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Home My WebLink About1000-78.-4-23 TOWN OF SOUTH OLD s Rental Permit 1373 Owner: Old House Out East LLC Occupied as: Single Family Dwelling Located at: 845 Corey Creek Ln Southold 78.-4-23 Maximum Permitted Occupancy: 6 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: 09/17/2025 Expiration: 09/17/2027 age o ntOfcial This Notice must be posted by the main entranc all times W TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax(631)765-9502 Iiit: :// ew e ssouth ld (� WEn -99—V RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two) s AY 14 2025 �.". Section A. Property Information: Bulldlng Department G Town of Southold Rental Property Address: / N S U �/ Tax Map Number: 1000 SECTION 07 -BLOCK 'V 0 ,_ -LOT - SECTION B. OWNER INFORMATION: 1 Property Owner Name: +�l �C'� �I c� S�A10 Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) s TdC el 16 IJ 516610 tj L./a su4 Telephone Number (s): Daytime Evening Emergency Property Owner Email Address: D�'a N/ i� �✓�I)�t- S0/� n) n1 t( t L Page 1 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: Requested Maximum number of persons allowed to occupy Dwelling Un Number of rooms in Rental Dwelling Unit: g, Use and Dimensions of each room in Rental Dwelling Unit: 1 ��1"� -L 0�a�! x J3 1, PAC L i V 6 kt 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 ❑ 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) I QAkli&2 (-1N1)��-S�l+n� 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: f�AN I - � �} PJ Property Owner's Signature: Sworn to before me this day of , 205 Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.01 BU6185050 Ouallfled In Suffolk County C� Commission Expires April 14,2�is Page 4 of 4 cw TOW OFSIO T''HOL D BUILDING DING INEPT. owl 631-765-1802 INSPECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [Y]IFIRE LATIOWCAULKING FRAMING /STRAPPING [ NAL FIREPLACE & CHIMNEY [ SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE RATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F AL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REM1lMARKS: � VA on - a- .11 (✓1 44 DATE D INSPECTOR _ . PROPERTYTOWN OF SOUTHOLD RECORD OWNER ISTREET VILLAGE DIST.I SUB. LOT a FORMER OWNERJ'/—d N E �ACR, S I W TYPE OF BUILDING I E RES. 1 SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP, TOTAL DATE REMARKS i w r_ P s OE a _ I i 7 " I A I/Al a : n 9 _ I AGE BUILDING CONDITION — v ` NEW NORMAL I BELOW ABOVE FARM I Acre Value Per Value � i Acre s i Tillable FRONTAGE ON WATER - Woodland f FRONTAGE ON ROAD Meadowland DEPTH 1 House Plot I BULKHEAD I Total DOCK } a_ � TRIAD AI.A OLOR ,`jl, [j s e 3 t _ s � 1 f . \\ \\ \ \ 3 _ E _ �y c B } -- 78.-4-23 01/2015 � G M. Bldg �C g ( i Extension Extension � m f - B�tension z ; [ r- ?Foundation Both � `� Dinette to Basement iG. ase t Floors� E 7 ` ' xt. Walls l .% Interior Finish L.R. Porch � . Breezeway Fire Place I Heat DR. s Garage 'Type Roof ;i?a ;rs 1st Floor ER. Patio Recreation Roorn 1 Rooms 2nd Floor 'Dormer 'Driveway F Total ` FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building 'Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No K-21052 Date SEPTEMBER 29 1992 THIS CERTIFIES that the building ADDITION Location of Property 84S COREY CREEK LANE SOUTHOLD NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 78 Block 4, Lot 23 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 28 1992 ursuant to which Building Permit No. 20661-Z dated MAY 28 1992 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 DECK ADDITION TO EXISTING ONE FAMILY ILY DWELLING AS APPLIED FOR The certificate is issued to PETER J. & EILEEN M. HUGHES (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED NIA Building Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-11837 Date AUGUST 9 1983 THIS CERTIFIES that the building DWELLING Location of Property 845 COREY CREEK LANE SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 078 Block 04 Lot 023 Subdivision COREY' cEEK ESTS. Filed Map No. 4923 Lot No. 023 conforms substantially to the Application for '8uilding Permit heretofore filed in this office dated.NOVEMBER 12 1982 ______pursuant to which Building Permit No. 12054- dated. DECEMBER 3 1982 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 DWELLING WITH ATTACHED DECK & PORCH. The certificate is issued to PETER & JOANNA MATTHEWS (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 12-SO-105t 8 1 1983 UNDERWRITERS CERTIFICATE NO. N-608098 - 7 1 1983 PLUMBERS CERTIFICATION DATED N A r Building Inspector Rev. 1/81 t 4z' tC CCA DECK F IT 7.'-Q K ...P.s7flewl.'& ftg O&% .. ' ...._ -.:r _ 1 MhSYea WVVPoA livw •Z..e. DWI" 1-.u,-,r•, r ,.�.�.� „� .,. E6 � v �� " 1w,tv C c a, t e+a+ee' A�nx+ti ftrruccrt fi I( ff V l70.fed„a«^"�cad P it A. w� r ;L Into•. 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