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Home My WebLink About1000-117.-5-38 C— N �O O U) C U) O +—' C c+� o Co �W O R--i0 Q E —O O � u � V - oa ca o Oc 0) cp � v 00 70 �_ o c — coboa (n m CU C cu or v u L c CL L bA o a� o 0 .� 5. " L - v CL CU CL U E--a O O � co C� O a) Q- E MOW ,� U O vat O z o O ._ a' CU o o � a) r4 N O 4- � o 01 o � ON O G a) rl N c O . . C/) p E o O cu a . cu U u o U cn U cn .x" 0 0 N w � TOWN OF SOUTHOLD—BUILDING DFI'A,B"rMF4. T r � �f, Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 http - / \fir so tholdtowill, F ql, RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. k Property Information: 110 Rental Property Address: (a (\ 16 DVV -✓ol 5� a Tax Map Number: 1000 SECTION -BLOCK S -LOT �g - SECTION B. OWNER INFORMATION: Property Owner Name:6 �� "�✓� Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) HE Telephone Number (s): Daytime Cclk Evening Emergency Property Owner Email Address: We—vt Yi . 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): Mailing Address of Authorized Agent: Telephone Number (s): Daytime Evening,_ / � Emergency Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling un%t "if a r Address of Authorized Agent (no P.O�oxes): Mailing Address of Authorized A nt: Telephone Number (s): Da Evening Emergency Email Address: SECTION E. SITE MANAGER INFORMATI N: (required for rental properties containing 8 or more rental units) Name of Managing Agent of d elling unit, if any: Address of Managing Agent no P.O. Boxes): Mailing Address of Man ging Agent: Telephone Number ( Daytime Evening Emergency Email Address: Page 2 of 4 SECTION F. vi PROPERTY DESCRIPTION: 2. 1 V1 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: 15N o.we,� l Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: cl ��" doec -fit✓btu, S Use and Dimensions of each room in Rental Dwelling Unit: Lx-% 2- &CC(voo✓►-� Le. 8' X l l.I I�Gc-f-�v�o✓n Ue -7 .`7 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 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) 1 R 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 ent, or Site anager. Property Owner's Name: Property Owner's Signature: Sworn to before me this to day of GG a 20_2"T_ P,4LIC /K MUHAMMAD ALI Official Notary Public Signature and Original Notary Stamp NOTARY PUBLIC STATE OF NEW YORK SUFFOLK COUNTY LIC.#01AL6170606 COMM. EXP.08/30/2027 Page 4 of 4 Pb Y-CA a , r........._. ..w ......_..... fA ...... __....._ _._.. _ _ ._.......... _._...... . _., _. . ..� ?/ M . . . ...._. _ t/eCk --- �, ... .. . ........... M ... ww _.. w. _. _.... _ ..........._. _ _....- .._...... . -a ..... _ ............ . ..._. _..._.. __.. ._ _w_ .......... ._w. ........ . a1 as^ P 0" Mug Town Hall Annex � Telephone(631)765-1802 54375 Main Road "wui Fax(631)765-9502 P. O. Box 1179 4 Southold, NY 11971-0959 H' BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a licensed architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Professional seal re aired for Architect or Engineer, Licensed Horne Insipector roust Provide cogy of valid current certification Rental Property SCTM Number: 1000-117.00-05.00-038.000 Rental Property Address: 685 Orchard Street New Suffolk 11956 Owner/Name: VALERIE MARVIN Rental Dwelling Unit Identifier: N/A Number& Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 —100 sqft., Bedroom #2—90 sgft., etc.) Bedroom#1-89sgft., Bedroom#2-108sgft., Bedroom#3-75sgft., Primary bedroom-180sgft. Property Description (include all improvements indicated on survey) 2-Story Frame House, Deck, porch, garage,fence, 1-Story frame house 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 Y pit State, the Fuel Gas Code of New York State,the Fire Code of New York State, the Property Mainte ce Code of New York State and the Energy Conservation Construction Code of New York State. Anthony Portillo, RA