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Home My WebLink About1000-103.-1-22 TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 1 11 + nl Town Of Socalhol°dl Telephone (631) 765-1802 Fax(631) 765-9502t :��t , otll . .4n� 'y Ye 4/0 9 27Z RENTAL PERMIT APPLICATION Rental Permit Fee$300(Application must be renewed every two years) C` w Section A. Property Information: Rental Property Address: 1480 Harbor Lane Cutchogue NY 11935 Tax Map Number: 1000 SECTION 103 -BLOCK 1.00 -LOT 022.000 - SECTION B. OWNER INFORMATION: Property Owner Name: North Fork Harbor House,LLC/ Nicole Roth Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 11-16A 45th Road Garden 8 11-16A 45th Road Garden 8 Long Island Ci , NY 11101 Long Island City,NY 11101 Telephone Number (s): Daytime 516-426-3309 Evening Emergency215-380-6060 Property Owner Email Address: northforkharborhouse@gmail.com Page 1 of 4 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, 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: Unit 1 z:1 Requested Maximum number of persons allowed to occupy Dwelling it. 16 Number of rooms in Rental Dwelling Unit: 11 Use and Dimensions of each room in Rental Dwelling Unit:Kitchen/dining(364.3 sq ft):cooking,eating Living Room (364.3 sq ft): lounging Basement Living Room (246.87 sq ft): lounging in m 1 leeping Bedroom 3 (114.17 sq ft):sleeping Bathroom 2 (56.25 sq ft):sanitation bedroom 4(196.5 sq ft):sleeping Bathroom 3 (56.8 sq ft):sanitation Office(151.92 sq ft):work/sleep 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. �m requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ I 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 Nicole Roth 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: Nicole Roth Property Owner's Signature: Sworn to before me this day of . 2025 Official Notary Public Signature and:Original Notary Stamp i HRIST1AN LEE NOTARY PUBLIC,STATE OF NEW YORK N0. 01 LE6187488 QUALIFIED IN QUEENS COUNTY MY COMMISSION EXPIRES 01 908 Page 4 of 4 TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 103- INSPECTION [ ] 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 7EN)TAL CODE VIOLATION [ ] PRE C/O [ REMARKS: Ok- ce, o ej sLe Sys 4�v - e & DATE INSPECTOR Town Hall Annex Town of Southold 54375 Main Road , d Rental Inspection Report PO Box 1179 F Southold, NY 11971-1179 a Tel: 631-765-1802 . Z'-" SCTM # Date .Z Owner A144 hv2 Ov Phone Address Q Visible Hamlet Inspector Floor level Quantities Sub 1 2 3 Smoke Detectors(not located in bedrooms) Carbon Monoxide Detectors Fire Extinguishers Exits Bedrooms 1 2 3 4 5 6 Smoke Detectors / F4= Egress - Occupant Count Building Systems Maintained&Operational Condition of Property Heating Building interior Hot water Building exterior Electrical Property clean,maintained&safe Mechanical 'Handrails&guards installed&secure Pool Safety Pool on Site Surface water alarm Date of CO issuance a 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 'STREET VILLAGE DIST;r SUB. LOT e 'd/ FORMER OWNER N E ACR fie s W TYPE OF BU 0 RES, SEAS. VL. FARM Comiv1 CB. mics. Mkt. Value LAND IMP. TOTAL DATE REMARKS r A 4 C) -2 zi cl 2 .. ....... 2 or 4- BUILDING CONDITION AGE Bf�— NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre Tillable FRONTAGE ON WATER Woociland FRONTAGE ON ROAD Meadowtond DEPTH Houp, p BULKHEAD jq Total DOCK } - - 17 t i w - TR[M K z F a -- Q g — -- - -- 103.