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Home My WebLink About1000-18.-5-6 TOWN OF SOUTH OLD Rental Permit 36 Owner: Claudia Jane Ramone Occupied as: Single Family Dwelling Located at: 130 Village Ln Orient 18.-5-6 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-annua Inspection. Issued: 08/08/2025 Expiration: 08/08/2027 c �4r � official This Notice must be posted by the main entran a at all 'me Town Hall Annex Telephone(631)765-1802 54375 Main Road Faz(634)765-9502 P.O.Box 1179 Southold,NY 11971-0959 . I3C,)'Il 'DIN'G DEPARTMENT' TOWN OF SO*tJTHOLD RENTAL. PERMIT APPLICATION INSTRUCTIONS Rental Permit Fee $200 (Application must be renewed every two years) The items listed below are required to be submitted with the completed applicatio . Fluor Plans: Floor plans of each Rental Dwelling Unit, please show location of all smoke&carbon monoxide detectors. ❑ occupancy tfies of or Pre-Certificates of�ccuriicates of Occupancy: �Certificates:of.;�Occupancy .. pane for each rental dwelling unit. ❑ Certification of Code Compliance (form enclosed): Must be submitted by a q license architect or engineer or license home inspector if an inspection by Town of Southold Inspector is declined. ❑ Rental Permit Fee: $200.00 `" OV PAC, � m�W Town Hall Annex Telephone(631)765-1802 � 54375 Main Road � Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 ,1 BUILDING DEPARTMENT TO" OF,SOUTHOLD, RENTAL PERMIT APPLICATION, q f Rental Permit Fee$200(Application must be renewed every two yea: f AUG 1 Section A. I " �� Property Information: Rental Property Add res s• Tax Map Number: 1000 SECTION -BLi» _w. " -LOT SECTION B. OWNER INFORMATION: Property Owner Name, ��i� f Property Owner Legal-Address:, Property Owner.Mailing Address: 6�L.44 AV� Telephone Number(s): Daytime g g y Evenin Emer enc Property Owner Email Address:Ac w Page I f� Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 M BUILDING DEPARTMENT TOWN OF SOUTHO,LD a Mailing Address of Managing Agent: v Telephone Numbers : DaYtlm ; 1�3 4vening Emer en o,"__ Email . Address: SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on proper#yi 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: 1 Use and Dimensions of each room in Rental Dwelling Unit: Li <2cXD Page 3 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 y Southold,NY ]1971-0959 BUILDING DFPAIt' ME:NT TOWN OF SOUT 3[O Section C. Authorized Agent Inform to Name of Authorized Agent of dwe ng unit, if any: Address of Authorized Agent (no P.O. oxen): Mailing Address of Authorized Agent: Telephone Number(s): Daytime Ev ening Emergent 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 Em rgency Email Address: SECTION E. SITE MANAGER INFORMATION: (required for rental properties containing 8 or more r tal 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 �N �� 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SO?C THOLD SECTION G. INSPECTION: Pursuant to tM Town Code of the Town of Southold Chapter 207 (Rental Properties);4 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 regulationszof 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 y from the Town of Southold I t'l 1 1 ❑ 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) 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 Nall Annex, , Telephone(631)765-1802 54375 Main Road a� � Fax(631)765-9502 P.O.Box 1179 � 3uuthulcl,NY 11971-0959 BUILDING G DEPARTMENT TOWN OF SOMMOLD applicable laws and rules. I further acknowledge that I will notify the Town of Southold a, 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 r �agreed`to abide,bythe 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 Property Owner's Signature: Sworn to before me thi0l day of f �>20 L Official Notary Public Signature and Original Notary Stamp CONN 1, ry Public,State o1 New York No.0 1 BtJ618WSO Qualified in Suffolk Counly �s rrr�oisslorExpims Aoril14, _ Page 5 of 5 e TOWN OF S01UHOLD BUILDING CREPT. 631-765-1802 Oak om ON& lNbpp =t;Tl0N [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING / STRAPPING [ ] AL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI AL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL DATE41�1� INSPECTOR Vitt t G�ZtN- ( S -- 5'-- � * ;TOWN OF SOUTHOLD BUILDING DEPT. 7654 802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING / STRAPPING [ ] NAL FI [ ] jovk j�4m At-- FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: DATE INSPECTOR 11a8 TOWN OF SOUTHOLD PROPERTY MMOKU UAND --0 1�ER _j STREET �` VILLAGE DIST.° SUB. LOT ,''ram U e FORMER N E ACR. �l r S W TYPE OF BUILDING Ku i P A RES. v� (b SEAS. VL. a FARM COMM. CB. MISC. Mkt. Value LAND IMP, TOTAL DATE REMARKS t fj I -a Az z I � f AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre Tillable 1 Tillable 2 Tillable 3 Woodland Swampland FRONTAGE ON WATER Brushland FRONTAGE ON ROAD �'�, �i House Plot DEPTH BULKHEAD I T I DOCK Total I i LC-) i s rOLOR _ Af [RIM A LLL I z a. NOr 18.-5-6 6/11 t ®F - I `� C) - _ Bldg. - M E M. Bld v % roundotion S-Ta^/t Bath b f ' PIK Basement Floors i9 Extension Extension Ext. Walls Interior Finish �Z4S7-r "� LR. 3117�-W I Extension i Fire Place Heat F, I DR. ;Type Roof G6tLL Rooms 1st Floor BR. R I F Porch 'Recreation Roo ?Rooms 2nd Floor! iN. B. ,'/ I Porch IDormer Breezewa I Driveway I y , Garage s I a Patio I s a_e - I w Total %%I ✓ � \ o \\\ - sio \ \\\max \: ...\ .� ,\\\ \..� .\ ;C:^'. \ \ \\\ \.• \\ .\\. a \ 44 ._ NO \ \ of \ \\ \ \ \ \