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Home My WebLink About1000-6.-7-16.1 TOWN OF SOUTHOLD Rental Permit 1518 Owner: Mill Race Farm LLC Occupied as: Single Family Dwelling Located at: 1959 Crescent Ave Fishers Island 6.-7-16.1 Maximum Permitted Occupancy: 4 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: 07/15/2026 Expiration: 07/14/2028 Cody rnfiorcement 4ceiai This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD—BUILDING DEPARTMENT 0i Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax(631) 765-9502 htt)s://www.soutlholdtownnn .gov RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) 6-1 Pd � rep. l c asy b Section A. Property Information: ' r1` Rental Property Address: 1959 Crescent Avenue Fishers Island, NY 06390 W "N Tax Map Number: 1000 SECTION 006.00 -BLOCK 07.00 16.01 - ' lown SECTION B. OWNER INFORMATION: Property Owner Name: Mill Race Farm, LLC Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 728 Ashbury Street, San Francisco, CA 94117 728 Ashbury Street San Francisco, CA 9411.7 Telephone Number (s): Daytim (443) 847-1783Evenin ' 3 847-1786mergency (410) 916-9651 Property Owner Email Address: johnsonnick4l@gmaii.com Page 1 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: 1 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: 1 Requested Maximum number of persons allowed to occupy Dwelling Unit: 4 Number of rooms in Rental Dwelling Unit: 8 Use and Dimensions of each room in Rental Dwelling Unit: Qipiti Room/ Kitclien 23'x 14'; Livivig Room, 21' x 11';Bedroom 1, 14' x 14';Bedroom 2, 10'x 10';Bathroom 1, 8' x 6'; Bathroom 2, 8' x 3'; Study, 10' x 10' 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 ❑ 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) Mill Race Farm, LLC, by I Nicholas L. Tohnson,Managing , certify under penalty of perjury,the following: member 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 wiFtp§p 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: Mill Race Farm, LLC, by Nicholas L.Johnson, Man*np member Property Owner's Signature: '"` NOWY sw Sworn to before me this V�day of m , 20 Official Notary Public Signature and Original Notary Stamp of Page 4 of 4 'oe TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 I N S mimio' E C T 10 N [ ] 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 . ` .. � 40e. TOWN OF SOUTHOLD PkOPERT �o?q *RD-/ . ..... -------- OWNER STREET QVILLAGE DISTRICT SUB. LOT r FORMER OWNER N E ACREAGE Sea eyl 1 n441- -A&4 S W, TYPE OF BUILDING RES, S WS VL FARM comm. IND. CB. misc. Est. Mkt. Value i �— LAND IMP. TOTAL DATE REMARKS 647 —Z 6 o 1) Aw APV AGE ING CON IT NEW NORMAL BELOW ABOVE FRONTAGE ON WATER Form Acre Value Per Acre Value FRONTAGE ON ROAD 0,::-)77 ,jo A Tillable I BULKHEAD Tillable 2 DOCK Tillable 3 Woodland Swampland Brushland House Plot —Total, TOWN OF SOUTHOLD PROPERTY RECORD CARD s -N "'STREET VILLAGE DESTQ COUNTY TAX MAP NO. LANs? � IMP. � TOTAL DATE REMARKS. o sa {. F € S� a f r . A s ` ----------------- � � I l t �iP r 7 y q" . 41 u' i a� z y it y 6-7-16.1 02/02 Nt .da Extemsiort a z Ext. Wolls _ interior Fan - - Fire Ploca N6 Hear - Pbrch Rao g st I - patio Roorm 2nd Floor _ pV ` - > _ 3 e z a A. ,, f r Town of Southold P.O. Sox 1179 53095 Main Rd r Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 47018 Date: 05/02/2026 THIS CERTIFIES that the building SINGLE FAMILY DWELLING Location of Property: 1959 Crescent Aire Fishers Island.N" 06 90 Sec/Block/Lot: 6.