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Home My WebLink About1000-104.-5-6.1 T0�N OF SOUTHOLD T Rental Permit Permit No. 0341 Owner Thomas Hudgens & Christy Carter Occupied as Single Family Dwelling Located at 6640 Skunk Lane Cutchogue 104-5-6.1 Village S/B/L Maximum Permitted Occupancy 6 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. 10/5/2020 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times �n P Town Hall Annex Telephone(631)765-1802 � 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 �" Iwo BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT"APPLICATION Rental Permit Fee $200(Application must be renewed every two ye AD CT 4 201 Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION U4 -BLOCK 'L SOT SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: -7 3�-17-3ZS -Li 34'1 Telephone Number(s): Daytime Evening_Emergency Property Owner Email Address: *VJ\��C° Page 1&S C� � �1C� Town Hall Annex , Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 & Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: A ........... Address of Authorized Agent (no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening 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 r Town Hall Annex ��Q, Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 a P.O.Box 1 179 A � Southold,NY H971-0959lou BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime �*e ing 4r7ncy Email Address: Tc d " OR 1 r�I'!e 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 Un t,: Number of rooms in Rental Dwelling Unit: _ k� Use and Dimensions of each room in Rental Dwelling Unit: ! .A-1-4. Q--JL�Aj"— j N r tr 1 K [ [ .. �1 &9 r Page 3 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 �C� l � 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. ❑ 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. 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. I 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 54375 Main Road Fax(631)765-9502 P.O.Box 1179311 �� Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD 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: W&S � Property Owner's Signature: Sworn to before me this day of 20J CHERYLANN HENDRIKS Notary Public-State of New York NO.01HE6122800 Qualified in Suffolk County My Commission Expires Feb 22, 202.1 Official No r Public Sig ature and Original Notary Stamp Page 5 of 5 S . Town Hall Annex ��,; Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 11794a, � Southold,NY 11971-0959 Cow BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a license architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Ero essionat seal required for Architect or Engineer,licensed donee lns ector must VLorvide gogy ot valid current certl ication Rental Property SCTM Number: _ Rental Property Address: d Lr l Owner/Name: (Ab 6 eL .. Rental Dwelling Unit Identifier: Number& Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom #1 -100 sq., Bedroom #2-90 sq., etc.) r r t tr X t R �o Property Description (include all improvements indicated on survey) I 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 of New York State, the Fuel Gas Code of New York State, and the Energy Conservation Construction Code of New York State. � )� Print Name and Title cf6 i21 — oa3 Original Signature Please place professional seal: TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING [ ] FRAMING /STRAPPING [ ] FINAL Am-14-- FIREPLACE & CHIMNEY [r/]�FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) ] CODE VIOLATION [ ``]-- PRE C/O REMARKS: fAovl 'moo STATE OF NEWYORK Vid"Come" \` s " ` tia TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTIOLD, NEW YORK CERTIFICATE OF OCCUPANCY NONCONFORMING PREI•IISES THIS IS TO CERTIFY that the Land Pre C.O. Building(s) Date- July A-j 19_ 6 Uses) located at 6570 SKUNK LANE (BAY AVE.) CUTCHOGUE Street Hamlet shown on County tax map as District 1000, Section 104 , Block 05 Lot 05 , does!not)conform to the present Building Zone Code of the Town of Southold for the following reasons: Insufficient total area. Insufficient front yard set-back. On the basis of information presented to the Building Inspector's Office, it has been determined