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Home My WebLink About1000-98.-1-1.3 of-goo TOWN OF SOUTHOLD Rental Permit co � 1438 Owner: Indian Neck IV LLC Occupied as: Single Family Dwelling Located at: 3375 Indian Neck Ln Peconic 98.4-1.3 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 arranging for the bi-annual inspection. Issued: 04/07/2026 Expiration: 04/07/2028 c�� Official Notice must be posted by the main entrance all tip _ TOWN OF SOUTHOLD—BUILDING DEPARTMENT „ Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-6959 Telephone (631) 765-1802 Fax(631) 765-9502 hil : / 'ww ogglj ldlownn 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 -BLOC ,-LOT - SECTION B. OWNER INFORMATION: Property Owner Name: Zfmi A-::!� Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) S ._. /4— Telephone Number (s): Daytime Evening Emergency Property Owner Email Address: 41a a f l� if 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 es): Mailing Address of Auf zed 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 Auth>Author' t (no P.O. Q s Mailing Address Agent: Telephone Nutime 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: f✓� 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, 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: Use and Dimensions of each room in Rental Dwelling Unit: '/ ��,,.✓.✓� 1�e�cam-- / 2: Al 2x IL" ot SECTION G. % Z x 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 ❑ 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 '1� e ', 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 20_ Official Notary Public Signature and Original Notary Stamp Page 4 of 4 Town Hall Annex Telephone(631)765-1802 631 54375 Main Road �� Fax( )765-9502 P. O. Box 1179 's 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 Professional seal re aired for Architect or Engineer, Licensed Home Ins ector must rovide copy of valid current certification Rental Property SCTM Number: Rental Property Address: � �C G � e- Owner/Name: 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.) 2 - Property Description (Include all improvements indicated on survey) 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. Print Name and Title Original Signature Please place Professional Seal: f4f so TOWN OF SOUTHOLD BUILDING DEPT. � 631-765-1802 lNSMob, [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN ULATIOWCAULKING [ ] FRAMING /STRAPPING [ ] INAL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTAXPENRATION ELECTRICAL (ROUGH) [ ] ELECTRICA ) CODE VIOLATION [ ] PRE C/O TAL REMARKS: DATE INSPECTOR GENERAL 5YM60L KEY: [ <- 1:7=1 t o rmo ME wwt xy N = rnom cvwcme�o.anr } �o O U s., aea zo x �a t s.�_< €^amass-3• - --. s _ b e Val I - —1 NIL- € § INDIAN NECK FARM GUEST HOSUE F4mm� � - MA PECCNIC�NY 11968 I ES INI,N NECK W I s €_ 33f, � s so1os - [. .=9- -. - •' - It;E OBlOBl23 SB OF 20 9 ' -- STRUG7IJRAL PLAN-FOUNDATION LEVEL La I} - GENERAL SYMBOL KEY: a f ml w El c o R M�(L 'Slwr�,V4L r rULl51 j S ,��A. - - 4-1 m r. m a - — : €�a ]IiND1AN NECK FARM GUEST HQSUE 3375 INDIAN NECK INIs ` _ s 3` PECDNIC,NY 58 119 if _ . E i € ( - % S- _ „E - 01 �x . - CONSTRUCTION PLAN—5ECOND FLOOR CONSTRUCTION PLAN—ROOF '- v. _ J¢, mY NN e� a �I a f r r. ^ j ,� psi°a w 41-1" LIU aaNA qj a 1 ,u, nau u" < m;r luo, N SMUr y , cc ED f " Ul La ,urn m� 9iw ,w 1L LL J"a a i % �,. 41 tllOk � e w, K� uw 4 ol low m� �7 r gym' rc w I I u 1 n ,m m, ;pp a �r N° J e z�z� N 0 V �4 N p r »^ �� . a to LU UA .mod LU �w m a z z O �' 0 0 w w p _J 0 LDLLJ Q A w Z Z �— O p Q w N, Li— LL. p m LLl � Ll. III e _ ww .... W , LLJ Q 0 i re� Z a, _o 3 LU D Z7 o 0 '� w �� ., �_ 3 z is mv,,,,. A.a„o.Hf u«wv,...,n„ pr Him.,.. .,,,No ------ e I I t �,. ,• m., ..., _. r � t M' ,.H } o m o A Ir g e i �w a, 1 ryryry N y»` .e.,y„ ,� 8,' f,j ( 4,�� 0� �'� � MP_".. � � ^ LL. �� T-T 1,4 mJ I r, H - � 4 �on gim r � o , C11 a i i FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 33126 Date: 06 0 08 THIS CERTIFIES that the building DWELLING AND ACCESSORIES Location of Property 3375 INDIAN NECK LA PECONIC (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 098 Block 0001 Lot 001.003 Subdivision Filed leap No. Lot No. conforms substantially to the Requireatents for a ONE FAMILY DWELLING built prior to APRIL 9 1957 pursuant to which CERTIFICATE OF OCCUPANCY NU14BER Z- 33126 dated JUNE 30 2008 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 ONE FAMILY DWELLING AND FOUR ACCESSORYBUILDINGS.* The certificate is issued to PHILIP R MARCO (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPAR794KNT OF HEALTH APPROVAL NIA R[.SCTRICAL CERTIFICATE NO. N/A PIADME3tS CERTIFICATION DATED N� *PLEASE SEE ATTACHED INSPECTION REPORT. uthor ed Signature Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HC3 ST 1K Cl k I iiSP CIICtiN PE K LOCATION: 3375 INDI'AN NECK LEA PECCEXI _,___.,� SLLSDIVISIdi: LAP NO.: LOT (S) NAME OF 001WER (S): PHILIP R MARCO OCCUPANCY: SINGLE FAMILY PHILIP_R,MARCOmmmmm„_„_ AlwWrTED BY: ACCONPANTED BY: EEy AV3XjU3LZ; BUFF. 00. TAX MAP NO.: 98.-1-1.3 SOURCEOF RBT': CHARLES CUD1C . . ._..u..... ........ _, DATE: Ob 30 Off DWELLING• TYPE OF G 01STRUCTION: WOOD FRAME # STCRIBS: 2.0 # EEITS: 2 NATICNL: CEMENT BLOC& BRICK STONE CELLAR: 1 2 C WIL SPACE: 1 2 TOTAL, ROCNS: 1ST FLR_: 5 2C® PLR_: 3 3RD FLR.: 0 BATHROO"(S): 1.0 TOILET ROOK W: 0.0 UTILITY ROOM(s): PORC1 TYPE: DEC[ TYPE: PATIO TYPE: BRERZENNY: FIRNP . DClCESTIC TER: YES TYPE NEATER. PROPANE A III TYPE BEAT: OIL HARM AIR: X EPUTIU►ER- OTEIER: MUDROOM _. ACCESSORY STRUCTURES: C3REmE, TYPE OF CALST.: _ww STURAU 3, TYPE C(AlST.: 4 WOOD FRAME _,_MDINGS SWINKL:Nf4 POOL- GURS_+ TYPE VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DZSCRImm ALt .,..rc. SEC, ..__...w...,._..n....,..-. OUTSIDE 2 ACCESSORY BUILDINGS IN NEED OF REPAIR N REDUU C M N pa y� V 1 1CB: _ w ............ IIiSPECTRD BY: q, DATE OH INSPNCTIOB: 0Cx 1? OS GARY J TDQ; START: 10:15AM END: 110:45 d