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Home My WebLink About1000-136.-1-42.1 of so TOYNN OF SOUTHOLD Rental Permit 1246 Owner: Daniel Wallace Occupied as: Single Family Dwelling Located at: 630 Oak St Cutchogue 136.-1-42.1 Maximum Permitted Occupancy: 3 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. Issued: 01/07/2025 Expiration: 01/07/2027 c de cement is This Notice must be posted by the main entrance at all times ��o o TOWN OF SOUTHOLD—BUILDI'NG DEPARTMENT , 1 o� Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, i i 97`1 0959 Telephone(631) 765-1802 Fax(631) 765-9502 h s //% ww.sc)u�il1oldtownn �"' DEC 2 7 2024 RENTAL PERMIT APPLICATION Rental Permit Fee $300(Application must be renewed every two years) Section A. Property Information: RentalmProperty Addres : `7 Tax Map Number: 1000 SECTION -BLOCK -LOT SECTION B. OWNER INFORMATION: Property Owner Name: A Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) ? d� A K 5:� C d f$l Telephone Number (s): Daytime yt Evenin V, Emergency Property Owner Email Address: 14el Og w ,v .. V01 MCI` 6 cal!./__ Page 1 of 4 Section C. Authorized Agent Information: �p Name of Authorized Agent of dwelling unit, if any: l Address of Authorized Agent(no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number (s): Daytime Evening Emergency Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: n 0 le 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: QWYlai r0k A,444$ 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: OW 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 Unit: Number of rooms in Rental Dwelling Unit: r // Use an Dimensions/of each room in Rental Dwelling Unit:Lk1 0 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. ❑ lam requesting afire safety inspection to be performed by a Code Enforcement Official from the Town of Southold i 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) l [ SIP e (ISM 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 Signature: ,r Sworn to b ore me this day of �^i � .� 0�7, f , Official Notary Public Signature and Original Notary Stamp William a Waltam Notary Public State of NawYe* Na 02WA4736498 Cluslifled in Nassau County t"0clabar 31.20 Sr Page 4 of 4 of sfd(14�� TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 /3&- /- Id-I INSPOEOCTION [ ] 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 (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [r,,]'RENTAL REMARKS: 0k— ��2 r7 ocG RATE � ~,�S� INSPECTOR LOVE OF DESIGN NMMF� IN WET CELLAR % a-q.IT4' CL-V4r LIVING ROOM CL 17-1. 9,7 WWI -EMMME-1k; fl 630 OAK ST W�_ A I CULAR <-, EAT IN KrICHEN DININ�RgPM CUTCHOUGE 91-e.IZF , , m 11 NY 11935 NMI IN- ME 0 0 0 MIN BEDROOM IIIMRO CL 48'S CL.9-6, 110- -------------------- MIN -T�r CELLAR FLOOR PLAN FIRST FLOOR PLAN 5CALE:A'zl'W SCALE:Y,*-l'T EXISTING FLOOR PLANS Al QUO n Town Hall Annex Telephone Telephone(631)765-1802 54375 Main Road a„, Fax(631)765-9502 P.O.Box 1179 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 Professional seal required for Architect or Engineer. Licensed Home Inspector must provide C22M of valid current certification Rental Property SCTM Number: 1000-136-1-42.1 Rental Property Address: 630 OAK STREET,CUTCHOGUE NY 11726 Owner/Name: DANIEL F.WALLACE 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.) BEDROOM#1 -95 SQFT BEDROOM#2-95 SQFT Property Description(Include all improvements indicated on survey) 1 STORY WOOD FRAME FAMILY DWELLING WITH 2 BEDROOMS, 1 BATHROOM AND 2 EXITS IMPROVEMENTS:CONCRETE BULKHEAD,WOOD WALK(DOCK),WOOD DECK 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 te. GINA NICOLE MUZIO,RA ! Print Name and Title Original Signature RD0 Please place Professional Seal: t3\COi * ' i w 04 91 �. -7 _ E TOWN F BOUTHOLD PROPERTY %.