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HomeMy WebLinkAbout1000-116.-2-26 o TOWN OF SOUTHOLD Rental Permit 1310 Owner: William Rich , Elizabeth Bourne Occupied as: Single Family Dwelling Located at: 500 Meadow Ln Cutchogue 116.-2-26 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: 05/15/2025 Expiration: 05/15/2027 o m ntOfficial This Notice must be posted by the main entrar a all times � 6 ' TOWN OF SOUTHOLD—BUILDING DEPARTMENT �on �., � Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax(631) 765-9502 lit , ://'ww . otil iol.dtowii RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two yeors),;,, 1 09 UI Section A. Property Information: Rental Property Address: I Ict Tax Map Number: 1000 SECTION 116. 00 -BLOCK 02.00 -LOT 026 - 000 SECTION B. OWNER INFORMATION: Property Owner Name: W < < ` 4C a ✓o e Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) e uJ r 1< Telephone Number (s): Daytime 117-41 -266 Evening Emergency Property Owner Email Address: `� ti 1I '► C. 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: A- Telephone Number (s): Daytime Eve ng Emergency Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: {{ Address of Authorized Agent (no P.O. Boxes): N Mailing Address of Authorized Agent: Telephone Number (s): Daytime Ev ning 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): �j Z Mailing Address of Managing Agent: 4 Telephone Number (s): Daytime vening _ 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, 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." Rental Dwelling Unit Identifier: 600 HC40 W LA t~ �. Requested Maximum number of persons allowed to occupy Dwelling Uni Number of rooms in Rental Dwelling Unit: S. Use and Dimensions of each room in Rental Dwelling Unit: kir ► iN►NCB �M. ib-�" 1S - av� 1 .Pb,. 17-8" u y L11 1 o" c, N7�8. ► 13`-cl"x 12-7.. 1 12-O 0 d 12'-11 / " 3 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 �[ 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 '%\V %A M 9,11ic V, 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 day of E,4py 202 Official Notar Public Signature and Original Notary Stamp BRIAN A. ANDREWS Notary Public, State Of New York No. 02AN5014509 Qualified In Suffolk Coun Commission Expires 07/15/ "t Page 4 of 4 Town Hall Annex k Telephone(631)765-1802 54375 Main Road � P. O. Box 1179 Southold, NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: Requested maximum number of persons allowed t ccupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: ZA Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to cupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: A Rental Dwelling Unit Identifier: Requested maximum number of persons allowe o occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: +` Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax (631)765-9502 P. O. Box 1179 ' Southold, NY 11971-0959 ` BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a licensed architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Professional seal rea auired for Architect or Engineer, Licensed Home Inspector must provide copy of valid current certification Rental Property SCTM Number: 1000 - 116.00 - 02.. - 02-6.000 Rental Property Address: I Owner/Name; 1=61'A M fZ1 Rental Dwelling Unit Identifier: 0 t c� t 2 Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 - 100 sqft., Bedr cam#2-90 sgft., etc.) 17 StL. r-4 #;Z ISO 6 3 Property