HomeMy WebLinkAbout1000-108.-4-8 x TOWN OF SOUTHOLD
Rental Permit
0043
Owner Ubaldo Gonzalez Irr Trt
Occupied as Single Family Dwelling
Located at 19475 Route 25 Mattituck 108.4-8
Maximum Permitted Occupancy 8
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.
4/18/2024 _
Code fog e ent of
This Notice must be posted by the main entrance at all times
so
TOWN OF' SOUTHOLD BUILDING D
63 -765 1802
INSPEC 101m
[ FOUNDATION 1ST [ ] ROUGH PLSG.
C l FOUNDATION 2ND [ ] INSULATION/CA
[ ] FRAMING / STRAPPING [ ] FINAL
FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN
FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PI
] ELECTRICAL (ROUGH) ELECTRICAL (FI
] CODE VIOLATION [ PRE C/O [
REMARKS: 6A-z�w, 490513 1
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DATE INSPECTOR
41 Town Hall Annex
Town of Southold 54375 Main Road
u"
Rental Inspection Report PO Box 1179
Southold, NY 11971-1179
" Tel: 631-765-1802
......
SCTM# Date
a
Owner
Phone
r� d Visible
Ad4dress .. . .,.,,._ Y1 .. .. _...�. .. ..... ....... ....,
Hamlet....._ _ .. ._._ ._w. -w_.. _ ...... Inspector
Floor Level Quantities Sub 1 2 3
...��.�
Smoke Detectors(not located in bedrooms)
..1��. .1. . . ............. .�_a„ .,�a. .., ..��„ .. .�..awb .� �... . .�„ ...... y .,.
Carbon Monoxide Detectors
....,
Fire Extinguishers
Exits .
Bedrooms 2 3 4 5
an. ,... „ ...., .W ,........
�.. _ 6
Smoke Detectors
� Egress.� � l
OccupantCount.,..... ....... .__ .. .�.�...�..... ...�.�., .. .... �.�.�..._ �..� ��.. ............ ._ �...m .. . ,.._.. .....�.._._ �........,
B
wilding Systems Maintained &Operational Condition of Property
eating Building interior
Hot water �.w...�. 1 H
._.. � Building exterior
��.1 ,..........., ..w. Mm,n..� �. n a.. ........, �
Electrical Property , ,ained,�w
Pro ert clean maintained &safe
(M _... �w.... . .. . ... . ...... . a.. .... � guards &sec
6 echarncal Handrails& uards .. _ secure
Pool Si
Safety Pool on te
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Surface water alarm Date of CO issuance
,o. .1-11..1 ,,,,�� ��aA�w........M, ....,.... �� . . �. .,,,e.. , .,_�,.. �...,,. ....�r..�..
Door alarms Pool completely enclosed
Self closing latching
gates .
Pool fence to code requirements
e .... w.. �.. �.. .... .. .....G
/ ..
CO s for all ite p sent Prior Rental „
' ms re
............ .. .....
Comments _...... .�........... �..., ,...ww.... a �,,,
_.... . . ....... ._ ..,.. ._.... .. ..._.. .. .. _. ...... ....... ..... ,.. . ...,....
...._.�._ .. ....._. . _....._..... _..�..... . ..... .......row.. .m...�.. ...m.......� .,w.. �.,..................
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TOWN OF SOUTHOLD
Rental Permit
Y 0043
Owner Ubaldo Gonzalez Irr Trt
Occupied as Single Family Dwelling
Located at 19475 Route 25 Mattituck 108-4-8
Maximum Permitted Occupancy 8
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.
