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HomeMy WebLinkAbout1000-17.-6-14.3 of so Tut"WYY N OF SOUTHOLD Rental Permit W. 1361 Owner: South Dyer LLC Occupied as: Single Family Dwelling Located at: 21920 Route 25 Orient 17.-6-14.3 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 arra ` g for th ka al s ction. Issued: 08/05/2025 Expiration: 08/05/2027 UdeEn rceVofficial This Notice must be posted by the main entra Uea ll times Town Hall Annex Telephone(631)765-1802 0 " ��� � � JJ Fax(631)765-9502 54375 Main Road P.O.Box 1179 Southold,NY 11971-0959 xyU J �i � b BUILDING DEPARTMENT TOWN OF SOUTHOILD RENTAL PERMIT APPLICATION �Rental Permit Fee $200 (Application must be renewed every t c. � Section A. ... Property Information: TOWN O ` 1 Rental Property Addre s: 1 0 Tax Map Number: 1000 SECTION BLOCK SECTION B. �, er LLCr) OWNER INFORMATION: y w� , �6 Property Owner Name: J �� AJAS / ce�// Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) j?6_6/Ov/ t b TU7_H[G L- 0 , 5 iv id i Telephone Number Property Owner Email Address: � ~°� � ►" a c" Page 1 of 4 7 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on prope 4l#4h 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." y7 Rental Dwelling Unit Identifier: -AU Requested Maximum number of persons allowed occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: �hL 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 NYS licensed architect, a NYS 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. c ❑ I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold. Page 3 of 4 1 am submitting a completed Town of Southold certification form from a licensed architect, a licensed professional engineer, or a licensed home inspector who has a valid New York State Uniform Fire Prevention Building code Certification. SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) ) COUNTY OF SUFFOLK) )r IC�1 N� 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 Cal, khold and,.... agreed to abide by the same. JUN 2 4 201 4. I 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: � eQrd i?S -tia(-Qc Property Owners Signatur4—p?f -�—"141 Sworn to before me this 6,day of 201 Notary pub11o,fttq of Nm York SSM Official Notary Public Signature and Original Notary Stamp No.Ott 1 "N g g Y p �cse1 in Suffolk county ` mmission ExPires Aprit 14„ ? Page 4 of 4 as M, ,'A Roo ©AM TOTOWNOF SOUTHOLD BUILDING DEPT. 631-765-1802 INSPEC;kTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANJPE TRATION ELECTRICAL (ROUGH) [ ] ELECTRICALL) CODE VIOLATION [ ] PRE C/O [ NTAL REMARKS: RKS: 0 DATE INSPECTOR -71311ao18 r TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET VILLAG I7tST.E SUB. LOT a � -gv-� L1,C, ' t ACR. REMARKS TYPE OF BLD. ROP. CLASS LAND IMP, TOTAL DATE na —� as e ; v_ FRONTAGE ON WATER TILLABLE FRONTAGE ON ROAD t Z3 WOODLAND T_ DEPTH C7 MEADOWLAND BULKHEAD HOUSE/LOT TOTAL COLOR a s TRIM M. Id Foundation B g. <' Both y£ � a c� rnent ., Extension 41 7- Flags K: f t5 . __ € , . Its 1U/9.G1. ' Extension Walls Interior Flnlsh Q LR: A _ -o i � ,� D� Place Heat Extension _ . "` _ ' P s -- ._ o tr^ t Type Roof ` Rooms 1st Floor BR: f._ Recreation Rob FIN 2nd Floo . B. Porch Porch Dormer Driveway Breezeway Garage (� otL ✓ /G�- b� f Patio 0 B. Total 3 T `f 7 L ro I ; �,SD BEDROOM LIVING ROOM SHELVING i IF w BATHROOM __................. lrj ............ � o � U I BEDROOM SUN PORCH CLOSET CLOSET ® W J/ i FIRST FLOOR PLAN KITCHEN r (2275 SQUARE FOOT GROSS SCALE: 116"=r o° TUTHILL RESIDENCE - SOUTH D YER L L C 21920 STATE ROUTE 25, ORIENT NwY, S.C.T.M. 1000 - 17 -06 - 14.3 C dAd C NdT, -------------- xg t f'sa I'r /r BEDROOM LIVING ROOM Sf1ELVfNC o BATHROOM 0 BEDROOM ?� SUN Q� PORCH !! CLOSET CLOSET W r r FIRST FLOOR PLAN KITCHEN 2275 SQUARE FOOT GROSS) SCALE: 1/8" V-0° TUTHILL RESIDENCE - SOUTH DYER L L C 21920 STATE ROUTE 25, ORIENT N.Y. S,C.T.M, 1000 - 17 - 06 - 14.3 � I � � CLOSET HALF BATHROOM ��� tiGV" wd, I BEDROOM BEDROOM � ? ..f CLOSET �f i p; �1 fi 1 BATHROOM CLOSET � CLOSET i so BEDROOM V r k i u SECOND FLOOR PLAN 950 SQUARE FOOT GROSS SCALE: 118"=rr-0r- I TUTHILL RESIDENCE - SOUTH DVYER L L C 21920 STATE ROUTE 25, ORIENT N.Y. S.C.T.M. 1000 - 17 -06 - 14.3 ��s L&-hr pEvrrpe- /vocr m 1. CLOSET HALF BATHROOM BEDROOM P� 4� Alt E BEDROOM 0 V r T CLOSET m J,ll a.�m�:• 1 {[ I� BATHROOM ® CLOSET CLOSET SD V BEDROOM��� ° I I� I, I I, SECOND FLOOR PLAN _....ww_..... www...wwwwwwww .ww.. 950 SQUARE FQ07 GROSS SCALE: 1/8"=V-0 I TUTHILL RESIDENCE - SOUTH DJOYER L L C 21920 STATE ROUTE 25, ORIENT N.Y. S.C.T.M. 1000 - 17 -06 - 14.3