HomeMy WebLinkAbout1000-135.-1-5 Rental Permit
1403
Owner: Andrew Cramer
Occupied as: Single Family Dwelling
Located at: 21515 Soundview Ave Southold 135.-1-5
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 arrangin for the bi-annual inspection.
Issued: 12/09/2025
Expiration: 12/09/2027 cod o en Official
This Notice must be posted by the main entrant0alles
r A TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 litt.s://www.soutlioldtowmi ,o
RENTAL PERMIT APPLICATION
Rental Permit Fee $300 (Application must be renewed every twoears-)
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Section A.
Property Information: G
Rental Property Address: 11 c1-11
1515 SOUNQVIEN -A-VUJvE_, SOUTHOLVI Nye 6
p ( _ j r _ C) I _ C7 5
Tax Ma Number: 1000 SECTION 00� BLOCK 3 J LOT,,,
SECTION B.
OWNER INFORMATION: ,,����--,,w" f�
Property Owner Name. �D�v E�
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
;ZS- M O�l STYE? 257 ffI � STk,EEF_T
)0 8 106
Telephone Number (s): Daytime 3 7' G3- Evening Emergendcy,
Property Owner Email Address: Orld(T UJ a CA-61 'I Pe,VCU/ Cloud Coo
Page 1 of 4
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any: SNE)CI �
Address of Authorized Agent (no P.O. Boxes): a5500 MA-1 N J2G1�1� GU7 -1 , f
Mailing Address of Authorized Agent: are
Telephone Number (s): Daytime6 31- 76 s_e Evening Emergency
Email Address: cs1n1 P� C o�G�2 ►J. Con,7
Section D.
Managing Agent Information:
Name of Authorized Agent of dwelling unit, if any: Sly I w►�7E�Q- 1►elG
Address of Authorized Agent (no P.O. Boxes): 2'!Y500 M 1`FIN )<c;AD C UT GFI000�p
Mailing Address of Authorized Agent: S a6 v"C
Telephone Number (s): Daytimes' Evening_ Emergency
Email Address: i.Ji9 C04ZCOe-1Pnll . L0r
SECTION E. N/lA
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:
J—
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
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: 5
Use and Dimensions of each room in Rental Dwelling Unit:
CM ED DI r
�1J�2sOQrY1 �. 10 2 Sr— k
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.
we I am requesting a fire safety inspection to be performed by a Code Enforcement Official
from the Town of Southold
W' 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 "OR-6kI.1 JnM:S C. - 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: -AN PA4LJ
Property Owner's Signature:
Sworn to before me this day of „ Nc)\/ 20 a5
Official Notary Pu ignature and Original Notary Stamp
PHILIP V. BOUKLAS
Notary Public,State of New YorK,
Reg. No.01 BO5046979
Qualified in New York County q
Commission Expires July 24, 20 ai l
Page 4 of 4
TOWN OF SOUTHOLD BUILDING DEPT.
Mum, 631-765-1802
lNz� rm%,;TION ,
[ ] 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 L)
[ ] CODE VIOLATION [ ] PRE C/O [ ' RENTAL
ce
DATE. � INSP"E C7`O
Oct 18, 2025
Town Hall Annex b} r; Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
'A
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PROPERTY CERTIFICATION
Form is to be completed by a license architect, licensed engineer or licensed home inspector
Separate form is required for each individual Rental Dwelling Unit
Professional seal required for Architect or EngLqeer iicensed Horne In Dectormust rovi le
copy 0f valid"current certi cation
Rental Property SCTM Number:
Rental Property Address: 21515 Sound" iew e,, Southold 971
Owner/Name: Andrew Cramer
Rental Dwelling Unit Identifier:
Number & Square footage of each bedroom as depicted in the attached floor plan:
(i.e. Bedroom #1 -100 sq., Bedroom #2-90 sq., etc.)
Bedroom #3 240 Scift
Bedroom #2 100 ft _, .
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, and the Energy Conservation Construction Code of New
York State.
Victor Cornelius III CEO Inspector
Print Name and Title ceo# 1216-023 Original Signat e
Please place professional seal:
TOWN OF SOUTHOLD PROPERTYEC 006
OW�ER ez STREET VILLAGE DISTRICT = SUB. LOT
FORMER O NER ' E _ ACREAGE
Vy ,
� ._ ` ;�R `�• - i S j W TYPE OF BUILDING
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RES. SEAS. VL. FARM comm. IND. CB. MISC.
LAND IMP. TOTAL DATE REMARKS
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Farm Acre Value Per Acre Value
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Town of Southold 2/1/2017
P.O.Box 1179
53095 Main Rd
Southold,New York 11971
Uri
CERTIFICATE OF OCCUPANCY
No: 38710 Date: 12/15/2016
THIS CERTIFIES that the building ALTERATION
Location of Property: 21515 Soundview Ave, Southold
1-----.......... ......
SCTM#: 473889 Sec/Block/Lot: 135.4-5
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
6/13/2016 pursuant to which Building Permit No. 40803 dated 6/28/2016
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:
LW- QA-SAR1`LlE,D
The certificate is issued to Adimey,Marijo&Lugris,Veronica
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 40803 11-03-2016
PLUMBERS CERTIFICATION DATED 11-11-2016 J Orlowski
46
h Signature
�tq Town of Southold 3/1/2016
53095 Main Rd
Southold,New York 11971
00
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: 38123 Date: 3/1/2016
THIS CERTIFIES that the structure(s)located at: 21515 Soundview Ave, Southold
SCTM#: 473889 Sec/Block/Lot: 135,1-5
Subdivision: Fled Map No. Lot No.
conforms substantially to the requirements for a built prior to
APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 38123
dated 3/l/2016 was issued and conforms to all the requriements of the applicable provisions of the law.
The occupancy for which this certificate is issued is:
wood frame one family dwelling with st!A_t99M and 2 accessory decks.*
The certificate is issued to Mcdonald,Mark Mcdonald,William
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
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11/13/25,413 PM room sizes-katemcramer@gmail.com-Gmail
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