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Home My WebLink About1000-9.-6-3 TOWN OF SOUTHOLD Rental Permit Permit No. 0215 Owner R. Bruce Oswald Occupied as Single Family Dwelling Located at Eque 'an Avenue Fishers Island 9-6-3 Village S/g/L Maximum Permitted Occupancy 10 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. 11/6/2019 Mike Verity Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times Town Hall Annex Telephone(631)765-1802 t Fax(631)765-9502 54375 Main Road f P.O.Box 1179 Southold,NY 11971-0959 � Cot, BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200(Application must be renewed every two years) n D Section A. G 6 . Property Information: � � Rental Property Address: T. �. -�� Tax Map Number: 1000 SECTION __.BLOCK_ _-LOT SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: Telephone Number (s): Daytime__4_�_� vening:j:_:_ Emergency Property Owner Email Address: Page 1 of 5 l Town Hall Annex ra Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 �' p r BUILDING DEPARTMENT TOWN OF SOUT OLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent (no P.O. Boxes): 4 0 � Mailing Address of Authorized Agent:" op Telephone Number(s): Daytime s � Mani 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): Page 2 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road ,� Fax(631)765-9502 P.O.Box 1 179 Southold,NY 1 1971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime Evening, m1OO,,,_ Emergency Email Address: 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:--JD- Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: r i ,p 2 � *041T d Ofl G}�— J5 1/ 1 Y 11 Page 3 of 5 Town Hall Annex �'�, Telephone(631)765-1802 54375 Main Road " Fax(631)765 9502 i y P.O.Box 1179 � u' Southold,NY 11971-0959 e g J' BUILDING DEPARTMENT TOWN OF SOUTHOLD 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. W/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. SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) ) COUNTY OF SUFFOLK) I . , 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 Page 4 of 5 Town Hall Annex Telephone(631)765-1802 Fax(631)765-9502 54375 Main Road P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUMOLD 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 as to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager. Property Owner's Name: Property Owner's Signature: Sworn to before me this �� day ofA 20 Official Nota Public,,, gnature and Original Notary Stamp Aoas W'C' , w Page 5 of 5 � o 0 Sr 69 C,9 . ` 'wK z CIO n 0 P�- A 6,,r�(ow57 fi,-ocf, �9 LOP o S 4 _ � 0 t N 5p (.9 I qo I- 0 N ". ✓�"�'� 7N� 6 3 .""""N."" .w. �+wt� �M�`NIMYwI' TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPOEOCTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [wr FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: DATE '�`�" / INSPECTOR 4 t1F o * TOWN OF SOUTHOLD BUILDING . � c u 765.1802 IN S P E(8;` T I ON . [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FI AL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: "g&u— Acee 4 DATE INSPECTOR R f -,JOWN OF SOUTHOLD PROPERTY RECC��Z2//8 OWNER STREET VILLAGE DIST SUB. LOT ORMER OWNER - r" i N N E ACR, Sw TYPE OF BUILDING i t _ .•p1 RES._ �EAS. VL FARM 'COMM. CB. MISC. Mkt, Value 1 , LAND IMP, TOTAL DATE REMARKS t R s F t AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE j ; S r �- FARM Acre Value Per Value ' Acre Tillable 1 �� Tillable 2 Tillable 3 --------------- Wood!cnd Swampland ' FRONTAGE ON WATER Brushland ` FRONTAGE ON ROAD j -_ DEPTH House Plot i i v � R�L�IFAD Total _ DOCK COLOR � f i 's b, TRIM , i I E m M. Bldg �E 3 �'Foundation Bath Dinette Extension i !Basement Floors K. r Extension Ext. Walls Interior Finish R. i - Extension Fire Place Heat , ' =DR. X7 - L/Y Y; �� o ! � ;T e Roof,Rooms 1st Floor r— BR. i Y / YP Porch Recreation Room Rooms 2nd Floon FIN. B. Porch ;Dormer Breezeway l Driveway Garage t a-U Patio f = O. B. j i Total lL � - , f ? .J 1 R. Bruce Oswald 732 Walnut Court Novato, CA 94945 May 15, 2019 Town of Southold Building Department 54375 Main Road O. Box 1179 Southold, NY 11971-0959 Dear Sir or Madam, I am the owner of a house on Fishers Island constructed circa 1880's. I rent the house out to single renters during the summer months, The house has been in the family since 1950 when my godmother purchased it. It was then passed down to my father in the 1960's and myself subsequent to that. Enclosed you will find applications for a rental permit as well as a buildirq cenlificate of o=.ipai icy. Also, enclosed are two checks ($200 for the rental perr nit and $100 for the certificate of occupancy). LafAly, as required, I have enclosed floor plans of the house showing tl-ie locations of srnoke and carbon monoxide detectors and a copy of a property boundary survey that my godmother, Mary J. Small had COMpleted by a licensed surveyor. I am currently on the island readying the house for the first renters on June 28, 2019. 1 am leaving on May 29, 20% If YOU need to contact rne, II am available by cell phone at: 646-808-4070 or e-mail at. t�tug Subsequent to that, Larry Horn can let the inspector into the premises. His cell is: 8CO 884F-0843 and his e-mail is: LaAre LI.C4ttLo(Lj5pft.nµr nl c o m. Thank you in advance for your assistance, R. Bruce Oswald