The URL can be used to link to this page

Home My WebLink About1000-64.-1-11.1 of so TOWN OF SOUTHOLD Rental Permit 1494 Owner: Town Creek 5 LLC Occupied as: Single Family Dwelling Located at: 195 Town Creek Ln Southold 64.-1-11.1 Maximum Permitted Occupancy: 10 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: 06/09/2026 Expiration: 06/08/2028 Co"forcemeqy6dall This Notice must be posted by the main entrance at all times P TO WN OF SOUTHOLD—BUILDING DEPARTMENT f 111��1404 Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax(631) 765-9502 IL(tpg.//WNYW,,,�oLit qLcltowlltly.&)ON� RENTAL PERMIT APPLICATION Rental Permit Fee $300(Applicotion must be renewed every tWo yeats) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION -BLOCK -LOT SECTION B. OWNER INFORMATION: C Property Owner Name: n CT-.e_ek - LL Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 0- L sacce— (G7 Telephone Number (s): Daytime Evening_ Emergency_,,, 1310-90M Property Owner Email Address: c m ea rn s 13 Omni 6 cv) c Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: ,n L� e Address of Authorized Agent (no P.O. Boxes): w ' Mailing Address of Authorized Agent: Telephone Number (s): Daytime y Evening Emergency Email Address: ► eI l It'17— 0 Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorised Agent (no P.O. Boxes): Mailing Address/of Authorized Agent: Telephone N ber (s): Daytime Evening Emergency Email Address: SECTION E. SITE MANAGER FORMATION: (required for rental properties containing 8 or more rental units) Name of Mana ing Agent of dwelling unit, if any: Address of anaging 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: ' I f �1►�+ Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: 4 e ms io r� G1� Use and Dimensions of each room in Rental Dwelling Unit: ' G 10 U C s x 1 i ?� 5 . Bokk--, 2, Spy SECTION G. i� 3"X 5 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) p 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 paws 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. c Property Owner's Name: r Property Owner's Signature:. Sworn to before me this day of , 20Lr)6 Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.01BU6185050 Qualified In Suffolk County `` Page 4 of 4 Commission Expires April 14,2�C � Town Hall Annex ��' � �,`, Telephone (631) 765-1802 54375 Main Road ; P. O. Box 1179 w can Southold, NY 11971-0959 rvw� BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: S Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: ivyPoo rn l , 15 X gti r 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: TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 (� f /—//•/ `0 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 (FINA [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: � . � ng oaf co DATE INSPECTOR �µ Town Hall Annex Town of Southold 54375 Main Road Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 µ. Tel: 631-765-1802 SCTM # -- Date ��•aSo Owner Phone Address ,q5 -7- rl (�Q �. Visible Hamlet J 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 Building Systems Maintained &Operational Condition of Property Heating Building interior Hot water Building exterior Electrical Property dean, maintained &safe Mechanical 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: b e a e v z a t >' - z _ e e , - d _ \ \ \\\ \\ \ \ \ z a v\yy \ y.y��yyyvy v y v v y. vv \ , �. y yA vAyv AV\\�A\\\VAy vA A� \v �.vA y� a \ \ gn \ \\\ Zk� IC \ \ o z s \\ 1 9/MiN OWNERS STREET VILLAGE DIST k SUB. LOT FORMER OWNER � N E n ACR S W It TYPE OF BUILDING RES`J/ � t SEAS, € VL. FARM COMM. CB. MICS. Mkt. Value i I � LAND IMP. TOTAL DATE REMARKS 1-7 a _ n _ r olC46 '. . s _ AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value C / Acre Tillable ! FRONTAGE ON WATER - .? Woodland FRONTAGE ON ROAD y, t Meadowland DEPTH House Plot BULKHEAD i Total �, DOCK i L R COI OTRIM x I - # € I s t = 1 € . € € t E € •fig � -_ a t- _-4 - = I 3 ;I - x z z - � z E z i i # M. Bld 9 # ? F ? 3 Extern rs -71 l2 I t t 3 Extension I _ i ; # Extension I ;Foundation Bath Dinette # Porch e ;1 _ _ _ — �36asement F [Floors 1 K. -- � �� ' fo 7 4 . 