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Home My WebLink About1000-56.-4-17.1 TOWN OF S 0 U T H 0 L D } Rental Permit j) 0674 Owner 622 Church Ln LLC Occupied as Single Family Dwelling Located at 63745 Route 25 Southold 56-4-17.1 Maximum Permitted Occupancy 8 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. 6/16/2022 e( Official This Notice must be posted by the main entrance at all times ode o Town Hall Annex Telephone(631)765-1802 54375 Main Road +` Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 ` ��` BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION P � �� r; �� orb Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: Sovf- , 14 � q7 Tax Map Number: 1000 SECTION -.BLOCK—LA -LOT \ 1 - SECTION B. OWNER INFORMATION: Property Owner Name: L—l- Property Owner Legal Address: Property Owner Mailing Address: � L q t Po f3ok 9C� Telephone Number s : Daytime_-, Evening Emergency ,_,_, Property Owner Email Address: (0 0?Q G'hvrGG� � r° a •eaY� �w Page 1 of S � 4 Town Hall Annex Telephone(631)765-1802 54375 Main Road �4 ��,' Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 60. BUILDING DEPARTMENT TOWN OF SO THOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any:__ n Ol Address of Authorized Agent(no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening Emergency Email Address: __...,.,._w._.. _. Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: T\01- .....................m., Address of Authorized Agent (no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number(s): Daytimeµ _ 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: Y'� Address of Managing Agent (no P.O. Page 2 of 5 ry. 041 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 1 1 97 1-0959 " BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime Evening Emergency Email Address: 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: Requested Maximum number of persons allowed to occupy Dwelling n Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: .............. t t r � VL&CV-z ter, � 2 V- 1 t - a }Pnrcm�3 7� 1OK(0r11�� Pageof� �r � � t k\V Town Hall Annex „ Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box I t79 �� ,m t", Southold,NY 1 1971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD 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 afire safety inspection to be performed by a Code Enforcement Official from the Town of Southold VI 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 OOFF�SUFF�OLK) A�!� ,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 Hall Annex ' « Telephone(631)765-1802 54375 Main Road 631 Fax j, ( )765-9502 P.O.Box 1 179 ' Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD 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 as to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager. Property Owner's Name: .112Z Property Owner's Signature: 4 Sworn to before me this L�L day of ,� 20a� Official Notary Pu 1c Signature and Original Notary mp BAR13ARA S f o York Notary Public, t Moo. DITA6086001 ( ualified 1n auj`fojk Oaunty commission Expire 01l1 / 0 as Page 5 of 5 &3 -7 J . r Sa�I d ,a S�� TOWN OF SOUT"HOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ECTRICAL (FINAL) [ ] CODE VIOLATION [ PRE C/O %9 REMARKS vt 0 vi RATS `� INSPECTOR TOWN OF SO►UTHOL D BUILDING DEPT. 765.1802 �� — Lt INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL�,A� FIREPLACE & CHIMNEY [V] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION ] PRE C/O REMARKS: *A Ul o . mwt�p it �_D_ Qf saucy T'0"'IM'N OF SOU THOL D BUILDING DEPT. 631-76S-1802 4 3 7qS 0 N souiim'o I N S P wrmm C T 10 [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING XFIRE NAL FIREPLACE & CHIMNEY SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: YIN N) �A CA DATE � � ��-�- INSPECTOR OR £L/Z abed LE L:LOZ ....9 L ,Z L 8"• ". ..O_ W_w. yr rNv sw(v war r arr;a v ao�� kC7 r v1iw 1S(NVId OOIJ S Ht IM ; OHlIM HOOId S" " �3510 V)dOSN3S ONI}I ANV O htNVt3tfVM, �W d� �, " " n/ a bs z:as e aaigeg (g L r_Z/l L,^L)N bs 4L£SZ wocupag ,,"usl NIt.wetz (.9-.S.Z i)19 bs 9L"90t a5c¢� wx�psg xL.s.c .tLs+.oti N bs y9-M t N )Z VS umog kpunLq uwauleg ba ZS IL YJ+ fl�`04 .6 Li"1Dl N bs tE VZt ACniS (,Z 9 t x,Z.b t)ty bs 10"6R utaonitvg ^. �.. ; (.S.CZ w.S DE)N bs 9L C79 . ol16upla 41 iN . .. . zip (.g5".9DL)N bs 9V 6S uwoMue pp, Harp .! b.w,V &&bs ZN9'dW9 .41 fiwwrvxgpr� KY /�`�L/,'�, N 66 VZ (.Z,LI:,S,ZL)N�£9f16 woos aoa oz wowpag . UiE9,LE•.P/££.SL)Nba9g-L69 wood Bw'41 DL ® d u b+Lo LUE 09 CZ.VL r.S.ZL)N be L6"SLL w qLp —pag _ 8:SvaOOH•11 bs 9Z,90££ :V3HV ONIAll•14 bs EL'96SE:V313V 1V1Oi cool j punoig . ......... UDI. oif511� .._ ._. ,__,.. .. . .. . .. . 