HomeMy WebLinkAbout1000-136.-1-1 TOWN OF SOUTHOLD
Rental Permit
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1451
Owner: Vera Cusumano
Occupied as: Single Family Dwelling
Located at: 425 Briarwood Ln Cutchogue 136.-1-1
Maximum Permitted Occupancy: 6
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-annu spection.
Issued: 04/28/2026
Exp i ration: 04/28/2028 de rce ent Official
This Notice must be posted by the main entrant at tim
C � q
TOWIN OF SOUTHOLD—BUILDING DING DEPARTMENT
Town Hall Annex 54375 Main Road P. O° Box 1179 Southold, NY 11971-0 5 1re* I
Telephone (631)765-1802 Fax (631)765-9502 1p1_tta> " r r n. ; k c LcJj xo" . t)
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RENTI. PERMIT AP'PCIC4TIIN
Rental Permit Fee$300(Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address: l
IV
.Tax Map Number: 1000 SECTION , 36 -BLOCK _LOT t�
SECTION R.
OWNER INFORMATION:
Property Owner Name: 44-4'� U-;`v rulOL
p
Property Owner Legal Address: Property Owner Mailing Address:
I
(Cannot be the same as Rental Property Address)
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Telephone Number(s): Daytime ,I:.. `4< °_ Evening Emergency
Property Owner Email Address: M nib w G �Su r ��a✓ Q C'a G���.
Page 1 of 4
Section C.
Authorizes!Agent Information:
Name of Authorized Agent of dwelling unit,if any: M A t"
Address of Authorized Agent(no A.O. Boxes):? 'r e e,, 4- pok 814,m
Mailing Address of Authorized Agent:
Telephone plumber(s): Daytimes".tL_L .��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. Boxesy
Mailing Address of Authorized Agent,
4
Telephone Numiber(s); Daytime Evening Emergency
Email Address:
SECTION E.
SITE MANAGER INFORMATION:(required for rental properties containing 8 or more rental units)
i
Name of Managing Agent of dwelling unit,if any:
Address of Managing Agent(no P.O. Boxes):
Mailing Address.of Whaging Agent:
Telephone Number(s): Daytime Evening Emergency
i
Email Address:
l
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, 8, 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 U it
-�
Number of rooms in Rental Dwelling Unit:
Use and Dimensions of each room in Rental Dwelling Unit: L a r
uo 104 Al� „ � ro� 4 ' f0
1pt
SECTION G.
INSPECTION:
ECTI+ON:
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 MOST die the owner of the dwelling unit
STAVE OF NEW YO.RK)
}
COUNTY OF SUFFOLK)
l" LtAAjftA&Q ,certify under penalty of perjury,the following:
1, I 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. 1 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.
1 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., l 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: S.
Property Owner's 5lgnature:
Sw before is ay of 20�-�
' MAG:#HH
D
Notary Gubiic of Florida
�,&l Nota blic Sig ature and Orlg nal Notary Stamp Commissio453788' `" My Comrt.Exn 1,Z0?8
Page 4 of 4
o ow.
TOWN OF SOUTHOLD BUILDING DEPT.
631-765-1802 13(v. - I - I
I No S P E C T 10' ON`
[ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN ULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] INAL
[ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE RATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL ( AL)
[ ] CODE VIOLATION [ ] PRE C/O ] RENTAL
REMARKS:
V1 -_ — ( P
DATE I INSPECTOR
5
TOWN OF SOUTHOLD PROPERTY REOR AJ 1
OWNER STREET VILLAGE DIST. S-UB LOT
ok ' H c ;
FORMER OWNER N ACR - 0)>` ! =a
5 W TYPE OF BUILDING
F
RES. SEAS. VL. =A RN-1, COMM. CB. MISC. Mkt. Value
LAND IMP, TOTAL DATE REMARKS
AIA
o
E U1LDING CON TIO�
F =
NEW N RMAL BLOW ABOVE F_ -
x
FARM Acre, Value Per Value
Tillable 1
Tillable 2
Tillable 3
Woodland
Swampland FRONTAGE ON WATER •w -
Brushland < FRONTAGE ON ROAD
,
House Pie. . � DEPTH ae
BULKHEAD
Total DOCK
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COLOR �
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s
— —
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VU
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F
a -- — —
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s
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. 131
s g` (Foundation Both Dinette
Extension
Basement Floors K_
Extension
3
I r _ Ext. Walls (Interior Finish
.
