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Home My WebLink About1000-18.-2-25 of so Rental Permit 1322 Owner: Angel Medina , Donna Medina Occupied as: Single Family Dwelling Located at: 23765 Route 25 Orient 18.-2-25 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 co a n ment officia This Notice must be posted by the main entrance at all times ,rvRryRtOR'Rd.p'; TOWN OF SOUTHOLD—BUILDING DEPARTMENT G/IDO&�3 I, Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 Fax(631) 765-9502 ttp ://r M . ou.tholdtownt Gov RENTAL PERMIT APPLICATION Rental Permit Fee $300(Application must be renewed every two yea r L Section A. Property Information: Rental) Property Address: 2 �)1vS M 26 d r,0G. 0 t t S t Tax Map Number: 1000 SECTION �� _ -BLOCK_ _ _-LOT 2 - 2 5 SECTION B. OWNER INFORMATION: Property Owner Name: nr` ( Az O '^►0. Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) Telephone Number (s): Daytime631 IIr�y1") Evening Emergency( S 166-7 `7Z Property Owner Email Address:. +'� c► Page 1 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, 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: 3 Number of rooms in Rental Dwelling Unit: t Use and Dimensions of each room in Rental Dwelling Unit: SDI �Oa Ar �� ) 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. L�1' I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ lam 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) 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 1 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 Sit anager. Property Owner's Name: �,,. � ti r, Property Owner's Signature: Sworn to before me thil4'' tiay of M4 , 20�1 Official Notary Public Signature and Original Notary Stamp CONNIE D.Bt1N4:ft Notary Public,State of Now York No.01BU618 050 uallf led in Suffolk Couanty COM i slon ExPlrasAprll 14, Page 4 of 4 TOWN OF SOUTHOLD BUILDING DEPT. 531-765-1842 INSPECTION [ ] 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 [ RENTAL Town Hall Annex Town Of Southold 54375 Main Road Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Te1: 631-765-1802 SCTM# �� _a�� Date Owner Phone Address 7 j A ttA 11CW Visible Hamlet 012 jarA linspector Floor Level Quantities Sub 1 2 3 Smoke Detectors(not located in bedrooms) Carbon Monoxide Detectors / Fire Extinguishers Exits Bedrooms 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 o2 C91 r Door alarms Pool completely enclosed Self closing/latching gates Pool fence to code requirements CO's for all items present Prior Rental Comments: as 18 TOWN OF SOUTH LC PROPERTY RMOR0 CAKID OWNER JSTREET VILLAGE DIST. SUB. LOT: 76 e-1)0nr,4 �AeJjyir16 su 1 zt ROE V ACR. NE N V00" E IfU e eL 4 S W f TYPE OF BUILDING RES, SEAS, 1VL. FARM 'COMM. CB. MISC. Mkt. Value 1 e Q/ LAND IMP, TOTAL DATE REMARKS 4D Ak 77 ff 7 �j Vocl rl PA oo G 4y4ft C?!!q-tNDL�l A j� $ Lai i9t -3 -7 NEW NORMAL BELOW ABOVE 41 FARM Acre Value Per Value Li Acre --4 Tillable I --ire- Co Tillable 2 Tillable 3 Woodland I Swampland FRONTAGE ON WATER Brushland FRONTAGE ON ROAD Al� House PlotDEPTH 'BULKHEAD DOCK Total - _ _ COLOR TRIM _ � z �.... _ g 18.-2-25 6/11 — I I i M. Bldg. j Foundation o a .. ° B th ° Dinette I Extension I Floors� = Basement _ - 3_ s Extension Ext- Wails Interior Finish LR. Extension g fi Fief Place Heat ` DR. TYA Roof ! Rooms I'st Floor BR; `Recreption RoorPorch Rooms 2nd Floor; Porch IDormOr i Breezeway Driveway I Garage Patio \- O. B_ — Total d � -s_ FORM NO 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.47304 . . . . . . Date . . . . . . . . . . . . . b"ov. . . .4). . . . . .. 1976 . THIS CERTIFIES that the building located at . . .N/9 M, .,A4*4L . .. . . . . . . Street Map No. .7Cc . . . . . . . . Block No. . .xx . . . .Lot No, . =. . Orient . .1.X. . . • . . . . . . . . • jr*qVA""9tC ov_*,_Eajaj • ina conforms substantially to the Wwl IT boil beforew ursuant to which ' o, t ancy dated . . . . . . . .. p � . dated . . . . . . . . . . .Nov . 9. . . ., 19. 76, 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 . tw.Q _(?). .private. oue. family.dwellings.& .four. .(4). accessory':'bldga. The certificate is issued to . .Jock . . Trvaau . . . . 0%m*r. of •r8e=4 • • • • . • • • • • • . • • • • • (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval pro-. existing. . