HomeMy WebLinkAbout1000-116.-6-5 of so�� TOWN OF SOUTHOLD
Rental Permit
1492
Owner: Weild D III QPRT , Weild Drue QPRT
Occupied as: Single Family Dwelling
Located at: 10450 New Suffolk Ave Cutchogue 116.-6-5
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- nnual inspection.
Issued: 06/08/2026
Expiration: 06/07/2028 co En f ' cial
This Notice must be posted by the main entrance t all ti e
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town HA Annex 54175 Main Road P, 0, 13ok 1179 Southold,NY 11971.0959
Telephone(631) 765-1802 Fax(631) 765-9502
RENTAL PERMIJ APPI.19ATIO-N
Rental Permit Fee$300(Application must be renewed every two years)
51.101° L4
500
I I 24
Section A.
Property Information: 6 M AY 2 0 2026
Rental Property Addrets:
tm
Tax Map Number: 1000 SECTION �--BLOCK_ -LOT_ 5
SECTION B.
OWNER INFORMATION:
Property Owner Name:
...........
Property Owner Legal Address- Property Owner Mailing Address-.,
(Cannot be the same as Rental Property Address)
-Rk�—
V, 444 SmiApoy 'PL,Aer-,
Vz�
Telephone Number(s); DaytlmAOM-2 Evenin �m+ergeney
Property Owner Email Address,
A�Jaa mat 'eo
11 1
Page I of 4
Section C.
Authorized Agent Information;
Name of Authorized Agent of dwelling unit, if any;
Address of Authorized Agent(no p,O goxes),
Mailing Address of Authorized Agent:
Telephone Number(s): Daytimme
Evening, Emergency
Email Address:
Section 0.
Managing Agent Information:
Name of Authorized Agent of dwelling unit, if any: - 6L 6--
Address of Authorized Agent(no P.O. Boxes):
Mailing Address of Authorized Agent:
Telephone Number(s):Daytime
Evenin g---�Emergency
Email Address:
.SECTION E.
SITE MANAGER INFORMATION:(required for rental properties containing a 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); Raytimei 2„ "" Evenin
,_ "Emergeny
Email Address;
Page Z iPf 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 R 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 Dime n i n Vach room in Rental Dwelling Unit:
� 3
lip
lYllkr �x 22r� �/ �e
" XI
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 srental 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
bythe laws adopted by the New York State Fire Prevention and Building Code Council.
I am requesting afire safety inspection to be performed by a Code Enforcement Official
from the Town of$outhold
l 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 i � ---- certify under penalty of perdu,%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 M legal
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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: ,
Wveeo,�,, t 6d( o .�
Property Owner's Signature:
Sworn to before me this day of
CI 1clal Notary Public Signature and Qriginal Notary Stamp N AfFRE c�T . .
1 1Q rk of r"Yo
1uatilHd M c
Page 4 of 4
TOWN OF SOU'"THOL � BUILDING PT.
631-765-1802 (o �
I N E%C;`T O N
[ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING / STRAPPING [ ] FI L
[ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ RENTAL
REMARKS:
DATE (Jq - lNSPECTaR
7/ 17% ) 3
. ..� TOWN OF SOUTHOLD PROPERTY 6 W UAR
OWNER ' STREET VILLAGE DISTRICT SUB. LOT
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RESCSAS VL. FARM COMM. IND. CB, MISC. 3
LAND IMP. TOTAL DATE REMARKS
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NEW NORMAL BELOW ABOVE
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z--24912 Date MARCH 5, 1997
THIS CERTIFIES that the building ACCESSORY
Location of Property 10450 NEW SUFFOLK AVE. NEW SUFFOLR N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 116 Block 6 Lot 5
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 23, 1992 pursuant to which
Building Permit No. 21070-Z dated NOVEMBER 6 1992
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 RECONSTRUCT NON-HABITABLE ACCESSORY GARAGE AS APPLIED FOR.
The certificate is issued to DAVID & ELZZABETH WEI'LD
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-293959 - OCTOBER 28 1993
PLUMBERS CERTIFICATION DATED FEB. 28 1997- RFECTION PLUMB_ & HEATING
it ng Inspector
Rev. 1/81
10450 N.Suffolk 10450 New Suffolk Avenue Cutchogue NY 11935
Connie Liappas
Licensed Associate RE Broker
Compass
1468 Northern Blvd
Manhasset NY11030
a► Direct Phone:516-517-4751
Mobile Phone:516-319-3274
Email:connie.liappas@compass.com
http://www.Compass.com
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