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Home My WebLink About1000-14.-3-2 of so TOWN OF S UTHOL Rental Permit } 1102 Owner: 1405 Terry Lane LLC Occupied as: Single Family Dwelling Located at: 1405 Terry Ln Orient 14.-3-2 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 Issued: 07/07/2025 R�' Expiration: 07/07/2027 °d En rce et official This Notice must be posted by the main ent -nce at a11 rme � V6LIJ A�f )/6 2-)" 5 r i -u Z.1z lz�� 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 lattp ://w sou c�[c(t RENTAL PERMIT APPLICATION Rental Permit Fee$300(Application must be renewed every two years) Section A. Property Information: Ren at Property Address: - —tl Tax Map Number: 1000 SECTION -BLOCK -LOT - SECTION B. OWNER INFORMATION: i Property Owner Name: 1 4D-5 Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 10 Telephone Number (s): Daytime Evening Emergency Property Owner Email Address: 4 G!)LA NJ Page 1 of 4 Section C. Authorized Agent information: Name of Authorized Agent of dwelling unit, if any: e ` t Address of Authorized Agent(no P.O. Boxes): Mailing Address of Authorized Agent: , Telephone Number (s): Daytime Evening Emergency Email Address: a K O Y" < ' t A(\4YA ( C) _� 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): 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: l 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 oom. 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: Number of rooms in Rental Dwelling Unit: (::;� Use and Dimensions of each room in Rental Dwelling Unit: b4c 1 ` t J � "3 a X. V "t t ec� Yvt. 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 Officiai from the Town of Southold 0 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) 1i Lu1 ' , 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: �GLvr&k-� !r Property Owner's Signature. 1 Sworn to ftlll�— day of V ir-Z 20 2) — Official Notary Public Signature and Original Notary Stamp MARTIN D.FINNEGAN Notary Pubiio-State of New York No.01 Fl6056707 Qualified In Suffoik County�l Commission Expires March 26,21I�1 Page 4 of 4 TOWN OF SLTHOLD BUILDING DEPT. .�� 631-765-1802 INS' POECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I SULATION/CAULKING [ ] FRAMING / STRAPPING [ 1NAL [ ] FIREPLACE & CHIMNEY ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTAFPETRATION ELECTRICAL (ROUGH) [ ] ELECTRICAL) CODE VIOLATION [ ] PRE C/O NTAL REMARKS: 4q � v `f o f,Pry DATE � INSPECTOR ___ ►`a 44khaw �\ Oo �ecxsoNr\ wovv\ co ZZ 0 TtA vs� in 0 fA� TOWN OF SOUTHOLD PROPERTY RECORD CARD- OWNER STREET VILLAGE D. LOT d. FORMER OWNER N E ACR, S W CODE DATE OF CONSTRUCTION LAND IMP. TOTAL DATE REMARKS Z Ale 14 i;,-A Q p'o :2 c3p Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH House Plot BULKHEAD Total -3 + ! I �- i Ci 1 i =fg � t 3 £- -� 4 t f « _ 14.-3-2 1Q/Q9 1 p /Z, v'' "[ M. 6ldg� �, Foundation Math T _ Basement Floors - T dam . Extension '�F ^- _ Ext. Walls n E t nsiloo '. 11 - Interior Fills r' r Heat vE� _ Extension Fie Place _ `° _ g < _ r a nCU - i i _E Attic G `< � - Parch ,-� `- -- _ Pool Patio Rooms 1st Floor Deck . Driveway Rooms 2nd Floor I �re�way �"kt + Garage S � 3 is 0 BE - u f bT' a I r" i1A ,P, ,r s g FORM NO 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N Y. Certificate Of Occupancy No Z„1m64541 . Date December R 1 , 1987 . . THIS CERTIFIES that the building . o n e f am 11 y. dwe 11 i n . . . . . . Location of Property R.0:W. off Main Road or i e n t . . . . . House No. Street Hamlet County Tax Map No 1000 Section . . 0.20 . Block .0 1. . . . . . . Lot . . . P/.o . .. . . . .. . Subdivision L.1 o y d T e r r y Minor Sub . .Filed Map No . . . . .Lot No . . . . . . . . . . . . . conforms substantially to the Application for Budding Permit heretofore filed in this office dated pursuant to wluch Building Permit No. . .154.71Z . . . . . . . . dated .Nov,., 8 ,. .1986 . . . 