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HomeMy WebLinkAbout1000-53.-2-23 of so TO N OF SOUTHOLD Rental Permit 1296 Owner: 180 Kerwin Blvd LLC Occupied as: Single Family Dwelling Located at: 180 Kerwin Blvd Greenport 53.-2-23 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: 04/30/2025 An' Expiration: 04/30/2027 Codelipf o44 merit of f i4d, This Notice must be posted by the main entrance at all times [� GEOVE i A N 2 1 2025 TOWN OF SOUTHOLD—BUILDING DEPARTMENT IN, 11 l Department Town Hall Annex 54375 Main Road P. O. Box 1179 Southold.NY 119 o Southold Telephone (631) 765-1802 Fax(631) 765-9502 Imes:r'i� � �.w.kc�w �o-ua��la1�d�����r► � �� /4 --� Ole C-If RENTAL PERMIT APPLICATION Rental Permit Fee$300(Application must be renewed every two years) Section A. Property Information: Rental Property Address: LiLi Tax Map Number: 1000 SECTION 053 ; 06d -BLOCK Z -LOT O23- 600 SECTION B. OWNER INFORMATION: Property Owner Name: C1y I Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 18 0 ,(ZrW1r1 LL CI :IY"d Avol por-4- LH � l - SS; 9 L'i1 Telephone Number(s): Daytime Evening Emergency Property Owner Email Address: rV ,. Page 1 of 4 Section C. Authotized Agent Infbirmatiori.: Name of Author,ized AgL%.ht 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: Clp-,�e- CICT-D Address of Authorized Agent(no P.O. Boxes): '� 4M.K) Mailing Address of Authorized Agent? =x,n N-N,4�W L-,zne , ,AfmncA Telephone Number(s): Daytime_l\ SS�I­EveniNn\\ Emergency Email -�Address: .-�\e-s�c�V� 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 NuTnber.(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: Use and Dimensions of each room in Rental Dwelling, Unit: d i, 'JZ/1--7) L SECTION � � ('" i f � � tm, INSPECTION. tf 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 tV_el,ws adopted by the New York State Fire Prevention and Building Code Council. am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ lam 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 dwellingUnit. STATE OF N E.W YO R K) COUNTY OF 5UPFOLK) N1 (J following: w �� -- , certify under pen�lty of p6rjury,the 1. 1 am the owner of the property identified 1h "Section ectio n A"'o.f this'a pp' 'flication. 2. The property owner's legal address set forth in "Section B"of this a0plication is my legal address and I understand thieTown will use the address for service pursuant to all applicable laws and rules. I futther 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)buslnes!i days s to:ariy change to the ififormation regarding Authorized Agent, Manag.iri'g Agent, or Site Manager, Property ownees Name: Prop*erty Owner's Signature- Sworn to beforg m this day of Aamk(ov'(� . ......... 20 Official Mt.a(y PU6)ic'Sige re and originail N'ptafy.-Stamp tqiwav,*V.20 Page 4 of 4 pE so TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 S 3-a_a3 INSPECTION [ ] 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 (F AL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL C1f soFlT r`r TOWN OF SOUT'HOLD BUILDING DEPT. * � 631-765-1802 �;-3_ 2 INSPECTION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI `L) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: L:o&P-14 94-A� �� ©�• � - de.w L mr`ry r � E Town Hall Annex " Town Of Southold 54375 Main Road C2, Rental Inspection Report PO Box 1179 40 i, Southold, NY 11971-1179 Tel: 631-765-1802 w SCTM# >5d ! LL Date -oL Owner Phone Address Visible Hamlet Q Inspector Floor Level Quantities Sub 1 2 3 Smoke Detectors(not located in bedrooms) Carbon Monoxide Detectors Fire Extinguishers Exits Bedrooms 1 2 3Z 4 5 6 Smoke Detectors Egress Occupant Count Building Systems Maintained&Operational Condition of Property Heating Building interior Hot water Building exterior Electrical Property clean, maintained&safe Mechanical lHandrails&guards installed&secure Pool Safety Pool on Site Surface water alarm Date of CO issuance Door alarms Pool completely enclosed Self closing/latching gates Pool fence to code requirements'" CO's for all items present Prior Rental Comments: / / S 1 OWNER STREET tVILLA�E - DISTRICT SUB.E LOT I � F OR ER OWNER E N ACREAGE � C = f� e 4 IG %`,-p✓�r>l F't:r #'? =1 S W TYPE OF BUILDING 5 ; RES. i SEAS. VL. FARM COMM. IND. I Ca. I MISC. . LAND IMP. TOTAL DATE REMARKS a / n 1 J h. r r : s F _f 0 as 6b C, V . [MG oil L �- d . t x LEW r o ® � �L� L O yE �eOn + - Farm Acres _ ',,vql Pe Acre °� C Tilab `) too -4 '7o0 ec��_ Tillablg 3 - -r Woodland i in Z5 _ v - tom= Swampland Brushlond r House Plot i - _:� �G eT_' Tcto l - r r } _H1 i { 2460 1 I I 53:2-23 10/06 — pry: t t t = M. Blcg. , : - �c», u � rt?�� Foundation I Both - Extension,' 'r ,� i � Basement Floors �; ;;✓ ten ' n - — �' � Ext. Walls J Interior Finish _ A A X c r (s�fled Extension m s Fire Places I Heat t Porch bj m; Attic e� _ t IJ Porch Rooms 1 st Floor i f f � Patio Rooms 2nd Floor Garage ro I � P Floor L �t �. Smoke Detector Bathroom _ Combo Bedroom Detector Dining Room Mud \ �,.„ Garage Room �y Door Kitchen Door �� Bedroom ar \. a \ \e 4 2nd floor 111 Floor ze \ � Bedroom Smoke Detector Bathroom �` e Combo LBedroom Detector - �. ItDining Room ti v r Garage Kitchen i Door a x Door _ a� m w�a =James. a� - - _ � �— ��w� ..y. . . . . . . Bedroom PRO ME e ygggg _ 2"d floor