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Home My WebLink About1000-40.1-1-4 TOWN OF SOUTHOLD Kenai Permit 1276 Owner: James Sage , Beverly Sage Occupied as: Multiple Residence Unit A4 Located at: 195 5 Calebs Way Unit A4 Greenport 40.1-1-4 Maximum Permitted Occupancy: 4 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: 03/19/2025 VV Expiration: 03/19/2027 tall - fo a ofcial This Notice must be posted by the main entr 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 htt)s: a ;otlolc.:ow� rt'o RENTAL PERMIT APPLICATION II 4 Rental Permit Fee $300 (Application must be renewed every tw arse r 1yrtt �.n14d1n Section A. Town of souttlold Property Information: Rental Property Address: Tax Map Number: 1000 SECTION L40 • -BLOCK _-LOT SECTION B. OWNER INFORMATION: Property Owner Name: U Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) Telephone Number (s): Daytim :` Evenin '" ergeny 4 Property Owner Email Address: » &wq 3- ad. CO m AIF 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, C); 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: i W 0 L '"`2' chu� D r � ,,, 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 ❑ 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 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: � f". � �. Property Owner's Signat �'" Sworn to before me th" , day of �_ 2 'rmy ROBINA.YEOMANS Official Notary Public gnature and Original Notary Stamp » ..' MYcoMMlssIONHH 158468 EXPIRES:November 3,2025 �a °r Bonded Thru Notary Public Undenvrilers Page 4 of 4 Town Hall Annex b�'�� Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P. O. Box 1179 Cn 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 rectuired for Architect or Engineer, Licensed Home Inspector mast rovide copy of valid current certification Rental Property SCTM Number: Rental Property Address: Owner/Name: f cl ' " i Rental Dwelling Unit Identifier: Number& Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 — 100 sgft., Bedroom#2—90 sgft., etc.) a Property Description (Include all improvements indicated on survey) aAAM)AJ I fn 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 York State and the Energy Conservation Construction Code of New York State. Print Name and Title Original Signature Please place Professional Seal: Telephone(631)765-1802 Town Hall Annex 54375 Main Road P. O. Box 1179 ar Southold, NY 11971-0959 N, '0 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use nd Dimension of each room: ' Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: jfA; On so m om TOW Off" S0 �`H nLDG DEPT. 631-765-1802 INSPECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ INSULATION/CAULKING [ ] FRAMING /STRAPPING [ F AL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI L) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL RE LAO " A DATE 3 l INSPECTOR 9 k l04_lo° 2y 4 x i I�I - - -' - - �- -447 D 5sorzcan gF92an:n 0 P}_F2�oM � R6D¢ooM •_ _� � 0 � �Yy x� �' �p � � 3 _�f: Il0 � y F3'O �} 4> .... d==�' ��\ l2b N �}s" 20 -ems A �a a•-. ��o� �#" .moo" r y - .� I 3En¢aM winnow - _ it [ s—'^ € � �-6iN�€1�Agee� za �� _� € � � _ A `-;�� - � = ��'a•' ��'' _ u-q.., � e - y.. �� e >O 34 I bmeA4 £€ Qp LIVdN C� f<mM - --"- e , e ❑❑� t •'q4 - - -S.IV tNG RocM_� d �� ,�- ":. HEo rcaa�-� { � � 65D¢ooui ' 0 7_.Z". f:- -j r z. S Jor2 ES LA.N TOWN OF SOUTHOLD PROPER OWNER STREET — VILLAGE DIST. SUB. LOT'"— t E n ACR. REMARKS g ,1 TYPE OF BLD. nn PROP, CLASS LAND IMP_ TOTAL DATE — =, r ;- ' = = - crCl ` f I -- 7 r! A- I 3 t I FRONTAGE ON WATER TILLABLE FRONTAGE ON ROAD WOODLAND I DEPTH MEADOWLAND a= BULKHEAD HOUSE/LOT i I TOTAL o c)u—L}O,I — I— SOMERSET MA YBERRY MA YBERRY SOMERSET IAEJ 01) IBII I (AEJ � . _ q COLOR r-'j �OQ��M ElDYCbM " A DED Doow oS /3'o"x/*o* //'O r/So � //O.rfStT ODY/+D BEDCoor+ Y� 4Y�MV - C LJviNG �` � 1440r/9-0• /4CX t3 � TRIM Krrewsr' D Ca;, KnrHe.+ 1.1v/Ruo�n DEDROOM �' /90 r 'p'2•o' /9 b'x 22•o , s 20 p7® 52`I /4 2' /z'/o /y'/a /4 2" S'2� 2o' c CL US TER M. Bld Foundation? Bath Dinette g- FUi _ Extension _ , __. 1 Basement S Floors �� KitVo - �..., Extension /cy 7 ELAB xt. Walls ��I �� , Interior Finish L.R. m_ - Extension ��-'' Fire Place Heat D.R- Patio - - Woodstove BR. �a Porch Dormer Fin B. — Deck Attic = Breezeway Rooms 1st Floor Garage Driveway Rooms 2nd Floor ED' CUM Pool FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OY OCCUPANCY No 9-24542 Date AUGUST 2 1996 THIS CERTIFIES that the building MULTIPLE RESIDEN+C'E Location of Property 1955-A-4 CALEBS WAY GREENPORT R.Y. House No. Street Hamlet County Tax Map No. 1000 Section 40.1 Block 1 Lot 4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated A=ST 17 1994 --Pursuant to which Building Permit No. 22296-8 dated SEPTEMBER 5 1994 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 UNIT 4A - MULTIPLE RESIDENCE - COMPLSI "A" AS APPLIED FOR. The certificate is issued to NOORNS LANE DNVBLOPXM CORP. (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-10-95-0011-JAN. 19 1995 UNDERWRITERS CERTIFICATE NO. PZNVING - JULY lar 1996 PLUMBERS CERTIFICATION DATED JULY 31 1996-DOOLRY PLYING G BEATING Building Ins or Rev. 1/81