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HomeMy WebLinkAbout1000-40.1-1-16 s � OWN F S UTHOL Rental Permit 1294 Owner: Robert L. Mills II Occupied as: Single Family Dwelling Located at: 1565 Calebs Way Unit D 16 Greenport 40.1-1-16 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: 04/27/2025 Expiration: 04/27/2027 Code Enfor ent Official This Notice must be posted by the main entrance at all times �.1 � TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O.Box 1179 Southold,NY 11971-0959 Mz3t_/09 Z Tele phone (631) 765-1802 Fax(631)765-9502 ht[12-:f,�w �r.su�:h�aldto.)Y!m . I hill A P R 1 7 202 RENTAL PERMIT APPLICATION BuRdIng Department Rental Permit Fee $300(Application must be renewed every two years) Town of Southoi Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION _ o / -BLOCK SECTION B. OWNER INFORMATION: Property Owner Name: t '— Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) S 3 Z V t 9 3 9 AE44 r /G.44u o.-- N Telephone Number(s): Daytime Q 1 '466'lte�<ning Emergency Property Owner Email Address: A s4i 11S e;> o e-1— y Page 1 of 4 Section C. Authorized 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 Evening 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 ivening 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: 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: &--rc L-1 ��►� cP + N� Use and Dimensions of each room in Rental Dwelling Unit: u trcofu1i !7, 133 f;K -c .33' L10 Rom, 132 f#I /3 Zr" 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) l , r Z— A416 `� , 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: � ► .. + « ��/�a -,E � r Property Owner's Signature: Sworn to before me this n day of r� 1 20J howrpwft stab of M w%* Na OIWMI4040 Official Notary Public Signature and Original Notary Stamp OW4Iaal#AO alk � W 60d Page 4 of 4 Town Hall Annexf � �� +�� Telephone(631)765-1802 54375 Main Road "" Fax(631)765-9502 P.O. Box 1179 Southold, NY 11971-0959 „z. e 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 required for Architect or Engineer, Licensed Horne Inspector must rovide co2y of valid current certification Rental Property SCTM Number: 41011 6 Rental Property Address: 44 1lix Owner/Name: a 4zj T .L ' l V1 P-1 Rental Dwelling Unit Identifier: /V/ Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 —100 sqft., Bedroom#2—90 sgft., etc.) Property Description (Include all improvements indicated on survey) 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 uwel Gas Code of New York State,the Fire Code of New York State,the Property Maint a Code of N w York State and the Energy Conservation Constru w f New Yor te. i r' �It Print Name and Title >N rigi ignature 0 Please place Professional �Il: 410. SQ1 TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 vlo. / — /—/�o IN-b" PECTION [ ] 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 (FI AL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: ��ti � DATE INSPECTOR TOWN OF SOUTHOLD PROPERTY RECORD CARD � V R STREET �� ' VILLA DIST SUB. LOT q 4 a - ACR- MARKS " 1 = r.- T YPE OF BLD PROP. GLASS , ti LAND IMP. TOTAL DATE / _ ` , �� � i r oa FRONTAGE ON WATER TILLABLE I FRONTAGE ON ROAD WOODLAND DEPTH MEADOWLAND I i BULKHEAD HOUSE/LOT TOTAL i , SCTM # 1 f (Oo O TOWN OF SOUTHOLD PROPE.. . BARD OWNER STREET ( S�' ��° VILLAGE DIST_ SUB. LOT . R ACR. REMARKS Ai - -T-_ tj TYPE OF BLD_ PROP. CLASS c a(��€� F` i 1 fyo LAND IMP. TOTAL DATE � sE � 2 q Z Z M zoo 5 ' FRONTAGE ON WATER HOUSE/LOT BULKHEAD TOTAL ` \ \\ 1e. w , I [[ M. Bldg, Foundation C© Bath Dinette FULL [= Extension ! Basement CRAWL SLAB Floors Kit. I Extension Ext. Walls Interior Finish L R- Extension Fire Place Heat D.A. Patio Woodstove BR- Porch Dormer Fin. B, Attic Deck Breezeway Rooms 1st Floor Garage Driveway Rooms 2nd Floor O.B, Pool t •t FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 5-25281 Date SEPTEMBER 24, 1997 THIS CERTIFIES that the building MULTIPLE RESIDENCE Location of Property 1565-D16 CALRBS WAY GREENPORT N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 40.1 Block 1 Lot 16 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 23 1995 pursuant to which Building Permit No. 22686-8 dated APRIL 19, 1995 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 16D - MULTIPLE RESIDENCE - COMPLEX "D" AS APPLIED FOR. The certificate is issued to MOORES LANE DEVELOPMENT CORP. (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-10-95-0011-JAN. 19 1995 UNDERWRITERS CERTIFICATE NO. N-425032 - JULY 9 1997 PLUMBERS CERTIFICATION DATED JULY 31 1996-DOOLEY PLUMBING & HEATING //,Au Iding Inspector Rev. 1/81 Floorplan ApproxirnAtaly 1206 st tolAl 16 CAI-64 ujqx- Room— mom EE7 I IMMUMENIM Savo" WPM Krichen D GffT It;0 CKM "I w0 + oa BWhron,n LMN barn syko-itc 0.)-IRM -L*:V uz�QLMYW A*7— n It %F ...................................--------------- ........ ............... Floorplan Approximately 11 4A sf total ........... 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