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Home My WebLink About1000-86.-2-13 A WN OF SOUTHOL Rental Permit 1252 Owner: Anne Hooker , Jane Dreyer Occupied as: Single Family Dwelling Located at: 3705 Wells Rd Peconic 86.-2-13 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. Issued: 01/23/2025 9� Expiration: 01/23/2027 Code iinforcement offid This Notice must be posted by the main entrance at all times ISO Town Hall Annex Telephone(631)765-1802 — 54375 Main Road CA Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee$200 (Application must be renewed every two years) Section A. SEF Property Information: ti i,jr" Rental Property Address: Tax Map Number_ 1000 SECTION CP BLOCK 'a- LOT , SECTION B. OWNER INFORMATION: Property Owner Name: lr t40& r ,, , VLc, t'e Property Owner Legal Address: Property Owner Mailing Address: be the same as Rental Property Address)g(Cannot Vl VIE. �V.' , E .. _ SDI �.II r r e (Uek\ )U� ) I?gq A Y11-715 i Telephone Number - S Property Owner Email Address: ^i �a SCd V2 � � - C 0 MA Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: v-v- i Address of Authorized Agent no P.Q. Boxes): _ Mailing Address of Authorized Agent: '-sa" �.,. � t_.., . "7 ' p. Telephone Number(s : °1 ,I LpSS-`7 �` Email Address: Y�rvl L E- � 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): 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.Q. Boxes): Mailing Address of Managing Agent: Telephone Number(s): Email Address: Page 2 of 4 SECTION F. A 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: S i ��-' �C'am ' ! it D U�e .�. Requested Maximum number of per,ons allowed to occil—[Moiling I knit; Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: Gar. e �? # Mj" .-Ap 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 F,er`or1:.edA b•Y the Town, a certification from a NYS licensed architect, a NYS 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 ;a.rs adopted b,,the Nety York State Fire Prevention and Building Code Council. ❑ I am requesting a fire safety inspection to be performed by a Code Enforcernent OffYclal from the Town of Southold. Page 3 of 4 �3 I am submitting a completed Tovrar..ofSra„art°hold certification form from a licensed architect, a licensed profession I en ine ror a licensed home inspector who has a valid New York State"Uhif6rin F-re Prevention Building Cade Certification. SECTION H. DECLARATION: Signature must he notarized and MUST be the owner of the dwelling unit, STATE OF NEW YORK) ) COUNTY OF SUFFOLK) i k r(e- t 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: 1/1V P d Prop ertY Owner's Signature: Sworn to before me thiM day of �`i 1�°°ram , 202C) Clairel.evy Notary PutAk,State of New York Official Notary Public Signature and Original Notary Stamp No.01L88408178 Qualified in Suffolk County Commission Expires August 17,2024 Page 4 of 4 Z I pF 5o Town Hall Annex Telephone(631)765-1802 S4375 Main Road Fax (631)765-9502 P.O.Box 1179 Southold,NY 1 1 97 1-0959 ` y 4 v� BUILDING DEPARTMENT JN' � 7 TOWN OF SOUMOLD RENTAL PROPERTY CERTIFICATION Form to be completed by a NYS licensed architect, NYS licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Professional seal re wired Lor Architect or Engineer licensed Home Inspector must provide o co of a valid New York State Uni ohm l ire Preven#ion Buildin Cade Certi ication. Rental Property SCTM Number: .0 Rental Property Address: Owner/Name: Rental Dwelling Unit Identifier: Number& Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom #1 -100 sq., Bedroom #2 90 sq., 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 the unit 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. '"' Print Name and Title OF NEW), riginal Signature �V 4 Please place professional seal: f so Town Hall Annex � Telephone(631)765-1802 S4375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 401107 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION Form to be completed by a NYS licensed architect, NYS licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Professional seal required Lor Architect or Engineer, licensed Home!ns ector must provide a coicy oL a