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Home My WebLink About1000-83.-1-30 of o TOWN OF SOUTHOLD Rental Permit 1479 Owner: Gregory Wood , Amanda Wood Occupied as: Single Family Dwelling Located at: 175 Birch Ln Cutchogue 81-1-30 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: 05/19/2026 Expiration: 05/18/2028 code rcement ciai This Notice must be posted by the main entrance at all times ' wIr* TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O.Box 1179 Southold,NY 11971-0959 d� Telephone(631) 765-1802 Fax(631) 765-9502 1ps://www.soLithg1L1towr '" o RENTAL PERMIT APPLICATION Rental Permit Fee$300(Application must be renewed every two years) 3 oo so loll 04 SC1312� Section A. Property Information: Rental Property Address: S' S Tax Map Number: 1000 SECTION 0 ,0 -BLOCK i7I Do OT 0--- ° " SECTION B. OWNER INFORMATION: Property Owner Name: o 1O o o Owd Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 1 S I�+"A I VA I- Telephone Number(s): Daytime f Y6 -Z 87' v'e'n ng Emergency Property Owner Email Address: k C f-o'JA c,1 b A-6[, ( o.n Page 1 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, 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: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: 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. IX 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 SUFFOLK) I �—Lyl e l �A w _ , 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: L14 Property Owner's Signature: Sworn to before me this leday of -k . 120 2(, fficial Notary Public Signature and Original Notary Stamp E IANNE CAROLINE FEDELE Public-State of New York NO.01FE0016050alified in Suffolk Countymissi on ExPO es Nov 1 1. 2027 Page 4 of 4 Of o TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 INsrECTION [ ] FOUNDATION 1 ST/ REBAR [ j ROUGH PLBG. [ ] FOUNDATION 2ND [ j INSULATION/CAULKING [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI AL) [ ] CODE VIOLATION [ ] PRE C/O [ ° RENTAL REMARKS: 4, czkoLi n o — % ot S 0 Co Gt� wev� 0 I S DATE INSPECTOR Town Hall Annex Town Of Southold 54375 Main Road Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 " k Tel: 631-765-1802 SUM # Date lea ` Owner Phone Address Visible Hamlet 111rispector Floor Level Quantities Sub 1 2 3 Smoke Detectors (not located in bedrooms) Carbon Monoxide Detectors Fire Extinguishers Exits Bedrooms 1 2 3 4 5 6 Smoke Detectors Egress Occupant Count 4,1 Building Systems Maintained &Operational Condition of Property Heating Building interior Hot water Building exterior Electrical Property clean, maintained &safe Mechanical lHandrails&guards installed &secure —4p, 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 �208" Co's for all items present r� + tit 'j''#�,��/,,,,,,; Comments: L4 Ea a TOWN OF SOUTHOLD PROPERTY' RECORD CARD OWNER A,,-o.-,ct 0 Vfcc STREET VILLAGE DIST. SUB. LOT � f ( 3 3 FORMER OWNER N E u' ACR. - S W TYPE OF WILDING RES ' SEAS. I VL. FARM COMM. CB, MISC- Mkt. Value LAND IMP, TOTAL DATE REMARKS I _ ,4 r - �`LAB`_1'✓N.. _ '� T AGE - tr :r BUIL ING CONDITION n ff ` � �L fL I ° � C?4V s NEW- FARM - Acre Value Per ` a40 1/1 i - Acre� Tillable 1 l — tx _ Tillable 2 Tillable 3 k 'fit f � Woodland £ • Swampland FRONTAGE ON WATER L Brushland 1 FRONTAGE ON ROAD House Plot DEPTH !BULKHEAD Total ( �DOCK ,I � 7 r i q _ I # COLOR 1 i,4 P F i,T E TRIM , - _ I E e 83.4-30 3/2014 _ f I s s M. Bldg £Foundation , ' Bath ; r Dinette Z i Extension ;Basement Floors IK� Extension EExt. Walls I n LR. - Interior Finish Extension Fire Place I I Heat DR I ;Type Roof E Rooms 1st Floor E Porch iRecreation Room Rooms 2nd Floor : FIN. B. Porch Dormer y v Driveway - I Garage ! pot id 0, B® f�t= i 6 `� 5Po t Total a � 1L _ FORM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.47.P? 7. . . . . . . Date . . , , . . . . . . . . Aug. 1 b . . . . . . . ., 197.7 . THIS CERTIFIES that the building located at Birch. lane. . . . . . . . . . . . . . . . Street Map NoBirch.hills Block No. . . . . . . . . . .Lot No, 1.5. . . . .Cutehogue. . . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . . . . Fab . . 28, 19.77. pursuant to which Building Permit No. 9069Z . dated . . . . . . . . . %lar.. . .7. . . . . .. 19. 77, 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 .f';rlvatre. .oxie. Xamily..dve11Ing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Aug. . . . . 1.977. - -bY.fit.-. -Villa . . . . . UNDERWRITERS CERTIFICATE No. .1934.1.17. . . . .?>IY. . 2.9. . . 19.77. . . . . . . . . . . . . HOUSE NUMBER . . . . . 1.75. . . . . Street . . . . . .Bir.ch.Lane. . . . . . . Cutchogue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Building Inspector FORM NO.a TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold,N.Y. Certificate Of Occupancy No. . Z9672. . . . . . . . . . Date . . . , September 12 . . . . . . . . . . . . .. 19 79 THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • • . Location of Property . . 17, .Birch Lane Cutchogue House No. Stneei Hsn+%t County Tax Map No. 1000 Section . . . . . 83 . . . .Block . . . . . . . . . . . . . .Lot . . . . . . . . . . . . . . Subdivision . Birch Hills . . . , . . , . ,Filed Map No. . .499R .Lot No. . . . . 15. . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated May, .P . . , , , . , „ . , , 19 .7.8 pursuant to which Building Permit No. . . . .9.72OZ. . . . . . . . . . . dated . . .May. .12. . . . . . . . . . . . . . . . . . 19 . 7A 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 to One Familyr Dwelling Everett J! ode The certificate is issued to . . . . . . . . . . » . . . . . . . . . . . . . . . . of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . N/.R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . .N,/R. . . . . . . b . . . . . . . . . . . .. . . . . . . � n . . . . .. . . . . . . . . . . . . . . . . . Building Inspector Rev VM FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20563 Date MARCH 4, 1992 THIS CERTIFIES that the building INGROUND SWIMMING POOL Location of Property 175 BIRCH LANE CUTCHOG'UE N.Y.. House No. Street Hamlet County Tax Map No. 1000 Section 83 Block 1 Lot 30 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 20 1987 pursuant to which Building Permit No. 15800-Z dated MARCH 28 1987 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 INGROUND SWIMMING POOL & FENCE ENCLOSURE AS APPLIED FOR. The certificate is issued to ROBERT & CAROLYN CONWAY (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N A UNDERWRITERS CERTIFICATE NO. N-805760 - APRIL 27 1987 PLUMBERS CERTIFICATION DATED N A Buil . ng Inspector Rev. 1 f 81 A' FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20562 Date MARCH 4 1992 THIS CERTIFIES that the building, ADDITION Location of Property 175 BIRCH LANE CUTCHOGUE N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 83 Block