Suffolk County, New York, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws,ordinances and regulations. (Si crlhure of apErll or no if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......(2, ............... .................. .......... Name of owner of premises- ..................... ............................. If applicant is a corporate, signature of duly authorized officer. .......... --,�Name and title of corporate officer) 4> 1. Location of land On which proposed work will be done. Map No: 4,!V.R ...... Lot No:AA.......... 'e�w. Street and Number ../vAts?, W/S.. .......... ......... Municipality (7 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ... ................. ........'--- ............ ......... b. Intended use and occupancy ........ ....... a- 3. Nature of work (check which applicable): New Building...X ......Addition....................Alteration..............,,,.,, Repair ---,. !. Removal .................... Demolition............... .... Other Work (Describe) ..... J:.4. Estimated Cost .t. aP........................................Fee-1Q..� this o..» ��(to be paid am filing ppli cation) M� 5. If dwelling, number of dwelling units.....0-7."` - ......Number of dwelling units on each floor.................. ..»»,.......,., Ifgarage, number of cars..........:' 1°1... .Q.C.-��.:....................................................».......................................... 6. If Etusiness, commercial or mixed occupancy, specify nature and extent of each type of use................. %. Dimensions of existing structures, if any: Front............................ Rear............................Depth................................ Height ...»........................ Number of Stories .........,................................................................................................... Dimensions of same structure with alterations or additions: Front ..,....,,„........-- ......... Rear .,...,......„............... Depth ................................ Height ....,.,,........,.,.,,,, ... Number of Stories .,.,.,.,.,,.....,..,,........... 8. Dimensions of entire new construction: Front .........1".a........... Rear .........�A........... Depth .3.V/3-0........ Height............................ Number of Stories.....,...............,.,........ 9. Size of lot: Front.....La. ..la..... Rear ............0..Q...... Depth ..91A:B........... 10. Date of Purchase ........................................................NQme61of XW, ner ,,.,...... » ...........--,,,... .....µ 11. Zone or use district in which premises are situated.......A... ........................................... .. . .......... 12. Does proposed construction violate any zoning law, ordinance or regulation? .,»...............„....,. ...................... 13. Name of Owner of premises...... ...... .. ..Address ,...........,,............................ Phone NO. .,......,..... Name of Architect 9a'rr w.4r,.,(:"" Address ....................�p.. _ ....... Phone NO. ...... Name of Contractor .,. ... KN t4rz!Sn,....i.9 n.�,Phone NO.$—daZi,ess LOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from props lines. Give street and block numbers or description accor ing to deed, and show street names and indicate whethc interior or comer lot. 4 - } 3 6 ff r STATE OF N 'Y ) S. S. COUNTY OF .. .�......) ......,..being duly sworn, deposes and says that he is the applicant (Name of individual si�Ii�acotiLon) above named. He is the ......... *° .. ..,.. (Contractor, apent,'oorporate offlca�r, etc.�)Wk of said owner or owners, and is duly authorized to perform or hove performed the sold work and to make and file this application; that all statements contained In this o plication ore trice to the best of his ledge and belief; and that the,work will be performedIn the manner set forth in the application filed therewith. JUDWH t: WKEW Sworn to before me this Fr r r Pow,sm6 ar arer v"1 .. ... dayo ... -*ice„ rn iP .: sM'A""C� r dllA ;�""19 Notary Public, ..,., Count f .,» y (Signature of applicant) ' 11 Town of Southold 7/30/2020 P.O.Box 1179 C$ " 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41298 Date: 7/30/2020 THIS CERTIFIES that the building DECK Location of Property: 485 Pine Rd., Southold SCTM#: 473889 Sec/Block/Lot: 54.-9-3 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore . filed in this office dated 5/27/2020 pursuant to which Building Permit No. 44874 dated 6/16/2020 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: " gilt"dqPk additio as applied for. The certificate is issued to Hano,Gregg&Jill of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED �Z�0r" ed Sian ur d Town of Southold 6/29/2021 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42135 Date: 6/29/2021 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 485 Pine Rd, Southold SCTM#: 473889 Sec/Block/Lot: 54:9-3 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 7/15/2020 pursuant to which Building Permit No. 45016 dated 7/23/2020 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: accesso in-grognd swimming ool fenced o code as a for. The certificate is issued to Paul,Ari&Jennifer of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45016 1/5/2021 PLUMBERS CERTIFICATION DATED eSignatae Basement 485 Pine Rd �tr,Yrw , „�:,�,�a��MNM� � O•iwrtw�wawwrr�w,�.;�irrvam �;, Laundry 19,2 x 33 R =s a$ �8 DeC#c �B 24x17 § a� WSW �a 2,7 x 4@.W 4iw p „1 6� d- 141 x 13,10 cog1 C3 _ 4:A4RMMxm 14Ax4t 196x202 I I