HomeMy WebLinkAbout1000-62.-1-24.7 (Horton Bldg #1W) TOWN OF SOUTHOLD
Rental Permit
1320
Owner: Colonial Vill Tenants Crp (Wade & Loretta Hinderling)
Occupied as: Horton Bldg. Apt. #4
Located at: 55075 Route 25 Southold 62.-1-24.7
Maximum Permitted Occupancy: 2
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: 05/28/2025
Expiration: 05/28/2027 Code Enf ern Official
This Notice must be posted by the main entrance at all times
- T c � SCCCIZ
jxj . TO L —BUILDING 1
Ton Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
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Telephone (631) 765-1802 Fax(631) 765-95021at :� ry«m .srattlol )tc►wm� y l�
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A7 7 202
RENTAL PERMIT APPLICATION
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Rental Permit Fee $300(Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
55075 route 25 southold new york 11971 Horton BLDG.apt#4
Tax Map Number: 1000 SECTION 1000- -BLOCK 62-1 -LOT24. -7
1� Z a4.
-7
SECTION B.
OWNER INFORMATION:
Property Owner Name: Wade& Loretta Hinderlin
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
1195 smith drive north Southold NY 11971 same
Telephone Number (s): Daytime631-461-7325 Evening Emergency6317651764
Property Owner Email Address: bunchyl @optoniine.net
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:
���,-
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 Evening Emergency
Email Address:
Page 2 of 4
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on property:Co-Op f elwl /
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: �R70
Requested Maximum number of persons allowed to occupy Dwelling Unit: 2
Number of rooms in Rental Dwelling Unit:
Use and Dimensions of each room in Rental Dwelling Unit: Living room 18'X12"
Bedroom 12'X11 1/2' Kitchen 8'X 10' Bathroom 6'X 7'
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
❑ 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)
1 104 -h / vim. I/VV4ertify 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: / /IQ
Property Owner's Signature:
Sworn to befor me this 7 day of 20 4r
Official Notary Public Sig a re and Original Notary Stamp
w ukvevoo¢l n° ✓ Dawn lk7hnson
r«rw I�ssey f�uaf�ufi�,State s�f'I?[eav York
No q1y,6J49053
` d Batt:sfua d in Suuff'03 Comity
Page 4 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)
I1dhb,6!' ., be,:Z/", ,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
th a reto.
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:
p Y
Property Owner's Signature: �
Sworn to b re me this day of, 20
ficial Notary Publi mature and Original Notary Stamp
µkrAaquuuHa✓,� ��R4NY0.��&�'k�a }Y'�
PtII)l1c,�"M1�Yfi''�1�"9iD W'��W &�'I"'�+
Page 4 of 4
° TOWN OF SOUTOLD BUILDING DEFT.
�cou 631-765-1802
1 N S Ph E At T 1 %06� 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 (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ RENTAL
REMARKS: kfir`
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r
TOWN OF SOUTHOLD PROPERTY RECORE
OWNER STREET VILLAGE DIST. SUB. LOT
FORMER OWNER ' N E — ACR
I
S W TYPE OF BUILDING
_ � C
RES. : SEAS. VL. FARM COMM. CB. MICS. Mkt. Value
i I
LAND IMP. TOTAL DATE REMARKS
.�
. r
-
-
I ,
f ,
� 3
l
-
r I00
7
=` he J
9 i
S I
AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE
FAR14'`i Acre Value Per Value
Acre
Tillable
FRONTAGE ON WATER
Woodland FRONTAGE ON ROAD
Meadowland I I DEPTH
House Plot BULKHEAD
DOCK
Total j
COLOR
f TRIM
gI i
I y
I
s
i
E — �a
.
[ f
M. Bldg !/ J
Extension ,
i
. � I
Extension I —
Extension
E
Foundation b _ Bath ;Dinette
Porch Basement Floors ; i K.
Porch - Ext. Walls ,.. Interior Finish
t
Breezeway lFire Place Heat w_ DR.
Garage !Type Roof ,. ._L Rooms 1 st Floor BR.
Patio !Recreation Room l Rooms 2nd Floor FIN. B
}
0. B. ,Dormer Driveway
Total
1
TOWN OF
SOUTHPROPE
TY j CAR
f
OWNER !STREET VILLAGE D15i, SUB. LOT
E J l
FORMER OWNER N E ACR.
