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HomeMy WebLinkAbout1000-137.-2-19.3 Rental Permit 1345 Owner: Lawrence Wall , Leslie Long Occupied as: Single Family Dwelling Located at: 4075 Pequash Ave Cutchogue 137.-2-19.3 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: 07/01/2025 Expiration: 07/01/2027 +c'4 4ment offi l This Notice must be posted by the main entrance at all times y--4- q43 TOWN OF SOUTHOLD—BUILDING DEPARTMENT 7-1. Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971,-99,59 fry Telephone (631) 765-1802 Fax(631) 765-9502 ht 2025 RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: 40 Pe a -£ UK i C +chi �� f 1 9 3 S Tax Map Number: 1000 SECTION -BLOCK J -LOT 4 SECTION B. OWNER INFORMATION: Property Owner Name: L roc.` Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) `7 `7 100Ckh r `r c� 917 9r17 Cr17 Telephone Number( ): Daytime F / Evening 536 a 3351Emergency Property Owner Email Address: I C,5( e 0 f 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: �Y) if . s 6A Requested Maximum number of persons allowed to occupy Dwelling Unit: g Xk Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: 3 d .-15-1 1c2- '-Red ` om . L i'v)'oG /fir � ,� '. -Q0 � 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 ❑ 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) f I I Lcw ye viu "� ` 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 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: ure.— N A Property Owner's Signature: XJ Sworn to before me thi( day ofF—cbryt 20-C�t5— Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.01BU6185050 Qualified Ira Suffolk County �� Page 4 of 4 Commisslon ExpiresApril 14;2 1f S� TOWN OF SOUTHOLD BUILDING DEPT. Al 631-765-1802 I N toqi" P E 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 [ AliENTAL 0CCv DATE 30,W5 N PECTOR _ Alf TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 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 (FI AL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL 0 9� Gon c/ s/o✓1 �i V1; s� yl AAQ Imo. DATE INSPECTOR £ e �8 Town Hall Annex 1 �� Town Of Southold 54375 Main Road Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 SCTM# /3 Date Owner Iva Phone Address --- A Visible Hamlet Inspector Floor Level Quantities Sub 1 2 3 Smoke Detectors(not located in bedrooms) X 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 J latching gates Pool fence to code requirements CO's for all items present Prior Rental Comments: 2 o,e 6 8n aS 1// -) I I � 7/ aO/ I8 'SOWN 4F S U H LD PROPERTY RECORD CARD EET � � VILLAGE DIST.". SUB_. _ . .. ....LOT OWNER STR air j S h v �_.. OWNER IV. N E ACR. J le ER O FOR It W �Z c��(�����L .7 TYPE OF BUILDING � � 44 , �t F fe Z e K ✓ _. Mm _.... -- _ _.....__ ........_ _.._ ...__.,..._..._._.W_.� RES. � SEAS VL. FARM COMM. CB. MICS. Mkt. Value� LAND IMP. TOTAL DATE REMARKS / v .....,.. ....... .,. ................. .,.,,,..,_ L^..,.,_.....�.._... ..... �!".�z, o 0 9 a o 3 � e AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE ...._...... ..._._ ........FARM Acre Value Per ValueAcre ,......, _�. ..__.,__...... ._.._._.._..__.. .. __.__..____._ Tillable -AGE GN YVAff-l!R , Woodland ._ ...._ ..,__ .._...__w_..__.___ . ..._. . , ..._. .. .....ry ,._ .... ______ ._ .. .... r. ...._._ 9... _M. ,_.....__ ...... _.._,,,,.._ ..__..m _....__ _.... FRONTAGE ON ROAD P �,.,.....�,.. .._._,�m..... .,,_...MM.__., ...,__.,.__w»..__M.._..m........................._.,..,.,,....,.....,,.,,,..,..................�.�. ._._,�.w, M ...._. ._,.... ...._ ......._ . ._...m............__,M.. ...Meadow I! .._,.. DEPTH �and � BULKHEAD > ..._. ,...._..�...�.._�.._._.n_.�� ...,� .,._.._.r_._._,.,._.,.._......,__..__.�.____�.a .,._._................