HomeMy WebLinkAbout1000-31.-4-27 of so 01RO'kWN OF SOUTHOLD
Rental Permit
1273
Owner: Fahad Naj am , Simmi Malik
Occupied as: Single Family Dwelling
Located at: 11003 Route 25 East Marion 31.4-27
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: 03/14/2025
Expiration: 03/14/2027 cod o tent of&
This Notice must be posted by the main entrance at all times
qf SOlt
TOWN OF SOUTHOLD BUILDING DEPT.
631-765-1802 3/_5!_�
7
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 (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ 'RENTAL
REMARKS: �o���o
AL�i
at ve- 13f2 s.
DATE ��/1�07�' INSPECTOR
N
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax(631) 765-9502 http :�L o t o1dto'"71111Y',' !V
RENTAL PERMIT APPLICATION
Rental Permit Fee $300 (Application must be renewed every two years)
�► rtC# (C) q$
Section A.
Property Information:
Rental Property Address:
nD nn-Ik+ N FP ewg~C 0.%t o�
Tax Map Number: 1000 SECTION ?J -BLOCK .LOT -
SECTION B.
OWNER INFORMATION:
Property Owner Name: *FAjtAtP N A-dAM
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
to b rev r sa-rn�
oo �
Telephone Number (s): Daytime Evening Emergency
Property Owner Email Address: '% a I 2 0 eq maI. 60&1
Page 1 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: I I
Use and Dimensions of each room in Rental Dwelling Unit: VWr- I4 )c [3'3 SAM-t (01-RXLI r-v
0 FF%.cF,-
d t n «. 1 l_. R 0A- 221-,6 k l cc��-
QlN • R/Y�` ['y''C7 � l o�'B� 2l1(�dV� - 2.0-fo��lb�-6M F3AT"A- &I-& yc lf.1-0
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.
❑ I am requesting afire 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)
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: Ck-
Property Owner's Signature:
r to be r (s. d'a f C�L' 2
clal Notary P blic i `rt to and ginal Notary Stamp
k A'THY M HOYOS
Notary Public-State of New York
NO.01H06336803
Qualified in Queens County
My Commission Expires Feb 8, 2028
Page 4 of 4
01.
Town Hall Annex Telephone (631)765-1802
54375 Main Road W -" 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 re uired for Architect or Engineer, Licensed Home Inspector must
provide com of valid current certification
Rental Property SCTM Number: (o o o -- 31 — 2-7
Rental Property Address: 11
b ll 3 0'1�I N FN-O - EA-S-r r✓ A-k%U
Owner/Name: f emp A—J A M
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.)
KLT. 1,&5-.5-� 13Al-+ '70 0 t-AvNCKzJ 60 FI=ceC
sa etoq m m 2.
0'1
Property Description (Include all improvements indicated on survey)
StN r- tZ Frfm,�A "vV
i i'VIW,I N CT `FC>0 —
z_
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 Mainte ce Code of New York Late
and th Energy Con action Construction Coa,6 ew York State.
Print Name and Title "8 Original Signature
Please place Professional Seats
2i
TOWN OF SOUTHOLD PROPERTY RECORD 1��,
OWNER STREET VILLAGE DIST.
lei
FORMER OWNER „ , N i E ACR.
r >
F P
$ I fin/ TYPE OF BUILDING
RES. 7 1 SEAS. VL FARM COMM. CB. MISC. Mkt. Value
}
LAND [ IMP. TOTAL DATE REMARKS
17
All
E :
Fr
.
x
AGE BUILDING CONDIT191 1a 1 IN �
NEW I ORa AL BELOW .'' oLov �1. u
,D 2u
FARM Acre I Value Pic , Value
= _ �= �
I
9
Lq
Ti
Tillable 2
Tillable 3
Woodland 6
�a
Swampland FRONTAGE ON WATER
Brushland i
FRONTAGE ON ROAD
House Plot DEPTH
kr
BULKHEAD
Total - ADOCK
SCTM #
TOWN OF SOUTHOLD PROPERTY RECORD C 3I
OWNER STREET I� �� � VILLAGE DIS` SUB. LOT
vArn
1
ACR. REMARKS .
