HomeMy WebLinkAbout1000-9.-9-26.1 Rental Permit
- 1308
Owner: Robert Anthony
Occupied as: Single Family Dwelling
Located at: 3913 Equestrian Ave Fishers Island 9.-9-26.1
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: 05/09/2025 `
Expiration: 05/09/2027 Code Enforcement official
This Notice must be posted by the main entrance at all times
2S
TOWN OF SOUTHOLD—BUILDING DEPARTMENT re—C !()CJ
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 h tWS w AyNy.sout1jo dtq. r a ,gy
RENTAL PERMIT APPLICATION
Rental Permit Fee $300 (Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:ess:
.- e � � I-�� plc r1 62 6
Tax Map Number: 1000 SECTION -BLOCK -LOTL -
SECTION B.
OWNER INFORMATION:
23 0
Property Owner Name:
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
Telephone Number (s). Da i'me Evening Emergency
-r
Property Owner Email Address: ° °
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): LID1 r l
Mailing Address of Authorized Agent:
n(
43601 9 90
Telephone Number (s): Daytime Evening Emergency
Email Address: 'i (cA ) -L
Section D.
Managing Agent Information:
Name of Authorized Agent of dwelling unit, if any: d. Cca
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:
Telephone Number (s): Daytime Evenine Emergency
Email Address:
Page 2 of 4
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on property: Y1'�L
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: y lrl
Requested Maximum number of persons allowed to occupy Dwelling Unit:
Number of rooms in Rental Dwelling Unit: 7L
Use and Dimensions of each room in Rental Dwelling Unit:
4
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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 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)
I )-(- � LA) . , 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:
Sworn to before me this 20 day of 20
Official otary Public Signature and Original Notary Stamp
JASON K DRENA *� e �
Qualified in Suffolk County
helot sry PwaWi I w C Of P lfy "YOlt
fr 9 l fa 'bCf+that �q C A PG I
My commission Eafdtw µ ffaa°dmlaer CST»2026 •,�
+. (P«* P ell"h 0 4.
Page 4 of 4 *
Town Hall Annex � � ��� q Telephone(631)765-1802
54375 Main Road N -1�2
P. O. Box 1179
Southold, NY 11971-0959 �w
M
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION ADDENDUM
Rental Dwelling Unit Identifier: Q rt i
Requested maximum number of persons allowed to occupy each dwelling unit: "
Number of Rooms in Rental Dwelling Unit: " I
Use and Dimension of each room:
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Rental Dwelling Unit Identifier:
Requested maximum number of persons allowed to occupy each dwelling unit:
Number of Rooms in Rental Dwelling Unit:
Use and Dimension of each room:
Rental Dwelling Unit Identifier:
Requested maximum number of persons allowed to occupy each dwelling unit:
Number of Rooms in Rental Dwelling Unit:
Use and Dimension of each room:
TOWN O SOL�lTHOL D E UIIL..IDING DE PT.
631-765-1802
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 (FIN )
[ ] CODE VIOLATION [ ] PRE C/O [ RENTAL
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Town of Southold
P.O. Box 1179
53095 Main Rd
Southold, New York 11971
.. ........
CERTIFICATE OF OCCUPANCY
No: 45758 Date: 11/18/2024
THIS CERTIFIES that the building ADDITION/ALTERATION
Location of Property: 319 1 Equestrian Ave Fishers Island. NY 06390
Sec/Block/Lot: 9.-9-26.1
Conforms substantially to the Application for BuildingZ--
Permit heretofore, filed in this office dated: 10/01/1997
Pursuant to which Building Permit No. 50622 and dated: 05/03/2024
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 and alterations, including covered porch, to existing single family dwelling as
applied for.
The certificate is issued to: Robert Anthony .............
Of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL:
ELECTRICAL CERTIFICATE: 47336 04/16/2024
PLUMBERS CERTIFICATION: Matthew Kolodnick-i 10/24/2024
Auth rized Signature
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