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Home My WebLink About1000-109.-2-11 of so TOWN OF SOUTHOLD Rental Permit 1524 Owner: Audrey Kerwick Occupied as: Seasonal Cottage Located at: 26135 Route 25 Cutchogue 109.-2-11 Maximum Permitted Occupancy: 2 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 arraI1141fig for the bi-annua , spection. Issued: 07/21/2026 Expiration: 07/20/2028 MErcem official This Notice must be posted by the main ent nce II tim � Far� 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 lath //wwN . gthol tow ZQV RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) O Rp Section A. Property Information: so Rental Property Address: !� Tax Map Number: 1000 SECTION -BLOCK SECTION B. OWNER INFORMATION: Property Owner Name: Kau)&Ajim1) 'i Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) o � Telephone Number (s): Daytime* SID �IL5 Evening Emergency Property Owner Email Address: r Page 1 of 4 s 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 Emergency Email Address: 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, 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: r Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: V Use and Dimensions of each room in Rental Dwelling Unit: 6 � "" ' "` ^� � °� -�f- 7 IJ 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 afire 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 f SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) ) COUNTY OF SUFFOLK) certify under penalty ofperjury, the following: iat44,1e-v �� x Y p Y g: 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: —Au �1 I ). Lerw)rK Property Owner's Signature: fi Sworn to before me this A' day of _ _, 20(ZR60 Official No Public Signature a Original Notary Stamp 'RACEY L DWYER "OTaARY PN,NEJUC,STATE OF NEW YO R1 NO.01oW6 N1 q 0-9ALIPIED NIA SUFFOLK COUNTY 1M 413SIO N EXPIRES JUNd 30,209 Page 4 of 4 Town Hall Annex ° Telephone (631)765-1802 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM 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: 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: of s TOWN OF SOUTHOLD BUILLEI G DEPT. 631-765-1802 t oI I,_ I INSPECTRO' N [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI L) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: UWfAview i DATE INSPECTO TOWN SOUTHOLD PROPERTY RECORD CARD OWNER STREET , VILLAGE � DISTR; SUB. LOT ML ACR. TYPE OF BUILDING RES. SEAS. VL FARM COM A& Co. MICS. Mkt. Valera AND IMP. TOTAL DATE REMARKS s t 2- 13 v L I Z,7 s — ——- —-----—--------------- AGE BUtLDING CONDITION NEW NORMAL BELOW ABOVE FA---Acre Value Per Value Acre Tillable i FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH Houma Plot BULKHEAD Total- DOCK e� E � � C JL0 r F v 104-2-11 3/19/2025 3 -L . e fvs. t _ to.-Sion Extension r 1 J OrC Baserr,�nt FIc ors Parch �! Ext, '4^r'alls t h� InTarir�r Finish B,c ez e way Fire NaCe �V�ea( z -Q)� f f pa=ia � Rarrec�iian RcQrr, Re rs:'.n FicOr Dormer Dri'acv�r-y _ Town of Southold Annex 4/16/2013 54375 Main Road Southold,New York 11971 PRE EXISTING CERTIFICATE OF OCCUPANCY No: 36196 Date: 4/15/2013 THIS CERTIFIES that the structure(s)located at: 26135 Route 25,Cutchogue SCTM#: 473889 Sec/Block/Lot: 109.-2-1 l Subdivision: Filed Map No. Lot No. conforms substantially to the requirements for a built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 36196 dated 4/15/2013 was issued and conforms to all the requriements of the applicable provisions of the law. The occupancy for which this certificate is issued is: w..___ftgmc one amily..dwelling witb fro enclosed porch. orb,certtage and accessory one car gWj&q.! Note:agAMOLp to e has one b raa one bathr lace: The certificate is issued to Hopkins, Robert&Hopkins,Deborah _... {OWNER)._, e_. _ a.,.,,......w........M. w. ....... ....,. . _..... of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. 7t Zed ign at. re . BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 26135 Route 25,Cutchogue SUFF.CO.TAi—MAPNO.. 169.12-11 SUBDIVISION: NAME OF OWNER(S): Hopkins,Robert'&Hopkins,'' ''Deborah ` " " ......... .......... OCCUPANCY: ................................................. .........ADMITTED BY: Deborah Hopkins .................. SOURCE OF REQUEST: Hopkins,Robert&Hopkins,Deborah DATE: 4/15/2013 DWELLING: #STORIES: 2 #EXITS: 2 .......................... FOUNDATION: cement bloc k CELLAR: full CRAWL SPACE: i ............"ll" -- .......-...-,.." .-.� ..'I ---'. BATHROOM(S): TOILET ROOM(S): 1 UTILITY ROOM(S): PORCH TYPE: DECK TYPE: PATIO TYPE: ...................... BREEZEWAY: FIREPLACE: GARAGE: DOMESTIC HOTWATER: yes TYPE HEATER: off boiiler AIR CONDITIONING:............... TYPE HEAT: oil WARM AIR: HOT WATER: x #BEDROOMS- 2 #KITCHENS-_-"'- "1 .BASEMENT TYPE. —unfinished ... . ................... OTHER- ............................. ............ ............ ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: accy one car STORAGE,TYPE OF CONST: SWIMMING POOL: GUEST,TYPE OF CONST: accessory cottage ............................................... ............ OTHER: VIOLATIONS: ----------- ........ REMARKS: ------------ ........... ............ ........... . ........ ............... INSPECTED BY: GARYF DATE OF INSPECTION: 4/12/2013 ...................... TIME START: 10:00am END: 10:30am FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. . . . .Z- 16079 . . . . . Date . . .August i9 , 1987w . . , THIS CERTIFIES that the building . . . ABOVE GROUND SWIMMING POOL . Location of Property . .25335 Main Road Cutchogue New York House No. Street Hamlet County Tax Map No. 1000 Section . . .1.0 9. . . . . .Block . . 9.? . . . . . . . . . .Lot . . . �! 1 . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . , . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated July 10, 1986 15083 Z . . . . . . . . . . . . . . . . . . . . . . pursuant to which Building Permit No. . . . . . . . . . . . . . , . . . . . . . dated , 4 *J u 1 y 1 1 , 1 986 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 . . . . . . ABOVE GROUND SWIMMING POOL The certificate is issued to . , . . . RO B E R T H 0. KIN S of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . I NIA „ . . . . . . . . . . . . . µ , µ . . . . . . . .. . UNDERWRITERS CERTIFICATE NO. . . . . , , , . . . . . . .N 8 2a5 4 0 8 . . . . . . . . . . . . . . . N/A PLUMBERS CERTIFICATION DATED: ell �i� .atq . Building Inspector Rev.1/81 ' aury Town of Southold P.O. Box 1179 53095 Main Rd R Ulm, � Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 47218 Date: 07/16/2026 THIS CERTIFIES that the building WINDOWS IN DWELLING Location of Property: 26135 Route 25 Cutcho ue NY 11935 Sec/Block/Lot: 109.-2-11 Conforms substantially to the Application for Building Permit heretofore,filed in this office dated: 05/23/2024 Pursuant to which Building Permit No. 50943 and dated: 07/15/2024 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: Window replacements to an existing single-family dwelling as applied for. The certificate is issued to: Audrey Kerwick Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL:. ELECTRICAL CERTIFICATE: PLUMBERS CERTIFICATION: (/7' 1 e Si attire r i