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HomeMy WebLinkAbout1000-53.-4-44.38 of so TOWN OF SOUTHOLD Rental Permit 1530 Owner: Christine Moran , Justin Moran Occupied as: Single Family Dwelling Located at: 1620 August Ln Greenpor 53.-4-44.38 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-an al inspection. Issued: 07/28/2026 1, Expiration: 07/27/2028 Codet o ment Official This Notice must be posted by the main entra ce at 11 tUes TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 1 E Q h'1 E ; Telephone (631) 765-1802 Fax(631) 765-9502 littt)s://www.sout,holdtow'nn" . v JUL Quilding Department RENTAL PERMIT APPLICATION Town of Southold Rental Permit Fee $300(Application must 6e renewed every two years) Sao 9kc I I ZI Section A. Property Information: Rental Property Address: 62L0 li-S T_ - P) 9L Y4� Tax Map Number: 1000 SECTION -BLOCK -LOT - 9 SECTION B. OWNER INFORMATION: MM Property Owner Name: f fi'C n5 hlne t"t oa, Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) ko 1. o Telephone Number(s): Daytime " ""` � ` Evening 54vk� Emergency -L-- Property Owner Email Address: a S 'DI�D q&lAP 4 r o►,x c 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 Emergency Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: {�C 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: 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, 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: Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: 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 1� 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 COUNTY OF SW t ") I -bvx mdan , 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: 5�'� A. Property Owner's Signature: Sworn to before me this day of , 20 Official Notary Public Signature and Original Notary Stamp KISHANKUMAR R PATEL Commission#50219988 Notary Public,State of New Jersey My Commission Expires March 18,2029 Page 4 of 4 .Yaxw r.,r 4 04 Town Hall Annex 6K rati Telephone(631)765-1802 54375 Main Roadw P. O. Box 1179 V> a Southold, NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM ro Rental Dwelling Unit Identifier: f fAA, '� ��w '- 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: #b�— 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 o—fp—erions allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Town Hall Annex Telephone(631)765-1802 54375 Main Roads Fax(631)765-9502 P.O. Box 1179 Southold, NY 11971-0959 t' �« "X BUILDING DEPARTMENT TOWN OF SOUTHOLD E la1i'n'g Depa ment RENTAL PROPERTY CERTIFICATION Town 0 S Uth(,)l'd 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 En lnegr Licensed Home Inspector must provide cogy of valid current certificiAllon Rental Property SCTM Number: 1000-053.00-04.00-044.038 Rental Property Address: Owner/Name: _jM,%tlt1 .ran 1ln�.c.rafa_................._.....�. . .._ Rental Dwelling Unit Identifier: _M1i11_�?Ift0 Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 —100 sqft., Bedroom#2--90 sgft.,etc.) Primar bedroom-343 sf Bedroom 2- 192 sf Den/Stud -124 sf Property Description (Include all improvements indicated on survey) Sin le fa,milv residential dwellin . 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 and the Energy Conservation Construction Code of New York State. _.. t1y.Hs ww._wwwww___....�_-___.,�w__._..._... _....� ✓", .w��;� ..._ a. a............_.�.._www. VzDAp � Print Name and Titles % Original Signature Please place Professional Seat: a V ' ',w1��,'",,�3 B 9 d 6�,*'" (]�d� Ofi N TOWN OF SO ITHOLD BUILDI G DEPT. 631-765-1802 lN5r =%;TlvAo` N wft ow [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTA7PETRATION ELECTRICAL (ROUGH) [ ] ELECTRICAL) CODE VIOLATION [ ] PRE C/O NTAL ov,4 pr C tZ � ! -- --__ --------- -— - — € - 13, r -10[ IT it 241101 EAIN I _ 609Dp �4 — n — < ( aerxfz DArHf1 r i DEDROOM f1 [ _ �=� x st t �":`.'-W •�" ����1 1 zLL Bma�ave=—=—.=—.°e.=—°aRa=a—F—=aax_a__---am_=. e n LL ` 1 yy 1 lam in — = I #- :- �"Eaw--- �. 'E iE+4€ I41r ,- Eas Nn wr ae 1leE 3 € i06� 10 — _ - [- 1 - PEN/STUDY BEDROOM 12 x 3j s 1 � � - FAA �• _ - 1p 1 rm e I I _=,-r=.=.e.>«a—me—sa>..-.»