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Home My WebLink About1000-78.-3-19.2 of so TOWN OF S UTH L Rental Permit CO 1298 Owner: Alexander Nyren , Kimberly Rittberg Occupied as: Single Family Dwelling Located at: 630 Nokomis Rd Southold 78.-3-19.2 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 arranging for the bi-annual inspection. Issued: 05/02/2025 Expiration: 05/02/2027 Cqkie E fo ement Official This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD— BUILDING DEPARTMENT Town Hall Annex 54375 Main Road 1'. O. Box 1 179 Southold,NY 1 1971-0959 1n Telephone(631) 765-1802 Fax(631) 765-9502 h '. = °� � MIT APPI.It�ATION RENTAL PER Rental Permit Fee$300(Application must be renewed every two years) o 0 0i 01- D& Section A. c � Property Information: Rental Property Address: 630 Nokomis Road, Southold, NY Tax Map Number: 1000 SECTION 78 -BLOCK 3 -LOT 11 9- SECTION B. OWNER INFORMATION: Property Owner Name: Alexander Nyren, Kimberly Rittberg Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 75 Henry Street, Apt#27E 75 Henry Street, Apt#27t., BrooWyn. NY 11201 Brooklyn, NY 11201 Telephone Number(s): Daytime 91° 36,4-44r3 EveningjLL±L!LL Emergency +� Property Owner Email Address: aVexWymyren gmad cony Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit,if any: Krista Jones Address of Authorized Agent(no P.O. Boxes): Mailing Address of Authorized Agent: PO Box 948 Cutchogue, NY 11935 Telephone Number(s):Daytime631-335-8175 Evening631-335-8175 Emergeng2,31-33 175 Email Address: millstonepropertyservices@gmail.com 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 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: Address of Managing Agent(no P.O. Boxes): ,, Mailing Address of Managing Agent: ,...., . ..._..._... ............................o..,.�.. Telephone Number(s): Daytime „ Evening Emergency EmailAddress: mn . .� . .........w........ .o. .. . . ... W . ... „, �a ., .............._ oa.,.mm.,. .�.. .a.. Page 2 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: 1 _ sin Ve family residence �µ 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:tooccupy Dwells g nit: 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. VI am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold O I 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 Kirnbeq Rift erg 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: Kimberl Fli Property Owner's Signature: _ Sworn to before me this day of, 20 Official NotaryPub..�� ... ..._........a.. ,........... ....................� . gnat r and Original inal Notary Stamp , S hqKl�\L F �C yl Notary r-t-iw.s-,lic of New York No 111S0h606, )-19 Qu.ilili a ui COUnty Conimr,-000 Lxuirt)s alan.h d 1,202T Page 4 of 4 TOWN OF SOU THOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. d [ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING FRAMING /STRAPPING FINAL ,(N ,L [ ] [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION I [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: r T" I i I a f i 4 DATA � `f ��%� �' INSPECTOR 1 Ap TOWN F UTHOL �� ER OWNER tA STREET VILLAGE DISTRICT ' SUB. LOT i Pa C-Q- FORMER OWNER _ N E ACREAGE F S W TYPE OF BUILDING RES. SEAS. VL. FARM COMM. IND. CB. MISC. Est. Mkt. Value LAND IMP. TOTAL DATE REMARKS c- F act h[' . /� ck t Pra R � � r AGE 6 -B ILDING CON Cc x I a- s r N ABOVE E� � � T ' 1 116 7I`jE� � Vie FRONTAGE ON ROAD BULKHEAD e _ DOCK Tillable, 3 r - Woodland c t p/` /� s / t w, . Swampland / �r � Brushland I r House Plot iv 04f i Total e SCTM # I p (I I L/ - q�-�3--i-�Z � - TOWN OF SOUTHOLD PROPERTY ) 's 6W—NE f STREET �:_ VILLAGE DIST SUB, LOT 6-1 7 - ACR. / REMARKS �n J � � 3 I e�cct �� frGl.1 TYPE OF BLD r PROP. CLASS I� LAND IMP TOTAL DATE �dUO 7 y� f 3 /y FRONTAGE ON WATER HOUSE/LOT BULKHEAD TOTAL I > � - F s y we { f 3 ?7 78.3-19.2 3/06 e e n z J , M. Bldg �� rZL Foundation �? Bath F -, Extension �`i '� Basement r Floors Extension Ext. Walls Interior Finish -1XP W ' _ Extension � � , Fire Place Neat f PorchRoof Type e - Porch Rooms 1 st Flr Y „ ® V _L,, Patio Rooms 2nd FI nor F Dormer Garage � �� _ . ;� F Driveway Q. B. \I' 7 -1).1� -41 A-11 Al- r ° .' F� - . `�✓ a� �s s TOWN OF SO OLD BUIMING DEPARTMM Town Gwies 01Bee Soud, N. Y. Certificate Of Occupancy No. Date . . . . . . . tT%aY. . . 