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Home My WebLink About1000-78.-1-10.6 TOWN OF SOUTH OLD Rental Permit 1281 Owner: Christopher Doman , Jocelyn Doman Occupied as: Single Family Dwelling Located at: 110 Sleepy Hollow Ln Southold 78.-1-10.6 Maximum Permitted Occupancy: 8 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 arran `ng for the bi-annual inspection Issued: 03/25/2025 MLI de f ke Expiration: 03/25/2027 nt Official This Notice must be posted by the main entrance t al time 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://w rvW.southoldt,owtin ov RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) gL Section A. Property Information: Rental Property Address: o slcc �o� (,��e So,.ri,.ld N Il°ll Tax Map Number: 1000 SECTION 7 g -BLOCK I -LOT l°�,�6 - SECTION B. OWNER INFORMATION: Property Owner Name: a„ Jocel DoMCLq Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 15 4 Wcs- ` 70,A 5 re, A 4% 3A aS Le�4 I Rdd�crt New K.11< ^'Y loon Telephone Number(s): Daytime 614- 3 13- °evening Emergency Same Property Owner Email Address: chr,s eLrple rock ptl nerf.corn Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: N/A 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 dwelling unit, if any: ^11A Address of Authorized Agent(no P.O. Boxes): Mailing Address of Authorized Agent: 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 dwelling unit, if any: N/A Address of Managing Agent(no P.O. Boxes): Mailing Address of Managing 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 Unit:_ Number of rooms in Rental Dwelling Unit: `� grdr°`"'S r L°�,° ^ ' k;+`tip c�^ /I zc fi 3 bc,4("-s Use and Dimensions of each room in Rental Dwelling Unit: Co 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. ZI 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 OFfiU ELK}--1 I Chn's+o �v V61VIaA 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 I day of �b 2025- 0 6& r blic 5 ature and Original Notar Stamp CHAVI BHATNAGAR Notary Public-State of New York NO.018H0021616 Qualified in Queens County My Commission Expires Feb 29, 2028 M n Page 4 of 4 TCI IVF CML.1 ► 81. 1.�11' 1aDEPT. 631.765-1802 I amm Sk P E C T [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS A' ION/CAULKING [ ] FRAMING /STRAPPING [ ] INAL [ ] FIREPLACE & CHIMNEY [' ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI L) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: @cw - , i evp 6v&A Wz- (VofvGc , m's sue*tVA04, o W DATE INSPECTOR STREET VILLAGE D,t 'T. SUB LOT _ MV F , E... ACR EO}WVN / f I � S W TYPE OF BUILDING REST F SEAS. VL_ FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS JA jioz - 3 I �l o m ` ve ,a s krcc 3 a g a 3 } I � Tillable r FRON AGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH House Plot BULKHEAD Total SCTM # \� � TOWN OF SOUTHOLD PROPERTY RE(, R STREET �� (� VILLAGE DIST, SUB. LOT } ACR. REMARKS a — TYPE OF BLD. — PROP CLASS LAND IMP, TOTAL DATE �s ie �q a m �s = c- L4 Lao'k _ _ i . ��- �£--a � � Ott'-- _ •`3;. t� — �--��_ �'-�'�� €"(a'a';� ��` _ FRONTAGE ON WATER HOUSE/LOT BULKHEAD TOTAL g z �ox. LOR j�,j � TRIM _.. I 4 i 1' s f } E E t ( t [ s I � I � 78.4-10.6 1/30/2020 i E � g M. , } 4z Ektorto Extemion - i Extension - Foundation Both Dinette Porch Basement Floors _ K. Porch Ext. Walls � Interior Finish LR. sr t 1, � _ _ Fire Place « Heat = 9 DR. Garage `£ Type Roof Rooms lst Floor BR. f Patio = Recreation Roo rm Rooms 2nd Floor FIN. B a - F 3 Dormer — Driveway -= p o Total i I 2 F _, FORM NO.4 a ' TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. ., Z.1.5012. » . . » . , . Date . . .October. 20 .. . . . . . . . .. .. . . . .. 1986 THIS CERTIFIES that the building .. . . One family dwelling with attached deck& •at-t•ac hem•gar-age 110 Sleepy Hollow Lane & 50Grissom Lane Southold , N .Y. Location of Property . . . . . . . . . . . . . . .. . .. . . . . House%Vo. treat , h►am%at County Tax Map No. 1000 Section . . S.. . . . . .Block . . . . . . . . . . . . . . . 