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Home My WebLink About1000-68.-4-4 TOWN OF SOUTHOL Rental Permit 1267 Owner: Eugene Hull Occupied as: Single Family Dwelling Located at: 3630 Soundview Ave Peconic 68.4-4 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. Issued: 03/05/2025 ` Expiration: 03/05/2027 iro ;dai This Notice must be posted by the main entra a at al s TOWN OF SOUTHOLD—BUILDING DEP, ,WI'*` �1 a .. Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, ' '119�E9� � Telephone (631) 765-1802 Fax(631) 765-9502 hj!p5 /°www saat�holcltowm� RENTAL PERMIT APPLICATION ( S—co Rental Permit Fee $300 (Application mast be renewed every two years) t CA Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION -BLOCK -LOT - SECTION B. OWNER INFORMATION: Property Owner Name: + . Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 0 . � "". .) Telephone Number (s): Dayti e o5P-Ac't Tgen`in-5— g 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 dwellin nit, if any: Address of Authorized Agent (no P Boxes): Mailing Address of Authorized gent: 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 dwel fng unit, if any: Address of Managing Agent ( o P.O. Boxes): Mailing Address of Man Bing Agent:. Telephone Number (s): Daytime Evening Emergency Email 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 Uni Number of rooms in Rental Dwelling Unit: '" Use and Dimensions of each room in Rental Dwelling Unit: Qr V1,V, 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. � I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ lam submitting a completed Town of Southold certification form from a licensed architect or a licensed professional engineer. Page 3of4 SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFOLK) I -� 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: _ S, 4 Property Owner's Signature: Savor to before me this L J day of e' "V 2015--' ANGEL A HERNANDEZ Notary Public-State of New York Offi " l Notary Public Si nature Original Notary Stamp No.01HE0018288 Qualified in Suffolk County My Commission Expires Dec.09,2027 Page 4 of 4 OWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 INSPECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ZINLATION/CAULKING FRAMING /STRAPPING [ L FIREPLACE & CHIMNEY [ SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F AL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL O 1�OKS: [ DATE INSPECTOR l OWNER IF — ' , ,� — STREET VILLAGE 1 DISTJ SUB. LOT FORMER OWNER 1 , �� a �1 �•, N,-- — E ACR. S W TYPE OF BUILDING f a RES. SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. ! TOTAL DATE REMARKS I � � a e� L� z z z . PA b �U f •_ AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre Tillable FRONTAGE ON WATER Woodland - FRONTAGE ON ROAD Meadowland ! DEPTH - a House Plot BULKHEAD E Total - DOCK \\\\~\ COLON 7 � - r" _ -. TRIM — m o f t [ � i t z 3 3 1 9 M. Bldg. Extension - i Extension l ! Eactension E I !Foundation i - - Bath �' r Dinette r, Basement lFloorsi<. Porch - - 1 l %• a ,Ext. Walls linterior Finish SLR. Breva}� 'e I �l � : �n �,5 � ' -a =Fire Piace �1�� Neat DR. Garage ;Type Roof Rooms 1st Floor BR. Patio I =Recreation Room Rooms 2nd Floor FIN. B O. B. Dormer Driveway l TotalC' l FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z18151 Date JUNE 28 1989 THIS CERTIFIES that the building ONE FAMILY DWELLING. Location of Property 4200 SOUNDVIEW AVE. SO'UTHOLD House No. Street Hamlet County Tax Map No. 1000 Section 068 Block 04 Lot 04 MAP OF Subdivision NORTH NECK Filed Map No. 387 Lot No. 3 conforms substantially to the Application for Building Permit heretofore filed in this office dated FEB. 17 1987 ursuant to which Building Permit No. 15712Z dated FEB. 27 1989 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 AS APPLIED FOR. The certificate is issued to ALFRED & ZINA HULL (owner, ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 86-SO-228 MAR. 20 1989 UNDERWRITERS CERTIFICATE NO. NG40936 OCT. 19 1988 PLUMBERS CERTIFICATION DATED J.E. WALTERS PLUMBING & HEAVING 6 26 89 Building Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE CERTIFICATE OF OCCUPANCY No Z-18325 Date AUGUST 30 1989 THIS CERTIFIES that the building ACCESSORY BUILDINGS Location of 'Property 3630 SO VI AVE SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 68 Block 4 Lot 4 Subdivision Filed Map No. Lot No. ____�, conforms substantially to the requirements for accessory structures built prior to: APRIL 9, 1957 pursuant to which Certificate of Occupancy Z-18325 dated AUGUST 30 1989 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 TWO ACCESSORY WOOD FRAME STRUCTURES* The certificate is issued to ALFRED & ZINA HULL (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NO RECORD PRE EXISTING UNDERWRITERS CERTIFICATE NO. NO RECORD PRE EXISTING PLUMBERS CERTIFICATION DATED NO RECORD PRE EXISTING *PLEASE SEE ATTACHED INSPECTION REPORT. ui ding Inspector Rev. 1/81 BASEMENT 1ST FLOOR 2ND FLOOR s >a ` - - {` \ f + T , s.. - � y'� � 3t� n _ _5 I E F -- — - — b744 D — *1PE - ,� Psrk Building Contractor. s'-At s'�e s �-`-' s +•:;z.. .., «r-r art' "".` Hull,resident.----7 n Ott : .