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Home My WebLink About1000-64.-4-15 TOWN OF SOUTHOLD Mental Permit 1434 Owner: Jason Bauer Occupied as: Single Family Dwelling Located at: 1575 Founders Path Southold 64.4-15 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: 03/30/2026 Expiration: 03/30/2028 Cod En f rce entOfPicial This Notice must be posted by the main entrance at all times B c pq uy TOWN OF SOUTHOLD—BUILDING DEPART°M'FN , Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 1197179, � wl°t lLirt : �°�1 Telephone(631) 765-1802 Fax(631) 765-9502 htt�)s://www.souttioldtowntI .�c`ry / RENTAL PERMIT APPLICATION Rental Permit Fee$300(Application must be renewed every two years) reC-4 Section A. Property Information: Rental Property Address: 1575 Founders Path Southold NY 11971 Tax Map Number: 1000 SECTION 64 -BLOCK4 -LOT15 _. SECTION B. OWNER INFORMATION: W� Property Owner Name: Jason Bauer Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 125 West 3rd Street 2B 125 West 3rd Street 2B New York NY 10012 New York NY 10012 Telephone Number(s): Daytime860-490-9479 Evening same Emergency same Property Owner Email Address: DIGMURLO@GMAIL.COM 9Gr' Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: NA Address of Authorized Agent(no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening Emergency Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: NA 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: NA 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: 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, 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: 1 Requested Maximum number of persons allowed to occupy Dwelling Unit: 6 Number of rooms in Rental Dwelling Unit: 8 Use and Dimensions of each room in Rental Dwelling Unit: Kitchen - 1 10" x 22"8" Primary Bedroom - 12"4" x, 14"11" Bedroom 2 - 8`8" x 10' 6" Bedroom 3 8"6" x 1011°" Room 6"11" x 132" Dining Room '1-" x 12"0" Living Room 207' x 13'1" Foyer 207" x 6'10" 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 ❑ 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 Jason Bauer 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: Jason Bau Property Owner's Signature: Sworn to re me thi day of - 20�s' cial Notary Publi na ure and Original Notary Stampmtct p el. New o<x Notary 0.OR stala 3 Page 4 of 4 q sorry° TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 E INSP TION� [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL i [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ NTAL REMARKS: ig iogt Ae-"6 DATE _ '/3•a� INSPECTOR __ e a Al 'r§_. i � rn ro rrr ru - rw rio ■o rims �'�`_- - M. Bldg. ,; Foundation Bath Extension 3 { Basement �`' Floors Extension Ext. Walls Interior Finish Extension y' - = :� Fire Place 3 j Heat r P -". Porch' Roof Type Porch Rooms 1st Floor Breezeway Patio Rooms 2nd Floor Garage j Driveway Dormer O. B. t-4 �p /fin x 4 el ) f� § 1575 Founders Path, Southold, NY / BREAKFAST NOOK Bmmo § ^ lolE x U« EE. U&" z� ROOK - < elex1a2 / \ _ !� z .. + � •� & . ... .. _ » , - = - �?e i !o&"xlzE BEDROOM,, �z m. sBxU k DININGDININGROOM 9' «E : 2"x12'0 a " _ .. , ..� . . - , - LA _ l ) / ) ) ksmml , �o«��4 2" ~ H> \\ �w e;"x °/ C m ;. . ! - - LIVING mom \ zo2xl3'2 ., $ _ ! . j PRIMARY BEDROOM !z". 2" FLOOR I FOYER �| z2xelz � !�! ` \ _ » FLOOR 2 SIZES AND DIMENSIONS ARE APPROXIMATE, ACTUALMA VARY 1575 Founders Path, Southold, NY BREAKFAST NOOK BEDROOM R 10'10"x 10'4" 8'6"x 10'11" 1/\ ROOM Z 6'11"x 132 ---------- KITCHEN 10'11"x 12'1" BEDROOM 8'8"x 10'6" DINING ROOM 9'10"x 12'0" NU 8*5' 7'2 LIVING ROOM 207'x 13'1" PRIMARY BEDROOM Z I 12'4"x 14'11", FOYER 20'x 6'10" �\ . � \ SIZES «62 -DIMEN-SIDNS AQ- A-DR-XIv'JAT» T"I MAY