25. . . . . . . . . .1 19- 70 THIS CERTIFIES that the building located at . . .630. X010MA$.Rom. . . . . . Street ... . . Map No. . - - - . . . . . . . . Block No. . . . . . . . . . .Lot No. . . . . , . . . . . „ . . . . . . . . .". . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . March . .24. . . . . . ., 19.78. pursuant to which Building Permit No. . . 96499 dated . . . . March . .24• . . . . . . ., 19.78., 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 . . . . . . . .Private .One. .ami.ly. .Dwel].ing. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . The certificate is issued to . . . . . . . .Tarus .Homes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (owner, ) of the aforesaid building. Suffolk County Department of Health Approval . . .8•-SO-41. . July.. .25,. .1978L , . . . . . UNDERWRITERS CERTIFICATE No. . . . . . . . M393950. . . . . . . . . . . . . . . . . . . . . . . . . . HOUSE NUMBER . . . . .630 . . . . . Street . . . . . s�QUTA .49i4d , . . . . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . . . . . . . .. . . . . . . . ... . . . . .. . . . . AutlhP142 . IrAr . . . . . . ... . . . B g Inspector �gUFlptrr Town of Southold 2/18/2024 P.O.Box 1179 ' 53095 Main Rd Southold,New York 11971 CERTIFICAFE OF OCCUPANCY No: 45003 Date: 2/18/2024 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 630 Nokomis Rd, Southold SCTM#: 473889 Sec/Block/Lot: 78.-3-19.2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/12/2022 pursuant to which Building Permit No. 48404 dated 10/14/2022 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: accesso in-ground swimming sal fenced t pplied fc r. The certificate is issued to Nyren,Alexander&Rittberg,Kim of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 48404 8/31/2023 PLUMBERS CERTIFICATION DATED .__.. .......... sar e _ ` taattare .... .._._ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31384 Date: 01/11/06 THIS CERTIFIES that the building ACCESSORY SHED Location of Property: 630 NOKOMIS RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 47889 Section 78 Block 3 Lot 19.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 22, 2005 pursuant to which Building Permit No. 31226-Z dated DUNE 24, 2005 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 IN THE REQUIRED REAR YARD AS APPLIED FOR. The certificate is issued to JOHN A & CYNTHIA SWISKEY (OWNER) of the aforesaid building.. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLU14BERS CERTIFICATION DATED N/A tho red ignature Rev. 1/81 FORK! NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31383 Date: 01/11/06 TSIs CERTIFIES that the building ADDITIONS ALTERATIONS Location of Property: 630 NOKOMIS RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 78 Block 3 Lot 19.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 4 2005 pursuant to which Building Permit No. 31115-Z dated MAY 9 2005 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 ADDITIONS & ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JOHN A & CYNTHIA SWISKEY (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 102421C 11/07/05 PLUMBERS CERTIFICATION ]DATED 03./05/06 BURTS RELIABLE Au i71i�64ure Rev. 1/81 ;0 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22995 Dat;e___Aty 12 199 THIS CERTIFIES that the building ACCESSORY Location of Property 630 NAROMIS ROAD SOUTHOLD, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 78 Block 3 Lot 19.2 Subdivision Filed Map No. Lot No.� conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 26, 1990 ursuant to which Building Permit No. 19079-Z dated JUNE 6 1990 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 STORAGE SHED AS APPLIED FOR The certificate is issued to LESLIE GILES (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO.� N/A PLUMBERS CERTIFICATION DATED N/A Buifdlinq Insp for Rev. 1/81