I Lot 30 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 13 1991 _pursuant to which Building Permit No. 20278-Z dated NOVEMBER 14 1991 was issued, and conforms to ali 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 & AROUND INGROUND SWIMMING POOL AS APPLIED FOR. The certificate is issued to ROBERT & CAROLYN CONWAY (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N A. UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N A B ding Inspector Rev. 1/81 � tltlt Town of Southold Annex 5/29/2013 P.O.Box 1179 54375 Main Road co ze c� a, Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 36263 Date: 5/29/2013 THIS CERTIFIES that the building DECK Location of Property: 175 Birch Ln,Cutchogue, SCTM#: 473889 Sec/Block/Lot: 83.4-30 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 3/11/2013 pursuant to which Building Permit No. 37883 dated 3/22/2013 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: 23'X 16'DECK ADDITION TO AN EXISTING DWELLING AS APPLIED FOR The certificate is issued to Costello,James&Costello,Nancy ...........................ww_.�w.___.w w____.www www_w......ww��..._..w..www..._..w_..._________.w..._.www.. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED `s ' r O f cn m BEDROOM BEDROOM 12'4" x 107" n 12'3" x 107" cn = j m CL CLOSET I I Sy1v HALL ° � „ 7 �R�J`'r114 x 8 0 A If E - 9'5" x Q'0" { n CLOSET PRIMARY BEDROOM -- -_- 11 11 x 185 BEDROOM 12'9" x 10'0" BATH 8'0" x 8'9" FLOOR 3 GROSS INTERNAL AREA FLOORS: 1033 SQ FT, FLOOR 2: 1087 SQFT, FLOOR 3: 990 SQFT EXCLUDED AREAS: GARAGE: 495 SQ FT TOTAL: 3110 SQ FT SIZE AND DIMENSIONS ARE APPROXIMATE, ACTUAL MAY VARY FR - I DINING ROOM 15'8"x 10'8" KITCHEN GARAGE N 17'10"x 11'11" /N oMx` 207"x 24'0" ` CLOSET BATH,- w 6 F x 5'9" - v x LIVING ROOM , 13'2" x 16'2" ► FAMILY ROOM 12'9" x 122" FOYER 7'0"x 15'9" N FLOOR 2 GROSS INTERNAL AREA FLOOR 1: 1033 SQ FT, FLOOR 2: 1087 SQFT, FLOOR 3: 990 SQFT EXCLUDED AREAS: GARAGE: 495 SQ FT TOTAL: 3110 SQ FT SIZE AND DIMENSIONS ARE APPROXIMATE, ACTUAL MAY VARY WIC}' UTILITY ROOM 20'2" x 107' ► < D MR, UTILITY ROOM 12'5" x 29'5" cn } RECREATION ROOM 17'6" x 15'5" Cu� } W D FLOOR 1 GROSS INTERNAL AREA FLOOR 1: 1033 SQ FT, FLOOR 2: 1087 SQFT, FLOOR 3: 990 SQFT EXCLUDED AREAS: GARAGE: 495 SQ FT TOTAL: 3110 SQ FT SIZE AND DIMENSIONS ARE APPROXIMATE, ACTUAL MAY VARY A p '-Z!i r- 0 m BEDROOM BEDROOM 12'4"x 107" 0 12'3"x 107" 0 M 1. CL CLOSET HALL 1 '4 x 8'0 " BATH V Z 9-5-x 8-0" PRIMARY BEDROOM ---------- 11"11 x 18'5" 71 BEDROOM 127 x 10'0" BATH ar y 8T f FLOOR 3 FIR DINING ROOM 15'8"x 10'8" Tab KITCHEN V, GARAGE UTILITY ROOM x 17'10" 111 ilk 207 x 107" 207"x 24'0" I ixi 2 < 1 1 1—N La CLOSETI BAT Z11 UTILITY ROOM xp 125"x 29'5" 07. 0 1 m H RECREATION ROOM 17'6"x 15'5" LIVING ROOM 0 0 RECREATION 1� 611XON S 7 65 13'2"x 167 FAMILY ROOM 12'9"x 127 FOYER 7'0"x 15'9" FLOOR I FLOOR 2 GROSS INTERNAL AREA FLOOR 1:1033 SQ FT,FLOOR 2:1087 SOFT,FLOOR 3:990 SOFT EXCLUDED AREAS:GARAGE:495 SQ FT TOTAL:3110 SQ FT SIZE AND DIMENSIONS ARE APPROXIMATE,ACTUAL MAY VARY d -,---Mur CU vk'M .. 0 .N P �"�. p � a I,! ary�P;sv1�L-( Rooh� rc� G I ° a9. '5� _ l Mta�w ac « �• 3_V-r TH11 oc,E � zxz,r s rt �, -C> ............ IT JR, ► ° w_ �.. M1474 uM1',"[KA'JWYaAa'.^4q+A4K.k. °,. kk°�rgz�,�;Fat v�K � � ",MHO q'�iKUM�AI PIMtlGka a r..mn, "d p r! _.- - Kin c .+.'wpnS"w�awza, a"�w�x�.�,tmre�,��awa. 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