Print Name and Title r 4 "�Ce g I Sign t o p" t Please place Professional Seal /-. IC:- 3 Lie jQJ LU , a 63 Ln r ■ rr `2 LLq U O 1 � I ¢ w w fi .w �I CL U < 7- w o ir ! C) c� 0 LLI Lu N L� LL LL m d Ln cw O CY > d w V � w 0 � j1 4 C` Q IN6 1 U a fl w � ` �`0 Z Q s V) Z m o IA w 4 N ilk b It Z w Q ii a� a, a —°a o a 7y J ) ' o a a o o o uj 0 ........),", arcs � rc se a 0 LL C) En ,, Q) E 0 0 AA 0 0 rc -C u 0 0 LL N C5 Al t , t .0 U-i w U-j TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, NEW YORK CERTIFICATE OF OCCUPANCY NONCONFORMING PREMISES THIS IS TO CERTIFY that the Land Pre C.O. Z15497 xI Buiiding(s) Date- D q_,_ 12, 11 U s e"(S) located at 685 ORCHARD STREET, NEW SUFFOLK Street Hainlet shown on County tax map as District 1000, Section 117 ., Block ..05 Lot 38 does%'�notjconform to the present Building Zone Code of the Town of Southold for the following reasons: Insufficient front yard set back on main ingi nc dwell - rm LjjL..con,L(��,ing cottage, insufficient side yard set-back on accessory garage; in- sufficient total area. On the basis of information presented to the Building Inspector's Office, it has been determined that the above nonconforming /ii Land a Building(s) 1JUse(s) existed on the effective date the present Building Zone Code of the Town of Southold, and may be continued pursuant to and subject to the appli- cable provisions of said Code. IT IS FURTHER CERTIFIED that, based upon information presented to the Building Inspector's Office, the occupancy and use for which this Certifi- cate is issued is as follows: Property contains 2 story, one family, wood situated in A-Residential Agricultural zone with access to Orchard The Certificate is issued to JOSEPH E. & ANNE T. NOLAN ......... ..... (owner, 4=,kA-g,,qX", ARq,3,atA of the aforesaid building, Suffolk County Department of Health Approval.---N A UNDER-WRITER�, CERTIFICATE NO. N/A NOTICE IS HEREBY GIVEN that the owner of the above premises I-LAS NOT CONSENTED TO AN INSPECTION of the premises by the Building Inspec- tor to determine if the premises comply with all' applicable codes and ordin- ances, other than the Building Zone Code, and therefore, no such inspection has been conducted. This Certificate, therefore, does not, and is not intended to certify that the premises comply with all other applicable codes and regula- tions. .............( `dull, - p e c t o r FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17210 Date AUGUST 19, 1988 THIS CERTIFIES that the building ADDITION Location Property 685 ORCHARD ST_ NEW SUFFOLK [louse No. Street 11 let, County Tax Map No. 1000 Section 117 Block 05 Lot 38 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated. JULY 21, 1988 .......pursuant to which Building Permit No. 172742 -dated. JULY 284 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING. The certificate is issued to JOSEPH AND ANNE NOLAN (owner, XXXXXXXXXXXXXXXX) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NLA UNDERWRITERS CERTIFICATE NO. NLA PLUMBERS CERTIFICATION DATED NLA U) Building I"pector Rev. 1/81 FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30700 Date: 01 21/0 5 THIS CERTIFIES that the building ALTERATIONS Location of Property: 685 ORCHARD ST NEW SUFFOLK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 117 Block 5 Lot 38 Subdivision __� Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 19. 2002 pursuant to which Building Permit No_ 28094-Z dated FEBRUARY 20, 2002 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 ALTERATIONS TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to GARY J BUCKNER & VALERIE MARVIN _ of the aforesaid building. (OWNER) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL_ _- N/A�. ELECTRICAL CERTIFICATE NO. 2036767 12 15/04 PLUMBERS CERTIFICATION DATED 11/01/04 BRIAN BLATT PLUMBING ... A riz/Signure Rev. 1/81