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Home My WebLink About1000-64.-3-7 0`11"0WN OF SOUTHOLD Rental Permit 1409 Owner: Warke V Revoc Trt , Simitch A Revoc Trt Occupied as: Single Family Dwelling Located at: 2500 Hobart Rd Southold 64.-3-7 Maximum Permitted Occupancy: 8 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 bi-annual inspection. Issued: 01/13/2026 Expiration: 01/13/2028 Code En ern ntOfficial This Notice must be posted by the main entrance 11 times 4 - 4 t t TOWN OF SOUTHOLD—BUILDING DEPARTMENT w Town Hall Annex 54375 Main Road P.O.Box 1179 Southold,NY 11971-0959 Telephone(631)765-1802 Fax(631) 765-9502 litt s:/Jwww.southoldtownll . owe RENTAL PERMIT APPLICATION Rental Permit Fee$300(Application must be renewed every two years) 1 , �ct> eV a `1 Section A. Property Information: So 0j, U �e Rental Property Address: o 2500 Hobart Road Southold NY 11971 Tax Map Number: 1000 SECTION 64 BLOCK 3 AOT7 SECTION B. OWNER INFORMATION: Property Owner Name: Andrea L.Simitch Revocable Trust&Val Warke Revocable Trust Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 286 Midline Road Freeville NY 13068 286 Midline Road Freeville NY 13068 Telephone Number(s): Daytime 607 216 5339 Evening607 216 5339Emergency 607 216 5339 Property Owner Email Address: a1934@comeil.edu&vkwl@comell.edu Page 2 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: 1 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: Unit#1 Requested Maximum number of persons allowed to occupy Dwelling Unit: 8 Number of rooms in Rental Dwelling Unit: 10 Use and Dimensions of each room in Rental Dwelling Unit: Bedroom #1 11-7"X 11'), Bedroom #2 (11-7"X 7'-2), Bedroom #3 Q1-10"X 6'-10"), Kitchen 22'x 6-6" Dining Doom 14" x 14'-2" Bathroom x - Bathroom x - , Screenea Porch 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. 96 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 3 of 4 N M m SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFOLK) Andrea L. Simitch Revocable Trust&Val Warke Revocable Trust I 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: Andrea L. imitch Rev cable Trust &Val Warke Revocable Trust Property Owner's Signature: Sworn to before me this�"day of 20 a5 KRYSTAL L EVANGELISTA --" Notary Public-State of New York NO 01 EV6340560 Qualified to Cortland County IA My Commission Expirea Of ial Nlbtary Public Signature Ad Original Notary Stamp Page 4 of 4 ELL a P ' TOWN OF SOUTHOLD—BUILDING CiFPARTME .� e ,� Town Hall Annex 54375 Main Road P. O.Box 1179 Southold,NY Telephone(631)765-1802 Fax(631)765-9502 littos://www.soutlioldtovaiU4ov C ED RENTAL PERMIT APPLICATION rcL±� Rental Permit Fee$300(Application must be renewed every two years) l 1 Section A. Property Information: Rental Property Address: 2500 Hobart Road Southold NY 11971 Tax Map Number: 1000 SECTION 64 -BLOCK 3 -LOT7 - SECTION B. OWNER INFORMATION: Property Owner Name: Andrea L.Simitch Revocable Trust&Val Warke Revocable Trust Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 286 Midline Road Freeville NY 13068 286 Midline Road Freeville NY 13068 Telephone Number(s): Daytime 607 216 5339 Evening 607 216 53 %mergency 607 216 5339 Property Owner Email Address: als34@comell.edu&vkwl @comell.edu Page 1 