that the above nonconforming /Land F/Building(s) /_/Use(s) existed on the effective date the present Building Zone Code of the Town of Southold, and may be continued pursuant to and subject to the appli- cable provisions of said Code. IT IS FURTHER CERTIFIED that, based upon information presented to the Building Inspector's Office, the occupancy and use for which this Certifi- cate is issued is as follows: Property contains a one story, one family, .WXM t he A-ResidentiahA ricultural zone with access to Skunk Lane & Haywaters. The Certificate is issued to E)RJI GCM (owner,_ Aenaat) of the aforesaid building. Suffolk County Department of Health Approval - N/A UNDERWRITERS CERTIFICATE NO. _ N/A NOTICE IS HEREBY GIVEI`I that the owner of the above premises HAS NOT CONSENTED TO AN INSPECTION of the premises by the Building Inspec- tor to determine if the premises comply with all applicable codes and ordin- ances, other than the Building Zone Code, and therefore, no such inspection has been conducted. This Certificate, therefore, does not, and is not intended to certify that the premises comply with all other applicable codes and regula- tions. ui"ldinr inspector -..__.,...-. RE: Real Property located at 6570 Bay Avenue a/k/a Skunk Lane, Cutchogue, New York Tax Map No. 1000, Section 104, Block 5, Lot 5 STATE OF NEW YORK) COUNTY OF SUFFOLK) SS. : FLORENCE M. PEMPEL, being duly sworn, deposes and says: That I am the Administratrix of the Estate of Catherine F. Drugon who passed away on November 4, 1984. That I was appointed on June 26, 1985 by the Surrogate's Court of Suffolk County. Attached hereto is a copy of my Letters of Appointment. o That the decedent, CATHERINE F. DRUGON was my sister and I state the following from my personal knowledge: That my sister was the owner of the real property and dwelling located at the above captioned location. That the improvements on the property consisted of a one-family dwelling without a garage. That this dwelling was erected prior to April 27, 1957 and there was an addition to said dwelling of a dining room and family room added within one year after the initial construction and all of such additions were added prior to April 27, 1957. That this affidavit is made in connection with an Application for a Certificate of Occupancy on a pre-existing dwelling and is attached to that application. ESTATE OF CATHERINE F. DR OON Sworn to before me this BY*�_ � FLCR'ENCF M. PEMPEL, Admi state . �&7/-day of April, 1986 w VMA R.tK " of Now Yoft aswwod M*Mh o BE—DROOM Na.2 IT 1'.11'IT -.0 'I W IF,'Mr- DINING ROOM 11. 3 H 15 8' BATH r cn -AMG ROCISM, aE�DPQQMN.I 13EDRQOM N.-3 CONCRETE PATIO "4'd—r-t—i-,p- CN GPAM 5400 wnm tripple glazed.ln,.latcd U-Val.e:036,SHCR:0.24 u 0 < nz 3�4 r, #AitW� 21 EXISTING FLOOR PLAN SCALE:1/4' V-0" yo, U um TEIRM5W 94 FR 4 1 1 SLOPE 1/4'PER FOOT WCH TO MAM DEC -4 2019 PLUMBING SCHEMATIC SCALE:NOT TO SCALE A-21 � O w 114 I„ _._ 6EDROOM No.2 t � IOt O Sf 3 �7 1 i W o 4 i ' a Q U DINING ROOM m BA7_H U � 3'9'xfi'T µl il." s e € e o I j T 43 } { ; T ^,,,A4 BEDROOM No.1 € z N E I BEDROOM No 3 Ule. w 13'I'x1"' II . =. issmse APTTiidd 9'3" 10'T ,G g P° 3895E f\ N € I CONCRETE PATIO 3 i EXISTING FLOOR PLAN ``` i SCALE:1/4"=P-0" A-2 f O E t f ] O 101 CRAWL SPACE BASEMENT w_ 1 ^Eg � ar53 w 5 ice, "s � o N ; EXISTING FOUNDATION PLAN Q = { Afm "' Town of Southold 4/14/2021 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERT"IF'ICATE OF OCCUPANCY No: 41845 Date: 4/14/2021 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 6640 Skunk Ln,Cutchogue SCTM#: 473889 Sec/Block/Lot: 104.-5-6.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/27/2019 pursuant to which Building Permit No. 44468 dated 11/27/2019 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: 4 s built"bathroom windgy relalscement cegral air conditiprCing and outdoor shower to existing single-family d e I I i pg_4s a lied for. The certificate g r,Chriscertificate is issued to Hud ens,Thomas& -- — .... of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-20-1315 2/8/2021 ELECTRICAL CERTIFICATE NO. 44468 6/17/2021 ..... _ .. ens A,PLUMBERS CERTIFICATION DATED _Wmm _µµg3/412021 w omas u e�w� .A ri d ignature