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HomeMy WebLinkAbout1000-67.-7-3 of so TOWN OF S UTH O LD Rental Permit 1283 Owner: William H. Harney III & Anne E. Matthews Occupied as: Single Family Dwelling Located at: 25 Miami Ave Peconic 67.-7-3 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: 04/01/2025 Expiration: 04/01/2027 Cod c ent Official This Notice must be posted by the main etra at all times pNw E 0 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 I tt : / r r. � uthol .town E I 'd E MAR 2 8 RENTAL PERMIT APPLICATION BulldIng Dop rtmer Rental Permit Fee $300 (Application must be renewed every two yearglown of Southold Section A. �C Property Information: Rental Property Address: Tax Map Number: 1000 SECTION d67. o y _-M LOCI N 00 -LOT SECTION B. OWNER INFORMATION: Property Owner Name: W Property Owner Legal Address: Property Owner Mailing Address: � .� r 1 k)(UJAiA, c?irl- �5,,20 03914 Telephone Number (s): Daytime Eveningk-f Emergency t� Property Owner Email Address: RJ f) ,C A hjATT+&u5 /q 3-7 Ca Ra 6-e ies',�o q Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized g an :Agent of dwelling unit if g Y Address of Authorized Agent (no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number(s): Daytime /ening Emergency Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent (no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number (s): Daytime Erne�ing� Emergency Email Address: SECTION E. SITE MANAGER INFORMATION:(required for rental grope t/essc con taining 8 or more rental units) Name of Managing Agent of dwelling unit if any: Address of Managing Agent (no P.O. Boxes): Mailing Address of Managing Agent: Telephone Number (s): Daytime Ev ning� __ 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: allowed to occ upy Dwelling Un : Requested Maximum number of persons a py g Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: 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 3 of 4 A UA)f 1 room I unAP M0 AOL4 L4 I. SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit STATE OF NEW YORK) ) COUNTY OF SUFFOLK) I A A)6 �5 o MA-I-TPC64 certify under penalty of perjury, the following: weWjl A 1. PIM 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: V IlUi Property Owner's Signature: Sworn to before me thisL-7 day of kAGrGk . 20 Lf:) Official Notary Pry .c Si ature and Original Vofary Stamp FRegistration CE'-AUFENANGER DARCEE AUFEN.--,,•: PUBLIC,STATE OF NEW YORK NOTARY PUBLIC,STATE OF C , '�� No.01AU0019644 Registration hlo. 01AU0019�:_,f alified in$uff�ik CountyQualified in Suffolk County sion Expires January 9 028 Commission Expires January 9, 20`81 Page 4 of 4 TO N OF SOUTHOLD BUILDING DEPT. ° W � 631-765-1802 VTOL -.* T -- 7 1 N S O wo%C'ok T 1O N [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND j ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY j ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI L) [ ] CODE VIOLATION j ] PRE C/O [ RENTAL � r DATE 1NS ECT0 "KK Telephone(631)765-1802 Town Hall Annex Fax(631)765-9502 54375 Main Road R 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 luiiured for Architect or En ineer Licensed Home Inspector must rovide copy of valid current certification Rental Property SCTM Number: 1000-67-7-3 Rental Property Address: 25 Miami Ave, Peconic Owner/Name: William Henry III&Anne Matthews 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#1-123sgft., Bedroom#2-123sgft., Bedroom#3(Master)-204sgft. Property Description (Include all improvements indicated on survey) 1 1/2 Story frame dwelling, bluestone driveway,Wood curb,outdoor shower, stockade