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Home My WebLink About1000-88.-5-29 TOWN OF SOUTHOLD Rental Permit - 1442 Owner: 185 Rambler Rd LLC Occupied as: Single Family Dwelling Located at: 185 Rambler Rd Southold 88.-5-29 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: 04/14/2026 Expiration: 04/13/2028 /Cod4forcement vial This Notice must be posted by the main entrance at all times �C 11mf � �� TOWN OF SOUTHOLD—BUILDING DEPARTMENT '` � Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971,E 954 Telephone 631 765-1802 Fax 631 765-9502 https://www.southoldtowmlygo 2 .., 2026 RENTAL PERMIT APPLICATION Rental Permit Fee $300(Application must be renewed every two years) Section A. Property Information: Rental Property Address: 185 Rambler Road,Southold, NY 11971 Tax Map Number: 1000 SECTION 88 -BLOCK5 -LOT29 - SECTION B. OWNER INFORMATION: Property Owner Name: 185 Rambler Road LLC (Sandra Jacobs, Mortimer Jacobs) Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 2 East End Avenue, PH-N 2 East End Avenue, PH-N New York, NY 10021 New York, NY 10021 Telephone Number(s): Daytime917-913-4806 Evening 917-913-4806 Emergency917-913-4806 Property Owner Email Address: micslana@aol.com Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Krista Jones Address of Authorized Agent (no P.O. Boxes): Mailing Address of Authorized Agent: 3685 Elijah's Lane, Mattituck, NY 11952 Telephone Number(s): Daytime631-335-8175 Evening631-335-817§nergency Email Address: millstonepropertyservicesigmail.com 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: 1-single family residence 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: 8 Number of rooms in Rental Dwelling Unit: 6 Use and Dimensions of each room in Rental Dwelling Unit: approx dimensions: Kitchen 13'x10'; Dining 9'x10'; Living 23'x13; Family 12'x11' Bedroom 14'x13'; Bedroom 11'x10' 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 ❑ 1 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 S- LK) I I11 TA C(3 -5' , 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: p g °Property Owner's Signature:_,.-,"' Sworn to before me this day of �� 20 �w(� Official Notar Public Signature and Original Notary Stamp �A l lA No.0Public-State of New Yo,* MA64 6: 1 Qualified sire New York County Expir Page 4 of 4 Town Hall Annex e '� Telephone(631)765-1802 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: 1 Requested maximum number of persons allowed to occupy each dwelling unit: 8 Number of Rooms in Rental Dwelling Unit: 6 Use and Dimension of each room: Approx dimensions:Kitchen 13'x10; Dining 9'x10;Living 23'x13;Family 12'x11' Bedroom 14'xl T;Bedroom 11'x10' Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: a TOWN OF SOUTHOLD BUILDING DEPT. � 631-765-1602 INSPECTRA"J' N [ ] 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 (FIN ) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: Ok-- ww DATE 'I3•��o _ INSPECTOR VW"', Town Hall Annex M Town of Southold 54375 Main Road pq Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 u;w J SCTM# Date Owner Phone Address a Visible Hamlet Inspector Floor Level Quantities Sub 1 2 3 Smoke Detectors(not located in bedrooms) 1 Carbon Monoxide Detectors 1 Fire Extinguishers Exits Bedrooms 1 2 3 4 5 6 Smoke Detectors Egress Occupant Count Building Systems Maintained&Operational Condition of Property Heating Building interior Hot water Building exterior Electrical Property clean, maintained&safe Mechanical Handrails&guards installed&secure Pool Safety Pool on Site Surface water alarm Date of CO issuance Door alarms Pool completely enclosed Self closing/latching gates Pool fence to code requirements CO s for all items present , ,,,,, %�%/%/a ;,,,,,f/ %!//r %?p ,; «► /%/ . Comments: FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.A4673 . Date . . . . 4Time 20. 19.Fj2 THIS CERTIFIES that the building located at Z/8 Rambler Road Street Map No. Terry Wtrs Block No. . . . . .Lot No. . 23 . Southold N.Y, conforms substantially to the Application for Building Permit heretofore filed in this office dated . . Nov . '1 19.72. pursuant to which Building Permit No. . 5603Z dated . . . . . . NOW . .t . . 