1 . . . . . . . . . . . .Lot ... ... . . .. . .. . .. . Subdivision M/o .S l e. p Y Hollow. µ . . µ . . . .Filed Map No. .6351 .Lot No. .. . . .. . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated J an u a r y.g.,. .. • . , 19 8 .pursuant to which Building Permit No. . .12 8 3 6 Z µ • * * .. . . January 9 , 86 dated . . .. . . . . . . . . . . . . . . . . . . . . . . . . 19 . . ,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 with, .attached deck & .attached, ,garage . • . .. . . . . • . . . The certificate is issued to . , . , » . Robert. . . . . . . . .&. .Carol Bohn . . . . . . . . of the aforesaid building. 225 Suffolk County Department of Health Approval . . .1 .. . . . . . . . . . . . . . .. .. » UNDERWRITERS CERTIFICATE NO. . . . . . . . . . .1V 725950. . & N 7 2 5 9 . » . W . + .* .. » PLUMBERS CERTIFICATION Dated October 14 1986 Bull Ming»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. ZJ5R13. .. .. .. . . . Date .. .October, 2Q.. . . .. . . .. . .. .. . .. 19 86 THIS CERTIFIES that the building .. . ;AgrPAAA?.�wj,,741P}p9 . pol, .0 fence, . . . . ,, , Location of Property 110 Sleepy Holl�owi Lane& 50 Grissom Lane µ4�* So•utihold ,N.Y. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . ... ... . . . ... County Tax Map No. 000 Section . ..7 . . . . . . ..Block . . .1. ... . . . ... .Lot . .. .1.... ... .� at M/o Sleepy Hollow 6351 4 Subdivision .. . .. . . . . . .. . . .. . . . . . . . . . . . . . ..Filed Map No. .. .. ... .Lot No. `...... ... .... conforms substantially to the Application for Building Permit heretofore filed in this office dated J u 1 Y. .1.a . . . . . . . . .. . . . 19 8 5.pursuant to which Building Permit No. . ....07Z.... .. . . . . .. . . . dated . . .July .3 . .. . . .. ..... . . . . . . 19 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 ...... ... Inground Swimming Pool & fence . . . .• • .. . .. • . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . ..., .... . . ....... . . . . The certificate is issued to .. . . . .Robert . . , *Robert & Carol Bohn . . .. µ . * .. . .. of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . . . .N... . . .. ... ... .. .... .... . . ... UNDERWRITERS CERTIFICATE NO. . . . . . . . . . .. . ...... .N 7 d 3 616. .. . . . . . . .... .... . . .. . . . Building I� pector. . . . . . . . * . . . Rwr.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-33303 Date: 12Z16LOS THIS CERTIFIES that the building ACCESSORY ....... - _� Location of Property: 110 SLEEP" HOLLOW LA _ SOUTHOLD (HOUSE NO.) m (STREET) (SET) County Tax Map No. 473889 Section 78 Block 1 Lot 10.6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 21 2007 pursuant to which Building Permit No. 32825-Z dated MARCH 21 2007 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 ACCESSORY SHED AS APPLIED FOR. The certificate is issued to ROBERT F & ELIZABETH A NEVILLE (OWNER) of the aforesaid building. SUFFOLK COUNTY DEVARTME11T OF HBALTH APPROVAL N/A ELZCTRICAL CERTIFICATE NO. _ N/A PIAN4BERS CERTIFICATION DATED "Aut Signature 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-33245 Dates OS 27 O THIS CERTIFIES that the building AIR CONDITIONING Location of Property: 110 SLEEPY HOLLOW LA � SO OLD (HOUSE NO.) (STREET) (HAMLET County Tax Map No. 47889 Section 78 Block 1 Lot 10.6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated �CH 20 007 pursuant to which Building Permit No. 32817-Z dated MARCH 20t,. 2007 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 CENTRAL AIR CONDITIONINGIN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. -,- _ ILLE The certificate is issued to ROBERT F..w6 ELL. ETH A n (OWNER) of the aforesaid building. SUFFOLK CONY DEPART"DEPART"M OF HEALTH APPROVAL -,N EffARC RICA . CERTIFICATE NO- 97143 02/13 O1 PLUT48E" C IMFICAT'ION DATED NIA e Uth iZed ignature Rev. 1/81 ��,UlFlrt,f� Town of Southold 7/15/2023 P.O.Box 1179 ' f' 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44298 Date: 7/15/2023 THIS CERTIFIES that the building PORCH Location of Property: 110 Sleepy Hollow Ln, Southold SCTM#: 473889 Sec/Block/Lot: 