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Home My WebLink About1000-75.-3-7 of so TOWN OF SOLTHOLD Rental Permit 1536 Owner: Michael & Monica Kelley Occupied as: Single Family Dwelling Located at: 360 S Harbor Rd Southold 75.-3-7 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: 08/26/2026 I Expiration: 08/25/2028 Cod farce ent Official This Notice must be posted by the main entra _ e a all times TOW N OF SOUR" LD BUILDING DEPT. u . 631-765-1802 � INSPECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND ZF' NAL SULATION/CAULKING FRAMING /STRAPPING FIREPLACE & CHIMNEY RE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL flRENTAL NAL) [ ] CODE VIOLATION [ ] PRE C/O [ s: �- ,c/ REMARK wiv rr- u� DATE 0 PECTDR \ \\\ �o\I' o„ \ ii 1 �j /.�/6/0 r r� f�i, �°°°°°°°°� IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIiilllllll �i �, „� IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII III � l�; ��f � u�u uuuu. � � ��'i � � , '� �� /, uuuu �iliuuuuu uuuuuu�p v vvvvvvvvvvvVvvi�lllllllllll 11 d � �ui� ;� �' ��ylllll�� Ilnll �III � � �� I�uu uuu u�u��u III um uuuuuuuuuuu �l III IIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIII��IIVVVV i i� uuuumiiiiYuuum i IIIIIIIII /� Q%%"/ �� -iii' �� r�(� TOWN OF SOUT:HOLD—BUILDING DEPARTMENT TownHall Annex 54375 Main Road P. O. Box 1179 Southold,NY 1 0959 1 ( ) ( ) P //ww v,so hol lover oy Telephone 31 75-i S(� Fax 631 765-9502 ht� s RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Propert��ddress cUbLl Tax Map Number: 1000 SECTION -BLOCK -LOT *17 SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) L 411'`<3r J Telephone Number (s): Daytime UEvening.Emergency Property Owner Email Address: ® 'ca t 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.Authoriied 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: G.- 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: �1p�,1Q1 T J 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: Gl.-e- �V Requested Maximum number of persons allowed to occupy Dwelling Unit„ 77 le js Number of rooms in Rental Dwelling Unit: 9 room total -there are 3 bed kitchen, living room, 2 an a a Use and Dimensions of each room in Rental Dwelling Unit: "tchen 5 ft x 19 ft x 23 ft x 19 ft Living Room: 13 ft x 28 ft Bathroom 2: 8 ft x 7 ft Room:Laundry 11 ft x 6 ft Master ed Bedroom:SECTION G. m: 12 ft x 13ft , Guest Room 1: 11.5 ft x 12 ft,--- INSPECTION: Guest Room 2: 11.5 ft x 9ft 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 ow"Air chooses not to have said inspection performed by the Town, a certification from a licen ed architect, a licensed professional engineer or a home Inspector who has a valid Ne York State Uniform Fire Prevention Building Code Certification is required stating that the property which is the subject of the rental permit dpplication 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. y"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) Monim „1Z\t\4 � , 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: M060 Property Owner's Signature: Sworn to befo e me this i day ofC 21212—Y Official Notary Public Signature and Original Notary Stamp MEHNAZ NOREEN NOTARY PUBLIC,STATE OF NEW YORK Registration No.01 N06310104 Qualified in Queens Cou My Commission Expires: Page 4 of 4 FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. Z1.1AQ4. . . . . . . . , , Date . . . . . PAQr;pber;,?9. . . . . . . . . . . .. .. 19 s'M THIS CERTIFIES that the building .d e r* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . Location of Property 360 , . . , . . . , ,South, ,Harbor Road Southold County Tax Map No. 1000 Section . 4.7.5, . . . . • . .Block . . 03 . . . , , . ,. , ,I,,ot . • 0 A 7. . . . . . . . . .M w Subdivision . . A . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . ?t. . . . . .Lot No. X . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated Decrosber_ 28 • • . . . . . , 19 8?. pursuant to which Building Permit No. . .?:?0,i4_ Z . . • , . dated , . . .ne nebelr% .29. 19$?. ,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. deck g. addition to dwellin , • „ _ . . . , . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . . . . . . . PRuline C. & Walter N. Pharr, Jr. . . . . . . . . . . . . . . . . . . . . of the aforesaid building. Suffolk County Department of Health Approval . . . . ,n!a. , „ , ` w • . . .. UNDERWRITERS CERTIFICATE NO. . . . . n/a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Building Inspector Rev.1/81 TOWN'60 I" ,V )BUILDING .DEP ,RTMINT TOWN,HALL- SOUTHOLD; N. Y.� BUILDING PERMIT. a (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTILULL COMPLETION OF THE WORK AUTHORIZED) No :42084 Z Date .. ..... .«.. «............ I 9.�y.. _ Peemissioh is hereby granted to. ....Ole 'ewl, .N......�».W»♦•..N.. .. ♦ .w.«. .«» a •.♦ ............... t0 ........ s . ..„ z«..».. •. x fl ..�................Nj..Y .......».... .......» .....r....... ...............�.............................. ..... ... .• ......... w ............. «r at premises I aced at ........ .»6;. ». ... ........ .......... w.. ♦..w wWx. w rwr .ww row..ewr ysx.w«�x aw�1«Trw A'r a:.. w •M»swMi ......... . ww V'M............. ..« ....................... �+f f ..... w».«. ........ ................... ...»........ .................... ........x ........,N.................. ......................................... d County T& Map No. 1000 Section :�� ."�.� �,, ... BiocN� .."�..»... w�.Iwot No.' ......,.y�......r«. Pursuant :to application Mated . ..». ,:.. . ......, ) . nd approved by the Buif'ding Inspector. fBuifdin0f Inspector« M 4 e FORM NO.6 TOWN OF SOUTHOLD Building Department Town Hall Southold,N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features, 2. Final approval of Health Dept. of water supply and sewerage disposal—(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5.Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner a,;to use,occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertipent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date . .December 28, 1982 New Building . . . A , . . . Old or Pre-existing Building . . . . , „ .. . . . . . Vacant Land (deck) . . . . . . . . . . . . . Location of Property . . . . 360 South Harbor Road Southold„ . House No. Street Hamlet Owner or Owners of Property . ,Walter N. Pharr,. Jr. and Pauline C. . Pharr w County Tax Map No. 1000 Section „, ,075.. 00. , . . , , Block . . . .0.3 . 00. , . , , , Lot. Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . , . . . . . . , .Lot No. . . . . . . . . . . . . . Permit No.1.aL.01"9•�-Date of Permit/�� ' ',0--AppIicant Health Dept. Approval . . . .7-, . . . . . , . . „ . . . .Labor Dept. Approval . , , , , • . . . . . „ . . . . . . , . . . . . Underwriters Approval . . . . . . . . „ . . . . , . . .Planning Board Approval . . . . „ . . . . . . . . . . . . . . . . Request for Temporary Certificate . , . . . „ . . , , „ . „ , . . , . . . .Final Certificate . . . , „X. , , . . . , .. , . . . ,. . Fee Submitted$ . . $.•.00. . . . . . . . . . . . . . „ . . . .. Construction on above described building and!,pP4mit meets al;7pcp" le codes and regulations. Applicant . !, , , . ,Pauline C. Pharr , , .. " . , . . ' . " Rev.70.10-78 ,. (�„ (to ' o a.IRON Pt PE - - 7i r��cep,-NO 0 4 Q " GkALTON N-17*1 r'5dE" a Nk UpOj O � W: 0 3 i Q1 �LAR. DR!V£WAY ANY S.804'2S100"W. 210.88 j BA " k . ..,.. � "ALt11 1 0kxly40 d4LPN';kJM1kk(AN4 0*AD01tioo. ,MAP r y N*akNMS S AVEY kS A hypM�., 4,Z,'+@,qr 6 6 Off^^ 'M'�P �" j SIMON 71�YD of 7 O' w V R d EDUCArAot4 LAW, �Nt�14W1 CkrkEs�F arals kawEr PAULINE C. f akkkc�EANij,sutcwE�OR'S 111011 S L KOM ., ..,.. «a..---•. .w...,..�,..«m NNA,N$ . �"U'ARANT, 'ES I�.irPC"A7d9y &tR tlW , �T �+ k r 6 k aOe SOUTHOLG � L • LI }k a .�f� ro tot A6,NCY AND �` " TOWN OF SOUS OLO�NY y� � � ��,��;.E �, ., . Ad,Ykj J l.Y'L.1:1+6'Y bNkk' +dY,p k k Jrgsrl* ,"FIN'YNA$ INSiOCa'.rIJONSr()A Slr�la�k.l�}S.I wit U S L-_ - 68 ITi_E INb,jfklV4(:(e C.O1-1f ANy, RODE— IFF�OLK CO,*rAX MAP . - O FORX NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERKS OFFICE SOUTHOLD, N. Y. Examined ............... Application No, ry Approved .0-46 ........ -.1k.7............. 