Description (Include all improvements indicated on survey) x r~ash S ck—" s�.ps 'rvB � vrzj-, Javts ? r Iv�wa , I certify that I havdone a physical inspection of the subjec rental dwelling unit and n that it fully complies with all the provisions of the Code of the Town of Southold, the Residential Co a of New York State, the Building Code of New York State, the Plumbing Code of New York State, the I Gas Code of New York State, the Fire Code of New York State, the Property Maintenance Code of Ne and the Energy Conservation Construction Code of New York State. „w iN j— Roogkr i Print Name and Title Original SignatureNN, m c Please place Professional Seal: Cs TOWN OF SOUTHOLD BUILDING DEPT. 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 (F AL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL RED A IKS'i: ro l i ► E INSPECTOR TOWN OF SOUTH OLD PROPERTY RECORD CARD ........ OWNER ,STREET VILLAGE DIST., SUB. LOT V zap FORMER OWNER f ( N E ACR.Jf ZT 'Az S W TYPE OF BUILDING ti RES SEAS� VL. FARM COMM. CB. MICS. Mkt- Value . LAND IMP, TOTAL DATE REMARKS C- -z Is�-JIJ "4 -7 j� 'Kr c Y f 7 -- 1 0 0 r ---LL, r AGE BUILDING CONDITION 4­t A Jr J A -r Ze NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH House Pic BULKHEAD Total DOCK - 1Y , 4 a R s R TRIM - � i t i 3 € t " - i k r.L, _ 116.-2-26 3/08 M. Bldg. O i 60 �� K Extension — } , Extension <yp y6z7f L,Oo i a , i { Extension '0 ;Foundation PL °Bath _ I Dinette �- Porch 66{4, y s 996 Z/ .Basement F��� ;Floors K. - - Porch f '' Ext. Walls Interior Finish Z- �f'� LR. - A R eezewa - ea Fire Place }Ht - !DR �' I�t� i age _ iType Roof - Rooms 1st Floor E BR. w o Recreation Room` Rooms 2nd Floor ; FIN. B I 2117 I - O. B. Dormer Driveway I0 o�UTotal � - O IU,9 � X-?- AVO FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29177 Date: 01/08/03 THIS CERTIFIES that the building NEW DWELLING Location of Property: 500 MEADOW LA CUTCHOGUE (HOUSE NO.) (STREET) (HAMT,ET) County Tax Map No. 473889 Section 116 Block 2 Lot 26 Subdivision Filed Map No_ Lot No_ conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 28, 2002 pursuant to which Building Permit 'No_ 28516-Z dated JUG 28, 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 SINGLE FAMILY DWELLING WITH TWO CARGA'�GE �Et, CO RED PORCH AND 2ND STORY TERRACE AS APPLIED FOR_ The certificate is issued to MARY KAREN LAND (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROvAL R10�97-0064 12/24/02 EIW ICAL CERTIFICATE NO_ 1053541 05/20/02 PLUMBERS CERTIFICATICH DATED 07 08/02 WILLIAM RICH t iced ignature Rev. 1/81 E�701L&P- GY-ROT Ho HEATER. SroP z, < n Y F 5700 MEa.D04,) Gv i cH©r u E �1.'( llq 3 S s.c.T K A000- )16.00 - O:Z.00- 026000 DATF-: �.z�'��a.,202s. t 1 1 D LIv'iti-►G. Room L+n�p-'Y_ (OPOI1 TO ABOVE) I OO GL. W nirE� C1 00 n Do To, s n BED2ooM . �aFW"M ABodV-) 173 5a, FT BAT} PI o up. � _ L P4WTP-1T;� puDr`.RM. !3'.q" 500 me-m)ow L4wp GUTGNOGU F- �. .'�, ��a35, sc,T. M. 1000- 1« 0. o. - 02.00 -o2b.� Dt,TE 22,'OFEs., 2as z Fi pzsr. FL ooR PLnN p 2O 3 o� o SH EI.VjtJ 4. I 5f�F ELJ��.iG, r�=54" GL GL. Op F.lJ $6L0 W. M BE BROOM 3 SHCLVtN4, O I I" 5Q-FT. f SP. 3s1 5Q FT o S,D.1G.o, r It �SD. cuSD• e f Dung Y e 0 a� 4c1A1TEQ, l7 r 4.. b BEDROOM 2, ISO 30L, Fr. 0 BATH. OPE{J TO SE-Lot') W. 1.C. .� ' �J BATH, ct,. c�. �T L�L 50Q MEaDo4J La1 F. GUTGNOGUEr R, 11935 s.c.T.M, 1000 - 116.00 =02.00- 02b.000 DAB: 22.'Fco,, 202.5, 5F-co�4D FLooP. FL4,�3 . p3°r 3_