�.,, House Pat DOCK Totil ti r r m OR TRIM X M 137:2-19.3 01/2017 _., i .__ _..__.. . y,M. 61 s a _.. ..... .._7� � .. ry` g t Extension 7A 7 = .13 Extension 7....__ � . ._ ._,. ..�.�.... _., .....�u_ _ ,9. _._._ 1 Extension Foundation Both / Dinette _..Porch 61, <;� __..�_. ._._.___...�.,......_._.,.�.,,. ....... '_�w._.rv_.�nM....... _�_......�....�...__..._ ..__....._�....4......w._.:.._._,._.._.. _.. m...._. .�._ _�_......w_w ._w...�_......�mmm. _._ ._._.w_.... _.__ .. ,........_�__...� Basement Floors K. Porc °/ �' S��Ext Walls Interior Finish LR. Breezeway Fire Place.... Heat o 13R. �J R Rooms Tst Floor Garage �TYPe Roof ....__... _...__. _ .__. ...__ a Patio Recreation Room Rooms 2nd Floor FIN. B _ .. O. B. 3�/ Dormer Driveway Totaldi 7 ;p a�37 .� FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy 18 No. g11304. . . . . . . . . . Date . . . . .Nover,?U . . . ' . . . . . . . . . . . . .. 198 THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . Location of Property 4P.75 . . . . . . . . . . . . . . . . 1'etl£ sh Avenue Cutchogue House No. Street Ham%t County Tax Map No. 1000 Section . , 13 . . . . . . .Block . .d. . . . . . . . . . . .Lot . . .019 .003. Minor Kerbs & Lakowitz 5699 4 Subdivision . . . . . . . .Filed Map No. . . Lot No. . . . . Requirements for a private one-family dwelling built prior to conforms substantially to the Appiicaftn-far Buitding•TvfTir liMrofdr%-filed'ui M§ office d"al'e� Certificate of Occupancy A p r i Z„2 3. . . . . . . . . . 1957.pursuant to which`B AdittgP �No. . . . . .1 . . 0 4 . . . . . . . . dated N o v em b e r. .18. . . . . , , 19 .8 2,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 . . . . . , . . . . . .a .private one-family dwelling., . . . . . . . . . . . „ . * . . . . . . . . . . . . . The certificate is issued to . . . , . CHARLES LARRY & NANCY J. McC�ORMICK (owner,*mew �imew-rmff) of the aforesaid building. Suffolk County Department of Health Approval . . . n/a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . , . Pi .5 6 7 9.0 3 . . . . . . . . . . . . . . . . . . g y a „ Building Inspector Rev.1/81 FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z1 1394. . . . . . . . . Date . . . . . Decembe•r 20 19 82 THIS CERTIFIES that the building ,deck ,addition . . . , . , , , , . . . . . . Location of Property 4075 Pequash ;Avenue Cutchopu House No. Street Ham/et County Tax INIap No. 1000 Section . ? 7 . . . . . . .BIock . . 0.2 . . . . . . . . . .Lot . . . .018. . . Minor , . Kerbs & L a . . . . . . .MrOd' -p No 2 5 , .Lot No. . . . . . . . . . . . . . Subdivision . . . 9 2 conforms substantially to the Application for Building Permit heretofore tiled in this office dated September 9 19 8 2 pursuant to which Building Permit No. . .1.19 P 9. . . . . . . . . . . . . dated . ,September .15. . . . . . . . . . . . 10?. ,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. d,gck, addition . to an, existing, one-family, dwelling: The certificate is issued to . . . . _ . , Jon C . Kerbs & William Lakowitz (owner,les&ae�temanfl ' of the aforesaid building. 11 Suffolk County Department of Health Approval . . . . . .nla. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . .n�a . . . . . . . Building Inspector Rev.1/81 n __..._ .__ _ _ .. ........ ..... ....__ ........... ... ........._.. .............. _.._. _.................. �........w. a• ..3»... ..,.7 .,�..... E„e,wows.an, d e,r wo�•�M w• am.m ^� " .�.•Im.uwe.ww wn evrasev b � wu�m raxmu'�m' �w"wtir .�..� � � ..err� '�.r. '�' ..,� .... .ti.. ,�^ :x �.._ �, _• • oN.,no Seal: eeweaeew x owr�m.'.w+w,mae. rv, PR ER ,. ks Esra Ozcan ..._ .,,,._���r .��".r,?" '.�✓,D � �Y"' d �i �' __ ..� n.,...' ���.�.�.. "ice � �✓ ,�.-.,,.. 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