19,q.9.,Permit No. Disapproveda/c ............................................................................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Dote -,.-........ INSTRUCTIONS a. This application must be completely filled in by typewriter or, in ink and submitted in triplicate to the Building Inspector,with 3 sets of plans,accurate plot plan to scalzlee according to schedule. b. Plot Plan showing locotioR of lot and of buildings On premises, relationship to adjoining premises or public streets or areas,and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application- c, The work covered by this application May not be commenced before issuance of Building Permit. ,d. Upon approval of this application,the !Building Inspector will issue a Building Permit to the applicant. Such permit sholl be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupancy shoal have been;granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other oppli,cable Lows, Ordinances or Regulations,for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable lows, ordinances, building code, housing code,and regulations, and to odmit authorized inspectors on premises and In buildings for necessary inspections. t/ ........... (Signature of applicant, of name, If a corporation) L V V VV State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...........--........--...... ....... Nome of owner of premises If applicant i,s a corporate, signature of duly authorized officer. lip jp (Nome and title of corporate officer) is -RAWFUL Builder's License No. ........... .......... Plumber's License No. ............. INCA TER Electrician's License No. ............................. 0C D Other Trade's License No. .., .AIJ 1. Location of land on which,proposed work will be done, Map No. Lot No. Street and Number -$!&.. Municipality 2. State existing use and occupancy of premises and intended use and Occupancy of proposed construction: a, Exisiting use and occupancy ........f tv 4,t 11V6-- ............ b. Intended use and occupancy ........0040A.115.-A60..F*.V.a:X2.")rk A)6 ah-re .......... ............... ....................... � ^ 3. Nature ofwork (check which oppicoble): No* amldinm.------ Addition �� Akamnv" Kwppi, .................. Removal ............. Demolition.................... Other Work ._--- ~ 4. Estimated Cost —. ........._Jee .......................................................... (to be paid on n|mo this mo� application) I Ifdvm|�o numberof dwelling units —'�V��x.............Number of dwelling units on each floor ...Me)................. If garage, number o;cars.......... 111A.......................................................................... .........---......... ~— 6. ff business, commercial or mixed occupancy, and of use 7. Dimensions wfewwmmg structures,if any: Front....... Rear ...... Depth .-le� .... . Height .~_. ......... Number of Stories -- ._ L4 p6" 777-t" I UC GZ` I Y- 1 1 SCE,L F- 40 OnIkON Poll j Eli MONUMF N TET".t ,b tD la B I I i�l IG oaI I•40 IEI v M i q: Q GALL DL:IYEWAY »m Z Of s.so`25'oo°w BA1<1ER -49.5 .. JNAUTHORIZED ALTERATION OR NOD YOFY TO THIS SURVEY IS A VIOLATION ate, SECTION 7209 OF THE NEW YORIf STAR EDUCATION LAW. MAP OF PPOPFRI Y b HOPIIA.or. THISsukv IURVIv 8ZAkiNg EMBOSSED JLAL, A. VR SURVEYED Fes. GUARANTEES I (PA U i. I ONLY TO TH pt L pE �VBt A IS PREPARED,hl=G , _....»..... ...,.....,»_..,,............ _..._.r..,,M.,�.... ....... TITLE COMPANY. G T LENDING INST{TUIi Per 10 TeE tiaG,SIES •, a SQl1TNULD >fUTION-GUAP.Alil., W AWFIGMA TOWN OF SO1,JNOI-M,�� ow�asxs, U.S.LIFG TITLE �KSLA�N(-(T COMPANY � &JFFDI..K GL?.TAK MAP Wsj"TION-, LI D 6U�V MIS 10 W� \\V y V \\ \\\ V\ co TOWN OF SOUTH OLD PROPERTY RECORD CARD OWNER STREET VILLAGE DIST. SUB. LOT /V OWNER N E ACR. S W TYPE OF BUILDING SEAS, VL_ FARM RES. COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS 7d 4 .94 c -or tA co- rlv� i2- in-ces -o 1 i j Kr t�j AN I -A AGE BUILDING CONDITION NEW NORMAL i BELOW ABOVE FARM Acre Value Per Value Acre Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadow" DEPTH House.0ok,, BULKHEAD 4 Total DOCK „ A TRIM F - - 7S.3-7 10/10/2024 - —s- -- M. Bldg. _ a J z Extension u_ I Extension _ [ 3 o o c i g 'Foundation Both Dinette I Porch i �� .