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Home My WebLink About1000-110.-5-5 of so�� TOWN OF SOUTH L Rental Permit Ic 1365 Owner: Hassildine Irry Trt Occupied as: Single Family Dwelling Located at: 2825 W Creek Ave Cutchogue 110.-5-5 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: 08/13/2025 Expiration: 08/13/2027 Code E o ce ntOf iciai This Notice must be posted by the main entrance at all times ECEU 1I r TOWN OF SOUTHOLD—BUILDING DEPARTM:E AUG y�� p�pg r - 1 p Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax(631) 765-95021 : e o �� c l�°l °aw i,.,�.g' II'dln Department own of Southold RENTAL PERMIT APPLICATION Rental Permit Fee $300(Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION _ -BLOCK SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) Telephone Number (s): Daytime 1.70'°'tj� -3�-Y Evening Emergency Property Owner Email Address: 04 V d Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent (no P.O. Boxes): U Mailing Address of Authorized Agent: Jam " �✓ Telephone Number(s): Daytime Zitl Evening _ Emergency Email Address: 5Ha4��/��` � r��I 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: 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 room. For properties with multiple Rental Dwelling Units use "Rental Permit Application Addendum." Rental Dwelling Unit Identifier: �,J, Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: . i Pl e,' N Use and Dimensions of each room in Rental Dwelling Unit: I)Z q3 x -I ,I i>010 ��.�1 ��z L4 d � �� /N lr c C' torIF si 'a 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 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) 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: w,, -) � t Property Owner's Signature: , ,Z- Sworn to before me this /6�day of .,15 20 357 Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.01 BU6185050 Qualified in Suffolk Countyt� Commission Expires April 14,2 Page 4 of 4 if sootAll * TOWN OF SOUTHOLD BUILDING DEPT. cou 631-765-1802 I N 41415 P E C T 1 (0) N [ ] 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 (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL Town Hall Annex " Town Of Southold 54375 Main Road c Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 SCTM # Date Owner AW, 00hc2 Phone Address a $- Visible Hamlet Inspector Floor Level Quantities Sub 1 2 3 Smoke Detectors (not located in bedrooms) Carbon Monoxide Detectors Fire Extinguishers r f 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 I Handrails&guards installed &secure Pool Safety Pool on Site Surface water alarm Date of CO issuance Door alarms Pool completely enclosed Self closing/ latching gates Pool fence to code requirements CO's for all items present Prior Rental Comments: '5QArV. 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USE OF HE STRUCTURE WITHOUT T WRITTEN NS O R ANY D TTENAPPROVALO ONA F MATTITUCK.N.Y. 298-M3-RIVERHEAD.N.Y. 727•8245 THE ARCHITECT.WILL THEREBY TRANSFER ALL RESPONS- IBILITY FOR THEIR USE TO THE USER AND THE AUTHORITY -.. - -.. ACCEPTING THEM." r ti E1t14T,QET0.M61 MALL.-1Ut : 4 , $TAMM&j. rl"wro,Savvil"Nam-1/o a kj ♦ 1 u ,� �: f *�_` 2•�1P'�r�+ - f�l��Ish+- ]41fiti•TtNh,Spe5F4 c�v�. ,�Gtla #te �`- `-� _ ( tea} L1da 4L 1 . 1 91•o"lCA:h�V L' �€• � �s�ll#atawa Oath.. is Y i t -€'ArtoTN 1 41 ff/ [ t_ N d �j{:t•2411(2 lout fTh.'��. 2"lOuc•61.AP. OVEM r alL RE/roVa E- C. WALL # d� = L-hla P(EruYLZ Nr P _ .- '`, ,€ '.. i A I.ts` 12'ItNG7�.Oe1L OR1 , Hai '- - _ iCio cp'u¢. ¢ 1 a r N• s � 'C°Yaco.><,FTa• �,� ! � t N� � [d 2�15T.,L,� al 1 fi s �A # 1 � �.' °-dt•_}� Il'r � t . �.�-_. .. e � .�;*rwLL=h. ,ara E�� I a j►�1�+ � � 1= m 1 A IN - ( [ ?9yD IL.D PYLeT.avn6 e i SI'S V C tx ALTIRMATI. PY0. f+ x 7 # f I =Yo Nf 4YT et hs we . 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'�%ISY•QET4�N�N[T OVAL�.. a • P1,AN PJC} .