8:SlN0023• L:SLi00lj•14 bs 9Z'94££-V32lV 9NIAll•4bs EL'96S£:V32iV lVtOi C� I U.1 l 13afoad v f ^� f p Sul Ia ~ � r � ; " a i k I C • 4 � �, �. N:��w( kb"n..F_,.e.�. .. p ~d�nw.6 �. � n F w 4 " IFS _r t . p '�ji'l ti .�...�.,.,._ .',..... f ,.F II t „, rtrt y 1 � I Apr 10, 2021 Town Hall Annex p` �� Telephone(631)765-1802 l 54375 Main Road Fax(631)765-9502 P.O.Box 1179 � � Southold,NY 1 197 1-0959 enufm 1 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a license architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Pro ssional seal required for Architect or Engineer, licensed Home inspector rmust rovide My of valid current certi ication Rental Property SCTM Number: Rental Property Address: 63745 Main Rd., Southold NY 11971 Owner/Name: Edward Harbes Rental Dwelling Unit Identifier: Number & Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom #1 -100 sq., Bedroom#2-90 sq., etc.) 6 SoftBedroom #3 132 s f Bedroom #2 155 s ft Bedroom #4 150 sqf Property Description (Include all improvements indicated on survey) home I certify that I have done a physical inspection of the subject rental dwelling unit and find that it fully complies with all the provisions of the Code of the Town of Southold, the Residential Code of New York State, the Building Code of New York State, the Plumbing Code of New York State, the Fuel Gas Code of New York State, and the Energy Conservation Construction Code of New York State. Victor Cornelius III CEO Inspector Print Name and Title ceo# 1216-0283 Orig nal Signature Please place professional seal: Project 1 [m] nagicplan TOTAL AREA:3596.73 sq ft-LIVING AREA:3306.26 sq ft-FLOORS: 1 ROOMS:8 ♦ Ground Floor TOTAL AREA:3596.73 sq ft-LIVING AREA:3306.26 sq ft ROOMS:8 Bedroom 00ve 175.91 sq ft(12`5'x 14'2 BBih- L 60.01 sq it LI'.ing Room ' 691.66 sq ft(754 314'x 31'6 V4') v Bedroom Ft2499 qfl 138 fi's sq ft 11'27 2499 sq{t Hal1N^ay IIIIIN fi8Ax 17'2 sq dM1 A' oars Bathroom 5946 sq It 110'6'x 5'W) '0oam'ato Q Dining Room - a 620 76 sq tt(30'S`x 20"5"; Ba[h 0 50 rwm .00 sq ft(''0'x 5) 2>9.0'sgft(14'2'x 16`2'7 124.31 sq'• 10 7 x'1 9 Halt 71?2 sq It(21'x3'5'; P.atnrea-r ® Laundry Room 54 20 sq ft 103 84 sq 11 710'*6'1'• 7 ox14' dt 48.34 h'156' 1B'T 2 W Bedreom 1 pM 6 r sq�t(12' 263 20 sq B(14'7 1/2-x 1?.') �- Bathrcor, THIS FLOORPLAN IS PROVIDED WITHOUT WARRANTY OF ANY KIND.SENSOPIA DISCLAIMS ANY WARRANTY 0' 4' 8' 12' 16' 20' INCLUDING,WITHOUT LIMITATION,SATISFACTORY QUALITY OR ACCURACY OF DIMENSIONS. �- --e.:"�C.-•- 111�1111MI 1:137 Page 2/13 Ik q 3 m ' LL �E " V f✓3 cr- Lta� N `"W'a LLJ us CL ow _ {N� r it U W .._..,... ., W R R t O ,�, �. V � w W fx O w (� 12 I yy"fix Lli w Z yr m y dw d cJ7 1 r F L � ` F -0 -ID o C., 6 —0. S (D L wu o N : O LO � — W ".^.�. o o 0 >, r E f i I M pp i i 1 , pp ry IF IF rn b. r W Q .min W L w r ,. o u yr 1 a " tL ti �w r a in jm W LIJ W i 0- d TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No Z-19909 Date MARCH 21r, 1990 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 63745 MAIN ROAD SOUTHOLD NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 56 Block 4 Lot 17 Subdivision Filed Map No. Lot No.