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Home My WebLink About1000-138.-1-4 of solut TOWN OF SOUTHOLD Rental Permit 1507 Owner: Shaper AC Revoc Trt Occupied as: Single Family Dwelling Located at: 1020 Monsell Ln Cutchogue 13 8.-1-4 Maximum Permitted Occupancy: 6 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: 07/01/2026 1--- X/I�z Expiration: 06/30/2028 CodiEnfo4iVentOffid4V This Notice must be posted by the main entrance at all times I 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)ettp5 .°;, ry >attli< 1r1e RENTAL PERMIT APPLICATION i Rental Permit Fee $300 (Application must be renewed every t r earn Pa Section A. Property Information: Rental Property Address; VM Tax Map Number: 1000 SECTION BLOCK ._µLOT. SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) r S29b Telephone Number (s): Daytime..._. Evening Emergency _._- .. ._._ Property Owner Email Address: Page 1 of 4 Section C. Authorized Agent Information: A Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent no P.O. Boxes): Mailing Address of Authorized Agent:� µ Telephone Number (s): Daytime )(.0 E e in � Emergency__..__ Email Address: v 1-(' —1T �. C,�� .. : 'Err..JC-.1 r-lKr-) . 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: � �cSYtS2l� Requested Maximum number of persons allowed to occu— welling Unit: Number of rooms in Rental Dwelling Unit: —T ?a V 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. 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) I ,� 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: fie �` Property Owner's Signature: Sworn to before me this 5 day of Ine 20T?� Official Notary Public Signature and Original Notary Stamp DARLENE K BRUSH Notary Public-State of New York NO.01BR6318051 Qualified in Suffolk County My Commission Expires Jai 20,20�V Page 4 of 4 01z," kiff Town Hall Annex �' Telephone(631)765-1802 � � � �*µ 54375 Main Road ' P. O. Box 1179 Southold, NY 11971-0959 W ��;��„� BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: 11w. Lk Requested maximum number of persons allowed to occqjy &ach dwelling unit: _ Number of Rooms in Rental Dwelling Unit: „ Use and Dime sion of each� room. 1 � r �� - � ..moo 4 o — tic 4 0 t 71 l!-A�� Rental Dwelling Unit Identifier: � � t7K 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: Telephone(631)765-1802 Town Hall Annex 54375 Main Road k Fax(631)765-9502 P. O. Box 1179 C4 At Southold, NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a licensed architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Professional seal re uired for Architect or Engineer, Licensed Horne Inspector,dust wide copy of valid current certification Rental Property SCTM Number: Rental Property Address: Owner/Name: "'r �— Rental Dwelling Unit Identifier: 14 CXL Number& Square footage of each bedroom as depicted in the a shed floor plan: (i.e. Bedroom#1 — 100 sgft., Bedroom#2—90 sgft., etc.) Property Description (Include all improvements indicated on survey) I certify that I have done a physical inspection of the subject rentai dwelling unit and find that it fully complies with all the provisions of the Code of the Town of Southold, the Residential Code of New York State, the Building Code of New York State, the Plumbing Code of New York State, the Fuel Gas Code of New York State,the Fire Code of New York State,the Property Maintenance Code of New York State and the Energy Conservation Construction Code of New York State. Print Name and Title Original Signature Please place Professional Seal: r4f so TOWN OF SOUTHOLD BUILDING