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Home My WebLink About1000-101.-1-21 of so SOWN SOUTH OLD Rental Permit 1401 Owner: Northwind R.E. Holdings Occupied as: Single Family Dwelling Located at: 17425 CR 48 Cutchogue 101.4-21 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: 11/19/2025 Expiration: 11/19/2027 4 forcement Vdal This Notice must be posted by the main entrance at all times P Nbv l 43a0 TOWN OF SOUTHOLD—BUILDING DEPARTMENTS"1 � u a Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11:971-0959 i Telephone (631) 765-1802 Fax(631) 765-9502 htipL,�/www. (IqLiiol(it J RENTAL PERMIT APPLICATION Rental Permit Fee $300(Application must be renewed every two years) Section A. Property Information: Rental Property Address: ��,�CN qz,� S Tax Map Number: 1000 SECTION � -BLOCK-0 (. OO -LOT Z - 0 V SECTION B. OWNER INFORMATION::J Property Owner Name: / v0 (4ji� •� • 1qv/c/1n Property Owner Legal Address: Property Owner Mailing Address:. (Cannot be the same as Rental Property Address) &�Idwttb TLx/1 ,4 veil f 176 Telephone Number(s): Daytime Del Evening`". Emergency Property Owner Email Address: M Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: 5 Address of Authorized Agent(no P.O. Boxes): ��! � N� 110 Mailing Address of Authorized Agent: S A/4 31_ lvening_: "Telephone Number(s): Daytime Emergency Email Address: Is �""� 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, 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 room in Re to Dwelling Unit: 01 s 0 Z, 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. �l 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. Page 3of4 SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFOLK) I 5f21l 'n �--LK�!lV��, 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; Property Owner's Signature: 7Sw or n 2tb me i � 20� 7"(Z ,n-ssj1� �wu1o0A Y poWleno Official Notary Pub c Siignature and Stamp scar1ta•oN V0A MI'N to 01 1S 011qnd mOJ'wuoN.0 PJ8t 1U Page 4 of 4 rjf sd?LJTFr��d V VV N OF SOUTHOLD BU L&G DEPT. 631-765-1802 lNzirECTION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I ULATION/CAULKING [ ] FRAMING / STRAPPING [ INAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL ( AL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL ro . ... r DATE R:j J— TOWN OF SOUTHOLD PROPERTY RECORD CARD JJ OWNER I STREET VILLAGE DIST. SUB. LOT AC-FORMER OWNER K 6 N— f, .4- A ie,- A TYPE OF BUILDING W f REST SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS 0 f nd If_ t AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE U v 0 c j - -T FARM Acre Value Per Volue Ac re Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland i DEPTH House Plot BULKHEAD Tota DOCK i _. COLOR rf't� TRIM V.I € € € € r s s € t — �n. � 7 �t -- - I t M. Bldg — Extension ` I Extension Extension Foundation Bath Dinette = t Pc!th �Z :Basement F` Floors _ K. — - Porch Ext. Walls Interior Finish LR. Breezeway Fire Place N, Heat DR. f Garage _ �� S Type Roof Rooms 1st Floor BR. '-patio- � � Z� $�� Recreation Room Rooms 2nd Floor i FIN. B O. B. -Dormer i j Driveway Total 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. Z-1 6355 55 pJ Building(s) F-7 Tlse(q) Date-October 30, 1987 located at 17425 County Road #48, Cutchogue, New York t i.e e t H am 1 et shown on County tax map as District 1000, Section 101 . Block 01, Lot 21 , does(not) conform to the present Building Zone Code of the Town of Southold for the following reasons: Insufficient total area; front yard set-back. On the basis of information presented to the Building Inspector's Office, it has been determined that the above nonconforming Z17 Land Building(s) /::7 Use(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 applicable 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 Certificate is issued is as follows: Property contains 2 story one family wood framed dwelling, with attached porch; accessory two car garage; all situated in 'A' Residential Agricultural zone with access to County Road #48, a county _...........__.................................. maintained highway. .............. ........ The Certificate is issued to KATHLEEN A. MICHELSON (owner, of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO. N/A NOTICE IS HEREBY GIVEN that the owner of the above premises HAS NOT CONSENTED TO AN INSPECTION of the premises by the .Building Inspec- tor to determine if the premises comply with all applicable codes and ordinances, 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 regulations. 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-29530 Date: 06 18."03 THIS CERTIFIES that the building ADDITION _ qq Location of Property: 17425 CR 48 CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 101 Block 1 Lot 21 Subdivision Filed Map No. Lot No_ conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 16, 2003 pursuant to which Building Permit No. 4 0Z dated ............._ JUNE 16,qq 2 0 0 3 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 AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ROBERT J KULL (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO_ N/A PLUMBERS CERTIFICATION DATED N A Sa- atureM Rev. 1/81 t l s le t E I /, tVJ I I - L - E _. � �. i�ems. 3't✓, ! -fl€�.{ "-# F: - .� -�' �.. r _ E ® � o f I f 1 . i �j