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Home My WebLink About1000-46.-1-31.1 (Unit H61) TOWN OF SOUTHOL Rental Permit 1444 Owner: Driftwood Cove Owners Inc (Robert Haase) Occupied as: Apartment (Unit H61) Located at: 1000 Ninth St Greenport 46.-1-31.1 Maximum Permitted Occupancy: 2 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: 04/17/2026 Expiration: 04/17/2028 LCode rement OfVal This Notice must be posted by the main entrance at all times /" 41V TOWN OF SOUTHOLD—BUILDING DEPARTMENT ltlq6g �.% Southold, 15� 4 Town Hall Annex 54375 Main Road P. O. Box 1179 l )"1 � Telephone(631) 765-1802 Fax(631) 765-9502 w squtl?oldgj%" 1 R y t RENTAL PERMIT APPLICATION Rental Permit Fee $300(Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION -BLOCK SECTION B. OWNER INFORMATION: Property Owner Name: (A fie Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) Telephone Number(s): Daytime&- — C �-Vgning6�-y2.6--373LEmergency4j Yz6-3736 Property Owner Email Address: C�" �' c1 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): 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: 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: `S �w� mcL /Aev� Address of Managing Agent (no P.O. Boxes):. Avg ivy IIq- Mailing Address of Managing Agent: rxzo,e. Telephone Number(s): Daytime[ ' Evening S c,,e, Emergency Scrk Email Address: 'o '� �� tm4 ,6 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, 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: Requested Maximum number of persons allowed to occupy Dwelling Unit:�___,, Number of rooms in Rental Dwelling Unit: X Use and imensions of each room in Rental Dwelling Unit: I `+tAl-tom 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 afire 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) 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 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: Property Owner's Signature: Sworn to before me this day of I��1 V1 , 20a En�nl-4" L , 02�n L Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.01BU6185050 Qualified in Suffolk County Commission Expires April 14,2 VC) Page 4 of 4 %A.aa. zx f so TOWN OF SOUTHOLD BUILDING DEPT. o 631-765-1802 4-/- 34 / IZ61 INSPECT14jim [ ] 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 (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ��RENTAL -f�IJ5 11�11 I DATE 'a� _ INSPECTOR 1 !Y 3 d AT% � A l. s" \ Y `` s will Cv'M J . F w Sys w f ; 13 mw Y„ fin ............... a R- � �C� � ��✓ am. I � 6 F. „� MI77a4EAl w p d .w. a w „ " r g + �IL IV tL w � b M �u µ W .µ m ^ a J : .. — m . nn fqb1 w s � FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. . . .Z10586. . . . . . . Date . . , July. 17 . . . . . . . . . . . . . . . . . . . .. THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . « . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property Main Road & 9th. Street, areenport, New York House No. Sireef ' H* » .lot County Tax Map No. 1000 Section . . .46. . . . . . .Block . . . . . . . .I . . . . . .Lot . . . . . . . . . . . xSt"iV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7k IFm. . . . . . . . .a X;. . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated April. 3A . . . . , . 19 .73pursuant to which Building Permit No. . , . . 6530. Z w µ . . M . dated . . , . .April .30. . . . . . . . . . . . . . 19 .7.4 ,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 . . . . . . . . .. Ot}e Bedroom, ,Apartment Bld .. .'!H" Driftwoo6 Cove. . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . . Xeugphon ,Damianaa c s .. . , . . „ . . . . . . , . of the aforesaid building. Suffolk County Department of Health Approval . . . . . Existing Public Sewer System UNDERWRITERS CERTIFICATE NO. . . . . . . N31769.7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . < . . . . , . . . . . . . . . . . . . . . . . . . Building Inspector Rev. 1/81