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Home My WebLink About1000-111.-14-11 Rental Permit 1323 Owner: Kristin Bernhard Occupied as: Single Family Dwelling Located at: 400 Little Peconic Bay Rd (aka 75 Sailors Ln) Cutchogue 111 .-14-11 Maximum Permitted Occupancy: 5 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: 05/29/2025 Expiration: 05/29/2027 ode rcem ntOfcial This Notice must be posted by the main entran eat ail ti TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone(631)765-1802 Fax(631)765-9502 hn, :j, �,� , �1 M1 I � C E � RENTAL PERMIT APPLICATION � , ?n?-g Rental Permit Fee$300(Application must be renewed every two years) p6 Section A. Property Information: Rental Property Address: 5 S w t, pet—S Likni C v T c�{c�G vE Tax Map Number:1000 SECTION ( ,{ -BLOCK SECTION B. OWNER INFORMATION: Property Owner Name: Kristin Bernhard Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) Kristin Bernhard Kristin Bemhard 3033 Oaktree Landing NE 3033 Oaktree Landing NE Marietta, GA 30066 Marietta, GA 30066 Telephone Number(s):Daytime 804869 450 Evening 8048692450 Emergency 8048692450 Property Owner Email Address: pckeilow@gmaii.com Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit,if any: Patrick Kellow Address of Authorized Agent(no P.O. Boxes).3033 Oaktree Landing NE, Marietta, GA 30066 Mailing Address of Authorized Agent: 3033 Oaktree Landing NE, Marietta, GA 30066 Telephone Number(s): Daytime 8048692450 Evening,60 869 45'OEmergency O4869 450 Email Address: pckellow@gmail.com Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit,if any: Joe DiVello Address of Authorized Agent(no P.O. Boxes):5 280 Main Road, Southold, NY 11971 Mailing Address of Authorized Agent: PO Sox 598, Southold, NY 11971 Telephone Number(s): Daytime 631655799 Evenin _ Emergency Email Address: lcdivello@gmail.com 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: 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: d 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: bFDRm If 1 14'-tt BAr(-k l a- 4 42.- 14'-o'I 1 .�- ,tw ot WZ 7-f F -q $E00.rh t 3 131-61 t2�'G uv . Rm , 2l'-lo'i�• 15'-2'' KtT. 14L!' 201 3t OlM• f4-m. so,-1 '�� l'E'-2�� $hctti2rri 3 I'`a �� 4' III-21i 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. ❑ 1 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) 1 Kristin Anna Bernhard 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. Kristin Anna Bernhard Property Owner's Signature: Sworn to before me this k day of JAL 202 Official Notary Public Signature and Original Notary Stamp ' 00%t� » �0 .. O Page 4 of 4 ''dk�"a rotnrw�""ww TOWN OF SO' TI-I LD BUILDING DING DE PT. co 631-765-1802 bll• �� 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 (F AL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL "2 " Telephone(631)765-1802 Town Hall Annex 0 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold, NY 11971-0959 ��q ��° r` -,7j 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 re uired for Architect or Engineer, Licensed Home Inspector midst provide copy of valid current,certification Rental Property SCTM Number: 100() — I L ( • — 14 11. Rental Property Address: 775- A-t,l,0K5 EQ Ve' 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) . C- 000 c fU CK—, 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 otN State,the Fuel Gas Code of New York State,the Fire Code,of New�York State,the Property M Code of New Yor State and the�.00kl. ergy Con �e .ation o ctiop Code of New Yor to " ay �� 4 F Print Name and Title; 'Original Signature Sear Please place Professi �y , TOWN OF SOUTHOLD PROPERTY RECC 1 /16� OWNER VILLAGE LAG E DIST. LOT ba T-C ILL,n -iLAhLr I �--,, I- FORMER OWNER N E N ACR. L- :�A-� t-4 6 ( VZ P4, 61 TYPE OF BUILDING RES. SEAS. VL. FARM COMM. CB. ICS. Mkt. Value KS LAND IMP. TOTAL DATE REMAR . . ............... 1411 2 i� 41,6 21 -17 15L;T oll ? 7 Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowl-and DEPTH 1 House Plot BULKHEAD Total COLOR TRIM I I i - I I _ i _ 3 d i I ,F - 4 40- t _ M. 131 d 3 , g a€ I � t _ Extension } s = Extension } 3 E Extension Foundation - Bath ;Dinette I Porch �'� _ //6 Basement J Floors C N, ,� K. Ext. Walls I Interior Finish �Nt TRoCK'LR Porch - 1 t' Breezeway :Fire Place i i Heat N.� DR Type Roof. I�Rooms 1st Floor BR Garage t t FIN. B Rooms 2nd Floor Patio ,Recreation Room I ;Dormer Driveway O. B. s Total /d./32 I FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. . . . Date .711e • • 19#/2 . THIS CERTIFIES that the building located at Uilors .& 7Litt3.e PeeomittrBW B$ Harbor cove a 'b Map NoNaSsaU poinVlock No. . Lot l o. . . . . Nassau t-oint Outchogue conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . Sgpt . $, 1971 pursuant to which Building Permit No. 54994 dated Apt •9. , 19.7t., 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 'Prilrate. .one fam13..y .dwelling . . . . • • • . • . . . • — . . . . • The certificate is issued to Warren.H&rdy . . .t3' er (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval J=e. . 5.49.72. . by I« Villa UNDERWRITERS CERTIFICATE No POAdIZ9 . . . . . . , • • • • • • . . IIOUSE NUMBER ktpp Street Little pecaonic Say Road 7 e s°. . BUdding la peetor E � I 3 I I .-} I i W LA F W TQ Lr I f W rn cosF: 3 fE i a I € II q LL I �3 c) Lo Llt i 3 P. Itzt r6'an'tia o4. - svx — ree s'A6.U�oF .. - - Sf-- IXg, NMy. ( FLOOR i FLOOR PLAN PLAN 1/4" = 1'-0" s 4.12.2025 i I JOAN CHAMBERS (631)294-4214