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Home My WebLink About1000-51.-3-12.10 of so TOWN OF SOUTHOL Rental Permit 1400 Owner: Twin Barns LLC Occupied as: Single Family Dwelling Located at: 610 Wildberry Ln Southold 51.-3-12.10 Maximum Permitted Occupancy: 12 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 i-annual in ection. Issued: 11/14/2025 " Expiration: 11/14/2027 c e En rce en official This Notice must be posted by the main entranc oatallryes 4-60ti PA ,►-►s-a-5 °. TOWN OF SOUTHOLD—BUILDING DEPARTMENT F � Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 hULLmy�tholdt.o vnn . c ' RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Ren al Prope y Addres !N� , " �A CCSOS Tax Map Number: 1000 SECTION .DO ___-BLOC1 .17 -LOT b - SECTION B. OWNER INFORMATION: Property Owner Name: 1 W,.'—n +�- Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 300 is&f S F 41I 3().O r�`!a Gtt'f' 3!a o'4%' 4%1 #,(), o'�-(o Telephone Number(s): Daytime— Evening Emergency Property Owner Email Address: 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): 300 L-'%f Mailing Address of Authorized Agent:*300 1&6 5 too a;. Telephone Number(s): Daytime Evening Emergency � �� Y6 , _ 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): 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, 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 M room, For properties with multiple Rental Dwelling Units use "Rental Permit Application Addendum. ......... w Rental Dwelling Unit Identifier: T4. c,1� Requested Maximum number of persons allowed to occupy Dwelling Un" Number of rooms in Rental Dwelling Unit: S ' Use and Dimensions of each room in Rental Dwelling Unit: �,e C �; 1 . 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. ❑ 1 am requesting afire 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 Schedule of Rooms Bedroom#5 9'-9.5" x 11'- 9" Office 6' x 11'- 9" Bedroom#4 11' x 13'-9.5" Den 17-1" x 11'-9.5" Master 16-11.75" x 22'-11.75" Bedroom#2 15'-11.75" x 14'-4.75" Bedroom#3 15'-9.5" x 13'-7.25" Living/Dining 24' x 41' Basement Bath Y x 8'-2.5" Bathroom#4 5' x 8'-11" Powder Room ' 5'-5.5" x 6'-4" Bathroom#2 j 8'-3.5" x 13 Bathroom#3 5' x 10'-9 Master Bath 9' x 12'-6" SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) lc- COUNTY OF S WK) 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 Agent, or Site Manager. Property Owner's Name: 1"" Property Owner's Signature: l4 Sworn to before me this day of NO VPrn 6all- , 20 2 ZS— ut c� < <� � t w Official Notary Public Signature and Original Notary Stamp NOW WN. Page 4 of 4 TOWN OF , OUTH LD! BUILDING, E T. 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 (FI AL) [ ] CODE VIOLATION [ ] PRE C/O RENTAL A)(- M �iG ✓� rjv ((cMA&CV ` Town Hall Annex ,` �� ~ Telephone(631) 765-1802 54375 Main Road a w` d Fax(631) 765-9502 P. O. Box 1179 °� o Southold, NY 11971-0959 F 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 uired for Architect or Engineer, Licensed Home Inspector must provide copy of valid current certification Rental Property SCTM Number: 1000-51-03-12.10 Rental Property Address: 610 Wildberry Lane, Southold, NY 11971 Owner/Name: Hal and Jessica Coopersmith 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.) Pri nary Bedroom #1-390sf Bedroom #2-213sf, Bedroorn '3-2'15sf Bedroom 04-149sf Bedroom #5-247sf Property Description (Include all improvements indicated on survey) The property contains a two story, five bedroom home with attached 2 car garage with screened covered porches and unscreen covers porc , s one pa ko and gunN 'e swimming pool, I certify that I have done a physical inspection of tP' ,.W a a tal dwelling unit and find that it fully complies with all the provisions of the Code of a old, the Residential Code of New York State, the Building Code of New York State, � New York State, the Fuel Gas Code of New York State, the Fire Code of New Yor t r rty tena ce Code of New York State and the Energy Conservation Construction o t Print Name and Title al Signature Please place Professional Seal: t TOWN OF SOUTHOLD PROPERTY �VNC ER 3 cj IJ EMARKS a � \ yg s I PE OF L - �... f i PROP U LAND s - o t y TOTAL DACE s 4 \ . �s �o v � t � � a a 4_��__ t x �F I - _ n, j �z j FRONTAGE ON WA p a f FRONTAGE ON ROAD I WC�ODLAND MOW L _AD _L s s t s € t _. n Wa JJ t 1.