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 . . . . . . One _garage and rear deck: The certificate is issued to FkLAIJR R . _iiELMINSKI of the aforesaid building. Suffolk County Department of Health Approval 8 6-S 0-.1.6 3. 8/ 1018.7 UNDERWRITERS CERTIFICATE NO. . N 8 2 7 3 3 3 8/ 17 /8 7 „ . . PLUMBERS CERTIFICATION DATED: MATTITUCK PLUMBING & HEATING CORP. YA . . . . . . . Building Inspector Rev 1/81 .......... Wt Town of Southold Annex 1/24/2013 P.O.Box 1179 54375 Main Road Southold,New York 11971 .... ...... CERTIFICATE OF OCCUPANCY No: 36120 Date: 1/24/2013 ............. THIS CERTIFIES that the building ALTERATION . ...... .... ......Location of Property: 1405 TERRY LANE ORIENT, N.Y. 11957, SCTM#: 473889 Sec/Block/Lot: 14.-3-2 ................... . Subdivision: Filed Map No. Lot No. .................. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 4/15/2011 pursuant to which Building Permit No. 36327 dated 4/15/2011 ............. 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: Lltqati�a gdgLla addition t a mil i As.A ppl licd-fm,, (L �Qqqf a- yAwdL ng The certificate is issued to MICHAEL&TERRY SMITH (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 36327 1/23/13 PLUMBERS CERTIFICATION DATED 1/15/13 Michael Smith ..........—.......... u rizc t rizc S. ture Town of Southold 11/16/2023 �A P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44737 Date: 11/16/2023 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 1405 Terry Ln.,Orient SCTM#: 473889 Sec/Block/Lot: 14:3-2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 2/15/2022 pursuant to which Building Permit No. 47625 dated 3/31/2022 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: sunroorn addition to existin a ]e fa ra ly w&li r The certificate is issued to Smith,Michael&Teresa of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 1 ut .ori e igrnature clllt Town of Southold 3/16/2024 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45051 Date: 3/16/2024 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 1405 Terry Ln, Orient SCTM#: 473889 Sec/Block/Lot: 14.-3-2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore tiled in this office dated 7/l/2020 pursuant to which Building Permit No. 44975 dated 7/13/2020 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�.builf'accessoal i0 gLqund swimming pool fenced to code as armed for er ZBA#72 2 dated /3/241 ►. The certificate is issued"to Smith,Michael&Teresa of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 44975 7/21/2020 PLUMBERS CERTIFICATION DATED Au on dg ature _ .......................................w �....... Town of Southold 3/20/2024 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45062 Date: 3/20/2024 n THIS CERTIFIES that the building HOT TUB Location of Property: 1405 Terry Ln.,Orient _..........w.w. w ....._....w.... _......w.w ...w....... ...._.............� _ _.w,......._...................... SCTM#: 473889 Sec/Block/Lot: 14.-3-2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 6/3/2022 pursuant to which Building Permit No. 48045 dated 7/6/2022 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: ""as lruiltw"acce,saaiat tub „aliwcr. The certificate is issued to Smith,Michael&Teresa r of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 48045 9/27/2022 PLUMBERS CERTIFICATION DATED riz i..natur � tllq Town of Southold 3/26/2024 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45074 Date: 3/26/2024 4 THIS CERTIFIES that the building GENERATOR Location of Property: 1405 Terry Ln,Orient SCTM#:. 473889 Sec/Block/Lot: 14.-3-2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 12/11/2020 pursuant to which Building Permit No. 45632 dated 1/4/2021 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: ""as built"acces-sory aenerator as applied for, The certificate is issued to Smith,Michael&Teresa of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45632 7/27/2022 PLUMBERS CERTIFICATION DATED __............ ...... .......A o . d i ate .