Extefnsion -
;Fire Place
Heat }
DR.
717-777
i �- I .
_ { Type Roof Rooms 1st Floor BR,
Pay - - -- --
4 F Recreation Room Rooms 2nd Floor FIN. B
Perch = u
` Dormer
Breezeway -
Driveway
Garage - ----
Patio - - -
Total
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERICS OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No. ..Z..144,3........... Date ...................19Wtq.... V2............. i9.§A.
THIS CERTIFIES that the building located at ...xa.. TA,.!r.. "........... Street
Ott er « ' •5
MapNo. ....**&.......... Block No. ........***....... Lot No. ..........*,**.....................................................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
....................OatobeX.21....................... 19...0 pursuant to which Building Permit No. .......... !.45'19
dated .........pub, „E-..2Z...................... 19....6,y 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 ........
ONB.. 7il".I> TELLC ..... ................................................................................
ah
The certificate is issued to ..............................." .. ..,. .. .. anr..,....Ruddell e...owneare».,.,........
(owner, lessee or tenant)
of the aforesaid building.
................................................................... ...........
Building Inspector
FORM NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N° 1589 � Z .....21...... ,9...61
Date .........................ft�1
Permission is hereby granted to:
...................................
19/6....ftrbor...U-j. ............................ .........
.................. t
ata + ......................,................
to ....NuIld. sEl ditfO> .. .. ..e3[i8 i3ig..dxe�1# .....................................................
at premises located at . ..fl"rf""" --fhwbor--La=j"CIIteh09 &........................ .••.... w
pursuant to application dated ............................0&t*b ......21.........19.61.., and approved by the
Building Inspector
Fee $...S. flE�...........
Building*µlnspe ro
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold,N.Y.
Certificate Of Occupancy
No. Z1.3524. . . . . . . . . . Date . . . June 17 . . . . . . . . . . . . . . . . . . .. 105.
THIS CERTIFIES that the building . . . . . . Deck. . . . .. . . . . . . . . . . . . . I . . . . . . . . . , , , , „ „
Location of Property 425. j3.ri4t'woo0. Lane. . . . . . « .. . . . . . ..chogue
House No. Street Hamlet
County Tax Map No. 1000 Section .1 6. . . . . . . .Block . . . « I. . . . . . . . . .Lot . . . . . . . . . . . . . .. .
Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
. . . .3 e p.t. .9. . . . . . . . . . 19N.pursuant to which Building Permit No. 1 z 7.§0 Z. . . . . . . . . . . . . .
dated . . . . . . . . . . . .N ou. .?.I. . . . . . . . 1983. ,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 . . . . . . . . .
peek, VLddition to. an existing one family dwelling.
The certificate is issued to . . J O T C E, MONK. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(owner, )v
of the aforesaid building.
Suffolk County Department of Health Approval . . . . . . . N AA . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . .
N/A
UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Building Inspector
Rev.1/111
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z19283 Date AUGUST 9 1990
THIS CERTIFIES that the building ADDITION
Location of Property 435 BRIARWOOD LANE CUTCHOGUE
House No. Street Hamlet
County Tax Map No. 1000 Section 136 Block 01 Lot 01
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 26,t 1990 ------Pursuant to which
Building Permit No._18904Z darted MARCH 25 1990
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 MATTHEW & VERA CUSUMANO
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N A
PLUMBERS CERTIFICATION DATED N A
Z.B.A. APPEAL #3870 2L Lz�L "I'll,
c lding 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 Z19345 Date SEPT. 7 1990
THIS CERTIFIES that the building ADDTTION AND ALTERATION
Location of Property BRI W( CDDLANE CUTCHOGI
House No. Street Hamlet
County Tax Map No. 1000 Section 136 Block 0 . Lot 01
Subdivision Filed Map No. Lot No.�
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 30 1989 _____pursuant to which
Building Permit No. 18326Z dated JOLY 25, 989
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 ADDITION AND ALTERATIONS TO EXISTING ONE PARTLY DWELLING--
DECK DELETED
The certificate is issued to VERA AND MATTHEW CUS NO
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N132820 JMgZ 4 1990
PLUMBERS CERTIFICATION DATED HARDY PLUMING & HEATING JAN. 22 1990
Bu lding Inspector
Rev. 1/81
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CERTIFIED TO: 9
CENTERBAW MORTGAGE CORPORATIONVERA
ACOff URANCE COMPANY -»
TITLE NO. UN-00490
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