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Home My WebLink About1000-18.-3-21 Rental Permit 1280 Owner: Barbara Bloom Occupied as: Single Family Dwelling Located at: 695 Edwards Ln Orient 18.-3-21 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: 03/20/2025 Expiration: 03/20/2027 Code n oc n Official This Notice must be posted by the main entrance at all times Marrs '. TOWN OF SOUTHOLD—BUILDING DEPARTMENT n Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765- (631) 765-9502 (t la :d� �ta111hol��t��wnn gq l 7 Fax '' � a RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) 2— ►r'e c t# 1 OQi L4 57 Section A. c_K 32� Property Information: Rental Property Address: 695 Edwards Lane Orient, NY 11957 Tax Map Number: 1000 SECTION 1000 -BLOCK 1& -LOT 3 -21 1000-18.-3-21 SECTION B. OWNER INFORMATION: Property Owner Name: Barbara Bloom Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 59 W 12th Street. 2C 59 West 12th Street 2C New York New York, NY 10011 New York, NY 10011 Telephone Number (s): Daytime917 340-0452 Evening same Emergencysame Property Owner Email Address: bbarbarabloom@gmail.com Page 1 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: one 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: 6 Number of rooms in Rental Dwelling Unit: 5 rooms +2 bathroms Use and Dimensions of each room in Rental Dwelling Unit: kitchen: /z/x& living room: bedroom 1: � bedroom 2; /�`� �h� �f bedroom 3: 117141 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. 0 1 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 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 Barbara Bloom 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: Barbara Bloom Property Owner's Signature: Sworn to before me this day of _ 20 Official Notary Public Signature and Originaiotary Stamp Page 4 of 4 TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 I N S P mEm (ChT 10 N [ ] 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 [1,�RENTAL REMARKS: / " � F Ire4 Town Hall Annex � Town Of Southold 54375 Main Road Rental Inspection Report PO Box 1179 } Southold, NY 11971-1179 Tel: 631-765-1802 xlr„ SUM# 3- Date I/ s Owner Phone Address tat Visible Hamlet linspector Floor Level Quantities Sub 1 2 3 Smoke Detectors(not located in bedrooms) Carbon Monoxide Detectors l Fire Extinguishers Exits Bedrooms 1 2 3 4 5 6 Smoke Detectors 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 Door alarms Pool completely enclosed Self closing/latching gates Pool fence to code requirements CO's for all items present Prior Rental Comments: 31 ) 2 Ll TOWN OF SOUTH-OLD PROPERTY-WICORD CARD OWNER STREET VILLAGEDIST. SUB. LOT FORMER OWN ER- r�re It.4" N E ` -7- -A W TYPE OF BUILDING RES. I« SEAS. VL. FARM Comm- CB, MICS, Mkt. Value —-—--------- LAND IMP, TOTAL DATE REMARKS/--- zi - 1�z 1-01 lip, '7 170 71 'k 5e P PG Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowk)nd DEPTH House Plot BULKHEAD Total -�� at COLOR TRIM L) k ,T 5 - i - r 1 � I an f e M. Bldg. _ f Extension Extension I Extension i Foundation - 'Bath Dinette ' Porch Basement u�� lFloors K. Porch ��9 _ �,� lExt. Walls 'Interior Finish 'LR. Breezeway 'Fire-Place ` Heat DR Garage' 'Type Roof ;Rooms 1st Floor BR Patio a Recreation Room ' =Rooms 2nd Floor FIN B t O. B. Dormer Driveway Total �f� _ �0 how ,', Town of Smith€,4d �"�' P 0, Box 1179 " f 309-5 Main tad South�rld, Neu York 11971 OFOCCUTANCY 'N,o: 45702 Date: 10/260024 THIS CERTIFIES that the building AS BUILT ALTERA'T'ION Location Of"><yt'ti?t ,� : O7 IJAIr Po410lS_Ln C)tlent NY 11957 S e iw., 11 1 k L i.,`1 1.