- -12e1 1/14/ 0 s _ M Blasi v �_ �€ xt -F �__ y., - - - - _ K.E n!C-no — �_ �- Hew — _ _ - Deco e � � Room t Firor rive - - ;. z - � - Twin Barns i I lot 4.Wild6ery Fields SohdiwW.,Southold NY O O O O O O F .' t O O ' 3 t Ar t =�u E ��h tec A m 3 3 sz'ewQulr hM > - � nand _ 3 —__ ._ o LI t s p crawlspa ,;t i' ll ;IVI O O O O —� ��£ E ws.q md„rd eae,re aso..z - 'rbeima a.m i�ui: p s�r.eu nw.a io..�wco,n-,e Scalc:114 i'.0'or as noted rc�,eo.�+� 2(3231ssued rar cons(niction RCP/Electric- >_ 4�a Basement t A.120 Twin Barns i ( Lol4,Mid 6erry Fields Su6dlvW-.Southold NY a tei m - •-` �� , —_ ., ¢ ' we PC er - >-, — _ 6na21nMrew�N rrdr k - rx - 3 e 1 � a d` q 3 2 3 an via� 17 f - Y prate Note[ i: _ ¢ aaW[om6utlbn � c yv Ma.x.e awM n•.wx,..x,xe.�.„„w�. ScalC:i/a•_tb'of Z noted # ��sr c+br�aMew � 7/3/23 lswed formnriruction- . � r �✓�L[u narvmM sbe tigN I �,eo RCP/Electric- Ground Floor Plan _ A.121 ' r - Twin Barns i i 'oL 4,Md'-y FLWf (� uhdivislon,Southold NY S _ ypz s E ;t �' Fina mry�<mr<n.<om s t - t � a t No _ s«ie:i/4 1 o t d r 2/3/231,—df—OnAh Lc Dn mn .M RCP/Elect- Second Floor Plan l 11,�I�d F o,. el , A.122 t tt� Town of Southold P.O. Box 1179 53095 Main Rd rrl Southold, New York 11971 CERTIFICATE TIFICATE OF OCCUPANCY No: 45815 Date: 12/10/2024 THIS CERTIFIES that the building SINGLE FAMILY DWELLING Location of Property: 6-I. ldber y. q qtw ttltj ._l I I See/Block/Lot: 51.-3-12.10 Conforms substantially to the application for Building Permit heretofore, tiled in this office dated: 02/21/2023 Pursuant to which Building Permit No. 49041 and dated: 03/20/2023 Was issued, and conforms to a1I of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: single family dwelling with finished basement, covered front entry, rear deck, rear covered deck, rear screened porch and attached garage as applied for. The certificate is issued to: Twin Barns LLC Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: R-22-2030 9/16/2024 ELECTRICAL CERTIFICATE: 49041 1.0/02/2024 PLUMBERS CERTIFICATION: James Hannow 04/22/2024 i W t t� Town of Southold P.O. Box 11.79 53095 Main Rd Southold, New York 11971 CERTIFICATE OCCUPANCY No: 45816 Date: 12/10/2024 THIS CERTIFIES that the building SOLAR PANEL Location of Property: 610 V% 1c11 ;1ly Ln Southold.,NY 11971 Sec/Block/Lot: 51.-3-1.2.1.0 Conforms substantially to the Application for Building Permit heretofore, f led in this office dated: 10/17/2023 g . c. „ and dated: 10/28/2024 Pursuant to which Building 4'ern�tt I`Ja. ��,..,.,.,., 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: install roof-mounted solar panels to existing single-family dwelling as applied for. The certificate is issued to: Twin Barris LLC Of the aforesaid build' SUFFOLK COUNTY EPA T ."N'I OF HEALTH APPROVAL: ELECTRICAL CERTIFICATE: 49954 2/07/2024 PLUMBERS CERTIFICATION: Aut rued Signature Town of Southold P.O. Box 1179 53095 Main Rd rs, Southold, New York 11971 CERTIFICATE OF OCCUPANCY ANCY No: 45817 Date: 12/10/2024 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 610w�4�l lt��tr�1. s� �aut,holdNY 11971. See/Block/Lot: 51.-3-12.10 Conforms substantially to the Application for Building Permit heretofore, filed in this office dated: 09/27/2023 g �,79 and dated: 10/28/2024 Pursuant to which Building Permit No. 4„m,,, ,,,, 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: accessory in ground swimming pool fenced to code as applied for. The certiBeate is issued to: Twin Batt-is I. I-C Of the aforesaid building. SUFFOLK COUNTY DEPAR'FMENT OF HEALTH 1 H APPROVAL: ELECTRICAL CERTIFICATE: 49879 9/-)3/202 PLUMBERS CERTIFICATION: And o zed Signature Town of Southold P.O. Box 1179 53095 Main Rd Southold, New York 11971 CERTIFICATE :IF 0CCU 'ANCY No: 459 Date: 10/11/2025 THIS CERTIFIES that the building GENERATOR Location of Property:P rt5'' 6 i:� �.ai:.,�t tittd, s 11971 Sec/Block/Lot: ~ _ 1 Conforms substantially to the Application for Building Permit heretofore, filed in this office dated: 01/25/2.024 Pursuant to which Building Permit No. 50377 and dated. 02/27/2024 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: Accessory ge eor as applied for. The certificate is issued to: Twin Barns LLC Of the aforesaid building, SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: ELECTRICALCERTIFICATE: 7 10/02/2024 PLUMBERS CERTIFICATION: Aulh r°i- d a ignature