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Home My WebLink About1000-17.-6-9.2 Rental Permit 1380 Owner: Susan Rodriguez Occupied as: Single Family Dwelling Located at: 22040 Route 25 Orient 17.-6-9.2 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: 10/01/2025 Expiration: 10/01/2027 ode nfo em nt Official This Notice must be posted by the main entra0eaall tim UZI f Town Hall Annex ° �'= Telephone(631)765-1802 54375 Main Road , ,�d Fax(631)765-9502 P.O.Box 1179 1d �1 F �4 wW Southold,NY 11971-0959 P' BUILDING DEPARTMENT MAY TOWN OF SO HOB DENTAL PERMIT APPLICATION ",�r Rental Permit Fee$200 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: I 1 tj Tax Map Number: 1000 SECTION -BLOCK -LOT - SECTION B. OWNER INFORMATION: Property Owner Name: 3 W '° Property Owner Legal Address: Property Owner Mailing Address: 101 5' ci 1'4 ---4 L+-6 1 -S 6 a Telephone Number(s): Daytime Evening Emergency Property Owner Email Address: 00 (' 5-30. L)b Q01c, (C)Ci(415' - Page 1&5 liJJkP I N A Town Hall Annex r�� , ��- Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 - y BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized 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): DaytimeL i 111"(1 vening Emergency 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 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): Page 2 of 5 Town Hall Annex � Yk Telephone(631)765-1802 54375 Main Road � �d 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:_ _ + tr 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 Unit: Number of rooms in Rental Dwelling Unit: �7 Use and Dimensions of each room in Rental Dwelling Unit: Page 3 of 5 tr„ r� Town Hall Annex w`t Telephone(631)765-1802 54375 Main Road fiFax(631)765-9502 P.O.Box 1179 ° #41" 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 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. SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFOLK) I S LAQ o,'n Gf JA Q , 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 Sf Fax(631)765-9502 P.O.Box 1179 m % Southold,NY 11971-0959 � '' " BUILDING DEPARTMENT TOWN OF SOLYMOLD 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: S A Il_l_ A Property Owner's Signature: Sworn to of ern this Z3day of 2023 Of' al o ry Public ignature p QUW16W In 1y Comm 0%2� Page 5 of 5 May 20, 2023 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 0� Southold,NY 11971-0959 Coll 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 ssionol seal required for Architect or fry ineer licersed N"aaarle lets ea;�st rovide cogy o vaailid current certl icatiorl Rental Property SCTM Number: Rental Property Address: 22040 Main Rd., Orient NY 11957 Owner/Name: Susan Grella 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.) Bedroom #1 155 s ft Bedroom #3 140 sqft Bedroom #2 150 sqft Property Description (Include all improvements indicated on survey) 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 Yorlc 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 Original Signature Please place professional seal: - � �� 1-�.oy,o fV�� R�- Dv�te�' TOWN OF SOUTHOLD BUILDING DEPT. � � TOWN OF SOUTHOLD BUILDING DEPT. r 631.765-1802 631-765-1802 R-_�_ o`nv-1 INSPECTION INSPECTION ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 1ST/REBAR [ ] ROUGH PL13d. ] FOUNDATION 2ND [ ] IN ULATION/CAULKING [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING ] FRAMING/STRAPPING [ ] ISIAL [ ] FRAMING/STRAPPING [ 1/1 NAL ] FIREPLACE&CHIMNEY FIRE SAFETY INSPECTION [ ] FIREPLACE&CHIMNEY RE SAFETY INSPECTION ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PEN TION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION ] ELECTRICAL(ROUGH) [ ] ELECTRICAL{F AL) [ ] ELECTRICAL(ROUGH) [ ] ELI<CTiICAL(F AL) ] CODE VIOLATION-- [ ] PRE C/0 [ RENTAL [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL :MARKS: REMARKS: ! rsl� ,,;r 4TE c INSPEC'li O DATE O ` INSPECTOR �r 1 o " II ,_ fi 1 u 7 w o a o� H o is i � f COM�1 r v itor Co { or - m ,x I �k f �f 1 z '"µi'h� x. � n 6, f xx lnh� l p y 4 1 A -7/-31 aO 18 r TOWN Of SOUTHOLD PROPERTY RECORD J= - v�.�e VILLAGE DIST. LOT si WER,,0W11 N - - E — AC . 4e L TYPE OF BUILDING - - W N-- RES. SEAS. VL. FARM COMM. CB. MILS. Mkt. Value E LAND IMP I TOTAL DATE R _ R� 4 XP y a _ - s s a �t Tillable FRONTAGE ON WATER I s _ Wood Ian FRONTAGE ON ROAD Mean DEPTH fiv House Ply BULKHEAD l � I TotoI -) n a , - COLOR ; TRI M k ,� i _ -4 — r 4 s { 1 t 1_►tLT r _ _ , __. i f R t 17.-6-9.2 6/1 t M. Bldg- Foundation 1 C 0 ; Bath Dinette a 0 K. Floors Basement Extension Extension i Ext. Walls r Interior Finish LR. X r U l Heat DR_ Extension _a72, o Fire Place I t Type Rooms 1st Floor BR. 1 L 25 Roof ND Porch --I-- o Recreation Roo Rooms 2nd Flood FIN. B - mer Porch s Garage - i ' _ - - % 0 B- Total , a � _ FORM NO. S TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. . . . . .Z9271. . . . . . . Date . . . .October 27 " THIS CERTIFIES that the building located at2204. Main Road .