DEPT. u 631-765-1802 llmtirECTION [ ] FOUNDATION 1ST/ 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 [ ENTAL REMARKS: �57`ti a h�seirc � O�w � �2sU� DATE INSPECTOR Town Hall Annex Town Of Southold 54375 Main Road Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 0 SCTM # Date Owners Phone Address f , 0`17-sell Visible Hamlet n� G✓ Inspector Floor Level Quantities Sub 1 2 3 Smoke Detectors (not located in bedrooms) / P Carbon Monoxide Detectors f Fire Extinguishers Exits Bedrooms 1 2Z 1 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 clean, 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: 7777 TOWN OF SOUTHOLD KOPEk 11 )4-tfpq- D CARD STRE ET VILLAGE L�G DIST��S�UB LOT� ✓ EET RICT ;7' 2 71,1 L/ 4r FORMER OWNER N E ACREAGE is W TYPE OF BUILDING fJ-1; Qi RES. SEAS. VL. FARM comm. IND. CB. misc. Est. Mkt. Value f LAND IMP. TOTAL DATE REMARKS C) C) FRONTAGE ON WATER -------Acre- Vqlyp)Per Acre Value FRONTAGE ON ROAD SL Tillable BULKHEAD Tillable 2 1 DOCK Tillable 3 Woodland Swampland Brushland House Plot I e, �, Tj�:.• f7//C� �r�/tip � "� �� f e__ i N r is Ll p s 138-14 02/02 .SniPvae , M. Bldg. �� - `4 Foundation Bath Extension o o y Basement Floors fG �Ifo = Z5[.� Exfertsio f3 Z �0 3z � Ext. Walls �Vilt�i� Interior Finish s/fQ f ten ` n �y� c ;= {� Fire Place Heat Porch Roof Type a=o spa, � Porch= Rooms 1st Floor Breezeway i Patio Rooms 2nd Floor E u Driveway ? Dormer 1 €3 FORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27902 Date: O8 3'0 01 THIS CERTIFIES that the building NEW DWELLING Location of Property: 1020 MONSELL LA CUTCHOGU_E__ (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 138 Block 1 Lot 4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 2 2000 pursuant to which Building Permit No. 26494-Z dated MAY 11�, 2000 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 WITH COVERED FRONT PORCH AND ATTACHED TWO CAR GARAGE UNDER AS APPLIED FOR.. The certificate is issued to GEORGE T SCHNEIDER (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-99-0260 OB 23 1 ELECTRICAL CERTIFICATE NO. H 072581 kqL27 01. PLUMBERS CERTIFICATION DATED 08 20 01 TIMOTHY HORTON c ut. rized Zignature Rev. 1/81 �- f t 71 77777 a �4 092A7 S S. AS . �S � ILY Ai xa Woe _ e e t _ — NO Jk cz- _ e . _ 77 —_._ a F a i NN PI TI cz ,. ram tauu ev � _ij i 7 4f- € 4 `t7 4 . , e a r yea ` yr g an 41 � a ; I s s U 3 t 1 � I BREAKFAST NOOK E 8'2'Ax 8�2�� ' � I't I = T7"x 12'6" KITCHEN. I BEDROOM I 13'0'x 12'6" � 10'4"x 107' # HALL F 8'6"x4'1" =ss DINING AREA 193"x 97' �€ BEDROOM [ a �I; 14'1"x 127' FOYER T5"x 7'6" �I ' s LIVING ROOM 14'11"x 19'4" :13 TOTAL:2160 sq.ft 1 st floor: 200 sq.ft, 2nd floor: 1223 sq.ft, 3rd floor:737 sq.ft EXCLUDED AREAS: UTILITY: 250 sq.ft, GARAGE:430 sq. ft, BASEMENT:265 sq.ft, FIREPLACE: 8 sq.ft, LOW CEILING: 115 sq.ft,WALLS:241 sq.ft BATH 6'0" x 6' ' PRIMARY BATH PRIMARY BEDROOM _ ,� 87 x114 24'6" x 137' HALL 3'1" x 5'4" BATH 7'8" x 153' ► W.I.C. LAUNDRY 193' x 7'11 " 817" x 813" TOTAL:2160 sq.ft 1 st floor: 200 sq.ft, 2nd floor: 1223 sq,ft, 3rd floor:737 sq.ft EXCLUDED AREAS: UTILITY: 250 sq.ft, GARAGE:430 sq.ft, BASEMENT:265 sq.ft, FIREPLACE: 8 sq.ft, LOW CEILING: 115 sq.ft,WALLS:241 sq.ft l IE ill BASEMENTl 20'1"x 13'2" GARAGE 19'1"x 23'2" $_ l I„ ROOM ' 1 ' 20'1"x 9'6" UTILITY 14'11"x 170" =11 TOTAL:2160 sq,ft 1 st floor:200 sq.ft, 2nd floor: 1223 sq.ft, 3rd floor:737 sq.ft EXCLUDED AREAS: UTILITY: 250 sq.ft, GARAGE:430 sq.ft, BASEMENT:265 sq.ft, FIREPLACE: 8 sq.ft, LOW CEILING: 115 sq.ft,WALLS:241 sq.ft t / %,n r II II it �/,fir fl�h V I ,