valid New York,Mate Uni orm Fire Prevention Building Fade!erti ication. Rental Property SCTM Number: , (6` � C t C � lV Rental Property Address: v1 L� � .t� �� Owner/Name: ', -1 c')r .., ' r .. Rental Dwelling Unit Identifier: -75" (<a wt ') 1 Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 -100 sq., Bedroom #2-90 sq., 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 the unit is in compliance with all of the provisions of the code of the Town of Southold,the laws rY g g Y Y, p the an sanity an housing regulations o the Count of Suffolk and b the laws adopted b t New York State Fire Prevention and Building Code Council. o 00ize1� Print Name and Title jai, riginal Signature Please place professional seal: " 100207 Ne� F, _ TOWN OF SOUTH OLD PROPERTY RD OWNS - ;STREET VILLAGE DIST. : SUB. LOT � � t r'j _ 7a �` . - _. � FARMER NE V A,,ne, �� N ACR.� f' S W ` '` TYPE OF BUILDING , :; i -7 , � o RES, SEAS. ' VL. FARM COMM. CB, MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS 40 42, L , 5-1Owl F _ t r ch LL t t Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Q Meodowkatd DEPTHVTT House Plot BULKHEAD -- r Total 1 s } _ E. OR _ • r'f}►�/ TRIM W H ► 7 t- I E I • VN { -51\1 3AI- ` 3 3jYOq a ' 86.4-13 1/30/2020 ` [ 5� G' M. Bldg. , i Edon = 3 Z 7 6 G Extension i i + Extension 3 Foundation 'Both r_ Dinette o SSAA Li Basement FloorsWA porch Ext. Wallso4,q:, Interiar'Finish Lt- 'LR Breeseway (Fire Place �.-5 g Heat `/ s DR. 5 j i oorRoaf Rooms1st Fl Garage [Type I Patio F Recreation Room i Rooms 2nd Floor !FIN. B i O. B. Dormer Driveway _ TQIGI $_ i FOXU NO f TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z6 F.. . . . Date . . . . . . . . . . . . . Dad. , 2 . . . , . . ., 19 THIS CERTIFIES that the building located at . . .WOU RW. . . . . . . . . . . . . Street Map No. AZ. . . . . . . . . Block No. —IM. . . . . .Lot No. . ss. . . ;I"oeok't;a. . . I�.Y.0. . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . .J=o. . .12-, 19.73. pursuant to which Building Permit No. .G�1�. 1i . dated . . . . . . . . . . . . .; . . 12, 19.73., was issued, anal conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Pr1Vata on, tui .�► drill .0 . . . The certificate is issued to . .pa'01 arobm . . . .Ovnorp . . . . . w . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Dae 18 1974 by R TiAU UNDERWRITERS CERTIFICATE No. 1}81 . . - • .�!t 12 197 . . . . . . . . . . . . . . HOUSE NUMBER . . . . .37PI. . . . Street . . . . X!41i ,Road . . . . . . . . . . . . . . . . . . . . . . . Building Ins4 Town of Southold 7/9/2019 P.O.Box 1179 co 53095 Main Rd Southold,New York 11971 ........... .................... CERTIFICATE OF OCCUPANCY No: 40486 Date: 7/9/2019 ................ THIS CERTIFIES that the building AS BUILT AUrERATION , Location of Property: 3705 Wells Rd,Peconic SCTM#: 473889 Sec/Block/Lot: 86.-2-13 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/20/2019 pursuant to which Building Permit No. 43801 dated 5/28/2019 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"WINDOWS IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Groben Paul &Anne Irry Trust of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL .......................... ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED ........... t ed Signature �T trees a +r e S VKc S) ,. It a � E{ t t 1.Q G t t c+ ure ea,'.Tti pIY7JRez � .I 'lira.17 t a - Ib>A mr•+3 ra��f�� a,A Y lei! .11 $ _ . °it _ t. n t. e , .f 3 'fit • ��4 EMLP.A jC. lri. .. _. - VV 6 a � h. b rch � v►� �... � y y�. � _....,_....,..�...v••__ � ..�a�._ �� " ter�_ f v-- *low A+ A jet QJIM I or -1m; mo AW-51 SO =00 IM ------ WR ME, amM wia k WAS% i n ke 06 "N "SIP L 01 vjm m MO FLOORPLAN SKETCH FIIC'Nw� Case No, City, Peconic stave NY T 11958 3V Mud e.7th Kitchen -.. Bedroom G a r 0-101,e- Bath) za cl Living Room cBedroom qO 26' 15' 19, vAAOA0l-lde e-\fe- 'ks oJ � () CL sawke-1 C- C) C Q al" Apo go"*s Ow4wd- JI, COMMwft U e-6- 300 ........... Cux So !NY'it" pewnic J A N Bath Kitchen 'AMdmom Ol 3 Living Room Bedroom 26' is, IN v-'AOAOMde 44c-'�cj-'Or -T-V\e-\f,e- 'k s c� s e� i �m c� +x e/c e� dam' c`ib v C VCj L.J m4 00