<J
S W TYPE OF BUILDING
ems'
RES. SEAS. I VL. FARM COMM. CB. MICS. Mkt. Value ;
LAND IMP. TOTAL DATE REMARKS
1,2
F
.:
y a : a
F J
s
i
i I
j g �
AGE BUILDING CONDITION
NEW NCRMAL BELOW ABOVE
FARM Acre Value Per Value
Acre
Tillable I
FRONTAGE ON WATER
Woodland FRONTAGE ON ROAD
I
Meadowl.and I DEPTH
House Plat BULKHEAD
Total � �� DOCK
I
COLOR TRIM \
s
I i
1 [ I
3 I
E
. .
-
.
e
t
3
`v
s
A
= M. Bldg.
3—E
b
Extension4-4
/y
a l
Extension
Extension
Foundation �o _ Bath Dine<<e
Porch Basement f i Floors 0� ;K.
Porch i `Ext. Walls Interior Finish 1 LR.
Breezeway ® lFire Place , Heat H DR.
Garage ;Type Roof Rooms 1st Floor i BR. I
Patio Recreation Room Rooms 2nd Floor FIN. B
I O. B. Dormer i Driveway t
Total
i
g.
TOWN OF SOUTHOLD PROPERTY R I1,-6 iRD
OWNER STREET VILLAGE DIST SUB. LOT
LCr
FORMER OWNER N E ACR
1J _ � . S
W car,, TYPEG
•
F BUILDING
RES SEAS. iVL. FARM 'COMM. CB. MISC. Mkt. Value
z
LAND IMP, TOTAL DATE REMARKS
I 'F s `
t i €
1 At
AGE I_ BUILDING CONDITION
3
1 NEW + NORMAL BELOW ABOVE
FARM Acre Value Per Value I
Acre I
Tillable 1
Tillable 2
Tillable 3
Woodland _
Swampland FRONTAGE ON WATER
Brushland FRONTAGE ON ROAD ` �- , rg
House Plot DEPTH �
BULKHEAD
Total I DOCK
COLOR
s_
£
x
TRIM
f
3
v
(( d
f i
i =
f
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3
' i3 I
£
f
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# iFondotion Bath Dinette
M. Bldg - ® i S� f q
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Extension i ; -v
=6asernert
In i a s o o I aSo t v L L (Floors oak , K.
Extension ! !Ext. Walls Ilnterior Finish
SLR. i
Extension Fire Place n� a Heat = A7 DR. I
T e Roof - - - Rooms 1st Floor BR. s
! FIN. B.
!Rooms 2nd Floor I
Porch �,/ creation Room i
Porch
;Dormer
Breezeway i Driveway
-------------
Garage �.
Patio !
o B.
F
Total i .` I ! !
,
,
i
I �
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F S JTHOLD PROPERTY RECORD �
►
OWNER STREET VILLAGE DIST.° SUB. LOT
C.
FORMER OWNER N E ACR.
S W TYPE OF BUILDING
RES. = SEAS. �VL. FARM COMM. CB. MISC. Mkt. Value
LAND IMP, TOTAL I DATE REMARKS
l
L
1.7
a s
AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE
FARM Acre Value Per Value
Acre I
E
Tillable 1
Tillable 2
Tillable 3 -
5
Woodland
Swampland FR�LIIdGE OPJ—VI�A-TER
Brushland FRONTAGE ON ROAD
House Plot € DEPTH
BULKHEAD
I
DOCK
Total
i
+` OWN OF SOUTHOLD P
ROPERTY £RED
OWNER STREET VILLAGE DIST. LOT
FORMER OWNER N E ACR.
S W TYPE OF BUILDING
ZA i�o Ff f fti �i
.ES. SEAS. VL. FARM COMM. CB. MICS. Mkt. Value
LAND t IMP. I TOTAL DATE REMARKS
<r c�C
s
E 4
i
F
I
i
I I
I
e
i I FRONTAGE ON WATER
'illable
FRONTAGE ON ROAD
Voodland ,
Aeadowland DEPTH
douse Ploy BULKHEAD
otal
i
i
yJk '24i
" a 1
COLOR 1�f �`�c TRIM
,
I
g 7 •
3
1 � -
its
I I
E
ss
a
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M. Bldg.
fi
3
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Extension �0�/3��
Extension
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fi -
Extension 1
Foundation r. Bath ! Dinette
Porch �a Y s6 ./ J a �f3 Basement a Floors K.
f
Porch F Ext. Walls Interior Finish LR, I
Breezeway Fire Place �l Heat /� N 1� DR.