�� Map No. . . . . . . . . . . . . Block �T �UnW TJ-V010-ONE-FAMILY 1)WELL"I9G- =LT VAIOR Tm conforms substantially to th dated . April 23 1957 psuant to which" No. ' October 27 78 dated . . . . . . . . . . „ , „ . . . „ . . . . . ., 19, . . ., 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 Dwelling k Glenn E. Moon & wf. The certificate is issued to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . . (owner, VA nt) of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . N/R/ . . . . . . . . . .. . . . . . . . UNDERWRITERS CERTIFICATE No. . . . . . . . . . . . . . . „ . . . . . . . . . „ . . . . . . . .. . . . . . . µ . HOUSE NUMBER 22040 Main Road . . . . . . . . Street . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. .. . . . .. . . . Orient, N.Y. Building Inspector HOUSING CODE INSPECTION October 27, 1978 22040 Main Road R-1 Orient, N.Y. Tax Roll: Glenn E. & W. Moon occupied: Upon receipt of an application for a Pre-Existing Certificate of Occupancy, I made an inspection of the dwelling on this premises; I began this inspection at approximately 9:00 A.M. with Mr. & Mrs. Moon. Located on this property is a two story, wood framed dwelling, no other buildings are on this property. This dwelling has a kill cellar. The foundation walls are constructed of brick, outside entrance only. Located in the cellar is the electric panel, water pump and tank, and oil fired steam boiler, which provides the heat for this dwelling. First floor consists of a very large front porch, large living room if flrlace, dining room, kitchen with a large pantry, which has a washer, dryer and freezer in it, there is also a full bathroom. Second floor consists of three large bedrooms and a full bathroom. There—rs " f -6--two stairways lei liid DFs:The outside of this dwelling is in very good shape. No violations of the Housing Code, Chapter 52, Code of the Town of Southold, N.Y. were found. Inspection completed at approximately 9:45 A.M. Respectfully submitted, Culv� ; CURTIS HORTON Building Inspector FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z 1.15?1„ „ . . „ . . . . Date . . . . February„ 25 . . „ „ . . „ . . . . 19 .83 THIS CERTIFIES that the building „ , Accessary . „ µ „ . . „ . „ . Location of Property 22D40 .Main.Rp.ad. . . . . . . . . „ . . . . . .Ori.entl. .N 0 X . . . . House No. Street Hamlet County Tax Map No. 1000 Section . 17. . . . . . . .Block . „ . .6. „ . . . . . . . .Lot . . . 9..2 . . . . . . . . . Subdivision , . . . . . , „ . . „ . „ . . . . . . . , . „ . , . . „ . —Filed Map No. . . . . . . . .Lot No. . . . . . . . . . „ . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated November 24 81 1 1491 Z 19 . . pursuant to which Building Permit No. . . . . . . . . . . . . . . . . . . . . . dated .Deeeaber. .3 . . . . . . . . . . . . . . . . . . . 19 . . . ,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 . . . . . . . . . an accessary garage The certificate is issued to . Alfred W. & Elizebeth " . :lose (owner,lessee or wr of the aforesaid building. Suffolk County Department of Health Approval . . . .VA . . . . . . . . . . . . . . . . . . . . . . . „ „ . „ „ UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . .NfA . „ . . . . . „ . . . , „ „ „ . . . . . . . . „ . . . „ 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-18547 Date NOVEMBER 8 1989 THIS CERTIFIES that the building ALTERATION Location of Property House 22 MAIN ROAD ORIENT N.Y_ House No. Street Hamlet County Tax Map No. 1000 Section 017 Block 06 Lot 09 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 8, 1988 pursuant to which Building Permit No. 17117-Z dated JUNE 17 1988 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 ENCLOSURE OF A PORTION OF EXISTING PORCH NO HEAT The certificate is issued to ALFRED W. & ELIZABETH H. ROSE (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-099969 - OCTOBER 30, 1989 PLUMBERS CERTIFICATION DATED N A Building Inspector Rev. 1/81 Town Of Southold Annex P.O. Box 1179 8/27/2013 54375 Main Road Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 36466 Date: 8/27/2013 THIS CERTIFIES that the building AS BUILT DECK Location Of Property: 22040 Route 25, Orient, SCTM#: 473889 See/Block/Lot: 17.-6-9,2 Subdivision: Filed Map No. L"ot..No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated .8/12/201-3 Pursuant to which Building Permit No. 38264 dated 8/19/2013 was issued, and conforms to all of the requirements of the applicable provisions of the- law. The occupancy for 11-11, which this certificate is issued is: a'40mLjt�d�mk ad�diti n tqZ or. The certificate is issued to Rose,Elizabeth&Channing, Susan (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED A A Bunch, Connie To: susangrella5@gmaii.com Subject: Rental for 22040 Route 25, Orient Attachments: Z-9271.pdf Good Morning, Thank you for submitting Your rental permit application for 22040 Route 25 in Orient. Attached is a copy of the Pre- Existing Certificate Of Occupancy with the housing code inspection report, If You compare,the report to your floor plans You will see they do not match. Because of this discrepancy the Building Inspector did not accept the certification of the rental and requires an inspection. Please contact our office at 631-765-1802 to schedule the inspection. Best Regards, Connie Bunch Principal Office Assistant Southold Town Building Dept, connieb8sppfhn1AfA1A1rW"t1 -nV 631-765-1802 P.O.Box1179 Southold, New York 11971 � �I �, ii .: �,,,��„ �� i,� i � �. ��..ti'a i � � ��.� � ::� �� :� p �...� _.�m:.;::::.� �� ,��, a �. ! « , � \ � mill" i<% :