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Home My WebLink About1000-116.-6-11 of so TOWN OF SOUTHOLD Rental Permit 1416 Owner: Nicola Plimpton Occupied as: Accessory Apartment Located at: 12250 New Suffolk Ave Cutchogue 116.-6-11 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 arranging for the bi-annual inspection. Issued: 02/03/2026 Expiration: 02/03/2028 ode nt ccai This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town ball Annex 54375 Main Road P. 0.Box 117 Southold, D 11 1��6 J It Telephone 6 1)76 -1 0 Fax (631)765-9502 lift s://%v .southoldtownn . ov r �S00 RENTAL PERMIT APPLICATION Rental Permit Fee$300(Application must be renewed every two years) Section A. Property Information: Q-tA+CA o q e- Rental Property Address: Tax Map Number: 1000 SECTION NP -BLOCK SECTION B. OWNER INFORMATION: Property Owner Name: w Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 161- 1 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): ". ` �AS Lav, 9V 1�P1�jZ Mailing Address of Authorized Agent: " �4 Telephone Number(s): Daytime µ� � ' Evening 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: 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 room. For properties with multiple Rental Dwelling Units use "Rental Permit Application Addendum." Rental Dwelling Unit Identifier: 0 E1Lk-Aa Requested Maximum number of persons allowed to occ y Dwelling Unit: Number of rooms in Rental Dwelling Unit: 41 Use and Dimensions of each room in Rental Dwelling Unit: Iq rL eg 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. ❑ I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold T�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 SUFFr;,L, ' '=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: d Property Owner's Signature: Z( e.. 11 ++ I_ TIFFANY J BEREZNy Sworn to before me this D( day of M��'JAx� &r , 202 Notary Public-state of New Yore. No.01 BE6284112 Qualified in Suffolk county My commission Expires 06117i[029 Officia otar lic Sign Lure Original Notary Stamp Page 4 of 4 ", Telephone 63'1 765-1802 Town Hall Annex �� P ( ) 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold, NY 11971-0959 r 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 required for Architect or Engineer, Licensed Horne Inspector must provide copy of valid current certification Rental Property SCTM Number: 1000-116.-6-11 Rental Property Address: 12250 NEW SUFFOLK AVE,CUTCHOGUE, NY 11935 Owner/Name: NICOLA PLIMPTON Rental Dwelling Unit Identifier: Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 —100 sqft., Bedroom#2—90 sgft., etc.) BEDROOM 2: 119 SF BEDROOM 1: 150 SF Property Description (Include all improvements indicated on survey) DETACTED STRUCTURE W/GROUND AND SECOND FLOOR. BOTH FLOORS HAVE DECK ATTACHED.TWO 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. KATHERINE SAMUELS4�Ga<'Le� JEft " Original Signature Print Name and Title �� g� g Please place Professional Seal: 43 era � , Ex I E-Til. i BE-12 a= 1-fi- ZIw H 1 1 i u ilil:1111oll HilO 0- 5E EXISTING CONDITIONS EXISTING CONDITIONS EXISTING CONDITIONS CRAWL SPACE Fl T;LOOR PLAN SECOND FLOOR PLAN -ACCESSORY APT.EXISTING sau* TOWN OF SOUTHOLD BUILDING DEPT. o 631-765-1802 INSPEC I ' lulm [ ] FOUNDATION 1 ST/ 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 f I' Oil lza TOWN OF SOUTHOLD PROPERTY RECORD CARD - s.=ate * - _ _ __ 2- a a� in- N E R ACREAU o OF BUILDING mve s Pe o ' - w � _ 1_ 3 _ _ , - MIS , = - - LAND t TOTAL - a-a- K. n AG BUILDING 6 EPd NEW BELOW ABOVE Faff Acre ue Peee i'lable g House p1ot l i ate_ A i +gam , t Li e „< e n � � r a' L � I M. Bldg � . rs _- n�at�o� = � Bath Extension Basement Floors i Extension ' _ 3 _£ Est. Nulls x_ Interior Finish 41, Extension Place I t Heat w a poro� Attic _ F Porc'� _ Rooms 1st Floor Breezewa; Patio Rooms 2nd Floor I -'l 1 T I - s f ��_ ,� � � � � � - nvew y _. u. B- x l � ' FOLTown of Southold 10/2/2023 53095 Main Rd Southold,New York 11971 PILE :EXISTING CERTIFICATE OF OCCUPANCY No: 44623 Date: 9/30/2023 THIS CERTIFIES that the structure(s)located at: 12250 New Suffolk Ave SCTM#: 473889 Sec/Block/Lot: 116.