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE No. .prov-s 1sting• . . . . . , • . • . . • . . HOUSE NUMBER Haia „llctd Orient Building Inspe or HOUSING CODE INSPECTION November 1, 1976 23695 Main Road & 23765 Main Road Orient , N.Y. Tax Roll: Jock Truman Upon written request from Irving L. Price, Jr. , Attorney at Law, Greenport, for a Pre-existing Certificate of Occupancy for these premises, I made an inspection of these two one-family dwellings. I picked up key for the two--story dwelling from Floyd F. King Real Estate Agency in Orient, and began this inspection at approximately 11:00 A.M. The first building inspected is a two-story, partial one-story, wood framed building, which was unoccupied. At the time of this inspection, the electricity was off 'in the building. The first floor consists of a kitchen, dining room, living room, entrance hallway, full bathroom, and utility room, and a bedroom with outside entryway. The second floor has three bedrooms and a full bathroom. The bathroom has access to the attic area which is used for storage. Heat is furnished to all rooms from an oil-fired, hot water furnace located in partial basement of the building's stone and mortar foundation. The one-story building is occupied by A. Ruroede, Tenant. This one-story, wood framed dwelling consists of a kitchen, livin room, �_,do bedrooms, and a bathroom. HrW sfur- ea the s bulr� ic dry a gas-fired i56 'furnace which is centrally located in the building in the living room floor. This building is constructed on a cement block foundation and a partial full cellar; the balance of the foundation is crawl space. A front porch is located on the side of building and wNicN provides �iW * " T e kitchen area. There are four accessory structures on the premises. The following violations of the Housing Code, Chapter 52 , Town of Southold, New York, were found: #23695 Main Road - Unoccu ied two-story structure Kitchen - gas cooking range, no shut off valve at uni— Article V, Section 52-52 B (2) . Dining Room - within closet, wall outlet on the face of closet, connection of conductor within the closet has been made without the proper junction box, Article V, Section 52-56 A (1) . Housing Code Inspection -2- November 1, 1976 Exterior - front wall electric meter box, cover is off, Art—is l Section 52-56 A (1) . #23765 Main Road - Occupied on6-star structure Kitchen - gas cooking range, no shut off valve at iiit,ticle V, Section 52-52 B (2) . Front march - flooring at the step deteriorating, and on north end of porch flooring is rotting and missing, Article III, Section 52-30 A. Exterior - Siding on east, south, and west walls, paint is peeling, leaving wood siding unprotected, Article III, Section 52-31 B. Accessory buildings - one located in the front yard area on tie-west side of premises in violation of the Zoning Ordinance, Chapter 100, Article III, Section 100-32. This building is deteriorating, and the rear section's roof is partially missing, Housing Code, Article III, Section 52-31 B C. Accessory storage building on the west side in rear yard area, building was locked. There is a broken window pane on the north end of this structure, Article V, Section 52-31 B. Garage and storage building located in the rear yard on the northeast end of property, shingles on the west side are loose and missing, trim and doors are deteriorating, Article V, Section 52-31 B. Inspection was completed at approximately 11:50 A.M. and the key was returned to the Floyd F. King Real Estate Office. Resctfully submitted, E ward i 'ermann Building Inspector EH:med Town of Southold 5/15/2018 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39644 Date: 5/15/2018 THIS CERTIFIES that the building IN GROUND POOL 23765 Route 25, Orient Location of Property: .��.....°.,.,..,..�....__,................._-.......w___w......_.....__mm__a�..........................�_._.. .��_.w_._.___.�,..�..__�....ww_.�. SCTM#: 473889 Sec/Block/Lot: 18.-2-25 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/10/2017 pursuant to which Building Permit No. 41537 dated 4/14/2017 mmmm 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: Q—,QE S Y IN-GROUNDaMMMWQ POOJ _IIE-NC .)" O C 01 �.I ILJE�PDT The certificate is issued to Medina,Angel&Donna of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 41587 09-13-2017 PLUMBERS CERTIFICATION DATED ....... M..__.w.... _ _ .. w.w._.. ................. Ar iz ignature .. ., o0 0... ...... WIN .. � F m� 'w,W") " C a IV ir ��. m � I Y I h