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Home My WebLink About1000-59.-5-24 TOWN OF SOUTHOLD Rental Permit 1487 Owner: Hyewan Lauryn Chun & Norman Parsins Roberts Occupied as: Single Family Dwelling Located at: 65 Lake Dr Southold 59.-5-24 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: 05/28/2026 Expiration: 05/27/2028 rcer+ent vial This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD—BUILDING DEPARTMENT � Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax(631) 765-9502 littps//w%AAx�v,,sotitlio dtoNvtrll v AFT RENTAL PERMIT APPLICATION Rental Permit Fee $300(Application must be renewed every two years) 112'C) 2.3 Section A. l „S» " - WLt 04a Property Information: + �60 00-11, Rental Property Address:, ww Tax Map Number: 1000 SECTION 0 00 -BLOCK C) _0Q SECTION B. OWNER INFORMATION: Property Owner Name: l Vww�l lr Vim►' Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) �; - .," r : Da time` n- Iqo-51venin �0e- Em3 f o Telephone Number(s) y qq �j y Property Owner Email Address: wh-ih� "I �" I ` �, �n robe v I5 2-kVA V►u ►�a;� , (�,,�- 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: g Number of rooms in Rental Dwelling Unit: , Use and Dimensions of each room in Rental Dwelling Unit: .f � � "� I -� r f2m,-k : 2-'-2-"x I I r 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 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 C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent (no P.O. Boxes): \ p 1 Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening Emergency Email Address:-912 Section D. -Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: r 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: Il & Page 2 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 �a4rV4 �-�✓ 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. 11 Property Owner's Name: ► ��(iW� Property Owner's Signature: Sworn to before me this(�ay ofAa--rd 2046 0 i �� Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.01 SU6185050 O:ualifled in Suffolk County a Page 4 of 4 commission Expires April 14,2 g �pr err p " 04 Town Hall Annex ^✓ + ` Telephone(631)765-1802 54375 Main Road � P. O. Box 1179 ° a Southold, NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: 1 s0&1 TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 I IN' !500' P Fm T 10 N [ ] 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 REMARKS: /h A&PS DATE ` a •..26 INSPECTOR _ ...._,_ 1 �� F Town Hall Annex K w Town Of Southold 54375 Main Road cz Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 SCTM# — - Date a Owner on— G?O ,Q Phone Address DA Visible Hamlet Inspector 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 ,a l Building Systems Maintained &Operational Condition of Property Heating Building interior Hot water Building exterior Electrical Property clean, maintained &safe MechanicalI Handrails&guards installed &secure 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 CO's for all items present Comments: TOWN OF SOUTHOLD PROPERTY RECORD jo 17 _J OWNER !STREET VILLAGE DIST.i SUB. LOT FORMER OWNER N E ACR. S W TYPE OF BUILDING FARM RES. SEAS- VL. comm. CB. MICS.Z Mkt. Value LAND IMP. TOTAL DATE REMARKS 4N L 4 AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre i Value Per Value Acre Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meodowl,ond IDEPTH House Plot BULKHEAD Total DOCK i - COLOR r` TRIM VP o i i a 1 I € i E i 3 F S t F . . _ I 4 i � 1 i . , I • M. Bldg. 5 Ilxte s Extension ( • E Extension i ;Foundation IBGth Dinette Porch Basement n/ .Floors K. Porch = ' :Ext. Walls �• --Interior Finish - 'LR. I • z Breezeway Fire Place v -s Heat r DR. Type G I oms Floor Roof I Ro l st s I 13 E i ti Recreation Room ?Rooms 2nd Floor ? FIN. B - ;i ,ate i O. B. — !Dormer Driveway _ Totals 3 l s i _ I FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy NoP104. , . , , . . Date . . . , , , . . . . My. . . .26. . . . . . . .. 19.72. THIS CERTIFIES that the building located at .1~ .Road•& Lak*. DJP. . . Street Map No. . .=. . . . . . . . Block No. 3=. . . . . .Lot No. .z= . . .80*t)Wld; . . .p.r-0. . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated >�[ . .Q 19'J1. . p g . . . . . . . , . . . . . . .. pursuant to which Building Permit No. . . . . dated . . , . . . . . . . .°.. . . 10. . ., 19 1 ., 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 . .PrITAtA.400 . ly. dx*114ag . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . a . . . The certificate is issued to . . 