—._..,_«..am—Pam 41 2 E5 E C O N P F L O O K P L A N I N N I V d�I WTI Lu LU 1 c0� § ` x t t - A6 JAN 2 D 2001 d l THIS DRAWING IS THE PRDPERTY OP. AND BNOULD BE USED EXCLU51VELY BY HAVEN HOMES. INC. ®®II W w HAVEN HOMES, INC. RESPONSIBILITY In LIMITED ID PAC70RY BUILT POR710N ONLY. 's ONLT. 1 j ,� d F` i�i vY - _ �=S O CC/ -._.. - le.ea. >C v�aJ-✓rw A+L NY56C .ro A__ �oO a .�>`� t# a.( / r � 3 i = 3 R �1 !Mal I s' rlr _ I �y8 i i 1 I r `T ' m g DINING AREA ._ tul $ " E.I°mot`ffsk LIVING ROOM NKItCsBATHt3 <9 v u ; - = N uYv �R `44 Eaw 2/11 ow €__. �€# IMF-, 11' I' 1 I ( GARAGEmm € ( € I t..D N R sat n = p ry -. € zs 131 "t ] 3 [ 1 ' RwR x'tFElfllF➢IIR! 9+F ` 3 If DeW¢ 1 A- T € I wRnDRmaa'•an mot£ S _! € = LIBRARY [ m I` twBm nm,IH¢E. 3 `V 73 s i FOYER HDFr tE _- - _�.o_aI oc,8 gfa i RAttD I WAIIN I E ( i ) 9' K}35� IWI ¢RET _-- �, IDES SID]10 tffd i4 BE I IDam III mft,[Ro -( € 77 p7 ( XV sm • ww NRvrt �i x ( _ - IEDIN � BNIIIH pyy - - ¢u® f - ° §'-+!Lr�• _ i ®•-0• i @•a' 2_T!' , 6`-6, ( 2'-8 VC Ll N CFIf c F I K 5 T F L O O K F L A N � ED DO HOT PROCEED WITH PROVIDE%NR.FIRE C� d i ALARM DEVICES ( FRAMING UNTIL SURVEY RATED SEPARATION TO AS 1 L anll AS TO PART.721.1 OF FOUNDATION LOCATION PART.717.3(f)(1)OF F Br N.T.S BUILDING CODE HAS BEEN APPROVED. N.Y.STATE BUILDING CODE. " Lu NOTIFY BUILDING DEPARTMENT AT - r DC V' 705-1802 B AM TO 4 PM FOR THE - 3 FOLLDVANG INSPECIIONC DNDERNRITERS CUITUMJDE € � U� I FOUNDATION-TWO REGUIREO REWIRED PLUMBING - 67 =LL FOR POURED CONCRETE ALLPILUXBONVIVOSTE - U 2.HOUGH-FRAMING a PLUMBING 4: T - z LU_ 3,INSULATION - 4.FINAL-CONSTRUCTION MUST ,)A -B ZDOI N N B CONST UCFOR C.O. "TO THE BEST OF MY KNOWLERGE, BELIEF AND PROTE.6${ ?IAL -' -- . - 0 ALL CONSTRUCTION SHALL MEET PROVIDE OPENINGS FOR THEE REQUIREMENTS OF THE N.Y. EMERGENCY ESCAPE AS "ad 1. THIS FACTORY MANUFACTURED HOME (FMH) PLAN HAS BEEN AFFROVED STATE, NOT IEsP N•ENERGY N FROM A 6Y5TF<t SET OF FMH PLANE PREVIOUSLY AFPROYED BY DNCR, X cooEB NOT REDPONBIBLE FOR REQUIRED BY PART.714 OF vswc oE910N OR CONSTRUCTION EMORB N.Y.STATE BUILDING CODE. vow _ € APPLICATION NO. A-1BB4. MANUFACTURERS NO. MBBIB, EX►IRAT ION 1nw of wpow 1= DATE BB-16-00. WHICH HAS NOT BEEN MODIFIED IN ANY MANNER. z g - - -- 2. THE ENERGY PORTION OF THIS FMH PLAN HAS BEEN PREPARED VWNO o_ PART 6 OF THE NEW YOKK STATE ENERGY CONSERVATION CONSTRUCTION d MUMMY OR PROVIDE ANTI-SCALD AND/OR CODE (ENERGY LODE) AND 15 IN FULL COMPLIANCE WITH THE ENEWY :F IS UNLAWFUL ramumruvfgmA� CODE.` r N.Y.STATE BUILDING CODE PLUMBER CERTIFICATION'�`t1T CERTIFICATE ( ` ' i, ON LEAD CONTENT BEFORE TM 18 DKAWI NO 16 THE FKOFEKTY OF, 1 CERnAICATEOFOCCUP tC. AND SHOULD BE USED EXCLUSIYELY } SOLDER USED IN WATER AVER I m` SUPPLY SYSTEM CANNOT LIMITED TO F INC. REBFON6IBILITY LIMITED TRD i0 FACTORY BUILT FDRT ION ONLY, TOWN OF SOUTHOLD PROPERTY RECORD CARD STREET DIST] SUB LOT OWNER VILLAGE ACR. REMARKS TYPE OF BLD. 0 l l Wi BBO l5v - PROP- Zb� TOTAL LAND IMP, DATE 7006 2 2, �jt- V e h �,A r�- 1�6 20r r7 (qq CrD 'i FRONTAGE ON WATER TILLABLE FRONTAGE ON ROAD WOODLAND DEPTH MEADOWLAND BULKHEAD HOUSE/LOT ------------ F TOTAL I � � a: _ . I U©p .—�I —�E�, 3Y N� 3 =a COLOR I r In TRIM 53444.38 02/02 EHH L17- -1-1 IT I t5-rc�l, M. Bldg 5`� Foundation GB Bath Dinette GKQ,I = tl �{ 7 a Extension Basement AwL Floors Kit. SLAB Extension Ext, Walls Interior Finish L.R. Extension Fire Place Meat D.R. Patio Woodstove BR. Porch °Y "r�^, �, �� �� Dormer Deck Attic Breezeway Rooms 1st Floor Garage 00 Coff Driveway Rooms 2nd Floor772— t E Pool - L ����. �.��' '-�� �� .t r _.- FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27880 Date: 08 20 01 THIS CERTIFIES that the building NEW DWELLING Location of Property: 1620 AUGUST LA GREENPORT (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 53 Block 4 Lot 44.38 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 1, 2001 pursuant to which Building Permit No. 27200-Z dated APRIL 2 2001 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 ATTACHED ONE CAR GARAGE AS APPLIED FOR. The certificate is issued to POSILLICO CONSTRUCTION CO INC (OWNER) of the aforesaid building.. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-00-0131 08 06 01 ELECTRICAL CERTIFICATE NO. N 565766 07/30 01 PLUMBERS CERTIFICATION DATED 07 13/01 ROBERT VAN ETTEN 000e.." Authorized Si ture Rev. 1/81