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HomeMy WebLinkAbout1000-145.-4-16 of s 'OWN OF S UTHOLD Rental Permit 1316 Owner: Hasday 2023 Family Trt Occupied as: Single Family Dwelling Located at: 200 Macdonalds Crossing Laurel 145.4-16 Maximum Permitted Occupancy: 4 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: 05/20/2025 Expiration: 05/20/2027 c r tOfficial This Notice must be posted by the main entranc at all 'me 4 TOWN OF SOUTHOLD—BUILDING DEPAR ( ?( r . Town Hall Annex 54375 Main Road P. O.Box 1,179 Southold,NY 11971-0959 Telephone(631)765-1802 Fax(631)765-9502 http :// +ww. outaitltrnny,gov ,", : RENTAL PERMIT APPLICATION 14 Rental Permit Fee$300 (Application must be reneged every two years) Section A. Property Information: Rental Property Address: A I �O D �d Tax Ma Number: 1000 SECTION 1 0� BLOCK fir ` p __� �- LOTS SECTION B. OWNER INFORMATION: Property Owner Name: ?f 11 Jf� VIA S-/l 12,-3 Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 0 Z) M C�CDO tdvj_z� 0%sf/ lJ G— o 60V a °r It� Telephone Number(s): Daytime 1�7�_��- vening .Emergency Property Owner Email Address: C OR179,0©0 .4,r �' LOn n r x Page 1 of 4 q� r Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit,if any: Address of Authorized Agent(no P.O. Boxes): k 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: 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 ontaining 8 or more rental units) an `" Name of Managing Agent of dwelling unit if y: A 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 d SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: pp For each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier(for example, d' 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." i a y Rental Dwelling Unit Identifier: '9'0 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: SECTION G. INSPECTION: Pursuant to the Town Code of the Town of Southold Chapter 247(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. p I am requesting afire 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 I' c SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) ) COUNTY OF SUFFOLK) Cg-p"IG- f�',D'-1 "r�� ``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_Z_Vay of ��_, 20, --CAI Official Notary Public Signature an riginal Notary Stamp CHARLES R.'CUDDY Notary Public,State of New York No.02CU5872225 Qualified in Suffolk Courtly Page 4 of 4 CAwjW%sW Expires Decerrtber 31, '.�Lo _._._w�....w... ......... .... .�. . _. _.... .. ..___.._.._........ .. w .....__. ._�........ .. a..�.� yam ,.,. u 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 required for Architect or ,En ineer Licensed Home Ina actor must provide copy of valid current certification Rental Property SCTM Number: ©00 a I L1 O t Rental Property Address: �� ���`�� re' P-4 10 Owner/Name: Rental Dwelling Unit Identifier- Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 —100 sqft., Bedroom#2—90 sgft., etc.) Property Description (Include all improvements indicated on survey) lI I certify that I have done a physical inspection of the subject rental dwelling unit and find that it fully complies with all the provisions of the Code of the Town of Southold, the Residential Code of New York State, the Building Code of New York State,the Plumbing Code of New York State,the Fuel Gas Code of New York State, the Fire Code of New York State, the Property Maintenance Code of New York State and the Energy Conservation Construction Code of New York State. Eric Peterson, Architect rc c Print Name and Title Original Signature � Please place Professional Seal: µ04 1 s,4 o OF �� >1710 TOWN OF SOUTHOLD S IL G DEPT. 631-765-1802 _ _ INS" PECTION [ ] FOUNDATION 1ST/ 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 REMARKS: CS D#% E INSPECTOR es k; AJ � I �9 p LU 041859 OP ry a w � TOWN OF SOUTHOLD PROPERT J 11�2-q a3 OWNER STREET VILLAGE LOT V ift L- FORMER OWNER rewACR.Ilk Le IS W TYPE OF BUILDING RES. SEAS. VL. FARM I COMM. CB. MICS. Mkt. Value LAND i [MR. TOTAL DATE REMARKS 7� z 00 I 30D Arn, AGE 1 BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre e D5 Tillable FRONTAGE ON WATER mm Woodland FRONTAGE ON ROAD Meadowl.and i DEPTH House PLqt BULKHEAD DOCK Toto I a OLORl�t, � TRIM ,E f � I f - 145.-4-16 3/2014 4+ M. Bldg - e 9• I , Extension [ Extension Extension 2 /6 Foundation C Bath Dinette , - Basement sem Parch Ba . , �/1 Floors i�' v ;-�1e K. Porch ...�-�--•-°-- ��.c-r.� � 2��7 7 '�• Walls Interior Finish LR. w [Fire Place Heat DR. • G � o Katy " a ya /.00 J,�C� sae i !Type Roof p Rooms 1st Floor I BR. �?o fo a f 3 f/ 'Recreation Room �' Rooms 2nd Floor FIN. B Patio / � � -2 I O. B. ;Doer I Driveway I Total Town of Southold 5/20/2025 53095 Main Rd r :' Southold,New York 11971 4, PEE EXISTING CERTIFICATE OF OCCUPANCY No: 46170 Date: 5/20/2025 THIS CERTIFIES that the structure(s) located at: 200 Macdonalds Crossing,Laurel SCTM#: 473889 Sec/Block/Lot: 145.4-16 Subdivision: Filed Map No. Lot No. conforms substantially to the requirements for a built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 46170 dated 5/20/2025 was issued and conforms to all the requrrements of the applicable provisions of the law. The occupancy for which this certificate is issued is: 4 oocl fi rlr, i�a t m. arr rly t r lling kith ugzi r t mlzatjo �2;r cry wl 411 •_ The certificate is issued to Hasday 2023 Family Trust �... .....