TYPE OF BLD-
�Y
PROP. ASS
F F° 0
I _
z
z _ _ _ _
LAND IMP. TOTAL DATE
FRONTAGE ON WATER HOUSE/LOT
BULKHEAD
TOTAL
\ _
\\ \\\ \' IBM? IOLOR
y \ \ \ \\ t 1
�\
Al
s
a �
— _
RI. - �
s
s
All
t= 71
Isom
gig
l [
y
Ad
f
— s
I �
i I
g 5 s e
31:4-27 2/05
M. B11cg. r ;Foundation e
Both Dinette
J
Extension � _ Floors K. -
I Basement
x
Extension I2 i �77r Ext. Walls Interior Finish LR. ✓
_.
Extension .� �5 c ;Fire Place Fi eat DR� '
I
` r F T e Root Rooms 1st Floor BR.
� i I
YP
Porch _;_ 14 t4 \ _ ;,, :Recreation Room
€�
Rooms 2nd Floors s
{gam t
. ,l s ——
P�i � � ii Dormer
p i
Breezeway � � ! ��.� ��c�e� Driveway
Garage Cloy,(
PQt10
G. B `r
f
Total A aT i ;d .o C j H - , �. 4
e
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31105 Date: 08 15 05
THIS CSRTIFM that the building NEW DWELLING
Location of Property: 11003 MAIN RD EAST MARION
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 31 Block 4 Lot 27
Subdivision Filed Nap No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 2, 2005 pursuant to which
Building Permit No. 31100-Z dated MAY 2 2005
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 SINGLE FAMILY DWELLING WITH A COVERED PORCH AS APPLIED FOR & AS PERmmm
STATE PETITION #2002-1271 DA:1'ED 2 27� 03.
The certificate is issued to ERIC W NOVICK
(OWNER)
of the aforesaid building.
SWpOLK COUNTY DEPARTM9tjT OF MALTH APPROVAL R10-01-0080 08 02 05
ELECTRICAL CERTIFICATE NO. 1054926 03 31 05
PLUMBERS CERTIFICATION I1RTED 0 B 11 05 K&K_PLUMSING & HEATING
"Z/. /,.;,
// thor ted Signature
Rev. 1/81
Town of Southold 7/8/2022
P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 43220 Date: 7/8/2022
THIS CERTIFIES that the building ACCESSORY
Location of Property: 11003 Route 25,East Marion
SCTM##: 473889 Sec/Block/Lot: 31.4-27
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
6/7/2022 pursuant to which Building Permit No. 47963 dated 6/15/2022
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 buu�acc o vil►on as applied for.
The certificate is issued to Novick,Eric&Martinson,Elizabeth
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 47963 7/7/2022
PL .. "HERS CERTIFICATION DATED
_..__w._.. wPhir..
t ri `i ;nature
k Town of Southold 7/8/2022
P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 43219 Date: 7/8/2022
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 11003 Route 25,East Marion
SCTM#: 473889 Sec/Block/Lot: 31.-4-27
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore fded in this office dated
6/10/2008 pursuant to which Building Permit No. 47580 dated 3/22/2022
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:
„ ssc ita mound swimming with fence to code as a li d for.
The certificate is issued to Novick,Eric&Martinson,Elizabeth
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 47580 7/7/2022
PLUMBERS CERTIFICATION DATED
orize gt►atnre
�TUATEs EAST..MRO......E - _... __.. _.... . ^
ION 4f.
TOWMs SOUTHOLD g yr
SUFFOL�C COUNTY, W
.SURVEYED 10-03-00
AMENDED 03-29-01
04-24-01,05-26-01
FINAL SURVEY 03-31-2005 "L mow,
SJFFOLK COUNTY TAX � +" ,
1000-3000-31-4-2-7
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"",`,° �I „-.......................-......,.N-:i'=:IHI:LTH SERVICES q
•LG!S'CR!:a'FOR
The sw*-.Qe tl%spwa's-f vn`a '.:ri}FICRiMr>:al Ws Ip alm Aav toe
besassfda
OBke ci W"uwaier Managemed
CERTIFIED TO: �^a
"a ERIG NOVIGK
CHRISTINE M,NOVICK
Yn1 ✓'"„°� CHIGAGO TITLE INSURANCE CO. u
NOTES: " v!.« „.,.
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