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Home My WebLink About1000-15.-1-29 of so TOWN F S UTH LD Rental Permit 1399 Owner: Robert LaDuca , Leslee LaDuca Occupied as: Single Family Dwelling Located at: 685 Greenway W Orient 15.-1-29 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 arran ing for the i-annua ectien. Issued: 11/13/2025 AA Expiration: 11/13/2027 c e E of a tofcial This Notice must be posted by the main entran at all ti e Soo rd 4-5.4,Y �a TOWN OF SOUTHOLD—BUILDING DEPARTMENT �, lb p� Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 n� . o r; RENTAL PERMIT APPLICATION APR Rental Permit Fee $300 (Application must be renewed every twva years) Section A. Property Information: Rental Property Address: qfeleol W c Tax Map Number: 1000 SECTION -BLOCK -LOT SECTION B. OWNER INFORMATION: Property Owner Name: v Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) U bls t-Akl le..,... 15- . ............. 6-_� Telephone Number (s): Daytime Evening Emergency Property Owner Email Address: �� L 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: ��F Telephone Number(s): Daytime Everfing 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: ` f Telephone Number (s): Daytime Everting 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): 7 Mailing Address of Managing Agent: Telephone Number (s): Daytime Evening Emergency Email Address: Page 2 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: 5'i cq Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: 6eJ toy 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. 0110 l 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) I ,o 4D UC4, 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 1 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: �UC A Property Owner's Signature: Sworn to before me this S day of , 20* BARBARA H. TANDY Notary Public, State Of New York No. 01 TA6086001 Official No ary Public Signature and Original N ► r Stamp Qualified In Suffolk C our+t 5"�d7 Commission Expires Page 4 of 4 Town Hall Annex Telephone (631)765-1802 54375 Main Road P. O. Box 1179 ;* Southold, NY 11971-0959 , BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: R (,6-e-- Requested maximum number of persons allowed tt occupy each dwelling uA- Number of Rooms in Rental Dwelling Unit: G pV` V, Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: o Town Hall Annex' & Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P. O. Box 1179 Southold, NY 11971-0959 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 Inspector must provide copy of valid current certification �j Rental Property SCTM Number: ✓ / Rental Property Address: ff 5 Owner/Name: Rental Dwelling Unit Identifier: Number& Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom #1 — 100 sgft., Bedroom#2—90 sgft., etc.) 1 _ � � y F" 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 York State, the Plumbing Code of New York State, the Fuel Gas Code of New York State, the Fire Code of New York State, the Property Maintenance Code of New York State and the Energy Conservation Construction Code of New York State. Print Name and Title Original Signature Please place Professional Seal: q so & *' 2, ic, TOWN OF SOU1�HOL �VUIILINPDVEPT. 631-7765-18 INSPECTION [ ] 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/(FAL) CODE VIOLATION [ ] PRE C/O [ ] ENTAL RE A K Sum LATE � ` " 1NSPE T R _ __�- so TOWN OF S UJ HCLD BUILDING DEFT. 631-765-1802 INSFXECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] AL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENET ATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F AL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: ATE l I SP EC'TO �_ 1 [Vn�I C) eP^ V1 C— Be ro orN Ic�Sr r � s� r� m,o C)5 lu.�� l STP, fL- { PA pV n � w ��- TOWN OF SOUTH OLD PROPERTY I OWNER STREET VILLAGE DIST SUB. LOT —7 FORMER OWNER N E ACR. $ W TYPE OF BUILDING RES, SEAS. VL. FA RM icomm. Cs, MISC. Mkt. Value LAND E IMP, TOTAL DATE REMARKS 7 A C'x B 141 QQN D I TJ�MP-' Z NEW NORMAL BELOW ABOVE FARM Acre Value Per I value Acre Tillable I Tillable 2 Tillable 3 Woodland Swampland FRONTAGE ON WATEem...._.._._.. Brushland ' FRONT/",GE ON ROAD House P'ot DEPTH ---------- 3BULKHEAD � DOCK Total I a CA OLOR I .,_ BRIM 3 i - - t = 15.-1-29 6111 _ _ __ � 4ion I Bath Dinette M. B! 3 e , ;Basement Floors Extension � dg :,I � p Ext. Waifs Interior Finish ,LR. . nsion ; e E Extension Fire Place �,,, Heat DR. I Hype Roof Rooms 1st Floor BR. _ _ Recreation Room Rooms 2nd Floor, FIN. B Porch Dormer Driveway Breezeway -- � 3 Garage I Patio � O. B. i f Total _ el �5Q FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Towu Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 7— 5F Z �. Date „� 5L lv)A.i� 197V THIS CERTIFIES that the building located at .h . .M. ...A`�. �aT . . . Street G-R Ex NACRJFS 1 2 Map No. . . . . . . . . . . . . Block No. . . . . . . . . . .Lot No. . . . . . , . . , , a . . . . . . . . . . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . .. 19. . . . pursuant to which Building Permit No. . . . . . . . . r3 M �\-i` 71- 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 I - - . . . ,()N E. . . . . , . . . �1. L, . , \A1 G C.L I h�. . . . , . . The certificate is issued to . . . . r.. . . . . .r. . . �, . . . . � .�. . . . . . ... . . . . . [3w`n� r r` (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . f. . . . . .-. �` . .+. . . . `. . . _ . . .� V e A UNDERWRITERS CERTIFICATE No. . . . . . . . . . . . . . . . . . „ . . . . . . . HOUSE NUMBER . . . . I . . . . . . .. . . .. . . . Street . . . .r' . .. . . . . . . . . .��. . . . . . . . . . . . . . . K' I JAI -7 Building Inspector Town of Southold 5/7nm P.O.Box 1179 r 53095 Main Rd Southold,New York 11971 CERTIFICATE TIFICATE OF OCCUPANCY No: 39633 Date: 5/7/2018 THIS CERTHUS that the building DECK Location of Property: 685 Greenway W,Orient SCTM#: 473889 Sec/Block/Lot: 15.4-29 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/20/2017 pursuant to which Building Permit No. 41320 dated 1/26/2017 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: 'SAS 13D111'PECK .Al)1711 IO .TO AN EXISTING ONE lM +IIL»" DWL;LLIIC. 5 - UL.D I'OR The certificate is issued to LaDuca,Robert of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED . � th -" Signature _____..�..._._... / / i r, h .z„ l ,. tv) C&eb � U r y � I u / ��/%;��'t%t l '��I'�,!D��?�r✓/,� yr�r�/11� m�' y, r/y/ �////i�� r0�fii rrl �� %I %f p;J�r/ /��//ri/�/✓�r lrr%,,. / l,�,r/ ,n�/�0 /! //iVrr �r f%v r , J' /�K�/�'l Ji�'f}l9f t hr� .✓ / / //�� 1 t l r, YI 'I ter/J / i r s rtj , " a a lei MAY — 6 2024 'xH VWPoo t./� WN n / /� v f ALER P L U SSMOKE & CARBON u MONOXIDE ALARM / ., Im • s .* M� *:. err „ �*m;�mw..,a^... /