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Home My WebLink About1000-51.-6-38.2 of so SOWN OF SOUTHOL Rental Permit Coy 1311 Owner: Sewell JW & MS Revoc Trt Occupied as: Single Family Dwelling Located at: 2255 Mill Creek Dr Southold 51.-6-38.2 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: 05/13/2025 Expiration: 05/13/2027 Codeqe t Official This Notice must be posted by the main entrance at all times �unr " TOWN OF SOUTHOILD—BUILDING DFPARTMENT " Town Hall Annex 54375 Main Road P.0. Box 11.79 Southold, NY 11971-0959 Telephone(631)765-1802 Fax(631)765-9502 I�tt :�/ aw�,suthc>1dtcwrw ." RENTAL.PERMIT APPLICATION q p Rental Permit Fee$300(Application must be renewed every two bears) ..,. ��4 I ('1, kA Oct G 4' Section A. Property Information: Rental Property Address: 2255 Mill Creek Drive, Southold NY, 19971 Tax Map Number: 1000 SECTION 51 -BLOCK 6 -LOT 38 _.2 SECTION B. OWNER INFORMATION: Property Owner Name: John and Maryann Sewell Revocable Trust Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) c/o Michael P. Sewell c/o Michael P. Sewell 4438 Ellicott Street NW 4438 Ellicott Street NW Washington DC 20016 (703) 347-4854 202 486-1648 703-812-2454 Telephone Number(s): Daytime Evening Emergency Property Owner Email Address: 7614bills@gmaii.com 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: Henry Santacroce Address of Authorized Agent(no P.O. Boxes):2520 Pine Tree Road Mailing Address of Authorized Agent:Cutchogue NY Telephone Number(s): Daytime 631-236-339%vening Emergency Email Address: henrysanta1 a@icloud.com 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: 1 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: 2255 Mill Creek Drive Southold NY Requested Maximum number of persons allowed to occupy Dwelling Unit: 6 Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: Master bedroom 12 x 17, Bedroom 2, 13 x 10, Bedroom 3 13 x 10, Living Room 36 x 14, Kitchen 23 x 14 Office 13 x 16 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. 1 am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ I am submitting a completed Town of Southold certification form from a licensed architect or a licensed professional engineer. Page 3of4 SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFOLK) I Michael P. Sewell 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: M c ae P. ewell Property Owner's Signature: Sworn to before 7me thi ay 0;:: 20Z,�`15 Official Notary Sig ftur OLginalotary Stamp Page 4 of 4z . so TOWN OF SOUTHOLD BUILDING DEFT. 631-765-1802I N li" P OEM C T 10 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 (FIN L) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: ARKS: �� C1v SO4t, TOWN OF SO OLDS UILDING DEPT. 6 1-765-181 INS I 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 (FIN ) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL V r d' q4 M ls� � Town Hall Annex ISSTown Of Southold 54375 Main Road Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 444 SUM# — Date M Owner 5cw Phone Address 5-S jM i f Visible Xf VIP Hamlet Seu cL lInspector Floor Level Quantities Sub 1 2 . 3 Smoke Detectors (not located in bedrooms) j Carbon Monoxide Detectors Fire Extinguishers Exits Bedrooms 1 2 " 3 4 5 6 Smoke Detectors Egress Occupant Count ZA1:9— Building Systems Maintained&Operational Condition of Property Heating Building interior Hot water Building exterior Electrical Property clean, maintained &safe Mechanical V 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 Pool fence to code requirements CO's for all items present Prior Rental Comments: TOWN F SOUTH SOUTHOLD PRO (? ' D CARD ? NE�- tC i ;� E STREET VILLAGE - DISTRICT SUB. LOT m a FORMER OWNERS -r�r n '' v N �' I E ,o �� ,r