2/18/2022
-)
Code Enforce_ Official
This Notice must be posted by the main entrance at all times
F 01
'�►
jg � `° Town Hall Annex
SOUTHOLD TOWN 54375 Main Road
= PO Box 1179 Southold,
C= Rental Inspection
NY 11971-1179
Tel: 631-765-1802
4 Fax 631-765-9502
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T�IP %, RJ1Ihli�% ���� f�
LEVELS ////ir ,r
Smoke Detectors (#- bedroom detectors excluded)
Carbon Monoxide Detectors (#)
Fire Extinguishers'(#),
Exits (#)
c „ r / /j�BEDROOMS
Smoke Detector Alarms`(#)
Carbon Monoxide Alarms (#)
Egress;(windows) (Y/N)
BUILDING SYSTEMS / CONDITION OF PROPERTYka
Heating system maintained/operational Building Interior is clean/maintained
Hot water system maintained/operational Building Exterior is clean /maintained
Electrical system maintained/operational Property is clean /safe/maintained
Mechanical system maintained/operational` Handrails &,guards present
POOLS 41 YC POOL BARRIERS Y/N
Pool present Pool is completely enclosed
Pool surface alarm and/or door alarm
Barrier is a min. 48"high
resent
POOL GATES Y/N All openings in barrier less than 4"
Self-closing, self-latching Max.'2" clearance @ bottom of barrier
Latch on pool side of gate, meets height Barrier capable of being locked'& child-
requirements,,, proof when unattended
COMMENTS`:
TOWN OF SOUTHOLD
Rental Permit
Permit No. 0043
Owner Ubaldo Gonzalez Irr Trt
Occupied as Single Family Dwelling
Located at 19475 Rt 25 Mattituck 108-4-8
Address Village S/13/1-
Maximum
/B/LMaximum Permitted Occupancy 8
I
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.
5/2/2019 John Jarski
Date of Issue Code Enforcement Officer
This Notice must be posted by the main entrance at all times
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OYSOUTHOLD
.RENTAL PERMIT AP-PLICATIQN
f
Rental Permit Fee$200(Application must be renewed every two years)
P
Section A.
Property Information:
a
Rental Property Address:
Tax Map Number: 1000 SECTION 17,E , 0 OB:LOC - �� � � LOT e., --3
SECTION B.
OWNER INFORMATION:
Property Owner Name:�. w �! in
r la k m
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
r-ckr-d ��: � .� 42"
Telephone Number(s): .5d '7 3 7 97 Z
p Y
Pro ert Owner Email Address: ...,.,..............................,. .._........ __..�...,�.�
Page 1 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." !
a
Rental Dwelling Unit Identifier: 0, ..
Requested Maximum number of persons allowed u4rupy-Dwelllr Unit.
Number of rooms in Rental Dwelling Unit: i �e
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 NYS licensed architect,a NYS 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
from the Town of Southold.
Page 3 of 4
❑ 1 am submitting a completed Town of Southold certification form from a licensed
architect, a licensed professional engineer, or a licensed home inspector who has a valid
New York State Uniform Fire Prevention Building code Certification.
SECTION H.
DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit.
STATE OF NEW YORK)
)
COUNTY OF SUFFOLK)
H h _. r certify under penalty of:perjury,the following;
.1, I am the owner of the property identified in "Section A"of this application.
1
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 .
k
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.
i
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:
Property Owner's Signature: ..._....._
Sworn to before me this day of20-
Official NotaP
ry ublic Signature and Original Notary Stamp
9 \OTRALorio1T McBrideMc
Page 4 Of 4 STATE OF NEW YORK
T
No.01 MC6368447
IL
�'�� F. Qualified in Suffolk Count•
A°"`° Commission Expires December It.2021
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-20141 Date AUGUST 13, 1991
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 19475 AMAIN ROAD MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 108 Block 4 Lot_ 8
Subdivision Filed Map No. Lot No. � �
conforms substantially to the requirements for a Private One Family
Dwelling built prior to: APRIL 9, 1957 pursuant to which
CERTIFICATE OF OCC. Z- 20141 dated AUGUST 13, 1991
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 ESTATE OF ANNE I. NEVILLE
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL— N/A
UNDERWRITERS CERTIFICATE NO. __ N/A
PLUMBERS CERTIFICATIQN DATED N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
Building
ng Inspector
Rev. 1/81
BUILDI_dG DEPA.RT:-Ii*N
T01lid OF SOUT`IOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location strO ez�_._...m
rtm"Irr IC r "r.