�� conforms substantially to the requirments for a private one family dwelling buildt prior to: APRIL 9, 1957 pursuant to which CERTIFICATE OF OCC. #Z-18909 dated MARCH 21 1990 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 FAMILY OWELLING WITH ATTACHED 2 CAR GARAGE* The certificate is issued to_w wRALPH CONKLIN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL, NO RECORD PRE EXISTING UNDERWRITERS CERTIFICATE NO. No RECORD PRE EXISTING PLUMBERS CERTIFICATION DATED NO RECORD PRE EXISTING *PLEASE SEE ATTACHED INSPECTION REPORT. .w A uilding Inspector 1� Rev. 1/81 BUILDIT•:G DEPARTMENT T0.111 OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT Location 63745 MAIN ROAD SOUTHOLD, NEW YORK t,numoer 6c streez) Nun. pality) Subdivision Flap No.� Lot(s) Name of Owner(s) RALPH CONKLIN Occupancy R-80 OWNER type o.-- er-zenanZ) Admitted by: SUZANNE HAHN Accompanied by: SAME Key available Suffolk Co. Tax No. 56-4-17 Source of request MICHAEL HALL Dote 3/9/90 MTELLING: Type of construction WOOD FRAME &stories ONE Foundation CEMENT BLOCK Cellar 1/4 Crawl space 3/4 Total rooms, lst. Fl 7�2nd. F1 -- 3rd. F1 Bathroom(s) 2 Toilet room(s) Porch, type Deck ', ..__..,._... � ��pe .„,,,,„ eio, type Breeze*.gay Garage2 C ,A. 'HED Utility room Type Heat OIL Warm Air Hotwater Fireplace(s) ONE NO. Exits 4 Airconditionin Domestic hotwater OIL Type heater DELCO Other ACCESSORY STRUCTURES: Garage, type const. Storage, type const. Swimming pool Guest,, type const. Other VIOLATIONS: CHAPTER 45—N.Y. STATE UNIFORM FIRE PREVENTION 6 BUILDING CODE Location Description Art. p Sec. N . p Renarks: B-P. # 676-Z Co OZ-2111 Inspected by: " _ Daze of Insp. 3/14/90 Gar Fish •Time start 9:30 end 10:00 FORM NiO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No Z..2111............... Date ...„...».......--........ C rUarr..2... .. 1965... THIS CERTIFIES that the building located at .....Main.-Road........ Street MapNo. ..........._....... Block No ......-'.77- ...... Lot No. ...... ...„..,.».„.............„.............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .........................IftrMh...27....................... 19,62.. pursuant to which Building Permit No. .....„.......... dated ...............kftx:c'h..27..........I..........I 19..62 , 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 ........ ...........Rowence.......... .......».........»....»„.»........».„.... The certificate is issued to .................................Rarl , „O :" .„...,....... „................. ....,.„...... (Owneressee or tenant) of the aforesaid building Bui[dingrt„I Spector VORM Nu. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31848 Date: 09 25 06 THIS CERTIFIES that the building ALTERATION Location of Property: 63745 � MAIN R0 An SO"�JT� (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 56 Block 4 Lot 17.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated pursuant to which Building Permit No. 3 a�Z dated JUNE 4 1991 was issued, and conforms to all of the requirements of the applicable Provisions of the law T-hd upancy for why, this certificate is issued is INSTALLATI OF ' MULLION UNITS TO AN R; "ISTING SINGLE FAMILY DWELLING AS APPLIED FOR. %. a The certificate is issued to THERESE M. SCHWARTZ of the aforesaid building. (OWNER) SUF 0LK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. N-A-.....-.. _...,...� PLUMBERS CERTIFICATION DATED z c A riz Sig ature Rev. 1/81 .......... ...... .......... '00 Town of Southold Annex 12/26/2013 P.O.Box 1179 54375 Main Road Southold,New York 11971 ........... .......... CERTIFICATE OF OCCUPANCY No: 36674 Date: 12/26/2013 THIS CERTIFIES that the building ELECTRICAL .............................. . .........................Location of Property: 63745 Route 25, Southold, .. ................................. .................... .............. SCTM#: 473889 Sec/Block/Lot: 56.4-17.1 ..........................Subdivision: Filed Map No. Lot No. .................... .............. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 9/27/2013 pursuant to which Building Permit No. 38362 dated 9/27/2013 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: 3,AQpLmp_!Lndergrqund jeectdcal service. The certificate is issued to Harroun,Ned W. ........... .......... .......... ... ... (OWNER) of the aforesaid building, SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Authorized Signature