041.Atlpo lte. . . . . . Ar . . . . . . . . . • . . . . • . • . . , • . . . • . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval fty .19. .tg72. . .by•R Tilli UNDERWRITERS CERTIFICATE No. . J1111+4 . . . . . . . . . . . . . • • . . • . . . . • • . . . . . . . . . . HOUSE NUMBER. 340g. . . . . . .Street. . y. Rd. . . . . . . . . . . . . . . . . . . . „ . . a . . . . . . . . . . . . bS Lake d; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Building Inspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy NoSM11 . . . . . . . Date . . . . . . . . . . . .Oct. . .24. . . . . . . , 19.72. THIS CERTIFIES that the building located at .Lake .Dr. ,d.$eey. AA. . . . Street Map No.=. . . . . . . . . . Block No. . . .XX. . . . .Lot No. .7004 . . .8eitkold 11.10. . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . .OQt . . . . .4 5. ., 19—72 pursuant to which Building Permit No. 61 63Z . . dated . . . . . « . . . . Oct. . .7. . . . ., 19.72., 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 .private. e•family dwe 11 . . . . . . . . . . . . . . . « . . . . . . . . . . . . . . . . . . The certificate is issued to . . . .galvadore -&-kTaidm MDoS .mow . . . . . . . • . . . . . . . . . « (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . . . X As . . « . . . . « . . . . . . . . . . « . . . . . . UNDERWRITERS CERTIFICATE No. BwRa• . • . . . . • • • • • • . . . . , . . « . . . . . • . . • . . . . . . . . • .. . . . . HOUSE NUMBER. . . . 65. . . . . .Street. . . . .Lake .Dri.. . . . . . . . . . . . . . . . . . « . . . . . . . . . . ftf . . . . . . . . . . . . . !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . mod. . . . . . Building Inspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z .5337. . . . . Date . . . . . . . . . . . . May. . . . .$. . . . . .. 19. 73 THIS CERTIFIES that the building located at . Ad• & .Lake- .Dr. . . . . Street Map No. . 7=. . . . . . . Block No. .XX . . . . .Lot No. "a. . AQUthQ14. . .J! . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . .. . 2 . . . . . . .. 1973. . pursuant to which Building Permit No.6329Z. • . dated . . . . . . . . . . . . . jim. . . It ., 1973. ., 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 .Privata Ave-Uing with detached .acesssory.build . . . . . . . . . . . . The certificate is issued to •Salvador A-Araida• • •Desposyto. • . Owners• . . . . • . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval A *Ro . . . . . . . . . . . . • . . . . . . . . UNDERWRITERS CERTIFICATE No. . . N,R.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . - . . . . . HOUSE NUMBER. . 31F0,5. . . . . .Street. . . . Kenny. Road. . . . . . . . . . . . . . . . . . . . . . . Dr 65. . . . . . . . . . . . . .Lake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , rue Building Inspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23625 Date MAY ill 1995 THIS CERTIFIES that the building ADDITION Location of Property 65 LAEB DR. A 3405 RENNYS RD. SOUTBOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 59 Block 5 Lot 24 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 25 1994 _pursuant to which Building Permit No. 22331-Z dated SEPTEMBER 15 1994 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 SECOND STORY ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to MARIO DiSANTO (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-344973 - MARCH 8 1995 PLUMBERS CERTIFICATION DATED APRIL 13 1995-FRANK GIANCONTIERI Building a :tor Rev. 1/S1 4 s ao i= Bad i Dining Area Bedroom( ! 12'2"x 11'3" 9'9"x 113 97"x 11'3' Kitchen Iili w `� 7'10"x 11'3" I is 6'8" x 11'3" E Hall 9'4n x 6'9.1 f I i �. Living Room / I Bedroom to 17'8" x 11'8" Bedroom(f) Bedroom 9'0"x 11'4" Z2T - i 12'1"x 11'4" 8'4"x 11'4" ' —Bedroom--- .f I ' 8-11" X 719" it Balcony Floor 1 21'i" x 10'11" I Porch 17'6"x 12'5" Floor 2 I i TOTAL: 1366 sq.ft FLOOR 1: 890 sq. ft,FLOOR 2:476 sq.ft EXCLUDED AREAS: PORCH: 225 sq.ft,FIREPLACE: 10 sq.ft,BALCONY: 155 sq.ft gtAt �.� INC -AU I Floor Wan Created By Cubltaea App.Measurements Deemed Hlphly Reliable But Not Guaranteed. o a a e a n WE . _. 7 a s f E.JS.I S"-Y I I.L Ca � ...say .€vts _i"I r�,�'( F�-• —° 1hal sm ";;OF_ Ins 0.]; 3( - - E 1 w f 7% J / / f6 d I p i �IU i um Jill , M NY I IF JA r �r�j��j ��, �%, ��,,,u,,i a „✓ i�';,,,,,,,,. �I��' Liar/i rrr,�f ii � i mid �U ry^ / vvvvv�� uuu11V V�V��80001 �db4 i��i��y�i p f vvvvvvvv iuuuuVVuuu uuuuuuuuu�u 'yyyu �"��dW��ll� ��/%//i , If Mill iKWfDhhFG'FUUn6'NOU,4�ftYKK4nDl >� VJ r a/i�rimii 1 I"✓l"r�1�'Jl n��U t J�Ijorr it r i�r�cP ��lnlyl��rf�iu