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: 1 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 Applicatio "'o, Addendum." Rental Dwelling Unit Ide ntifier: Unit#1 Requested Maximum number of persons allowed to occupy Dwelling Uni: Number of rooms in Rental Dwelling Unit: 10 Use and Dimensions of each room in Rental Dwelling Unit: Bedroom#1 11-7"X Bedroom#2 (11-7"X 7'- , Bedroom#3 (11-10"X 6'-1 0'"), eml tom �vIncg 0 y Kitchen 2'x 5'-6" .Dinin Room 14'x 14'-2" , Bathroom x - , Bathroom x - , Screene orc 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 a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold M 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) Andrea L. Simitch Revocable Trust&Val Warke Revocable Trust 1 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: Andrea L. Simitch Revocable Trust &Val Warke Revocable Trust Property Owner's Signature: Sworn to before me this day of Apr 120 2q Official No Public Signatur nd Original Notary Stamp TRACEY L, DWYER NOTARY PUBLIC aTATF OF NEW Y ORK NO OIDW630690o OLIALIFIED IN SUFFOLK COUNTY Page 4 of 4 TOWN OF SOUTHOLD BUILDING DEPT. Mum, 631-765-1802 Cry. INSPECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSUJ.ATIOWCAULKING [ ] FRAMING /STRAPPING [ ] F AL [ ] FIREPLACE & CHIMNEY _ [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F AL) [ ] CODE VIOLATION [ ] PRE C/O ] RENTAL REMARKS: CM . . . r - -C w DATE INSPECTOR , TOWN OF SOUTHOLD BUILDING DEPT. t� 631-765-1802 6 51 3 - 7 INbr =CTION [ ] 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 [ K RENTAL REMARKS: 41 4&A- �� DATE INSPECTOR ' Town Hall Annex . 4 �w Town of Southold 54375 Main Road r Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 ....�.. �................. _...w.......-.... .._....................w ,... _..................................................._.....................w.__,,,,..... ... _........e. _.__..... ,_µ . .. .'... �....'......w. Dat CTM# �� w._�._ ww_w..,...........W _w_. ........ .a..._.......__. .�Owner Phone �"�- Visible amlet ..._.... S01. . ..- Inspector Floor Level Quantities Sub 1 2 3 ...... ........_. ...... .... .. . _. _ . .. Smoke Detectors(not located in bedrooms) Carbon Monoxide Detectors ...... ....._ „ .. .....,. __... ....... ... ... ... . .. _ . .... _. ...... ... _. ... ...__....... Fire Extinguishers Exits _....... _._. Bedrooms 1 2 3 4 5 6 .m. ...... -i0;0;;1_ .. �� Smoke Detectors r E g ess .. .. ... .. .... ..F .... -.. .. _._..._.._ OccupantCount ...__.. .. ... ................�. ... ._ ..�. ..... �� .. a.. ...... ..._ .., ...- -... ............. a ,. -. ..._w...� ••"'Buildin.g� 5y....�s_t...e.,,m� s...�.Maintained &Operational .........,..........�....�.��....�...............,.....w.... Condition onditio�n...of Property .. ....�.......��_..�.........�..��_.w.,� �.....�,. . ......��.�.�.....m.... Heating_ Building interior .......w-� � w�� .,........�. �....��. .�� ....,,..�„� .-................ . �_....�.�„� -...��......._.._..w��w. �.-�....,.....�,...�. .�.�� .,�.,,. ...� ._..� ...�w...._.�,��.� Hot water Building exterior ,Electrical Property clean, maintained &safe Mechanical Handrails& cards installed &secure Pool Safety Pool on Site �.�� a.. � ... w �w.,�...... ..... ...�.w. ,,...,., .