-_ (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. . ... .. ...... car' A Si,�... ........ _........ gnature BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPOR LOCATION: 200 Macdonalds Crossing,Laurel SUFF. CO.TAX MAP NO.: 145.4-16 SUBDIVISION: " . ................... NAME OF OWNER(S): Hasday.2023 Family .Trust ............. .......... ................ OCCUPANCY: ADMITTED BY: SOURCE OF REQUEST: Chisholm,Joan DATE: 5/20/2025 .......... DWELLING: #STORIES: I #EXITS: 2 FOUNDATION: Cement block CELLAR: CRAWL SPACE: --"' .... .. ...... BATHROOM(S): I TOILET ROOM(S): UTILITY ROOM(S): PORCH TYPE: . ...... .... ... DECK TYPE: PATIO TYPE: Concrete ....... ...... ..................... BREEZEWAY: FIREPLACE: 1 GARAGE: ...... ..... ............ DOMESTIC HOfWAfik" Yes TYPE HEATER: AIR CONDITIONING: TYPE HEAT: Gas WARM AIR: Forced hot air HOT WATER: .. . ....... .................. .......................... #BEDROOMS: 2 #KITCHENS: I BASEMENT TYPE: OTHER: .......... . ........... ACCESSORY STRUCTURES- GARAGE,TYPE OF CONST: Wood frame STORAGE,TYPE OF CONST: SWIMMING POOL: GUEST,TYPE OF CONST: OTHER: ....... ... VIOLATIONS: .............-'-............ ............. ...... REMARKS: . ..................- .......... .......... .............. ............. .................... .......... INSPECTED BY: JOHNJ DATE OF INSPECTION: 5/20/2025 . ..............- TIME START: I 1:00am END: 11:45am FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z 4967. . . Date . . . . . . . ..Tan , 19 73 . THIS CERTIFIES that the building located at Pvt Bond Off Pea. pay BjjMeet Map NoEdgemere Pk Block No. . . . . . Lot No.1 18 Pt 12 Laurel. n.Y.. . conforms substantially to the Application for Building Permit heretofore filed in this office dated Sept .22 , 19 66 pursuant to which Building Permit No. 3268Z dated IOct. . :i 3 . . . . . , 1966 ., 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 Private one family.dwelling • • (Approved by. •Bd Appeala .Oct_ 69 1966 The certificate is issued to A13ce.Dave . . . . Ouner . of the aforesaid burl g. NOTEt Original house built before April 233 1957 Suffolk County Department o e pprova Pro— ex"ting UNDERWRITERS CERTIFICATE No .Pre.p. existing . . . . . . . . HOUSI: NUMBER 460 Street Private Road # 2. (NeDonald Crossing) �A) : � Building Inspector e ° e . . ire_ i� r � FORM NO. E TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N0 3268 Z Dote October 13,j..1966 9........ Permission is hereby granted to: 13Ce L. I1'lM�e ................................................................................. ................. ................................... to ...... *..alterations and..build,.an..addition on„ezietin1. rtkV*1lin j..&... . ................M AMP Ao1r...bldt..............................................,........,...................................................... at premises located at .... ,A. r.. .. ..jlt.. 29.......U90 .., ............................................ ... 9 .....A/6........V .P. +Q...$1I�3!..��.�i� ....... 1G4�' �.s..NAB............................ pursuant to application dated ..........................S&Pt.....22............... 19.66.., and approved by the Building Inspector. Botet Approved by Bd of Appeals Fee $.. !00............. . ..». ................... ............ • ............. . Building lnpect »...,.............,... of SO(J,r Town of Southold P.O. Box 1179 53095 Main Rd 4oON11 Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 46169 Date: 05/19/2025 THIS CERTIFIES that the building AS BUILT ALTERATION Location of Property: 200 1acccalcl 1M , Ling ,1,� ql_NY LL94,8 Sec/Block/Lot: 145.4-16 Conforms substantially to the Application for Building Permit heretofore, filed in this office dated: 06/05/2024 Pursuant to which Building Permit No. 51280 and dated: 10/15/2024 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: "As built" alterations and addition, including HVAC, window/door replacements and deck, to existing single family dwelling as applied for per ZBA #7997, dated 3/20/2025. 3 Family 202 The certificate is issued to: Hasda.�' ......._........_..w._� Trt�..._......ww_.�.w_._......w..ww......w_........m................. .w__..........._.__.�,....�. Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: ELECTRICAL CERTIFICATE: 51280 4/6/2025 PLUMBERS CERTIFICATION: Au orir d Signature " Of OT Town of Southold P.O. Box 1179 53095 Main Rd 000 't Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 46168 Date: 05/19/2025 THIS CERTIFIES that the building ACCESSORY ALTERATIONS Location of Property: 200 Macdonalds Crossin&L ur l NY 11 4 Sec/Block/Lot: 14 .4-16 Conforms substantially to the Application for Building Permit heretofore, filed in this office dated: 08/22/2024 Pursuant to which Building Permit No. 51771 and dated: 03/21/2025 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: "as built" alterations of existing garage to non-habitable non-sleeping conditioned storage building with half bath and HVAC as applied for. The certificate is issued to: Hasday 2023 Family Trt Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: ., ELECTRICAL CERTIFICATE: www _w 50937 _ 4/6/2025 PLUMBERS CERTIFICATION: Pipe Dreams 10/7/2025 tAl