��`2 y OF Z DOIn��d D C!D �1450 V1/I1�1 �� ° f�- L 1�c 'f�l�° 5 SE PLANS ARE F DAT OF A rI. ARCHITECT ® "THESE PLANS ARE FOR THE CONSTRUCTION of A SINGLE s. 4 y A� A - STRUCTURE ONLY.USE OF THESE PLANS FOR ANY ADDI- �(IS�Yf((El7Ly W W TIONAL STRUCTURE WITHOUT THE WRITTEN APPROVAL OF THE ARCHITECT,WILL THEREBY TRANSFER ALL RESPONS- MATTITUCK.N.Y. 298-48113-RIVERHEAD.N.Y. 727-5245 -= 1BILITY FOR THEIR USE TO THE USER AND THE AUTHORITY ACCEPTING TMM'• 1 � � TOWN OF SOUTHOLD PROPERTY RECORD -)jai OWNER STREET s VILLAGE 6IST.7 SUB. DUI FORMER OWNER I N E ACR. Z 1C- S W TYPE OF BUILDING RES. �� SEAS. VL. FARM _ COMM. CB. MISC. Mkt, Value LAND IMP, TOTAL DATE REMARK76 S = / ' 14 G' C� I 3 = S O I _ AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre Tillable 1 Tillable 2 Tillable 3 Woodland 6 Swampland i FRONTAGE ON WATER - Brushland FRONTAGE ON ROAD < House Plot I DEPTH I _ , 3 , I � a v Total u DOCK I CCLOR - - E -V ' s a w - . / J- � F C_ vim_ I > s I t U1 t r;r 7= Faundation Bath Dinette M. Bid Extension a Basement r K Floors - �.,.. > +�� ` 'Ext. Walls _ Interior Finish LR. 4 Extension X 0 `{ J "' t Extension Fire Place 4 Heat DR. ` ;Type Roof Rooms 1 st Floor 1 BR. Parch S. Recreation Room Rooms 2nd Floor! FIN. B. a_ Porch 1 ;Dormer Breezeway Driveway Garage Patio F s O. B. I Total i t of sorrry Town of Southold P.O. Box 1179 53095 Main Rd Southold, New York 11971 P: E-CERTIFICATE OF OCCUPANCY No: 46383 Date: 08/08/2025 THIS CERTIFIES that the building PRE-CO Location of Property: 2825 W Creek Ave Cutcho gue NY 11935 Sec/Block/Lot: 110.-5-5 Conforms substantially to the Application for Building Permit heretofore,filed in this office dated: 08/01/2025 Pursuant to which Building Permit No. 52160 and dated: 08/08/2025 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: Wood frame single family dwelling. Please Note: The currently existing floor plan and dwelling conditions were established under BP 6719 (CO Z-6619). These conditions supersede the Pre 1957 structure which is indicated on the attached housing report. Violation: None The certificate is issued to: Hassildine Irry Trt Of the aforesaid building. Please see attached Housing Inspection Report, A hori d Signature Housing Ins ection Re ort Props Info SUM # 110.-5-5 Property Class: 210 ONE FAMILY RESIDENCE Address: 2825 W Creek Ave Hamlet: Cutchogue Owners: Hassildine Irry Trt Condition of Property: Clean, maintained and safe Structure Type of Construction: Wood frame Number of Stories: 2 Foundation Construction: Block Number of Exits: 3 Finished Basement: Cellar: Crawl Space: Garage: not pre (BP 6719) Breezeway: Deck Type: wood Porch Type: partially covered Patio Type: Mudroom: Building Systems Type of Heater: Fuel Type: Hot Water: Electric Panel: Air Conditioning: Fireplace: Dwelling Components Rooms/Floor Levels Sub 1 2 3 Additional Items: Kitchen 1 Living Rooms i Dining Room Bedrooms 2 3 Bathrooms i Toilet Rooms Utility Rooms Entry Areas Other Accessory Structures: Garage: Construction: Foundation:. Barn: Construction: Foundation: Shed: Construction: Foundation: Sleep Quarters: Kitchen Facilities: Plumbing: Swimming,Pool: Other: Comments: Violations: None Inspected By: Nancy Meyer Inspection Date: 08/07/2025 Na 4 TOVW OF SO OLD B INO DEPART AUNT Town Clark$i Office Southold, N. Y. Certificate Of Occupancy No. .Z6639. . . . . Date . . . . . . . . . . . . WA�. . . . . . . . . . . ., 19.19 '. .. THIS CERTIFIES that the building located at .hest Creek.. . . . . . . . . . . . . Street Map NO. . .xx. . . . . . . . Block No. . xx. . . . . .Lot No, . . . . Outchogue N.Y.. . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . . . July. . .10 1973 . pursuant to which Building Permit No. 671.9Z. . dated . . . . . . . . . .J�y. . . .i . . ... 19 73., was issued, and conforms to all of the require- ments of the applicable provisions of the law.The occupancy for which this certificate is issued is . .Private, one. family dvolling vith an addition . . . . rt . . . . . . . The certificate is issued to . Edw & BettyJean Hassildine w Lvners (owner, lessee or tenant) of the aforesaid building. W*R. Suffolk County Department of Health Approval . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . UNDERWRITERS CERTIFICATE No. pending, . . . . . . . . . . . . . . . . . . . . . . . HOUSE NUMBER . . 28p5. . . . . . . Street . . . . . . . . Creek fiveµ . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . .. . .. .. . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . . . . . . Building Inspector