78.4-10.6 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 8/15/2014 pursuant to which Building Permit No. 49430 dated 6/29/2023 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: coy r d fronlpoorch addition to e i t" le fa dwelLjqgA&4p9lied The certificate is issued to Neville Robert &Elizabeth Rev Trt of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED ` A o ze S xaturc._ 4 Town of Southold 7/15/2023 P.O.Bog 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE F OCCUPANCY No: 44297 Date: 7/15/2023 THIS CERTIFIES that the building WINDOWS Location of Property: 110 Sleepy Hollow Ln, Southold SCTM#: 473889 Sec/Block/Lot: 78.1-10.6 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/27/2012 pursuant to which Building Permit No. 49429 dated _6/29/2023 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: wµ l� Q_r. The certificate is issued to Neville Robert&Elizabeth Rev Trt of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Aut S Town of Southold 7/18/2023 „ P.O.Bog 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OIL OCCUPANCY \ a No: 44326 Date: 7/18/2023 THIS CERTIFIES that the building ALTERATION Location of Property: 110 Sleepy Hollow Ln,Southold SCTM#: 473889 Sec/Block/Lot: 78 4-10.6 Subdivision: Filed Map No. Lot No. confbimss substantially to the Application for Building Permit heretofore filed in this office dated 11/2/2017 pursuant to which Building Permit No. 49431 dated 6/29/2023 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: onim)air single family dwe 1iapplied f r. The certificate is issued to Neville Robert F &Elizabeth Rev Trt of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 49431 7/5/2023 PLUMBERS CERTIFICATION DATED Town of Southold 8/1/2023 P.O.Bog 1179 53095 Main Rd Southold,New York 11971 CERTMCATE OF OCCUPANCY No: 44361 Date: 8/1/2023 THIS CERTIFIES that the building ELECTRICAL Location of Property: 110 Sleepy Hollow Ln,Southold SCTM#: 473889 Sec/Block/Lot: 78.4-10.6 Subdivision: Filed Map No. _ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/l/1900 pursuant to which Building Permit No. 49432 dated 6/29/2023 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: gpderground eigggLe sMiM The certificate is issued to Neville Robert &Elizabeth Rev Trt of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 49432 7/5/2023 PLUMBERS CERTIFICATION DATED utlxariid gignature Ceiling Mounted (See Bonus Room) 110 Sleepy Hollow Drive - Southold, NY lst Floor Smoke/Carbon Monoxide Detector Locations Ceiling Mounted Q UEEN GU TWIN GUEST 7 a • 1001 KING GUE F RIMAR) EU_ M tT ----r GO 110 Sleepy Hollow Drive - Southold, NY 2nd Floor Smoke/Carbon Monoxide Detector Locations (Floor 2) Ceiling Mounted If (Floorl) BONUS ROOM 110 Sleepy Hollow Drive - Southold, NY Bonus Room Smoke/Carbon Monoxide Detector Locations e CO Ezi a 1 a a e s .s u. F <- 3 `L-1 _44F 4 IWO a t F � p y a ff774 o a�. , ' as r coppw - 4 ivbifts.n - L ' SURVEY OF: PROPERTY LOCATED AT SOUTHOLD LOT No. 4 AS SHOWN ON MAP OF SLEEPY HOLLOW FILED: FEBRUARY 4. 1976: FILE No. 6351 TOWN OF SOUTHOLD SUFFOLK COUNTY. NEW YORK S.C.T.M. * 1000-76-1-10.6 SCALE: 1`=40' SL NOTE: THE EXISTENCE OF RIGHT OF WAYS. EEpY HQLL WETLANDS AND/OR EASEMENTS OF RECORD IF ANY. NOT SHOWN ARE NOT GUARANTEED. 0 W S 7 `0 LANE FENCE 0 VE J c' RAD= 20.00' POLE LEN = 31.42' @o *am0• ievc `cvG �� s ce "simp p #-GAZEBO WALK )� �} S k Nr�LO.BLLK.CURB (r3 w = 1 z p ( F (sari 1 } I CO =� r y xw aRfw- N rn 7 ItH - GRAVEL jilt - 4RIYENA.Y o PENCE CHAIN- PENCE 8.5'ls 4.�S S 86'42'00"W JB,ff/E 283.13' LWAUH ED ALIERA M AWnM TO MS SOW"0 A Ye TWN LOT 3 W�I=OF n Nev r WAIE EUXAMN CnK. Cams ffTmBLRVEYWw W-mm THE L"SURMORS Nm SURVEYED BY: OR ElBOa&L�6ML NOT BE CON M M N A VA JO YR1E C - wARAN ON�s �swrum EwsuuRu+vwvm PAUL BARYLSKI LAND SURVEYING THE MEE".E t+uWANY.QcVERQx�rAc ASOCYAAND�M MgWffUTM PATCHOGUE NY 11772 ITUTM mi�w,wr'Ec�"a,�� mMWOOK& PHONE 631-294-6985 wsn Tm m suSUGtL wneRs FAX 631-627-3186 CERTIFIED TO: STEWART TITLE INSURANCE COMPANY NOVEMBER 20. aYAH00.COM NOVEMBER 2®. 2023 5675