4 7 lO l
Subdivision Map No. Lot(s)
Name of Owner(s) ESTATE OF ANNE I. NEVILLE
Occupancy_ A-1 RES
I;typej downer-tenant)
Admitted by: ROSIE NEVILLE�Accompanied by:—SAME
Key available Suffolk Co. Tax No, 108-4-8
Source of request LAWRENCE M. STORM, ATTY Data JUNE 3, 1991
DY�'LLING:
Type of construction WOOD FRAME #'sror.ias 2
Foundation BRICK & STONE Cellar 1/2 Crawl space 1/2
Total rooms, lst. F1 5 2nd. Fl 5 3rd. Fl - -
Bathroom(s) 1Toilet room(s) 1
Porch, type ENCLOSED ON Deck, type Patio, type_
Breezeway G,j �,�,,go Utility room
Type Heat ELECTRIC 'darm Air Hotwater
Fire lace s) NONE No. Exits _ 4� Aircondition�-
P ( ung
Domestic hotwater YES Type heater LILCO GAS
Other 2 REAR ENTRYWAYS
ACCESSORY STRUCTURES:
Garaoe�mmm^
type const. NONE Storage, type const. —
Swimming pool Guest, type const.
Other
VIOLATIONS:
CHAPTER 45—N.Y. STATE UNIFORM FIRE PREVENTION �—
— ... ..-.� & BUILDING CODE
ius .I "a�n T?G >c :rind.:,on Art. � Sec.
EYTRRIOR BXTERIOA STAIRS, PORCHES, ENTRANCE PLATFORlLS CUAIx�&". ?..
FIRE ESCAPES AND THE RAILINGS THEREON SHALL �
.� .. HE ]242_5 C C
MAINTAINED IN A SAFE AND SOUND CONDI i�1N — �-
4 EXTERIOR SURFACES SHALL BE MAINTAINED IN GOOD C1IAEI F
13'
�.�..0@I'D F�"'fiC�1� �"7Td�,1•"+h1E".�" tl7!3" IC3ETaP�"D[T:Y�E,a�LS"AAW"C_., 1.-... .__.y k.--
pp� TO DETERIORATION SHALL BE TREATED WITH A
N _PROTECTIVE COATING OF PAINT OR OTHER
PRESERVATIVE.
Rem
Inspected by -_Date of Ins -NNE 26, a AUG 12, 1991
Time start 9:00 — end 9:30 am
_1
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-23370 Date NOVEMBER 23, 1994
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property 19475 MAIN ROAD MATTITUCK, NEW YORK
House No. Street _.....-_. __ Hamlet
County Tax Map No. 1000 Section 108 Block 4 Lot 8
Subdivision _ Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 3, 1992 pursuant to which
Building Permit No. 20417-Z dated FEBRUARY 5, 1992
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued isPORCH ADDITION & ALTERATION TO EXISTING ONE FAMILY DWELLING
m_ AS APPLIED FOR.
The certificate is issued to JOAN P. HILLIARD & UBALDO GONZALEZ
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-333177 - NOVEMBER 10, 1994
PLUMBERS CERTIFICATION DATED OCT. 11, 1994 - HARDY PLUMBING & HEATING
Bui 'ili.ng Inspector
Rev. 1/8_l
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TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER VILLAGE DIST.I SUB. LOT
FORMER OWNER N i ACR.
evy
„ S W TYPE OF BUILDING -
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SEAS. VL. FARM COMM. CB. MISC. Mkt. Value
LAND {MP_ TOTALE REMARKS
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AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE
FARP'_. Acre Value Per
Value
Acre
Tillable I
Tillable 2
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Tillable 3
Swampland FRONTAGE ON WATER
L_
Brusnland i FRONTAGE ON ROAD
— g
House Plot DEPTH
.. BULKHEAD
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Total 1 DOCK
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_ 4 F COLOR
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_ 1
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M. Bldg,
_ - - Foundations Bath Dinette i
_—
- t 'Basement I
� K-
Extension
Extension „¢ Ext. Walls
nterior Finisl
Extension e Place j ec.
Type Roof i Rooms l st Floor
BR
Z SL
Porch Recreation Roo 1 Rooms 2nd Floor i FIN. B
i
Dormer
Breezeway Driveway I - - -
Corcge
I
Patio I
O. B
Total — t,
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