HomeMy WebLinkAbout1000-64.-5-8 of so 01""WN OF SOUTHOLD
Rental Permit
1390
Owner: Patrick Fahey
Occupied as: Single Family Dwelling
Located at: 1070 Town Harbor Ln Southold 64.-5-8
Maximum Permitted Occupancy: 4
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: 10/28/2025 -
Expiration: 10/28/2027 code nfo a ent Official
This Notice must be posted by the main entrance at all times
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TOWN OF SOUTHOLD BUILDING DEPARTMENT cp
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Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone(631) 765-1802 Fax(631) 765-9502 littp ; / ww.southol(ttgwi)Ry �)v
RENTAL PERMIT APPLICATION �a
Rental Permit Fee $300 (Application must be renewed every 14�ars) �
Section A. I �V°
Property Information:
Rental Proper, ddress:
Tax Map Number: 1000 SECTION ��-BLOCK -LOT, -
SECTION B.
OWNER INFORMATION:
Property Owner Name /
p Y
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot bethe same as Rental Property Address)
ko
Telephone Number(s): Daytim 3 q-1 Evening EmergencyL __ "
Property Owner Email Address:
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, 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:
Use and Dimensions of each roomin Rental Dwelling Unit: V�h 'r l�
H 3A3 A XIS
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 SUF)FOLK)
-, 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: 0) �G1
Property Owner's Signature:
Sw rn t bef me^ eday of _ , 20t �"" "" `
- RACHEL CON.1
Notary Public µ'to `"'York
NO 41 754
Qualified 1C oun
Official Notary Public Signature and Original Notary Stamp My Core miss�ioA r , 9'z029
Page 4 of 4
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TOWN OF SOUTHOLD BUILDING DEPT.
631-765-1802 s�
lNbrE%A*;ft T 1 O N
[ ] FOUNDATION 1ST/ 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 [ NTAL
IEMARKS: � � � �
� f fat/( Town Hall Annex
Town Of Southold 54375 Main Road
e u; Rental Inspection Report PO Box 1179
^r I Southold, NY 11971-1179
Tel: 631-765-1802
SCTM# Date �d o�a'� o?
Owner Phone
Address 1"— G/L Visible
Hamlet Inspector
Floor Level Quantities Sub 1 2 3
Smoke Detectors(not located in bedrooms)
Carbon Monoxide Detectors t
Fire Extinguishers
Exits
Bedrooms 1 2 3 4 5 6
Smoke Detectors
Egress
Occupant Count
Building Systems Maintained &Operational Condition of Property
Heating Building interior
Hot water Building exterior
Electrical Property clean, maintained &safe
Mechanical lHandrails&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:
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TOWN OF SOUTHOLD PROPERTY RECORD CARD
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REMARKS
DOE SUBLDING CONDITION
NEW .-O MAL B EIL 90V $ f-a
FARM Acre galas Per VGlUq
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e MNTAGE ON WATER
Wcvndland rRONNIAGE ON 01D
Md0ard DEPTH
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HEAT PUMP
(D LG POMPE A CHALEUR
MODEL/MODBLE LMU 1 $�O�H�V
208/230 V 60 Hz 1 Ph
Maximum Fuse or CKT.BKR. 20 A
Fusible maximum. ou disjoncteur maximum
Minimum Circuit A npacity 54 A
Courant admissible minimal du circuit
Refrigerant R 10A 3.9.7Ibs
Refrigerant
Design Pressure(H/L)
Pression de calcul H/B 4`5,0 / 40 Psi
AC. v.OUTDOOR USE MADE IN K�R�A
UTILISATION EN EXTtRIEUR FABRIfU;E EN C(
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