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Home My WebLink About1000-63.-3-23 TOWN OF SOUTHOL Rental Permit 00 } � 1519 Owner: Maher Jada , Jacob Walker Occupied as: Single Family Dwelling Located at: 57635 Route 25 Southold 63.-3-23 Maximum Permitted Occupancy: 5 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 Co a En went Official This Notice must be posted by the main trance t al TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 11.79 So athold� X71qq; Telephone(631) 765-1802 Fax(631) 765-9502 l3ullding napartment Town of Southold RENTAL PERMIT APPLICATION nr Rental Permit Fee$300(Application must be renewed eve two years) Section A. Property Information: Rental Property Address: 5 4 3 Road SDu W I Nq Tax Map Number: 1000SECTION 063. OO -BLOCK 03 . oo -LOT _ 0(lU SECTION B. OWNER INFORMATION: Property Owner Name: Jauob oval ker and Maher Tada Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 3 25 C11il1Ton AV& APfi. 12 32.5 01ATOA AVe APT. !2F Telephone Number(s): Daytime 602-341-510,fAvening 03-34l-.fOf2Emergency bja-9Q-6245 Property Owner Email Address: f , Q ,+ m i ( -(0 ) Page 1 of 4 Section C. Authorized Agent information: Name of Authorized Agent of dwelling unit, if any: qZA Address of Authorized Agent(no P.O. Boxes): N /A Mailing Address of Authorized Agent: Telephone Number(s): Daytime NZA Evening A Emergency — IT Email Address: N 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: A Telephone Number(s): Daytime N 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: N/A 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, 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: V fr Requested Maximum number of persons allowed to occupy Dwelling Unit: '" Number of rooms in Rental Dwelling Unit: 10 Use and Dimensions of each room in Rental Dwelling Unit:it'Clu k in 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. ❑ 1 am requesting a fire safety inspection to be performed by a Code Enforcement Official �om 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) I b 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: tA Property Owner's Signature: ��.�.,,„. C- Sworn to before me this dayo �,20=1 � �,�r�wtrrnrnrrr�,�� c al Not Public ature and Original ` • .• STATE •, `'. + OF NEW YORK ". NOTARYPUBW King minty ;« x per, Of AM '' "oarMaa a ►aW SOUTHOLD BUILDING DEPT. ° S ,. INSPECTIOIV I ] FOUNDATION 1ST [ ] ROUGH PLBG. I ] FOUNDATION 2ND [ ] INSULATION/CAULKIN [ ] FRAMING /STRAPPING FINALG [ ] [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT P ETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL ( INAL) I ] CODE VIOLATION [ ]REMAR S.- PRE C/O ] RENTAL Town Hall Annex �� "� Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O. Box 1179 Southold, NY 11971-0959 Ott � 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 P'r 1 its i d f2r Archftegt or E Lriginggir, Licenls§ Horne lns 2mid2 c2ml pf vallig currelArt Rental Property SCTM Number. 1060—063, 00 — 03. OU -12 3 000 Rental Property Address: 3<- /Y,&,e Y) &CJdl id 6 u-7 6 o t 7i Owner/Name: # Rental Dwelling Unit Identifier: Gt lips Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 —100 sgft., Bedroom#2—90 sgft., etc.) 13f d ('cx)m .# ( - I (o S 5 r0J .. Property Description (include all improvements indicated on survey) [ t C r I certify that I have done a physical inspection of the subject rental 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 a and the Energy Conservation Construction Code of New York State. "y " ' r, final signature �12— N;rPrint Name and Title ;QF � 'g gA Please place Professional Seale ;0 06 w FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.X. PRE EXISTING CERTIFICATE OF OCCUPANCY No Z-23298 Date OCTOBER 20 1994 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 57635 MAIN ROAD SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 63 Block 3 Lot 23 Subdivision Filed Map No. Lot No. conforms substantially to the Requirements for a one Family Dwelling built Prior to: APRIL 9 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER X-23298 dated OCTOBER 20# 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 ONE FAMILY DWELLING The certificate is issued to ALICE WOKDSKY (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. Building Znsp for r Rev. 1/81 Q �.i (711 nmvP LD _ m z o Zj LC) r CIQ LL- LU CL r � y µ G� " (75^TMw .a u MF �t 8 W lo W U Z Z 0 (D V � � _ �.. CO LU L p En r" W... M 3 _ Tµ W Q Q � J U ` V � LL m W Y. 0) \y b0 0 0 0 �6 0 _ t a I V a� cy- Z � J ® O z 0 a z ._ . _.m.. .__ Q O u IJ ` m a Q co z t W Q W c z w ° p ] .- � Q — o u o 0 ..: �� Z �- �- � Z 0 _ _ O c � Z m L a . .. ZZ. O O S ) LL LL a-. O Cl p r +? o o o_....'' ... _ a o o m LL in o- _ _. _._...w .. _ ._I... .... ... __ ..._ _.. .W _.m . ......_ g o! .. uuu O — O O P Li a a C@ �i- M f l/ Y v C a c c c Ol 0 O O rr� m �( - m LI Lu Lu a° no. 0 00. CO Fo- FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28597 Date: 07' 16 02 THIS CERTIFIES that the building ACCESSORY Location of Property: 57635 MAIN RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 63 Block 3 Lot 23 Subdivision Filed Map No. Lot No_ conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 22 2002 pursuant to which Building Permit No. 28027-Z dated JANUARY 22 2002 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 INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. The certificate is issued to WILLIAM A & PURA CAPONE (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 32939 11 10/99 PIAMERS CERTIFICATION DATED N/A Au� e' 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-28598 Date: 07 16 02 THIS CERTIFIES that the building ALTERATION Location of Property: 57635 MAIN RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 47889, Section 63 Block 3 Lot 23 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 18 2002 pursuant to which Building Permit No. 28028-Z dated JANUARY 22 2002 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 INSTALLATION OF A NEW HEATING SYSTEM AS APPLIED FOR. The certificate is issued to WILLIAM A & PURA CAPONE (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PIAMMERS CERTIFICATION DATED N/A th ized. 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-32244 Date: 03/13/07 THIS CERTIFIES that the building ALTERATIONS Location of Property: 57635 MAIN RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Kap No. 473669 Section 63 Block 3 Lot 23 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated pursuant to which Building Permit No. 32770-Z dated FEBRUARY 5, 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 "AS BUILT" ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS\ APPLIED FOR. The certificate is issued to WILLIAM A & PURA CAPONE (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A��_ ELECTRICAL CERTIFICATE NO. PLU14BERS CERTIFICATION DATED N/A A/46oriz6d Signature Rev. 1/81 0 LLI X O O tl Z O Y U Cl w cL Z w .` � mo Q U o O O 0 Z Z w T p m .+' w m T O � � O N O .....�.�...�...........�..... 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