« to the App1Wone A Wong Pen-inh hc,root"orq filed W this ot`6ce dated: 08/0512024 t,7, 6ti h B u'H<.8inmg Pa~anh N o. ji '191 and dawd: OW 1 721JM ni, cc)nnforn is to Anil of be ralr.rirc:nne nts of We nr}:np1ka.bb 1;zn•ov dons of the law. 31 .1p 1 c", h'ich ffii is issued IS: as built" second hoar bathroom alterations to existing single-family ilyr welling as applied for. The is issued Barbara Bloom d'Of,Y,. (T)"J!"'I Y DEP R.TMi" N'll' ilia`1HHALT"°f APPROVAL: ". .RJ(,'AL C'E'R i i i°i CA TI : e r F , r. FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. .Z74 . . . . . . Date . . . . . . . . . . . . . ,'� . . , . .3�. . . ., 19. .76 THIS CERTIFIES that the building located at . vt. . .(. ,8 jWard S. .yg) Street Miner Sub Map No. . . . . . . . . . . Block No. . .3= . . . .Lot No, x=. . . .Qrieat . N..Y: . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . .Oct. A . . . ., 19.76. pursuant to which Building Permit No. 8896Z . dated . . . . . . . . . . . . 3vt. . . . . . ., 19`/6. ., 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 .Privatc. .040. ��tn�lac►: c?'-v��:a��x��p . . . . . w . . . . . . . . . . . . . . . . . . . The certificate is issued to . �]- A04 Dad -5%Rl. . . . . . . `. . . . . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ;)ea. . .23. . .1.976. . .by. R. .Villa.. . . UNDERWRITERS CERTIFICATE No. 1316?.50 . . . . . .bee... .15. . .1976. . . . . . . . . . . . . . HOUSE NUMBER . . . .69 5. . . . . . . Street . . . - - SAwFard o.La . -(lvt -Rv 0#W%). . . . . . . . NOTE I- Future.bath-& porch -t® be fi.alahed• by.owner. . . . . . . . . . . . . . . . . . . . . Building lnspctor y , Town of Southold P.O. Box 1179 53095 Main Rd nrN", Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45702 Date: 10/26/2024 THIS CERTIFIES that the building AS BUILT ALTERATION Location of Property: 695 Edwards Ln Orient. NY 11957 Sec/Block/Lot: 111.4-21 Conforms substantially to the Application for Building Permit heretofore, filed in this office dated: 08/05/2024 Pursuant to which Building Permit No. 51197 and dated: 09/17/2024 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: "as built" second floor bathroom alterations to existing single-family dwelling as applied for. The certificate is issued to: Barbara Bloom _.._ Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: ELECTRICAL CERTIFICATE: PLUMBERS CERTIFICATION: VAutkorize aignature FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-25232 Date SEPTEMBER 3 1997 THIS CERTIFIES that the building_______MLTFR^TION Location of 'Property 695 EDWARDS LANE ORIENT N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 18 Block 3 Lot 21 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated N "gR 7, 1996 ursuant to which Building Permit No. 23827-Z dated NO ER 27 1996 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 ALTERATION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to BARBARA BLOOM (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ilding Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No z-24902 Date FEBRUARY 7, 1997 THIS CERTIFIES that the building ACCESSORY Location of Property 695 EDWARDS LANE ORIENT N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 1B Block, 3 Lot 21 Subdivision Filed Map No. Lot No. , conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 40, 1996 ___pursuant to which Building Permit No. 23771-z dated OCTOBER 23 1996 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 BUILT" ACCESSORY SHED IN REAR YARD AS APPLIED FOR. The certificate is issued to ELIZABETH FM Y (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A iIrgnspector Rev. 1/B1 695 EDWARDS LANE ORIENT, NY 11957 19 ft 1 ST FLOOR SCREENED PORCH i u Smoke Detector �.�. KITCHEN LIVING ROOM 10 r HALL 0 CO2 Detector 37 ft 695 EDWARDS LANE ORIENT, NY 11957 ND FLOOR r BATH a ' BEDROOM BEDROOM � u BEDROOM !41f ! 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