-1-22 9/6/2024 �- - a � ., E46'nsian - e t Extension to oth Foundation Dinci errsent = _ f Fiaors cFinishLR. F Wails �� or a� � � Interi � Fire Riac ea -H � I - MAe T , _ Typ Roof e R�cros tst Floor ER, t` s � _ -� 4 Al � BRec eo i n Ra�rr, Rooms Floor O. B. e DormerDriv€woy Totol _$ - t FORM NiO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'SOWN CLERIC`S OFFICE SOUTHOLD. N. Y. CERTIFICATE OF OCCUPANCY No. ? 33 9 . . . Date . . . . .D.e.q o .,P;r . .?--.4. . . . . . . . . .. 19.013. THIS CERTIFIES that the building located at 4430 q;. .Aane, „.. .. . .. . .. .. . . . Street Map No. . . . . . . . .. . . . Block No. . . . . . . . . . . . .Lot No. CMtPhQ9A0#, .NOq .Y03*.. . .. . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . .November . . 18 q . . . . .. 19.6,7 pursuant to which Building Permit No.3716 .Z. . dated . . Kovembex ..2� . . . . . .. 19 A7,, 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 . . . . JRIOX4e .one, 4kn4y, 4VgA1Ar)q. . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . The certificate is issued to . . ?'`WWKIR . .. .» .. .. . .. . . ..... . . .. . . . . . (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ?.°,.a j961A• �tgbQxt.MX.4. » « Building; Inspector 1 i I 1A MUARE {' -r ft R41Np CC+JC 'S.21c:)�F7 4.2 z 3 — — __ 1'.EI:K'FSROF z2 ff - .R.Rf•1 - _ _ ; a_=_= ae.,.P -a fvaea_ saa__- -_.__x �aaae a <ae: e e -F�e �_ �4 a gs_'_ _._ 1 T _ JFLP7fi ICSULA Cfl APfhE.e f0EA+1 JC - 7 - _ Cf.�112 IJ6 _�7'lurll F NTLa vtp' € lik P'CALL QLd'3(G`. 6L 4:K Pq ltJparGH <tNk a r CCW,CAEt ' I i� .N 15 A ,.� 0.}CFpN I1LTAL � FAST --,R i,- =�a F 1 1 s ' t � _ �v. . Ec�EaswE c _ AS Fr Oft P.v ; �£ = GFLIUE d _ =c cs Jr __ ;2-tC fl t, WAT*1V FROV f`IOTEA IOLFJ RTOE f � AMMON 7APd12A C hlLVty It n a ,"alron of Nrs Law for anvpemnn. F�udtschok Residence BASEMENT RENOVATION PLAN AR{ I��T A_1 urkTss rip ?is am under rite dxact+en of � if cn-Ln�C -. krinsnif tsroressirimW engmeor-to otu3r Nis PLY\lOOD s'wtic ..,t. ilnZ tfa`=�' �Wafy it,2024 4 > __4 I.GU6 SPRArsiM..f '. � N N(ri RIYER R t-44N!CtSTP,t0 -- —' g N W W Flirt R AIM} 'VhLS rF 0 CEi 14 � _S _ ------- _ �. E � � IL R--�J it CLOSED — t,—... �•— --zi1€ - ,$ CFk(SPRArdQ iHFA..T!W�C.ARAr'k WALL E 4 _ } s _ i fl t` s n < s e > a+R�� f � _ e a r _ aid r s `" —R17tlf RAFTER t A t c s e I Of NYS Law wdatwn !Or an _ TAMARA L WLMLY rr is 8 _.. _. y per .. ARcnrr�cT bud6chck Residence FIRST FLOOR PLAN unss tin ra krl ]€sraier trio rfaer^e[xr of a le _ A_2 k eerssed protessronal eog~to Oder It-$ PUVOW studo Garr t t t'=V-0, February - draw"in any way 2;`r tr if,A`�ix�,.Al1A`6 e fait(� Town of Southold 9/8/2024 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45523 Date: 9/8/2024 THIS CERTIFIES that the building ADDI'T'ION/ALTERATION Location of Property: 1480 Harbor Ln,Cutchogue SCTM#: 473889 Sec/Block/Lot: 103.-1-22 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 12/28/2023 pursuant to which Building Permit No. 50363 dated 2/22/2024 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: additio and alte ins includin rant can regl dec_ fi?��. "" "t°" t.'p �s ing AtWkd e to livingsnace.to existing sine family dwellingapplied or. The certificate is issued to Budischak,John&Lisa of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF BEALTB APPROVAL ELECTRICAL CERTIFICATE NO. 50363 7/24/2024 PLUMBERS CERTIFICATION DATED 8/12/2024 Cutcho E Plumbing Heating w..w A _ err_�.d .�iatur .�.. .