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Home My WebLink About1000-26.-1-13 of so TOWN OF SOUTHOLD Rental Permit CIO . � 1457 Owner: Scofield Frederic C Jr Tr Occupied as: Single Family Dwelling Located at: 2355 Village Ln Orient 26.4-13 Maximum Permitted Occupancy: 3 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: 05/06/2026 Q WL Expiration: 05/05/2028 C#e fo ent official This Notice must be posted by the main entranc at a time r� TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, -119�71--0959 , . Telephone (631) 765-1802 Fax(631) 765-9502 htt; s://WWW.soLitholcli riiiy.v RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) H I1, 1x Section A. Property Information: Rental Property Address: 3 s \✓ III _ 4M YJ 119 57 Tax Map Number: 1000 SECTION -BLOCK d -LOT_ -_ Y SECTION B. OWNER INFORMATION:�— Property Owner Name: l— s Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) // 3 a jr Sd,4- y4-a1NK L // © T 'K X/v2- G3-e 2- � /- Telephone Number (s): Daytime Evening 1 ?of Emergency d//o Property Owner Email Address: i� < Srl/Fi�l �T�rt il/.cT 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): 0./ 61' t #1% 'e 1-4✓i- .7 ,. Mailing Address of Authorized Agent: Ro O Telephone Number (s): Daytime 4776— C "°Vilning Emergency `� �JJ t J-- Email Address: /d s e rc �� /v ,,a,� 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: 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: r LevLlI 5F F r cl IE " -7 F SECTION G. t` C INSPECTION: Le,,r-�i 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 i .�by,;thIe,laws.adopte,d-by the New York State Fire Prevention and Building Code Council. 'Pr-11`arrf re 0estin afire safety inspection to be performed by a Code Enforcement Official � g Y p from the Town of Southold �1'f h e e e s sca-•D) ❑ 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) 5c,�i��rtify under penalty of perjury, the following: lti'L y f TGE' 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 247 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 W NOTARY SW of ft AJ LMOIN Off' i„gal Notary P lic Si ature ltsriginal Notary Stamp my cwm.E`'" 19, Page 4 of 4 �'�� ► 0 T OF UTHOL-D BUILDING DEPT. � 631-765-1802 -y(Q INSPECTlu [ ] FOUNDATION 1ST / REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS LATION/CAULKING [ ] FRAMING / STRAPPING [ ] NAL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PEN TRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F AL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: (rD DATE INSPECTOR - TOWN OF SOUTHOLD PROPERTY RECORD Ak y, L STREET VILLAGE DIST,� SUB. LOT OWNER F"I fjr FORMER OWNER N E AIR/ VA 'e w TYPE OF BUILDING \..........x t I 'COMA& CB. MISC. Mkt. Value FARM RErx SEAS, VL. LAND Imp- TOTAL DATIE REMARKS A� -z- n6d -Y, i 2 21) 0 &q 2 v A at AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE - - — —------- MW7 Acre Value Per Value Acre Tillable I Tillable 2 - - Tillable - ------ Tillable 3 Swampland FRONTAGE ON WATER FRONTAGE ON ROAD 0 Brushlond House Ptot =DEPTH iBULKHEAD a u � ; i Sao ' NA ell 1 26.4-13 11/15/2022 >......... V_ "t a P a — — f M, DIdg. Vc.in d Cl 7 �'ntn L�ineYfct� E csernent Ff �r� Extension � � � l fve E.�#er�si�n !nt€ri�r f my_-1 _ _ L F' PIa•-� Heat L Fite Eytc rns ion t j t ` — I k vr�e _'�i t ns t ut - 17 - - Fr.re� i cl., 1, 1 h Porch Breezeway Garcge E a C_ B_ Toto! of$0�r.�� Town of Southold P.O. Box 1179 53095 Main Rd *�r Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 46936 Date: 03/27/2026 THIS CERTIFIES that the building DEMOLITION Location of Property: 2355 Village Ln Orient NY 11957 SecBlock/Lot: 26.-1-13 Conforms substantially to the Application for Building Permit heretofore,filed in this office dated: 04/07/2021 Pursuant to which Building Permit No. 48396 and dated: 10/13/2022 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: Additions and alterations to an existing single-family dwelling as applied for with ZBA #7588 dated 3/17/2022. The certificate is issued to: Scofield Frederic C Jr Tr Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: R-21-0843 12/31/2025 ELECTRICAL CERTIFICATE: 48396 2/15/2024 & 6/24/2025 PLUMBERS CERTIFICATION: James Hannon 10/2 /2025 Al utho ' e Si attire