7� FExt. Walls Interior Finish LR. Breezeway Fire Place _ Heat DR. I 4 Oarae` - ' Typ-01 e Roof :Rooms 1st Floor BR. I =Recreation Room 'Rooms 2nd Floor FIN. B O. B. n ° Dormer 1 Driveway I"�JOL ' z1U5� 7x � Z = 0 17"r��-1` �� I Y Total j 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-18550 Date NOVEMBER 9 1989 THIS CERTIFIES that the building_ ONE FAMILY DWELLING Location of Property 195 TOWN CREEK LANE SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 64 Block 01 Lot 11.1 ** Subdivision Filed Map No. Lot No. conforms substantially to the requirements for a private one family dwelling built prior to: APRIL 9, 1957 pursuant to which CERTIFICATE OF OCC. #Z-18550 dated NOVF14BER 9 1989 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 The certificate is issued to CARL V. NISSEN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NO RECORD PRE EXISTING UNDERWRITERS CERTIFICATE NO. NO RECORD PRE EXISTING PLUMBERS CERTIFICATION DATED NO RECORD PRE EXISTING *SEE ATTACHED INSPECTION REPORT. ** WITH RIGHT-OF-WAY OVER PROPERTY. uilding Inspector Rev. 1/81 s BUILDII:G DEPARTZ-TE"iT T0.lid OF SOUTHOLD, N. Y. HOUSIIdG CODE INSPECTION REPORT Location 195 Town Creek Lane Southold N.Y* (numoer & street) kfiun.LcipalitiYl Subdivision clap No. Lot(s) Name of Owner(s) CARL V. NISSEN OWNER occupancy R-40 OW (type) t owner-tenan Admitted by: CHARLES NISSEN Accompanied by: CHARLES NISSEN Key available Suffolk Co. Tax No.64-01-11 . 1 WITH-_R.O.W. OVER PROPERTY. Source of request JOSEPH GIBBONS Date OPT. 30, 1989 D',IELLIPiG: Type of construction WOOD FRAME rstories 2 Foundation CEMENT BLOCK Cellar FULL Crawl space Total rooms, lst. F1_ 4 2nd. Fl 3 3rd. Fl Bathroom(s) 2 Toilet room(s) 1/2 Porch, type SCREEN PORCH Deck, type Patio, type Breezeway Garage 2 CAR Utility room Type Heat OIL 'Warm Air Hotwater XX Fireplace(s)ONE IN LIV'INCNO. E:cits 2 Airconditioning mom Domestic hotwater OFF THE BOILER Type heaver Other ACCESSORY STRUCTURES: NONE Garage, type const. Storage, type const. Swizrmming pool Guest, type const. Other VIOLATIONS: CHAPTER 45—N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE Lnca"tion Descrivtion Art. Sec. EXTERIOR Exterior surfaces shall be maintained in good CHAPt,1 F condition. Surfaces not inherently resistant to 1242.5E'� deterioration shall be treated with a protective coating of paint, or other suitable preservative. INTERIOR Buz, angs an --rwi tures s a be maintaine re of insect vermin and rodent harborage and 712421. —� infestation. Remarks Inspected by: Date of Insp.NOV. 3, 1989 GA FISH .Time start 14J:.3p end 11:00 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20231 Date SEPTEMBER 20 1991 THIS CERTIFIES that the building ALTERATION REPAIR & ADDITION Location of Property 195 TOWN CREEK LANE SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 64 Block 1 Lot 11.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 20 1991 pursuant to which Building Permit No. 19729-Z dated MARCH 25 1991 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 REPAIRS ALTERATIONS & DORMER ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR.. The certificate is issued to RITA CURRY (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NG. N-197536 - JULY 25r 1991 PLUMBERS CERTIFICATION DATED VA uil ing Inspector Rev. 1/81 l r1 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20232 Date SEPTEMBER 20 1991 THIS CERTIFIES that the building INGROUND SING POOL Location of Property 195 TOWN CREEK LANE SOUTHOLDg N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 64 Block 1 Lot 11.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 18 1991 ___,pursuant to which Building Permit No. 19746-Z dated MARCH 28 1991 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 DECK SHED & FENCE AS APPLIED FOR. The certificate is issued to RITA CURRY (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N A UNDERWRITERS CERTIFICATE NO. N-196404 - JULY-164 1991 PLUMBERS CERTIFICATION DATED N A Wilding 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: Z-34616 Date: 10/19/10 THIS CERTIFIES that the building ADDITIONS ALTERATIONS Location of Property: 195 SOUTHOLD" TOWN CREEKw LAw (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No_ 473889 Section 64 Block 1 Lot 11.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 16, 2009 pursuant to which Building Permit No. 35160-Z dated NOVEMBER 16 _ 2009 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 FLOOR ADDITIONIALTERATION AND COVERED WRAP AROUND PORCH ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to CONSTANCE BARES (OWNER) of the aforesaid building, SUFFOLK COUNTY DEPARTMENT OF WRAITH APPROVAL N/A ELECTRICAL CERTIFICATE NO_ 11834 11/30 09 PLUMBERS CERTIFICATION DATED OS/03 10 MICHAEL LIEGEY m uthor. d Signature Rev. 1/81 reel I IIII II � f r f � J