�..�..... .. . a �. .W ., .�....�.._..� , Surface water alarm Date of CO issuance Door alarms .w. Pool completely enclosed .....Self closing/latching gates,. .......M� ........ w........ . _._. . ........�w.... ., a to q ......�,�,�.�. � .. ........ ..�_....�_..�......�.�,....�..... .,.._ .._..-.._.�.� .��. .�,.__�...."Pool fens code requirements ......_..�..,..�M ........�..._,,..... ....��... ......_..-._. ._..�.._�.......__...�_ O s for all items resent . . ...- Prior -..............._. _.,..... C._..'�.. ......�_.. e p _._.. Prio Rental Comments: ,.m....,.µ_�µ..�..�..�., .......... .... ,_...........�..,.�. �..._...Y.... ...� . ., Town Hall Annex ^ Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 � 'i" 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 Professslonal seal re ulred for Architect or Engineer, Licensed Home Inspector must provide cgpy of y qI14 current certification Rental Property SCTM Number: 1000-64-3-7 Rental Property Address: 2500 Hobart Road Southold NY 11971 Owner/Name: Andrea L.Simitch Revocable Trust&Val Warke Revocable Trust Rental Dwelling Unit Identifier: I Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 —100 sgft.,Bedroom#2—90 sgft.,etc.) Bedroom#1 11-7"X 11`),Bedroom#2( 10 11-7"X 7'-2)„Bedroom#3 11-10"X V- ""), Kdcben " , Bathroom#1(6'-5"x 7"--10"),Bathroom#2(5'x 4'-5"),Screened Porch(388sf) Property Description (Include all improvements indicated on survey) Single family home 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. Andrea Simitch,Architect NYState#017169 . w M, Print Name and Title � q P2�rl Signature " Please place Professional Seal: 4.1 Xh x Y TOWN OF SOUTHOLD PROPERTY REC OWNER i STREET VILLAGE SUIT LOT � 2 - ss FORMER OWNER N E ACR. , a S W TYPE OF BUILD NG dc RES SEAS. VL. FARM COMM. CB. MISC. Mkt. Value N LAND IMP. TOTAL DATE REMARKS I - e -79 g F � t s AGE _ BUILDING CONDITION — NEW NORMAL BELOW ABOVE FARM 1 Acre Value Per Value Acre Tillable 1 f Tillable 2� I i Tillable 3 Woodland Swampland I FRONTAGE ON WATER Brushland I I 3FRONTAGE ON ROAD � � House Plot DEPTH I BULKHEAD Total DOCK COLOR F t - 'Ilet s f TRIM ' fi - E i s i 3 z a M. Bldg. i = Foundation Bath Dinette Extension ' Basement r�e� Floors K Extension _ l rj a i X X A Ext. Walls Interior Finish E6 4 I Extension _ DR. Fire Place i Heat �e � 41 'Type Roof Rooms 1st Floor. BR, Porch1 Recreation Roorr Rooms 2nd Floo FIN. B. E_ I Porch I Dormer j = Breezeway Driveway I Garage r, F I Patio a I t 1 0. B. _ e Total I 4-/'10 t YOM NO. 4 TOWN OF SOUTHOLD BUILDING DEP T° I"' Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ,5903. . . . . . . Date . . . . . . . . . . . . . .M7. . . .'�4. . . . ., 19 7� . THIS CERTIFIES that the building located at . . . . .Hobart .Road . . . . . . . . . Street Map No.Founders .P 'tw JWo. . . . . . . . . . .I of No. 122.& .123. . .SQUth Q14. . .tl conforms substantially to the 1 1 ou code daltbefere• -Apri.1• .23. ., 19.57. pursuant to which ,occupancy �5903 . . dated • . . . . . . . . . . .Play - - - 14 ., 19?4 ., 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 . . Private .an.a .famJLly. dwelling . . .4. 10.st mssp 'y. building, 4, vago) The certificate is issued to .Curtis. W. .Davis. . . . . . . der. . . . . . . . . . . . .. I ,. . