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Home My WebLink About1000-74.-1-35.51 of so- TOWN F S UTH L Rental Permit 1321 Owner: Patricia Homan Occupied as: Single Family Dwelling Located at: 4630 Blue Horizon Bluffs Peconic 74.4-35.51 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: 05/28/2025 � Expiration: 05/28/2027 c ment flffi This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD 4 —BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-'959 Telephone (631) 765-1802 Fax(631) 765-9502mttp5ee rr RENTAL PERMIT APPLICATION AN 2 9 2025 Rental Permit Fee $300(Application must be renewed every two years)' ' Section A. Property Information: Rental Property Address: 4630 Blue Horizon Bluff, Peconic, NY 11958 Tax Map Number: 1000 SECTION 74 -BLOCK 1 -LOT 35.51 - SECTION B. OWNER INFORMATION: Property Owner Name: Patricia Homan Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 100 Blue Horizon Bluffs 100 Blue Horizon Bluffs, Peconic Peconic NY 11958 NY 11958 Telephone Number (s): Daytime631.445.0106 Evening531. 45.0106 Emergency631.445.0106 Property Owner Email Address: homan atriciag maii.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: po 6pXq T Telephone Number (s): Daytime i 1 ing Emergency Email Address: • Vri Section D. 4() 0 Managing Agent Information: 3 - 1 D 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 Ev ing Emergency Email Address: SECTION E. SITE MANAGER INFORMATION: (re ired for rental properties containing 8 or more rental units) Name of Managing Agent of dwelling nit, if any: Address of Managing Agent (no P.O Boxes): Mailing Address of Managing Ag t: Telephone Number (s): Daytime Evening Emergency Email Address: Page 2 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: One dwelling 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: Requested Maximum number of persons allowed to occupy Dwelling Unit: 4 Number of rooms in Rental Dwelling Unit: 5 rooms Use and Dimensions of each room in Rental Dwelling Unit: kitchen 12'6"x 162" /bathroom 7'4"x 8'/Open plan dinning and living room 20'x 24'/porch 8'x 8' master bedroom 12'x 8' & 2nd Bedroom 12'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. 0 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) I Patricia Homan ,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: Patrici Oman Property Owner's Signature: 4% Sworn to before me this o�q day of Ann I 20-d (, -�axia i "-�14 f am , Official Not T blic Signature a Original Notary Stamp T? '�% EY L. DWYER NOTARY PUPUC,STATE_OF NEW YORK NO,O1DW6306900 0.1J,1171F0 I'J R1J-F,-XK CVJ�JTY COMM1-`3 ON EXPi DES,ACNE 30, Page 4 of 4 ;XVW,kk pf Sol/. TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 I N f"i' P mm"m 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 (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ q--`R`ENTAL REMARKS: iKS: ��— se �'ooJvt DATE r-a3-a� INSPECTOR TOR r. 'p��U TOWN OF S 19 . HOL " UILDING DEPT. A �1-7fi5-1�0 7iL/- 3S s/ [ ] 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 (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ q""R/ENTAL REMARKS: DATE INSPECTOR p � y Town Hall Annex Town of Southold 54375 Main Road CD Rental Inspection Report PO Box 1179 r� t Southold, NY 11971-1179 Tel: 631-765-1802 SUM# Date 5./a —07 Owner Omfil Phone Address /� l Visible Hamlet Inspector Floor Level Quantities Sub 1 2 3 Smoke Detectors(not located in bedrooms) Carbon Monoxide Detectors Fire Extinguishers Exits Bedrooms 1 2 3 4 5 6 Smoke Detectors Egress Occupant Count Building Systems Maintained &Operational Condition of Property Heating Building interior Hot water Building exterior Electrical ,Property clean, maintained &safe Mechanical 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: 7777 TOWN OF SOUTHOLD PROPERTY REc 31 _ WER _ STREET VILLAGE DIST. " SUB. LOT FORMER OWNED N E ACR. S W TYPE OF BUILDING E RES. SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS E f ` s a ` r _ t :Iaa I � s `� € , dA I I Tillable FRONTAGE ON WATER -F Woodland FRONTAGE ON ROAD s Meadowl,and DEPTH I House Plot !�, = - BULKHEAD t Total Imo(-c> OLOR TRIM 0 I i i , — - < , E E F s n 74.-1-35.51 4/07 M. Bldg Extension �y -rt F a = V Extens ro 7 r_ Extension ... Foundation i Bath Dinette 7 if ' Porch X z : fa �2 = II Z o Basement Floors _ K. por lax flr� E Interior Finish LR. Ext. Walls t r BfeezeNWJ ire Place C c Heat Y'� DR. x°, C9 ' - Garage �Type Roof Rooms lst Floor BR Patio Recreation Room Rooms 2nd Floor FIN. B 40 _O. B. Dormer Driveway Total FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-32457 Date: 07 11/07 THIS CERTIFIES that the building DWELLING Location of Property: 4630 BLUE HORIZON BLUFFS PECONIC (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 74 Block 1 Lot 35.51 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 6, 2006 pursuant to which Building Permit No. 31713-Z dated JANUARY 6, 2006 was issued, and conforms to all of the requirements of the applicable µ' provisions of the law. The occupancy for which this certificate is issued is RELOCATE AN EXISTING SEASONAL DWELLING AS APPLIED FOR & AS PER CONDITIONS OF ZBA ##5616 DATED 12 29 04. The certificate is issued to CHARLOTTE DIC RSON (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2081483 07 03 07 PLUMBERS CERTIFICATION DATED 05 11/07 CUTCHOGUE EAST PLUMP&HEAT Au prized Signature Rev. 1/81 Am z LLI 0 U) wz ui -'-5 3/16 ME w r FT AB QVE ho 1,0 RAL C A 16o iTt z L 'u 0 FLOOR PLAN 918 SF 0 GRANJL SPACECO.NVERTED TO FULL 34SEMENT GIRDERSADDEDf CHANGED TO STEEL 8-FOR STRUCNRA-SUPPORT S do Z € Z a CT »-C U3 - FF--WZ Aj> Y O O U W ! ��a .F------- ------------------------------------- ------------------ E- - -- t� -�� CRAWL SPACE PA'C SLAB ABOVE } E m 3i 1' CRAWL SPACE 1 ? m E -- 'I - a er _ _ ____ ----------------------------------- 1. ------------------- r F ter„--------------------- ------------------------------------- z 1 _ s _ � ( -- -____._-_____ A ,_ ' FOUNDATION PLAN F� 7-7]