� Basement r_ 'Floors K. s _ , r r_ Y 4 v Porch, e _ Walls Interior Finish . Ext. W �� Inte r LF� I Breezeway Fire Place Heater = DR_} Garage s� , €T�� Roof Rcoms 1st Floor BR. _ - Patio Recreation Room_ `Rooms2nd Floor FIN, B G. B. Dormer Drivewoy Total VoRx NO. 4 TOWN OF SO OLD WELDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. .9%U . . . . . Date . . . . . . . . . . . . THIS CERTIFIES that the building located at 3 6 0 South Harbor Roa4. AWYW Map No. . . . .XXXX . . . Block No. ,. .XXXX. . .Lot No. . . . .Xxxxxx. . . . . . . . . . . . . . . . . Requirements for one Family dwelling built prior conforms substantially to the x to Certificate of Occupancy g _ . . . .Apri1. 23.,. . . . . . .. 19. . 57 pursuant to which)X' *WNo.Z916b. . . dated . . . . .&ugust. 11. . . . . . .. 19. Y.$, was issued, and conforms to all of the require. meats of the applicable provisions of the law. The occupancy for which this certificate is issued is . . PRIVATE ONE FP.MILY DWELLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . „ . . . . . . The certificate is issued to H... .A1gp. .CTARA .F,. GMJAQoHFR. . . . . . . . . . . . . . . . . . (owner,*=WW*0200) of the aforesaid building. Suffolk County Department of Health Approval . PRE. EXISTING. . . UNDERWRITERS CERTIFICATE No. . . . . . . . . . . . . .PRE-EXISTING. . . .. . . . . . . . . . . . . HOUSE NUMBER . .3 6 0.. . . . . . , , . Street , South Harbor Road, Southold, . . . . . . .York. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . Building Inspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-26491 Date: 06/02/99 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property: 360 SOUTH HARBOR RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 75 Block 3 Lot 7 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 29 1998 pursuant to which Building Permit No. 25426-Z dated DECEMBER 18, 1998 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 ADDITION & ALTERATION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to WALTER N PHARR, & PAULINE PHARR (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N-488772 05/17/99 PLUMBERS CERTIFICATION DATED 04/29/99 JACK GISMONDI Buildix nspector 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-31594 Date: 06/06/06 THIS CERTIFIES that the building ALTERATIONS Location of Property: 360 SOUTH HARBOR RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 75 Block 3 Lot 7 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 19, 2006 pursuant to which Building Permit No. 32019-Z dated MAY 19, 2006 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 INTERIOR ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to WALTER N PHARR & PAULINE C. PHARR (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 1203998 05 11/04 PLUMBERS CERTIFICATION DATED 06/14/04 JOHN W. REICHERT Authorized 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-34763 Date: 12/28/10 THIS CERTIFIES that the building SOLAR PANELS Location of Property: 360 SOUTH HARBOR RD SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 75 Block 3 Lot 7 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 19 2010 pursuant to which Building Permit No. 35832-Z dated SEPTEMBER 7, 2010 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 SOLAR PANELS ON AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to WALTER N & PAULINE C PHARR, JR (OWNER) of the aforesaid building.. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 35832 12/03/10 PLUMBERS CERTIFICATION DATED N/A �r Authorized Signature Rev. 1/81 � � � 1 SECTION F. 0,engym' 1 PROPERTY DESCRIPTION: Number of Rental DwellingUnits on property: } p p Y� � � W1Cio� 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." g 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 202 (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. lY"l am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ lam submitting a completed Town of Southold certification form from a licensed architect or a licensed professional engineer. Page 3 of 4