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Home My WebLink About1000-18.-2-31.1 Rental Permit 0 1272 Owner: 24275 Main Rd LLC Occupied as: Single Family Dwelling Located at: 24275 Route 25 Orient 18.-2-31.1 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: 03/12/2025 41t"-X >IVO2 Expiration: 03/12/2027 Code forcemeat o cial This Notice must be posted by the main entrance at all times 0 Mn F/ t-L2 � TOWN OF SOUTHOLD—BUILDING DEPARTMENT f Oaf 1` -9 t e �e Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone(631) 765-1802 Fax(631)765-9502 http 4 Q JAN 1 6 2025 RENTAL PERMIT APPLICATION Rental Permit Fee $300(Application must be renewed every two years) Section A. Property Information: Rental Property Address:. Tax Map Number: 1000 SECTION .O _6 __-BLOCK 18 -LOT ol - 31 - SECTION B. OWNER INFORMATION: Property Owner Name: H A e,4 ce.e Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) oc��,- N %\ Telephone Number (s): Daytime 4-ISS-5-1-7µ6Evening Emergency Property Owner Email Address: �115 '2-`-� ' ��- ca Page 1 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: L 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: 15 Number of rooms in Rental Dwelling Unit: S ellok� .+ 2. Use and Dimensions of each room in Rental Dwelling Unit: Beboorn 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. W, I am 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 t A Nr k -9,oaet 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 15 day of _Y(X-)Cg(' -~ " 2025 Official Notary Public VgnVure and Original Notary tamp DARCFE AUFI NANCER NOTARY PUBLIC,STATE OF NEW YORK Registration No. 01A00019644 Qualified in Suffolk County page of 4 Cornrnission Expires January 9,2028 tv SoCfiTy a TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 /S-"'?- IN S rw" E tAo;'hT 10 N [ ] 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 (FIN L) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: � 40�2 5 5o v g�7, DATE ��/�-�� INSPECTOR F toll, Town Hall Annex � � 4 Telephone(631)765-1802 "` Fax(631)765-9502 54375 Main Road ` 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 aired for Architect or E:n ineer Licensed Home Insipector must provide copy of valid current certification Rental Property SCTM Number: 1000-018.00-02.00-031.001 Rental Property Address: 24275 Main Rd,Orient, NY 11957 Owner/Name: Mark Breen Rental Dwelling Unit Identifier: N/A Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 —100 sgft., Bedroom#2—90 sgft.,etc.) Bedroom#1 -196 sq.ft Bedroom#2-168 sq.ft Bedroom#3-99 sq.ft Property Description (Include all improvements indicated on survey) 2 1/2 story,one family wood framed dwelling with attached porch.Accessory garage and attached shed. 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 Maintenance Code of New Yor ,.State and the Energy Conservation Construction Code of New York S e. � � 4 Print Name and Title �� M al Signature Please place Professional Sea(. r °w I co Li 2 �.�►�y ti 1 ci -7 or c� -sr►+�'c� VW p u t•.7 1 2 S F fV the 1 f i _... �_, .. ......_. _.�.��..a„, . _o ,m P - 3� Lj Li P�j3 4 _ 4 1 E TOWN OF SOUTHOLD PROPERTY Rk I ))I R OWNER , STREET ti_ ' '�t_;" VILLAGE ' DIST. SUB. LOT > > i -FORMER OWNER N // E ACR. e vl b,n S W r TYPE OF BUILDING RES. SEAS I VL. FARM COMM. CB. ti11SC. Mkt. Value 3 , LAND IMP_ TOTAL DATE REMARKS ,• �� f { Yy t { 5 qA p` F a II C z g AGE BUILDING CONDITION NEW NORMAL_ BELOW ABOVE FARM Acre Value Per i Value Acre Tillable 1 Tillable 2 I I f Tillable 3 Woodland f FRONTAGE ON WATER Swampland I a ! FRONTAGE ON ROAD Brushland House Plot ; DEPTH IBULKHEAD DOCK Total I CC R .. t e` r TRIM _ z £. nf 7- x V s' p a -- m - - M-2-31.1 6111 - i M. Bldg ne te= Foundation C-11 Both C}i F Extension Basement - Floors K. Extension p Ext. Walls Interior Finish Lft. �. Extension Fire Place Heat Di;_. Type Roof Rooms 1st Floor; BR. Porch - Recreation R O Rooms 2nd Floor FIN* B1 I ' Dormer.,. _.. Porch Breezeway Driveway Garage `�F - f Patio I Q. B. Total TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR. TOWN HALL SOUTHOLD, NEW YORK CERTIFICATE OF OCCUPANCY NONCONFORMING PREMISES THIS IS TO CERTIFY that the Land Pre C.O. Z13987 ____ Building(s) Date- F/ Use(s) located at 24275 MAIN ROAD ORIENT StreetHamlet shown on County tax map as District 1000, Section 018,09 Block 02.00 Lot—031.00 does(not)conform to the present Building Zone Code of the Town of Southold for the following reasons: Insufficient total area. lt%4L _2 r�ui n4_2 t 0 r I L 11 rl On the basis of information presented to the Building Inspector's Office, it has been determined that the above nonconforming /—x I Land Ix Building(s) /_/Use(s) existed on the effective date the present Building Zone Code of the Town of Southold, and may be continued pursuant to and subject to the appli- cable provisions of said Code. IT IS FURTHER CERTIFIED that, based upon information presented to the Building Inspector's Office, the occupancy and use for which this Certifi- Property contains a 2J story, one family wood cate is issued is as follows: framed dweII22,&wi,.t.h attached orch. Property _b&AjLe_iJ�Lw one s id e of property and a fence across the rear. Property situated in the A- I He $4.1 , PA a f e maintained road. The Certificate is issued to ROBERT T. BENTON & KATHLEEN F. BENTON of the aforesaid building. (owner. Suffolk County Department of Health Approval NIA UNDERWRITERS CERTIFICATE NO. N/A NOTICE IS HEREBY GIVEN that the owner of the above premises HAS NOT CONSENTED TO AN INSPECTION of the premises by the Building Inspec- tor to determine if the premises comply with all applicable codes and ordin- ances, other than the Building Zone Code, and therefore, no such inspection has been conducted. This Certificate, therefore, does not, and is not intended to certify that the premises comply with all other applicable codes and regula- tions. BM di iz S;v c tor