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HomeMy WebLinkAbout1000-70.-7-8 g gp TOWN OF SOUTHOLD Rental Permit 1249 Owner Vera E. Smith Occupied as Single Family Dwelling Located at 49000 Route 25 Southold 70.-7-8 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. 1/13/2025 o fo c rr�er�t bfffigal This Notice must be posted by the main entrance at all times cry b A;aL 3op� TOWN +I F sou'fit i tol.D _ �3U LDIIN ' DEPARTMENT ire C, �09 p 3Lf I'r F ex 54375 lain o 11. U Box 1179 'O thold,NY 11971-0959 G�l� l� l4l�i ( il.) 7C5-131uax� (C1') 7 '-9C► t /� � o �mim1n . )cw RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: s6 l q Tax Map Number: 1000 SECTION -BLOCK 7 _ - -LOT SECTION B. OWNER INFORMATION: Property Owner Name. !� 25�61�,O S01 Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 3Q, ,6 12211,21 Telephone Number (s): Daytime Evening Emergency Property Owner Email Address: 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: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit if any: Address of Authorized Agent (no P.O. B es): Mailing Address of Authorized Agent: Telephone Number (s): Daytime Evening Emergency Email Address: SECTION E. SITE MANAGER INF RMATION: (required for rental properties containing 8 or more rental units) Name of Managing gent of dwelling unit, if any: Address of Man Bing Agent (no P.O. Boxes): Mailing A dress of Managing Agent: Tele one Number (s): Daytime Evening Emergency E ail Address: Page 2 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 Unit: 12 t J 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 ❑ 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 9 ,r 41t c201 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: � Sworn to before me this day of com, °(� , 20�7 Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.01BU6185050 Qualified in Suffolk County Co mmIs lon Expires April 14, _P Page 4 of 4 � OF soPrX,y�,� TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 �o- 74" INSPECTION [ ] 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 [�ENTAL REMARKS: (f ie han AAoh JaL -Au� �ko L"'l DATE ANSPECTOR " � Town Hall Annex Town Of Southold 54375 Main Road k Rental Inspection Report PO Box 1179 b, Southold, NY 11971-1179 Tel: 631-765-1802 SCTM # ( — Date o� Owner Phone Address U14 Alk Visible Hamlet U lnspector Floor Level Quantities Sub 1 2 3 Smoke Detectors(not located in bedrooms) C Carbon Monoxide Detectors Fire Extinguishers Exits Bedrooms 1 2 3 4 1 5 6 Smoke Detectors Egress Occupant Count a Building Systems Maintained&Operational Condition of Property Heating Building interior Hot water Building exterior Electrical Property clean, maintained&safe Mechanical Hantlrails&guards installed&secure Pool Safety Pool on Site Surface water alarm Date of CO issuance Door alarms ; Pool completely enclosed Self closing/latching gates Pool fence to code requirements CO's for all items present Prior Rental Comments: TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER 1STREET VILLAGE DIST_ SUB. LOT FORMER OWNER- I N E� [ ACRel 66 1 S W ., TYPE OF BUILDING RES. ?f SEAS. VL. FARM COMM. CB. MICS. Mkt. Value i LAND IMP. ! TOTAL i DATE REMARKS t I � t z l : I I Y - � l E : I AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per j Vo_lue Acre I Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD S I Meadowland DEPTH House Plot BULKHEAD DOCK Total `�' l COLOR TRIM a � i 2 � 3 i° If I E i ! i ° E E s E _ t i M. Bldg yv X, g = -5,p o "d 6 I 00 Extension E ° E , Extension _ 1 E E E Extension ;Foundation I (y 13 Bath Dinette Porch 113asement �v G L Floors _r I K. Porch _ iExt. Walls Interior Finish LA, LR.w,- Breezeway i tFire Place Heat I , L DR. Garage I T �,3 _ / !Type Roof Rooms 1st Floor BR. Patio Recreation Room Rooms 2nd Floor FI N. B O. B. - _ 'Dormer Driveway I Total i i�-317 , FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No Z-22453 Date DULY 12l 1993 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 49000 MAIN ROAD SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 70 Block 7 Lot 8 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-22453 dated JULY 12 1993 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 DWELLING WITH ACCESSORY GARAGE The certificate is issued to HENRY J. SMITH & WIFE (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. Bu ding Inspector Rev. '81 P 1 J F- J p o- 5 A-11