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval pre-.exlstIng. . . . . . . . . . . . . . „ . . . . UNDERWRITERS CERTIFICATE No. .P70r: .p?tiWpg. . . . . . . . . . . . . . . . . . . . . . . HOUSE NUMBER . .25..00. . . . . . Street . . . . .HAhSrt. .RQad. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ��;:. . . . s Building Inspector HOUSING CODE INSPECTION May 13 , 1974 2500 Hobart Road, Southold New York Sub. Div. - Founders Estates Lots - part 122-123 Tax Roll: CURTIS W. DAVIS Upon request of the Southold Town Building Department, I made inspection of this two story framed dwelling and found the following violations of Chapter 52, Housing Code, Town of Southold. I was admitted to building by Mrs. Alvah Goldsmith and began inspection at approximately 11:35 A.M. The first floor consists of sitting room on entry, dining room, kitchen and eating area, living room and bathroom. The second floor has four bedrooms and a full bathroom. Heat is supplied to all rooms from oil fired furnace located in full cellar. FIRST FLOOR - Sitting room at front entry - wall outlet requires ceiling fixture removed, open electrical box. Article V, Section 52-56 A-1. KITCHEN - Outside entry, no means of controlling light in room on entry. Article IV, Sec. 52-56 B-2. BATHROOM - Requires moisture resistant floor covering. Article III, Sec. 52-32 D. SECOND FLOOR - Ceiling headroom 6 ' 11" . Violation Zoning Ordinance, Chapter 100 , Sec. 100-13 B, Floor Area Livable. BATHROOM - Requires moisture resistant floor covering- Article III, Sec. 52-32 D. EXTERIOR - Front entrance enclosure - frames of enclosure rotting. Article III, Sec.52-32 A. Accessory Buildin - two car garage in front yard, shingles on lout s. a deteriorating. Art. I Sec. 52-31 D. Inspection completed at approim 12 :00 P. Res ctfully sub tted, EH:mm Edward Hin ermann, Bldg. Inspector SCREENED PORCH S/CM 36'5,X lot" J HALL 5'9'.13'lG" HALL '4'xlT5' Vi BEDROOM DINING ROOM FAMILY ROOM 117'X liv PRIMARY BEDROOM 1TW PRIMARY -M I 1�BEDROOM 1410'.Wr V7 227' S S BEDROOM S S SCBIEDROOM W J rx72" 1, M 1,10,x6'16, KITCHEN 22'X6'6 BAFH.4- LIVING ROOM 1n,X15,6, BATH L 6'5xTIU' FLOOR 2 FLOOR 3 7 x4'r - S/CM STORAGE 8,rxW KEY S smoke detector S UNFINIHED BASEME 35'6'x 28'11" NTsmoke & carbon monoxide detector 2500 HOBART ROAD GROSS INTERNAL AREA "ow Ground: 0 sq.ft,FLOOR 2:981 sq.ft,FLOOR 3:785 sq.ft EXCLUDED AREAS:STORAGE: 77 sq.ft,CRAWL SPACE. 121 sq.ft,UNFINISHED BASEMENT: 738 sq.ft, SCREENED PORCH: 388 sq.ft TOTAL: 1766 sq.ft 1EASUREMENTS ARE CALCUI ATED BY CUBTCASr TECHNOI-CG) DEEMED-11GHL1 RELIACLE EIJI NOF CUARA;j SCREENED PORCH 355,x 10,13" 117 HALL 5'W x 1xv, HALL 1141 x ITY BEDROOM DINING ROOM PRIMARY BEDROOM 14! FAMILYROOM 117'x WD" 1"x 11'4' 01 x 147 171Y x 27211 15 vl m sm-acQ, f- F� SEDR'..Ap: 1117'x 77 A 11,10"x 6110* BREAKFAST NOOK K-n---N 11'4"X TS' 07 x TS" BATH-*;_7 7'2"x 4". LIVING ROOM lmx 16-6- BATH 6'5"x Tl 0' FLOOR _ 2 FLOOR 3 70'x4.1" STORAGE 87"X 84" 1; 3WxW11' I'E il- 4> GNoKt- FLOOR I H6- A GROSS INTERNAL AREA Below Ground: 0 sq.ft, FLOOR 2: 981 sq.ft,FLOOR 3: 785 sq. ft EXCLUDED AREAS: STORAGE: 77 sq,ft,CRAWL SPACE: 121 sq.ft,UNFINISHED BASEMENT: 738 sq.ft, SCREENED PORCH: 388 sq.ft TOTAL: 1766 sq.ft