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Home My WebLink About1000-87.-5-23.2 Rental Permit 1297 Owner: Hillman J Revoc Trust Occupied as: Single Family Dwelling Located at: 8340 Main Bayview Rd Southold 87.-5-23.2 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. 1---7 Issued: 05/01/2025 1 Expiration: 05/01/2027 ode E+Jementioffgial This Notice must be posted by the main entrance at all times I� TOWN OF SOUTHOLD—BUII,DING DEPARTMENT L Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax(631) 765-9502 Litt.s:/L% outholdtoxvE {� u W E " F APR RENTAL PERMIT APPLICATION polldI r)qnartment Rental Permit Fee $300 (Application must be renewed every two yew' n 6f Southold to011Ta Section A. Property Information: Rental Property A�re Tax Map Number: 1000 SECTION �7 -BLOCK -LOT 23 - 2— SECTION B. OWNER INFORMATION: Property Owner Name: f?lt Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) p 1 e we S -' 34'4S Telephone Number(s): Daytime � - 6 ` Evening Emergency Property Owner Email Address: GIN </ 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: j Name of Authorized Agent of dwelling unit, if any: (;XQ G' / Address of Authorized Agent (no P.O. Boxes): �� /�Oale- /V YI[G171 Mailing Address of Authorized Agent: >�� ?0 Y 2- efea 7 Telephone Number(s): Daytime PE ing 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 on Units 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, C);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." -1y)Rental Dwelling Unit Identifier: f N�e S/ ! � #f t Requested Maximum number of persons allowed to occupy Dwelling Unit:ilk Number of rooms in Rental Dwelling Unit: l D Use and Dimensions of each room in Rental/Dwelling Unit: AO v er /r /0 ' �'f?aS r'a lGf�Or►} / �' / i4 !d'�/N I'?70K� t/ / �aroo4pkl 2- Iq '6 "y // 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 0 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) 1t 1 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. ✓ p ' Sw to bef re me this day of 200-5 Official Notary Public Signature and Original Notary Stamp LORI LEENotary Public. A ftin2�- Pt�Eiic� STATE OF DEL W RE My Oaxrrtwrni si r�Exile 0 -21_2026 Page 4 of 4 rat S0G y TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 NA P E C T O N [ ] 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 (FINAL [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL f-p, �� 9 �~ 1!1 REMARKS: �� FA Town Hall Annex � 5 Town of Southold 54375 Main Road Rental Inspection Report PO Box 1179 zz Southold, NY 11971-1179 Te1: 631-765-1802 SCTM # Date Owner Sh (e,s Phone Address F356 v/e-c..) Visible Hamlet sp Inspector Floor Level Quantities Sub 1 2 3 Smoke Detectors(not located in bedrooms) Carbon Monoxide Detectors 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 tProperty 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 113ool fence to code requirements CO's for all items present I Prior Rental COMM OU ;; TOWN OF SOUTHOLD PROPERTY OD CARD OWN ER s RE _ VILLAGE � DIST, B, LOT tL ` it ir Rd i S ver yet w ' TYPE OF BUILDING RES. SEAS. VL. FAltlwl - GGARM. MILS. Mlct...Yal _ T LAND IMP. TOTAL DATE REMARKS Alt C ih E - -e IST L K I ct== yi TIII+ Ie FRONTAGE ON WATER � x E Woodland FRONTAGE ON ROAD _# c- Meadawland DEPTH House PIS BULKHEAD - Total COLOR TRIM r 87 i } _ - n ' Ei^'y a z 3 s _ ..e r i M. B f # = [ i Extension _ - � Extension i I i f I E Extension f I e c - X ��= q Foundation Both �/� Dinette Porch 3n 1� Basement Floors I<. Porch - Ext. Walls 3 Interior Finish LR 5. - - Breezeway Fire Place Heat I I D R. 1 Croe - _ . Type Roof I Rooms 1st Floor cL 16R. _: LI In Patio 3 Recreation Room Rooms 2nd Floor 3 FIN. B _ O. B'_ rmer I Driveway I Total t I a FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No E-22894 Date MARCH 10 1994 THIS CERTIFIES that the buildin xxv D ING Location of Property, 8340 MAIN RA ECM RD. SOUTHOLD NEW YORE House No. Street Hamlet County Tax Map No. 1000 Section 87 Block 5 Lot 23.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 29y 1989 ____pursuant to which Building Permit No. 14206-s dated AUGUST 16 198S 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 ORB FAMY DMULLING Vim GARAGE UNDER k ATTACHED DECK AS APPLIED FOR. The certificate is issued to RUSSELL SILL (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 65-SO-101 MAR. 1 199 UNDERWRITERS CERTIFICATE NO. H-0390SO - JANUARY 14, 1994 PLUMBERS CERTIFICATION DATED JAN. 18 1994 - K" PLUMBING rx HEATING ui ding Inspector Rev. 1/81 a 1 E FIwA. i 17 1 S So` - 3 s - a ROCIA ZW o 17�t 2q ffi JI qG _ i L L�,:11 e. 0 . 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