Garage �,? I y Ufa L9 ; ,_ Type Roof Rooms lst Floor BR. Z
Pao �z Recreation Room' Rooms 2nd Floor FIN. B
1 r
0. B. Dormer Driveway I
Total '1 I C
i
TOWN OF SUTN+tLD R -kRTY RECR rt r
O
�S, ;
VILLAGE _ DEIST
WNER STREET `LOT
v/
4
FORMER OWNER N E AIR,
is W TYPE OF BUILDING
RES :�- VL. FARM COMM. CB. MICS. Mkt. Value
r
LAND IMP. I TOTAL DATE REMARKS
44 A
-
7
Li
I
i
I
s
Tillable FRONTAGE ON WATER
Woodland = FRONTAGE ON ROAD I3
c
i
Meadowland ! DEPTH t '
{
House Plot BULKHEAD
Total
10U(�—ln ,-1-24.
1,1
COLOR TRIM
t
IBM
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E
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E i
€
M. Bldg I F
Extension
i
tenon 2 Z 1 t
Extension
i Both
Foundation I Dinette 71
Basement K.
° Floors
Porch
Porch Ext. WallsI Interior Finish LR.
Breezeway ;Fire Place Heat :DR. I
Garage 2 _ I, Type Roof ' Rooms 1st Floor BR.
< .
�,
Patio Recreation Room l Rooms 2nd Floor FIN. B
0.—B. :Dormer 1 Driveway
Total
E
e
TOWN OF SOUTHOLD PROPERTY ��CARD
OWNER :STREET VILLAGE I DIST, SUB. 1-0
t L�
.DORMER OWNER N j E ACR
-L-Z
S 1W TYPE OF BUILDING
RES. SEAS. I VL. FARM COMM. CB. MICS. Mkt. Value
LAND IMP. TOTAL I DATE REMARKS
x
fl
x. "c- Iv
v
il
AGE BUILDING CONDITION
..............
NEW NORMAL BELOW ABOVE
FARM Acre Value Per Value
Acre
Tillable FRONTAGE ON WATER
Woodland FRONTAGE ON ROAD
Meadowland DEPTH 210
House Plot BULKHEAD
Total DOCK
Io(Do-tom,
COLOR �.,/ 1
j n � TRIM I-IJr 7 E
J�L
g 77
M.
€
f
€ €
s
s
1
3
Bldg.
e
€
i
Extension
F
i
Extension
i
Extension
€ i
;Foundation _ Bath Dinette
Porch ,Basement { v Floors v )< K.
Porch Ext. Walls Interior Finish
Breezeway ;Fire Place ^, Heat DR. j
Garage Type Roof ;Rooms Ist Floor BR.
Patio
;Recreation Room Rooms 2nd Floor FIN. B
€
O. B. Dormer Driveway
Total
c
1
c
_� .-'-a •� TOWN OF SOUTHOLD PROPERTY j CARD
OWNER STREET VILLAGE DISTJ SUB. LOT
,
t �
e-
_FORMER OWNER N E C R
!?
I
F-
e - P
S W - ) ��V L:'�:' F BUILDING
,P �3
I TYPE O
,( � 3
'ta
RES. T-_ SEAS. VL. FARM COMM. CB. MICS. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
{� 4no
l t
f
$ 3
z
I
--
r
i
AGE I BUILDING CONDITION
E �
NEW NORMAL BELOW ABOVE
FARM Acre Value Per Value
j Acre
Tillable I FRONTAGE ON WATER
Woodland FRONTAGE ON ROAD
Meadowland E DEPTH °
House - �; BULKHEAD
DOCK
Total
COLOR TRIM
t
}
3 � j
v
p
i I z ' '
' t
t
I
f
F ,
+
+
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M. Bldg.
Extension ?
3 i
Extension {
+ � I
Extension
j 6 I Foundation Bath " Dinette
Porch j Basement I jFloors
Porch Ext. Walls Interior Finish LR.
Breezeway l 'Fire Place Heat i DR
Garag Type Roof Rooms 1st Floor ?BR.
t 6 n zz - 189z 4��a 'FS 7_�'�' 's
54�� t z �Zz r z �.� - 50 1 t 3Z t l
Doti Recreation Room Rooms 2nd Floor FIN. B
0. B. Dormer Driveway 1
1 Total �6 I
IcJ, � tS
I , t
;� ►
TOWN F S UTH L PROPERTY
OWNER STREET VILLAGE DIST.' SUB. LOT
D ER OWNER N / E - ACR.s
S ' W TYPE OF BUILDING
j
R - ; SEAS. - VL. FARM COMM. CB. MICS. Mkt. Value
7
LAND IMP, TOTAL DATE REMARKS
f
,.� �> €:.` � ;'. � �' ✓ ,� �'' � n � �.- ate. �. .. _ :,
I r 3
s
3 � #
AGE ' BUILDING CONDITION
NEW NORMAL BELOW ABOVE
FARM Acre Value Per I Value
Acre
Tillable FRONTAGE ON WATER
Woodland ' FRONTAGE ON ROAD
Meadowland DEPTH
House Plot BULKHEAD
<� l
Totg�r-. �-�. DOCK
l
- -�� LL
COLOR TRIM -_� - -f-
ti
€
' _ l
s
€ # L
€
s
E
t
€
I
l I
Bldg,
€
€
[ i t
Extension —44
5
I
t
Extension
i
°
€
°
Extension i
Foundation Both G Dinette
Porch 'Basement ` Floors D K.
