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Home My WebLink About1000-62.-1-24.7 (Wells House Apt #1W) 01" � of so � OWN F S UTH L Rental Permit 1319 Owner: Colonial Vill Tenants Crp (Wade & Loretta Hinderling) Occupied as: Wells House Apt. #1W Located at: 55075 Route 25 Southold 62.4-24.7 Maximum Permitted Occupancy: 3 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 � " ' This Notice must be posted by the main entrance at all times E C E V E o TOWN OF SOUTHOLD—BUILDING D PA iTl�'I:ll�� AY 025 o ,p Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 119m Department Town of Southold Telephone (631) 765-1802 Fax(631) 765-9502 lath/xwww sout�liol�cltc Wg v RENTAL PERMIT APPLICATION Rental Permit Fee $300(Application must be renewed every two years) �I�-31a5 110 Section A. Property Information: Rental Property Address: 55075 route 25 unit 50, Southold New York Tax Map Number: 1000 SECTION 62 --BLOCK 1 --LOT 24 -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 1195 Smith Drive North Southold New York 11971 Southold, New York 11971 G-e Telephone Number (s): Daytime 631 7651764 Evening E y631 461 7325 Property Owner Email Address: bunchyl @optonline.net Page 1 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property:co-op apartment- 1 unit 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: Wells Building Requested Maximum number of persons allowed to occupy Dwelling Unit: 3 Number of rooms in Rental Dwelling Unit: 4 Use and Dimensions of each room in Rental Dwelling Unit: Kitchen 8'X10' Living Room 20'X 13' Master Bedroom 16'X 11' Bedroom 10'X 11" Foyer 8'X 8' 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 Wade&Loretta Hinderling 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 Mana er. Property Owner's Name: Wade& Loretta Hinderlin Property Owner's Signature: ,' Sworn to before me thiso23 day of M4u _ _ 205 A; a F Frar Down Uaras�;ao¢ O cial Notary P c Signature and lginal Notary Stamp w0 '()-Any Notary Puhlic,State of New"York No 0 J01r34Fu053 Q a,aMled dew sarfkAk(,"a'saaaqy° Page 4 of 4 f so TOWN OF SOUTHOLD BUILDING DEPT. o 631-765-1802 1 N zSP mEm a %Cav-kTlvo% N [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING [ ] 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: Gy4,115 1 Vr i r/6W-p � ate.c.a awa.v.a..rsry if ••••. ,•.�•• TOWN Of SOOTHOLD suffm C UNW.N.Y. CERTIRCATE OF OCCUPANCY Southold„ Me str"#. THIS CEWMjs rlur 16 i"" loa.hd .tom_ �P N`�.•--� fLd i�lltis .f$.adhold, ��'� wb.lasN.pT � tL •pp� p4rn aad�i-�+Rut'wm.b«.le/ar� Tn ib. Tv� 19 ppw..r to W" A&ApokaHew for�aidiiy P•rwif at *a r�qo� owwi*g p�elo.1SB—�•d•!.J of m.n rs of!6��P OtO d10"�of"la.. 71»o w f-y far-&;.& "a phY{cafi��• • �^'� to of!!.+ &A&rq. H.D.Approval lfov 19, 19& bar R. Yina 1 ., -4 ... • .w J oot**w�,r .w..tM rsj-a.r Y 4-4-.+ . A.-.wq-4 -THE COLONIAL VILLAGE AT SOUTHOLU INC. WELLS HOUSE 's /j( - TWO-BEDROOM APARTMENTS Bedrooms Kitchen m Foyer Vestibule Foyer Co KitchenBedroom 10' x 11 '=£ th 10' X 8' 0 8' x 8' 8' x $ ' 0 10' X e' Bat 10' x ill a c> i Closet * L Closet 3 y) Bedroom � Living Room Living Room a�i Bedroom lb' x o 16' x 11 ' 20 20' �j Terrace Terrace TYPICAL FLOOR PLAN ALL meaautemen.ta ant app�toXimate.