-7-16.1 Conforms substantially to the Application for Building Permit heretofore, filed in this office dated: Pursuant to which Building Permit No. 10894 and dated: 08/18/1982 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: Seasonal single family dwelling with unfinished basement. Replaces Certificate of Occupancy#11148 issued in August 20, 1982. The certificate is issued to: Mill Race Farm LLC Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: 10-SO-67 11/17/1980 ELECTRICAL CERTIFICATE:~ N521195 05/26/1981 PLUMBERS CERTIFICATION: thori, d igna ure FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33065 Date: 06/02 OS THIS CERTIFIES that the building ACCESSORY Location of Property: MADELINE AVE FISHERS ISLAND (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 6 Block 7 Lot 16.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 22 2008 pursuant to which Building Permit No. 33651-Z dated JANUARY 28 2008 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 "AS BUILT" ACCESSORY SHED AS APPLIED FOR. The certificate is issued to MICHAEL L LAUGHLIN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF BSALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A A hor ed signature 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-33066 Date: 06/02/08 THIS CERTIFIES that the building HEAT AIR COND. SYSTEM Location of Property: MADELINE AVE FISHERS ISLAND (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 6 Block 7 Lot 16.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 20, 2007 pursuant to `rich Building Permit No. 33164-Z dated JUNE 25,_ 2007 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 HEATING AND AIR CONDITIONING SYSTEM AS APPLIED FOR. The certificate is issued to MICHAEL L LAUGHLIN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF EDYALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Au r3 Si Lure 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-33243 Date: 08/26/08 THIS CERTIFIES that the building ALTERATIONS/ADDITION Location of Property: MADELINE AVE FISHERS ISLAND (HOUSE NO.) (STREET) (HAMLET) County Tax Flap No. 473889 Section 6 Block 7 Lot 16.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUKE 20# 2007 pursuant to which Building Permit No. 33165-Z dated JUNE 25 2007 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 ALTERATION AND DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to MICHAEL L LAUGHLIN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTNOT OF HEALTH APPROVAL NIA EIJKCT+ICAL CERTIFICATE NO. 3037939 08/20/07 PLUMBERS CERTIFICATION DATED N A A o/e�d i nature. Rev. 1/81 Town of Southold P.O. Box 1179 53095 Main Rd �w Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 47019 Date: 05/02/2026 THIS CERTIFIES that the building GENERATOR Location of Property: 1959 Crescent Ave Fishers Island.NY 06390 Sec/Block/Lot: 6.-7-16.1 Conforms substantially to the Application for Building Permit heretofore, filed in this office dated: 02/14/2025 Pursuant to which Building Permit No. 51774 and dated: 03/24/2025 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: Accessory generator as applied for. The certificate is issued to: Mill Race Farm LLC Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: ELECTRICAL CERTIFICATE: 51774 04/27/2026 PLUMBERS CERTIFICATION: t th r Sig atur SCALE: = t'- '001, � ` eta Na ual'cluevtRia k141,KsvAY - FULL HEIGHT TOWEL CUBBIE5-VIF SHAMPOO NICHE-VIF DECK --. - - - -- 2A'-5tr OA VIF a 3 ' 8 0 V-O• ..R vC ---. 6'-0• Td-1LD• IT, 9'-1918' WA7 F i woon - O MR h MON �f-M 1-/5en�� M AEort7 m ' VAS COATCL.-- - 3.1314'X 1B'LVL Rt GEMMl ABOM 1i _ ( Z ALIGN AM � C PENINSULA(O'a4rt v S ♦GAFF a Sv Trri17Nsm r- " � "- STUDY S @EQBQQM DININGromo GQ&kIEN I (BY OFMER) I 14 OD p q O O O I C4CL 8-10r, 2.7 2-5`Jl4• 2-55W 73'-81J4.OJ1. LAUGHLIN RESIDENCE. FIRST FLOOR PLAN DO NOT SCALE DRAWING SCALE: 1/4"=1'-ply DATE: JUNE 21,2001