Porch lExt. Walls Interior Finish
Breezeway ;Fire Place 3 Heat DR.
i
Garage Type Roof ,€ Rooms 1st Floor 'BR.
I € 1 _ I i
Patio Recreation Room !Rooms 2nd Floor ; FIN. B }
0. B. ;Dormer.. 'Driveway €
_
Total I ;
t
`OWN OF SOUTHOLDPROPER1 l CARD
OWNER STREET VILLAGE DIST. SUB. LOT
FORMER OWNER i N E ACR.
�_ 11 S S\U ,(!a H .r W TYPE OF BUILDING
RES . = SEAS. VL. I FARM COMM. CB. MICS. Mkt. Value
T 3 i
LAND ! IMP. TOTAL DATE REMARKS
j 0 G? r4'
r
l
I
•
i
_ � 3
AGE BUILDING CONDITION
NEW 1 NORMAL BELOW ABOVE
FARM Acre Value Per Value
Acre
i
Tillable I FRONTAGE ON WATER
Woodland FRONTAGE ON ROAD g
Meadowland DEPTH
House Plot
� � BULKHEAD
Total DOCK
f
:
COLOR !.>J TRIM
s 4
:
�i �_ ! i 1
i
I �! f
:
i
I
€
€
€ €
FF S 6
x
i }
M. Bldg. _ R� ffi 3 i z i I
I _ 1 1
Extension ip z
3 I
Extension i
,
E
I I
Extension
Foundation G Both t Dinette
_ ;
Porch Basement f 'Floors ?K.
.--lEi•;
Porch !Ext. Walls - � Interior Finish i LR. I
Breezeway Fire Place Heat I u DR.
Garage Type Roof !Rooms 1st Floor BR
ara
9 i
Patio Recreation Room 1 Rooms 2nd Floor I FIN. B
O. B. Dormer Driveway
Total
7'� �Pa Y�t��.1�.�"'-�:� � ±° i.'�`� pJ.)C `l-^.".� '�htfl.c�a�l C��. `i i� r7•
swcavaoxs ortter Tow"�f�
.,��`* wnanlG DEPARTMM I.f_
.a fntto
TOWN OF SOUTHOLD
su ft"fr01,m.1a.r.
CERTIFICATE OF OCCUPANCY
DUIIaM # 2
p.t, eaz n 1r�
(Ana's Yay)
Mop me.....—=M -....... .dock
6 oe Town of SaAi K md— aobds-wl to tho "Wa-d plea mod speamaSom lnnfofero fiW G Ah
.Wm. .;fh Appr—t on fur C.Mwy 1dr"if dst*d Na 2b 19-0 r..* fo..led
&g,r...g p@ pra Ns.fi.R. L�,d.M.d...�.�.�.......,. —OL 19.V5.w":nrd...d co..fams to A of the r.q%rirs- �.m.
. is of Om.prpc"provirian of as low 71w oco.ps.ry for.Kd We a r6fksto b;Uu.d k,
..
T6 edrfiflc.e b irusd fs tAettla R, ft T sA !t
brook 1o.wr. r foo.otl
OF fb aforo.rd bwld'm9.
R.D.Appravd Sept. 28, 1965 by R. 911E
(no f#004,0o.f p"q va 60:r+i .1t.r R. s.rsy for r a••+.o.a of a.e..sili...f K.
&w � Mti
of... ..4....Yt"L-3
Horton, Corwin a Tuthill- -
I;taAs Luuveled Uuua Houses .
oV
7 "U .�
BAT'11 Barnabas llort.►►►►
Scaler MaLhias rvrwi ►►
1 4" a � OEPROOAI henry TuLhI I I
(A1+1ataY . Ditcy) U.J —2
12 x 11- 1 /2
u
Il.tUity ApaAtmv.n to
Claa e't Sepa4a tech
_ 811 Vottbte
Iitaittate1l
' lJatta
LIVING I DINING AREA
x 12
►— '^
w ►
V► M
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i
u
Ptctime Window
Covered Walkway