fence,frame 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 Y Late, the Fuel Gas Code of New York State, the Fire Code of New York State,the Property Mainten C de of New York State and the Energy Conservation Construction Code of New York State. Anthony Portillo, RAC Print Name and Title � � ��,� �� �'r , � inal Sign t f Please place Professional Se 1, TOWN OF SOUTHOLD PROPERTY RECO OWNER, I STREET s VILLAGE DIST.1 SUB. LOT ! - FORMER OWNER N E ACR. no c I S \N TYPE OF BUILDING I - RES.'; - SEAS. VL. FARM ¥COMM. CB. MISC. Mkt. Value LAND IMP, TOTAL DATE REMARKS I ; P AF�9 - _ - _ � n A BU�. N, ON{ I N - - f t NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre Tillable 1 Tillable 2 j Tillable 3 I Woodland — I FRONTAGE ON WATER I Swampland FRONTAGE Brushland FRONTAGE ON ROAD I � DEPTH House Plot I BULKHEAD I F v . DOCK Total j I - - COLOR I 6 s f i TRIM - ' I � �A [ i I -4_ s -------------- I ,r I � F l 3 I I € $ �✓ B t i M, I Zb�3 Foundation I i Bath 7 Dinet Basement �L ��i� K. f i Floors K i Extension s _ - € Ext. Walls Interior Finish c, LR. i ` Heat I1� i z� Fire Place Extension DP 4i ^' ; Type Roof i - ; Rooms 1st Floor BR. g Porch Recreation Rote Rooms 2nd Floo FIB B -� g — I - --i' i Dormer Breezeway _ 1 Driveway Ga rage 1 Patio I I i /5 Total FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. . . . . . 15 8. . . Date . . . . . June 25 , 1987. . . . . . . . . , THIS CERTIFIES that the building .ONE FAMILY DWELLING WITH ATTACHED WOOD DECKS ' , Location of Property 50„Miami .Blvd, . & Mill Road Peconic , N.Y. County Tax Map No. 1000 Section . .6 7. . . . . . . .Block . . .07. . . . . . . . . .Lot 3. . . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated Sept a mb e r 2 6 , 19.8.6. pursuant to which Building Permit No. . .1.5.3 4 7 Z . . y . . . . . dated S e p t e mb*e r 2 6 , 198 6 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 WOOD DECKS AS APPLIED FOR g The certificate is issued to . . . . DAV I D C I. H AN O. I C 2 . . . , . . . . . . . . (owner,7g „" of the aforesaid building. Suffolk County Department of Health Approval . . . . . .8 5-SO-2 5 0 . . . . UNDERWRITERS CERTIFICATE NO. . . . . ` M . . « µ .N. 9 6 0 0 8 . . . . . . . . . . . . . . . . PLUMBERS CERTIFICATION DATED: April 14 , 1987 � . . . , . . . . . . . . . . . . . . . . . . . . Building 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 Nos Z-27290 Date; 09/05/00 THIS CERTIFIES that the building ADDITION Location of Property: 2315 MILL ROAD PECONIC (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 67 Block 7 Lot 3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 20 1999 pursuant to which Building Permit No. 26148-2 dated NOVEMBER 10 1999 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 ADDITION & DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to WILLIAM & MAUREEN HIGGINS III (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH ]APPROVAL N/A ELECTRICAL CERTIFICATB NO. 40115� 01/10/00 PLUMB]= CBRTIFICATION DATED N/A utho zed Signature Rev. 1/81 .... .... .� �. �....., _ .... �� -._. ... .. . ....�.��.m,. _� _ ......._ - l .-.... .... ......u... � ... __ ...... ....� 1 i__ .... . _� ....... .. .... � _�_z. .....:: _...... ..� .... �m� _. ��w. j..::. ... ..... ._._ �� �....... �.. .... .. .....�.� . . .�.�... :...,_ r �...� .. . .__�_ �.,,.�._ m_. �.. �� ? . ... ... ... .. .. .m �u__ _ r ��... . ..... ___�-- .a... �__, __�_. r � - .... _ .� .. ...��.. 6 . .. . .... _... _ �.... .._. . .... �.. .. ���.,. ... ...m......, ._ �� -- . .. ..._i— _.,_ . ��........ ,,.,,�m p V, �.�. . 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