ACREAGE 1 i S W TYPE OF BUILDING ! s , IT RES. SEAS. VL. FARM COMM. IND. I CB. MISC. Est. Mkt, Value LAND IMP. TOTAL DATE REMARKS I l / } _ 1- � � a, l �0_ _ AGE BUILDING CONDITION _ s NEW NORMAL BELOW ABOVE [!FRONTAGE ON WATER i Farm Acre Value Per Acre Value FRONTAGE ON ROAD Tillable 1 BULKHEAD Tillable 2 DOCK s Tillable 3 Woodland Swampland Brushland House Plot = ; l I e Total } •v,TOWN OF SOUTHOLD PROPERTY R� e R VILLAGE STREET' _ DIST. COUNTY TAX MAP NO. 2 , 5 LAND IMP. TOTAL DATE REMARKS: Af ---------------------- F ; F f , 3 F LZ ° _ 3� 32,) a 1 l TOWN OF SOUTHOLD PROPS 7 F QD CARS OWNER STREET ' VILLAGE DIST. SUB. LOT - FORMER OWNER a -- C dR 4 W TYPE OF BUILDING RES. SEAS. VL. FARM COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS � � � cZa � 4, S a- i B 10 I [ ING� (6 0 NEW 1 NOUU1, BELOW ROVE FARM Aare` Value Per Value Acre Tillable 1 ' Tillable 2 3 Tillable 3 Woodland I Swampland I FRONTAGE ON WATER Brushland FRONTAGE ON ROAD House Plot DEPTH i 0 0 BULKHEAD Total DOCK } AA - — - a — - m � COLOR { F i : i I .a 3_ s9 � f Y TRIM +Lf tf i a f r [ [ / 5 — M. Bldg un a i a m Fo t'on d 1 Both Dinette Extension a t Basement ` Floors K. F a e E Extension i Ext. Walls , ; Interior Finish �, - _ LR. Extension e Fire Place Heat DR. Type Roof ; . - Rooms Is Floor € BR. Porch Recreation Roorr Rooms 2nd Floors FIN. B.! Porch - [ Dormer Breezeway 1 Driveway - I 5 . _ CrO Patio 7 , Total - � - 1 — I 0 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29756 Date: 10 02 03 THIS CERTIFIES that the building ALTERATION Location of Property: 2255 MILL CREEK DR SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 51 Block 6 Lot 38.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 3, 2002 pursuant to which Building Permit No. 28405-Z dated MAY 20 2002 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 ALTERATIONS & GARAGE CONVERSION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to MARYANN SEWELL (OWNER) of the aforesaid building.. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 68108C 02/11/03 PLUMBERS CERTIFICATION DATED 09/04 03 CUTCHOG'UE EAST PLUM'B&HEAT k.4 Aut «�P SRO-r:Lzed ignature Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDINGr DEPARTMENT TOWN CLERIVS OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ' . . . Date .. . . . . . . . . . .... . . .. . "... , THIS CERTIFIES that the building located at 4mA4J11jCrajek. D:Vi :e.. . . . Street Map No. .),. . . . .. . Bloch No. . . . . .=. . .Lot No. XX.. . . . ., Q1d$. . .N.*Ys. . . .. . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . .. .. . . . ,AU9U$t. . .2.. ., 1963. pursuant to which Building Permit No. ...21.39Z dated .. . . . .... .kUg St• . 2. . ., 1963. •, 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 . JP31'.V4tA .QAa. ;CAMJJ.Y.AVOning. . . . . . . . .. . . . .. .. . . . . . . . . . . .. . . .. .. .. . . . . . The certificate is issued to . .aAn$1car. .`Zak,. •.0=er•• . . .... . •... ..... . . .• . .. . . .. . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . . .17/ .11 .{. 65. . .Andres . . . . . .. • . . . • • . Building Inspector Floor Plan for: 2255 Alill Creek Drive a � - - - - - - - - - - - - - - - - - Southold, NY 11971 smoke detector t front porcb Master Bedroom 12 x 17 — — — — — — — — — — I • ti Bath o F = 3 closet 3 Office _ 13 x 16 t 2 i Bedroom Kitchen 13 x 10 as Hall 23 x 14 osei smoke A €j detector smoke ; 11 �=pa detector closet - dft ;smoke/CO close los closet =doset detector NA laving Room ' 36 x 14 ` `' Bedroom 3 ; ` L � - - - � - - 13x10 smoke detector F a — — e — — aa — a — m — — _ — — _�: - — - - - - - - - - - - - - - - - - - - - - back stepsIt a ._ note: Additional smoke/CO detectors in roof crawlspace and basement