19.,72., 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 -one. •f'ami17 •dwel-1 ng. . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to Jul us.& Edith -Downs • • • .Owners (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ;Une .12. . .1972 . by ri V.ijla UNDERWRITERS CERTIFICATE No J. 22p9 HOUSE NUMBER .185 Street Rambler Read, Building hispector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. . . Zg5 9 .. . Date . . . . . . . . . . . . . . . . . . ., 19. THIS CERTIFIES that the building located at . .185. Ram'b .er Road . . . . . . . Map No. . .?90I. . . . . . Block No. . . . . . . . . . .Lot No. . . . . . . . ?5. . . . . . . . . . . . . .. . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated .June. . .12. . . . . . . . . . . .. 19. , .7.8pursuant to which Building Permit No. . . .97997 dated .June - .25. . . . . . . . . . . . .. 19. 78, 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 One Family Dwelling With addikion. . . . . . . . . . The certificate is issued to . . . . . . . Jul�.. . &.Edith Dawns . . . . . . . . . . . . . . . . . . . . . . . . (owner, of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . .UIR . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE No. . . . . . . . . . . . . . . . . . . . . FA. , . . . . . . . . . . . . HOUSE NUMBER . . . 1 Q5. . . . . . . Street . . . . . . . . . .Rambler Roads . . . . .. . . . . . Southold, New York . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . . . . .. . . .. . . . . . . . . . . . . . Building Inspector County '_Carr Map Number 1000--88-5-29 FORM INO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy 18 No. . „Z1290.4 . . . . . . . . Date . . . . . . . .October . . . I . . . . . . . . . . .. 104. THIS CERTIFIES that the building . . . Access(?FY . „ . . . . . . . . . . . . . . . . . . „ . . . . . . . . . . Location of Property . . 1.,8`5» . . . . ,. . . . , „Rambler Rd. Southold , House No. Street H andet County Tax Map No. 1000 Section . .0 8 8. . . . . . .Block . .0 5. . . . . . . . . . .Lot . S?.9, . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . » . . . . . „ . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated Sept._ , 17 , l 9 ,8 4 pursuant to which Building Permit No. . . ?3 4 4 2. . . . . . . „ „ . „ . dated . . . . . . . „ . . SePt.. „ , . , 17 , . . , 19 $4 ,was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is . . . . . . . . . . .A qqP ;g;KY. 5he�d. �A ttlp— .$e4x. A470 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . . . . . . . . . . . . . .JULTLj , RQ1 1 5 . . . . . . . . « . . . . . . . . . . . . (ovr ner,4 t t) of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . .. . . . . . . . . . . . K/.k . . . . . . . . . . . . .. . . . . . . . . . . . lk � e'G44 Building Inspector Rev.1/81 • FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. AIM . . . . . . . . . Date . . . . . . . , r twc fi . . . . .18 . . . . , . . ., 1984. THIS CERTIFIES that the building . . , ,Addition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property . . . . . . . . . . . . .Rambler lid. , , Southold House No, St t N�rrrle� County Tax Map No. 1000 Section 0 8 8. . . . . . .Block . . .0 5. . . . . . . . . .Lot . . . . . . . . . Subdivision . . . . . . X. . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated M4 . pursuant to which Building Permit No. . . 13 4 41 Z, , . . , , . . , , , . dated . . .. . . . . . . . . . . 17 . . . . 19 A ,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 Existing one Family Dwelling The certificate is issued to . . . . . . . . . . . . . . .JULI S O ? . . . . . . . . « . . . . . . . . . . . . (owner, of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . . ..N/A, , , . , , , , . , , , , , . . , , . . , „ UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . . NSA. . . . . . . , . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Building Inspector Rev.1181 c P ;r 3/27/26,12:03 PM 2D Floor Plan for 165 Rambler Road.Jpeg 'T I FAMILY ROOM 12'1"x 11'6" I KITCHEN DINING AREA FBEDROOM BATH I 13'2"x 10'7' 9'6"x 10'11" '4 x 10'7" 5'S"x 10'7" 3 � HALL 87"x 3'0" LIVING ROOM 23'5"x 13'4" PRIMARY BEDROOM i 14'0"x 13'9" Mu https://mall.google.mrrdmall/WO/Mnbox?pmjactor--1 1N