-6-11 Subdivision: Filed 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- 44623 dated 9/30/2023 was issued and conforms to all the requrrements of the applicable provisions of the law. The occupancy for which this certificate is issued is: Wood frame with stucco in 1e fami dwelling, two enclosed Dorches and accessor_y wood frame and stucco shed.* The certificate is issued to Plimpton Family LLC (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. thori Signature BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 12250 New Suffolk Ave P _wwwww_.............. ........... SUFF.CO.TAX MA NO.: 116:6-11 SUBDIVISION: NAME OF OWNER(S): Plimpton Family LLC ._..............................................w.�........_..._ .......ww.__.... _ �_ __..w_._........_.._.................... ................., vv............._�.. ......_._._... OCCUPANCY: ADMITTED BY: .. .........._. ...__...._�._..... ._�. _w.�.._wwwwwww_aa_ SOURCE OF REQUEST: Plimpton Family LLC DATE: 9/30/2023 DWELLING: #STORIES: 2 #EXITS: 4 FOUNDATION: brick CELLAR: partial CRAWL SPACE: BATHROOM(S): nn TOILET _.......... .__...�... ._._. OI OOM(S): 3 UTILITY ROOM(S): PORCH TYPE: 2 enclosed— DECK TYPE: on grade PATIO TYPE: BREEZEWAY: www._._........ FIREPLACE: 1 double side GARAGE: DOMESTIC HOTWATER: - oil TYPE HEATER: AIR CONDITIONING: TYPE HEAT: floor grate W WARM AIR:-.- HOT WATER: #BEDROOMS: 5 #KITCHENS: 1 BASEMENT TYPE: OTHER: _......._............................ ACCE ORSTRUCTURES: GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: wood/stucco SWIMMING POOL: GUEST,TYPE OF CONST: OTHER: VIOLATIONS: REMARKS: INSPECTED BY: NANCYD DATE OF INSPECTION: 7/10/2023 TIME START: 10:40am END: 11:20am Town of Southold 9/30/2023 fi 53095 Main Rd Southold,New York 11971 RE EXISTING CERTIFICATE OF OCCUPANCY No: 44624 Date: 9/30/2023 THIS CERTIFIES that the structure(s)located at: 12250 New Suffolk Ave SCTM#: 473889 Sec/Block/Lot: 116.-6-11 Subdivision: Filed 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- 44624 dated 9/30/2023 was issued and conforms to all the requrrements of the applicable provisions of the law. The occupancy for which this certificate is issued is: wood frame with stucco es paq q-t with second floor deck.* a w The certificate is issued to Plimpton Family LLC (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. A tho ' ?Signattr r BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 12250 New Suffolk Ave SUFF.CO.TAX MAP NO.: 116:6-11 SUBDIVISION: NAME OF OWNER(S): Plimpton Family LLC OCCUPANCY: ADMITTED BY: SOURCE OF REQUEST: Plimpton Family LLC DATE: 9/30/2023 DWELLING: #STORIES: 2 #EXITS: 2 FOUNDATION: stucco over brick CELLAR: none CRAWL SPACE: .... WWW ........ BATHROOM(S): 2 TOILET ROOM(S):� UTILITY ROOM(S):_w„ PORCH TYPE: DECK TYPE: wood PATIO TYPE: BREEZEWAY: i FIREPLACE: GARAGE: DOMESTIC HOTWATER: ....... electric TYPE HEATER: AIR CONDITIONING: TYPE HEAT: electric WARM AIR: HOT WATER: #BEDROOMS: 2 #KITCHENS: 1 BASEMENT TYPE: -�........ww. OTHER: CCESSORY ffRUE : GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: SWIMMING POOL: GUEST,TYPE OF CONST: OTHER: ._.._..�.____...�w...�....,_w_..... �............_...._.. VIOLATIONS: REMARKS: INSPECTED BY: NANCYD DATE OF INSPECTION: 7/10/2023 TIME START: 10:40am END: 11:20am NO. i TOWN OF SOU OLD RunDING D Town les 016" SMAWK N. Y. certaic,ale Of OcCupancy No. $3... . . . . Bate . . . . . . . . . . .Oc-t . .2$. . . ..... ., It.77 TIJIS CERTMES that the huilding located at Pcw..=J,0lX Ave. . . . . . . . . Street No. .It&... .♦ .. • no, ♦ . . 1 T 1 *Lot No. • Kx f .. "tcha ,T ♦♦ f��T♦f► ♦ T i f. conforms substantia4y�to the Application for Building Permit h is Ibs ofte dated . . . . . . . . . . . . . .octt♦27., 19.27, pursuant to which Building Permit N0.9520Z. .. dated . . . . . . . . . . . .Och. .27. . . ., IWT ., WAS wed. and conforms to 8u of/the bpi mewls of the applieWe provisions of the law.The occupftcy for which the mtificate Is issued is . .PP YOP MLIP. X%Am .7.¢W.e.11ing, .. . . . . . . . . . . . The-cert. . to is-issued-to :Gharle-s.-PX4►p :=. . . .. . , . .0 . . , . , . .. .... .. . . . . . (ownert leaft or of the aforesaid lm Suffolk County Department of Health Approval N•l ' . . . . . . . . . . . . . . • .. .• . . . . . . . . . �0 ,D—ERW IT: RS- CERTIFICATE No:11-a.. . . . . . . . . . . . . . . . . . . . .. . . .. . . . . .. .. .. .. . . HOUM NVIUM . . . . .#92 . . . StIMMt . .New.Sur.ft2#- .Ave. . . . .cutoh guo.... .. Building