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Home My WebLink About1000-63.-6-10 TOWN OF SOUTHOLD Rental Permit 1522 Owner: Kristina Ivy , Harolyn Ivy, Ben Wartofsky Occupied as: Single Family Dwelling Located at: 50 Oaklawn Ave Southold 63.-6-10 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: 07/21/2026 Expiration: 07/20/2028 Code inforce64Official This Notice must be posted by the main entrance at all times 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 ha ./v W . oLitilol LoAv"rlll . ov RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION G -BLOCK I) 6 --LOT SECTION B. OWNER INFORMATION: Property Owner Name: � OYO `'� .. Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) Telephone Number (s): Daytime `�q Z — Evening L11 Emergency Property Owner Email Address: r G 6 -° " m a Page 1 of 4 Section C. Authorized 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 Emergence Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: '50(� a-S ow kes- 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: 0 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: Coe, �t bpAwo�,- ' a, ( Requested Maximum number of persons allowed to occupy Dwelling Unit: n _� � Number of rooms in Rental Dwelling Unit: 6 ed-tuns! ; 0—Me 14){'e�t buAS l c+ucc� l!.y .6 Use and Dimensions of each room in Rental Dwelling Unit: t �! cQocV o x 4 6cd SX6 M&9[er bed , CL X 12 vfl 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. l 1 I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold 0 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) 1 � �: 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 1 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. m� Property Owner's Name: t Property Owner's Signature: Sworn to before me this day of �, a n e 20� � e Official Notary Public Signature and Origintat~ stamp Notary Puke State of Florida 49 �lcrralan Dradkrtwry IN11 My Gsrnsralasion ttht 71 877 xpfremS 4/712027 Page 4 of 4 Town Hall Annex '�� Telephone(631)765-1802 54375 Main Road » P. O. Box 1179 Southold, NY 11971-0959 °r BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: 1(641 Number of Rooms in Rental Dwelling Unit: !O Use and Dimension of each room: ,, aJr 1 t 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: f4f sou'- TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 65L&40 I IN S Or"t C T 10 N FOUNDATION 1ST/ REBAR ROUGH PL13G. FOUNDATION 2ND INSULATION/CAULKING FRAMING / STRAPPING FINAL FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) ELECTRICAL (FI CODE VIOLATION PRE C/O [4 7RENTAL REMARKS: j ""A ..................... ............. .............. DATE — INSPECTOR 1 Town Hall Annex Town of Southold 54375 Main Road c Rental Inspection Report PO Box 1179 r-we cn x Southold, NY 11971-1179 Tel: 631-765-1802 Alt SCTM # _f Date Owner ✓ Phone Address Ave, Visible Hamlet Inspector Floor Level Quantities Sub 1 2 3 Smoke Detectors (not located in bedrooms) Carbon Monoxide Detectors Fire Extinguishers Exits Bedrooms 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 Prior Rental #: occupants: Comments: TOWN OF SOUTHOLD P' ROPERTY RECC OWNER 1 STREET I VILLAGE DISTRICT SUB. ! LOT ACREAGE FORMER OWNER N _ i 1 E`er 1 l t TYPE OF BUILDING RES. 3t SEAS. ; VL, FARM COMM. IND. CB. MISC. Est. Mkt. Value LAND IMP. TOTAL DATE REMARKS C) � o � - -, �"- 77r`e a �v� -� 3 A ls AGE BUILDING CONDITION ;2— 1 p -7 - 8-2�— NEW i NORMAL BELOW ABOVE , FRONTAGE ON WATER Farm Acre Value Per Acre Value FRONTAGE ON ROAD _. Tillable 1 BULKHEAD Tillable 2 [ DOCK Tillable 3 Woodland Swampland 3 Brushlond-., House Plot II i Total b, i f A CUP, - — - I ! M. Bldg. -- _ Foundation Both LO Extension Basement Floors Extension Ext. Walls interior Finish Extension Fire Place Heat _ Porch Roof Type Rooms i st Floor Breezeway Patio Rooms 2nd Floor Garage , V � Driveway j Dormer O. B. FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. .Z 1.1.08 4. . . . . . . . • Date . . . .July. . 16. . . . . . . . . . . . : . , 19 82 THIS CERTIFIES that the building .s . . .(.2) M • . . . . . . I . • . . . . . . . . . . . . . » « . w • . . . . . . . . . 50 1 Oaklawn Avenue Location of Property 5210. . . . . . . . . .Main ,Road . . . . . . . . . , . Sau tho.ld .. , House o. Street Hamlet County Tax Map No. 1000 Section . 0.6.E . . . . . . ,Block . . 0.6. . , . . . .Lot . . . .0.1.0, . . . . . . . . . Subdivision . . . . .Y, . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . X . . . .Lot No. . . .$. . . . . . . . . Requirements for a private one-family dwelling built prior to conforms substantially to the ApplicatiQn.Xor_'BuiLUn Remiit-hero -sled-in- Certificate of Occupancy • •l4 p r i•l •2 3 • • • _ . , 19 .5.7pursuant to which B 4t-No. . .Z1105.4. . . . . . . . . . . . . dated . . . .JtI4 .16. . . . . . . . . . . . . . . . 19 .B?,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 . . . . . . . . . a. privat.a .ono-family_ dw.e.1:1�;IZ .aAd. .agc,e,s,s9ry, ga•ra,gq , , , , , , , „ µ , , , , The certificate is issued to . . Southold. Fr.a9. 1+ 'a%^y . . . . . . . . . . . . . . . . . . . . . . . (owner,le ��'� �- of the aforesaid building.- Suffolk County Department of Health Approval . . , A/r. . . . . . . . . . . . ... . . . . . . . . . . .. . . . , . . .. UNDERWRITERS CERTIFICATE NO. . . . . . . , . . . A1. '. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Building Inspector k Rev.1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. .23979.............. Date ...........................Sept.......23........ 19-70. THIS CERTIFIES that the building located of )# .-AV*................... Street A AM Map No. ...3=.............. Block No. .=................ Lot No. ..I=......SeUtho.].4.....gwy,.................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .-I.......I ...........---...jV1. 7..........7.......... 19.7jO.. pursuant to which Building Permit No. .4.844Z... dated .......................Jaay...................... 19..7.0.,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 ........ ..............PftV*t*--0"...foally .idWe 11-ing................. ............... .......... ....---...—.........-- The certificate is issued to ...loPeTterry.........Owwr...6 wn er,--i e--s-s-'e.-e..o.r.'t.en-.a--n-iJ.......... ..... ....... of the aforesaid building. Hous* # 52450 Maim Rd ..... -9u--iidin--g-- Inspeci' or.. ..................... Prl .P4 p M IA-N D �� bc`�Eco�' �coUb0 g�fas �r4 TO.'att'.0 iv Lo t a-� -F� vw or 61 C- /p/ � hcOGPi e,A V�v �4oS l a J Door' to uer w v O", y � F � 8 L olr�x Y3 Z IK x FVI- S AD C� V �f C � � � � � � � w ��-- �- � �` «- � ,li I � 4 C� _ � � y � z a S�� u �� U �� U P 5v�od rs -rU AAfive vo ow DOD aj S G koo tot r a � v 3 2�� 3��, E C E JUL 2 2026 Building Department Town of Southold / N