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Home My WebLink About1000-128.-6-12 of so TOO"`WWW N OF SOUTHOLD Rental Permit 1342 Owner: Alison Ross Occupied as: Single Family Dwelling Located at: 2840 Great Peconic Bay Blvd Laurel 128.-6-12 Maximum Permitted Occupancy: 5 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: 06/30/2025 Expiration: 06/30/2027 coke En went ofci This Notice must be posted by the main entrance at all times Of sore, TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 I N S P E CT 10 N [ ] FOUNDATION 1 ST/ 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 [ �ENTAL REMARKS: asS n.e —_� oe DATA: - � �� _ INSPECTOR 11,Ofat a Town Hall Annex Town of Southold54375 Main Road Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 SCTM # -- & Date Owner ICOSS Phone Address , Visible Hamlet inspector Floor Level Quantities Sub 1 2 3 Smoke Detectors(not located in bedrooms) Carbon Monoxide Detectors ?E Fire Extinguishers Exits Bedrooms 1 2 3 4 5 6 Smoke Detectors Egress Occupant Count Building Systems Maintained &Cl eratlonal Condition of Property Heating Building interior Hot water Building exterior Electrical Property clean,maintained&safe Mechanical 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: TOWN OF SOIIJT1111OLD—B'IJHDING DEP Wf M ENT y Town Hall Annex 5437 lain Roar(P. O. Box �1.179 Southold,'Ny` '�1.1�971 095 9 � � ��5 � Telephone(631) 765-1802 Fax(631) 765-9502Lula fd €?� al� � wtt �ww a 300°= re J RENTAL PERMIT APPLICATION c -� 09 SUS V-.W- 34 Rental Permit Fee $300(Application must be renewed every two years) 1 I Lk Section A. Property Information: Rental Property Address: z.ib 40 r__r4_0_t c 8 Blvd Tax Map Number: 1000 SECTION L+38S9 -$LOCK i ZQa -LOT SECTION B. OWNER INFORMATION: Property Owner Name: A 4,S4 RoS 5 Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 11 "« si�a(e I�ri�rrfl & gUVj U t2-+Jvert�C,�. v- Liu(J Nrw �+r1�C nl l 2 10o11) Telephone Number(s): Daytimelo%6 42:022tEvening S mac_ Emergency s2vy%-C.. Property Owner Email Address: 0LL�5`ea^e'0 5la) nn-Z_41 . Page 1 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: oIA-c" 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: UAt+ J— Requested Maximum number of persons allowed to occupy Dwelling Unit:(2 Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: A 4iALn U * �ejroip efts =lS'x 11, S q 1411 horn 10, Z5 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 ❑ I 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) IIva S S 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: on 5 Property Owner's Signature: Sworn to before me this 1 day of 20,vZ5 Official Notary Public Signature and Origina Notary Stamp SABRINA M BORN Notary Public, State of dew York No.01113043317038 Qualified in Suffolk County //77 Commission Expires Dec.22,2001 Page 4 of 4 OLOR TRIM Sri m - 'r - P I _ 1 l f I � f �E i � t s I i TT77 - - - - —, ~~t - - --- -i----�- - _ I s f s, 3 i Al e e Fact ion ° F,.xten t S ✓ 1 � _ I s i lr Sc I late f ions' —� a ' EFoundation Bath - f l y f 'Dinette ! - / C ,.Porch X' G Basement Floors i /� 1 K. Pe mh _ =Fact. Walls Ga✓ S, Interior Finish S, /� LR. Breezeway IFire Place 'Heat DR. Garage ✓ `__ 'Type Roof Rooms 1st Floor R. Patio.`,"`.;'y ' - ;Recreation Room Rooms 2nd Floor ;FIN. B O. B. jDormer Driveway Total I - I FORM NO. S TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z9419 . . . . Date . . . wJanuary. 30 79 . . . . ., 19BTVd. THIS CERTIFIES that the building located at . 2840 Great Peconic Bay gtix MapNo.. , . . . . . . . . . . . Block No. . . . . . . . . . .Lot No. . . . » . . . . . » . . . . . . . . . . . . . . . . . » . , . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . .June 30. . . . . . . . , .. 19.78, pursuant to which Building Permit No. . .9815Z dated . . Jung. , 30„ . „ ., 19.78, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is Private One Family Dwelling issued is . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . » , . , . . . . . . . . , . . . . . » . , . » . . » . . . » , » The certificate is issued to . . , . Donald J. & Mildred M. Brown of the aforesaid building. (owner, xx Suffolk County Department of Health Approval January 30, 1979 8-SO-13k µ F UNDERWRITERS CERTIFICATE No. . . » . N419601. . . . . . . . . » . . . . . . . . . . . . . » . , . „ . . » . . . HOUSE NUMBER . 2840. . . . . Street . . , , Great Peconic Bay Blvd. » F Laurel, . . » . . » » . . . . . . . . » , » . » . . , » » *New York. . . . , . . . . » . . . , » » . -4- e� ' . . . . . . . , . . . . Building Inspector County Tax Number 1000-128-6-12 CC)ve D F,6 444 h cU a � v f C.lo € £ �— '< i�. ... € •,QED•�ul-�i' ;� day v' r € * I�, • _ P i ilk z-e- -K4TC.GFiSfDlktkuC�p €. {'-� z; r,bAoer 1 TYPL. "40 dp-4 _ two XerAkcK.; € l4€ 1 ie4�• 3 T ��, � ��u$,R 4 e ( 4 F e * LT oc i�R s _ L_ «.; v6R ` un t -,`te �£ £z=-'• ` .4 r U CAL-L'M nM*%9;*W IwSUtST[N4'AFCS•S,CilA34 o o�Il�1dD aQOMn7�1 t 's 1 o P k ££ . FLAN SN Lk 1 FLE W A1%EP qY BUILPIkG PfPARiME%T 77 --.. - -. NPUe k ARCXITELT'S SELL HER£ta, _ —ju r,c �-I 7-a 2 �r-;Z>ey\ U`576 1 'K Zgqo Petotll�*4 1, t YKI 4�m 14- IlesA 40 o vlzt va+ OL y A �o „f mi�� iluuuuuup�ui0000ui000000000!l°1l°1lu00000000000uuuuuuuui ti e�IIII;p,��V Sent from my iPhone ATTENTION: This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. 2