#kIt OWNE STRI=ET _ VILLAGE DISTRICT SUB. LOT ' — I � ic/ FORMER OWNE N E ' ACREAGE \Aj r 0h S W TYPE OF BUILDING RES.,) J� ' SEAS. VL. FARM COMM. IND. CB. MISC. : st, Mkt. Value LAND IMP, TOTAL DATE F Z �; as 13a Ineo g F f� 7 Y - t AGE BUILDING CONDITIONa - - -- _ - F . NEW ; NORMAL BELOW ABOVE FRONTAGE ON WATER .,,. Form Acre Value Per Acre Value FRONTAGE ON ROAD A Tillable 1 BULKHEAD Tillable 2 , DOCK Tillable 3 Woodland - I ' y Swam land - Brushland "I R House Plot I I Total 1 - 3 3 t gPIT - -- -- _ 3 � r \ m g 4 . f A Bldg. K Z (F = o ! v Foundation e-g Bath j Extension Basement 'I Floors `''` -- - Extension Ext. Walls ,� ��f Interior Finish �� '%• Extension Fire Place f �' ;Heat Ile tea° Porch 'Roof Type a •� � 3 Q o Porch ? Rooms 1 st Floor Breezeway Patio ;Rooms 2nd Floor Garage Driveway Dormer O. B. ou �iAWiG dCwB�Y A;N .w o A14es'Yrm1�C' fiikws Ott1v� egp 'k4#.bMw AtligilL..WN! ,iC'.psy�Y�Ot Torn Ssli soot holdr N-Y. PAS 876ISTZNG CBR=72Ch= OF OCCUPANCY Nos Z- Dates 12/24/98 THIS CgRTIFILB that the building D IlYa1 LOCU&tion of property 630 OAK ST FS OGUE (RODSX no.) (S'TRE'ZT) ( &T) county Tax Map No. 47 889 section 126 Dlcctc, 2001 Lot 24 2.001 Subdivision Filed Map No. Lot NO. conforms substantially to the Requirements for a F ;! D I; built prior to "_rL 9 1957., pursuant to which CERTIPICATA OF 006trPANCY NUMUR Z-� 2§102 dated DECRMBER 24 199 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which thin certificate is issued ie fA1ill"1.,1i LLINQt.+► The certificate is issued to azmztm a. WEAMTX Nf of the aforesaid building. {OWNER} 07FOLK COUNTY DXPARTMXRT OF RRALTH APPROVAL N/A ELECTRICAL CERTIPICATE NO. N/A 'pSMibtliERS CERTIFICATION DATED NIA *PLRASH BEE ATTACEMD INSPROTION REPORT. d ,9 I'napacrts r Rev. 1/81 t _..we....,._.._.............._........... ....., Sc:arvied wWi 8 iir ainunuew" LOCATIONS . .. . gQEDIVISIONt )OsP RO.s LOP (8) Atlm Cr CWM 181� OOLY)DA3CY s ... AMOTM By, $Yt nsnr EEL AVAZIMLBs CC). TAX NU MO.s tta..t.r s• sou=.GP REGCESTs DATA• 12/24129 TYPE or CMMMUMM, '. ST 2m g i.6 ELMS � TOTAL Roams 1ST PLR.s 1 2ND PLR.s _.R 7RD PLR. .P O*(d)s _j-& TOILRT'R0RM(8)s e.n QPILITYRIOMMs PORCE TYPEt , DECK TYPAs PATIO TYPA•r ,. IM=%ZMTs FMPLACEs OARA68s. 110MMU IC ROTMCAT Rs 3LI TYPE IMTRAs ELVenTC AMRco tDITIOlEmat TM HMO nrr, MAM AIRS x.. ROMTARs ml1iA=. TYPE OP CONST.s 81CRACEr TYPE C6M-1 . din2immm POOLS CHESTS TYPE CCU?-s VIOLA , CHAYM IS W.T. STATE VI nWH nU PArMWOU 4 RDILDIM CODE t p � t ) t G I t 't w ) t 1 1 t t t t RLIARiI i A ft 1EYptcrov BY. DATA ON IEAPAC IAM, 11(12142 GARY J. 1 TII03 S7'AA1'+ tt.ts: Am XMi t1 AS Scanned with VCamscannerl TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Not 2- 6187 Date= 12 4 98 THIS CERTIFIES that the building 7 •1ESATION- Location of Propertyt a30 OAR STREET CUTCRoaux (HOUSE ', (STREET) (R 'E'T) County Tax Map No. 473889 section 136_ Block 1 Lot 42.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this of floe dated SSP.T1gaM 2 L 1988 pursuant to which Building PeM t No. ,1.`7'+2C- dated SEPTEMBER,,14 1988 wan ieaued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate i-s issued is CFlI Ey ADD'I°TIO14. TO AN EXISTING ONE F LY D INo A8 APPLIED FOB. The certificate is issued to HBLENE s, NMITZRI hTERJ Of the aforesaid building. SDFFOLK CODNTY DEPARTMI3NT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. - N/A -- -� PLUMBERS CBRTIBICATION DATED N/A a Su chi» Inspector Rev. 1/81 Sci nine wi9ts rnsc ana°n r"' o- n TOWW OF soOTHOLD BUILDING DEPARTMEM Office of the Building Inspector Town Nall Southold, N.Y. CERTIFICATE OF 00MANCT Not t-I. Date: lY 24/ S THIS CERT=FINS that the mUding J�1D3iI7[ICAI� �"� Location of property: 630 OAN S ET CUTCHOG (HOUSE (STREET) (R T) Ca=4-y Tax Rap No. 47..73889 Section 136 Blook L Lot 4 Subdivision Filed Map No, Lot No. conforms substantially to the AppLioation for Building Permit heretofore filed in this office dated pursuant to which funding Permit No. 1 dated J UL " 13 1909, was ieeued, and ccnfosme to all of the tequixemente of the applicable provisious of the law. The occupewcy fox which this Certificate is issued Is "V IN "1HFCA• '1099 AND DECK ADDITION' TO AN E INTIN�1 ONE FAMILY D I NKi D Ap& I D FOR. The certificate is issued to �WWON 1 of the aforesaid building. SUFFOLR COUNTY DEPARTMENT-OF HEALTH APB N/h BLECTRICAL CERTIFICATE NO. N- pLUMERS CERTIFICATION DATED N/A U din nape: tor Rev. 1/B1 Scanned....,.,•.,.... with scann r':