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Home My WebLink About1000-139.-4-13 TOWN OF SOUTHOLD 4 Rental Permit AVII 0041 Owner Margaret Jablonski Occupied as Single Family Dwelling Located at 1355 Marys Road Mattituck 139.4-13 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. 10/2/2023 Code Eta ce t Official This Notice must be posted by the main entrance at all times a� 631 765 1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAl [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE &. CHIMNEY [ ] FIRE SAFETY IN! [ j FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (TOUCH) [ ] ELECTRICAL (TIN [ ] CODE VIOLATION [ ] PRE C/O [ d REMARKS: ok DATE coo F 014 Town Hall Annex Town of Southold 54375 Main Road Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 , Tel: 631-765-1802 *,o 0* 0�, e SCTM# Date ,� . /� _ . . we . ... ... ._.. _.. . _ Phone Owner Address 75 Visible Hamlet J Inspector " Floor Level Quantities _ ... ..... .,, Sub....,..)._. .. ? .. �... 3. .. Smoke Detectors (not located in bedrooms) Carbon Monoxide Detectors Fire Extinguishers Exits _ Bedrooms 1 2 �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 dean, maintained &safe Mechanical Handrails & guards installed & secure Pool Safety Pool on Site Surface water alarm Date of CO issuance _...®. _... . _.. _ . lY encloselet Pool completely ° Door alarms Po- d Self closing/ latching gates Pool fence to code requirements Co's for all items present Prior Rental 00 _ Comments: '"' - HAvwr& L OWEL "" AN ES uAvw& U`T u u TAvw N Rental Permit 3 Permit No. 0041 Owner Margaret Jablonski Occupied as Single Family Dwelling Located at 1355 Marys Road Mattituck 136-4-13 Village 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. 5/12/2021 Qk�2��O � Code Enforcement Official This Notice must be posted by the main entrance at all times Town Hall Annex �° '- SOVTOLD TOWN 54375 Main Road PO Box 1179 Southold, M' Rental Inspection NY 11971-1179 Tel: 631-765-1802 ' Fax 631-765-9502 SCTM'# 139 . 4 — 13 Date Owner PALALsAl3Lo u Phone Address 1396' rVA2V-5 ",AN Zip Hamlet YyAOrI lInspector Address visible from street? LEVELS SUB 1 2 3 Smoke Detectors (#-bedroom detectors excluded) J J Carbon Monoxide Detectors(#) / Fire Extinguishers (#) Q z Exits(#) / BEDROOMS 1 2 3 4 5 Smoke Detector Alarms(#) Carbon Monoxide Alarms(#) / Egress(windows) (Y/N) Y Y BUILDING SYSTEMS Y/N CONDITION OF PROPERTY Y/N Heating system maintained/operational Y Building Interior is clean/maintained Hot water system maintained/operational y Building Exterior is clean/maintained Electrical system maintained/operational Property is clean/safe/maintained Mechanical system maintained/operational y Handrails&,guards present POOLS Y/N POOL BARRIERS Y/N Pool present N 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 { roof when unattended COMMENTS: LAV Y TOWN OF SOUTHIOLD Rental Permit - Permit No. 0041 Owner Margaret Jablonski Occupied as Single Family Dwelling Located at 1355 Marys Rd Mattituck 139-4-13 Address Village sJ6J1- I 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. 5/1/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times Town Hall Annex ��" �' ,1 '` Telephone(631)765-1802 54375 Main Road � d � fi;� Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200(Application must be renewed every two years) Section A. Property Information: Rental Pro Iert Address:35. �. . � � 4. �� Tax Map Number: 1000 SECTION __ar - LOR SECTION B. OWNER INFORMATION: Property Owner Name: � ..1�GA � l-on►s� I Property Owner Legal Address: Property Owner Mailing Address: (31 Telephone Number (s): Daytime. IT19 Evening "`i'7S-66_TEmergency Property Owner Email Address: _ C aAN °u - �^'\� �N YAHOO Page 1 of 5 Town Ha11 Annex �ph ' Telephone(631)765-1802 54375 Main Road i Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 tou y,. BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, If any: A aLo IS .. Address of Authorized Agent (no P.O. Boxes): '�0 t✓ mm m Mailing Address of Authorized Agent: _„ S'A/Rti - A5 /a Q 0Vk- c3/- y-7Y' G31-yes Telephone Number(s): Daytime C,6173 -,Evening 6623 Emergency Email Address: r G _S Longs JCi @ j/k NOo. Cam 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 an Address of Managing Agent (no P.O. Boxes): Page 2 of 5 f Town Hall Annex s� � , Telephone(631)765-1802 54375 Main Road ;u + � ":� Fax(631)765-9502 P.O.Box 1 179 Southold,NY 1 1 971-0959 , BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime__ Evening Emergency Email Address: SECTION F. PROPERTY DESCRIPTION: r Number of Rental Dwelling Units on property: C2/V L, 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: m Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: . 00µ0/w1,9 l r w 66-1 h S /04/i'un Use and Dimensions of each room in Rental Dwelling Unit: L � µ,A X �� n II' � "X /(7'S" 6e17.a..aM,. 3 , /0 `y«X !l' �c�Tclk,✓: �lo�..��l7r� (� 2 �, . �o �Ar S-fq e'/7 : U /J r 1 rJ f to - '� / j Page 3 of 5 Town Hall Annex o �r - w Telephone(631)765-1802 54375 Main Road7 Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD 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 am submitting a completed Town of Southold certification form from a licensed architect or a licensed professional engineer. ,SECTIONI.I OECL R T N: Signature„Must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFOLK) l! A�&A CIO C - �A lo�►Sk1 certify under penalty of perjury,the followin �?�..,...� Y P Y p J Y g- 1, I 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 Page 4 of 5 Town Hall Annex "q ' " �� ' Telephone(631)765-1802 54375 Main Road �, Pr Fax(631)765-9502 P.O.Box 1 179 � � 'M;t Southold,NY 11971-0959 � BUILDING DEPARTMENT TOWN OF SOUTHOLD 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 as to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager, Property Owners Name: GAkZI � "SABL S p Y _ ,2 ..... . Property Owner's Signature: paml 1'tixbgr,-ewe d Nc .01 �5$W 9 In Suflolkr 7. CommWakni i low Sworn to b('f re me this) wday of ., 20Lq Qlj, Official N hary Public Signature and Original Notary Stamp Page 5 of 5 � .TOWN OF SOU-11140LD BUILDING DEPT. 1765-111802 INSPECTION JII 11"'OUINIDA-riON 1ST lf° I,,,I l,. III„ IFOUMDATION 2ND I N S U IIIb,,,,, „1,,,01 �I 114::"Il VIII' l,—TIS III. A � I4,vl i ll::::::lREPLAGllE & C11HIMIMEEYIIS lR SAf IIIA ' [114SPEC""1"'I1' 1 FIR[,.;;;., Ill::l;; llll "'lllF N'-r ,,nit.I TI N FIRE RESI „Ill" W PENETRATION III., ELII,X rRI ll,, (ROUGH) EII ECTRI NlFI II', III, CODE.:. '1 11... ,r � � �, � CAUI,,,,,IBS I �__ ......_._ w .�..m. Di0k,'FE INSPECTOR _ �., .. ,�� r�� a � �.. � _ . � �: ; �. (P. ,:, .., a ,,-� ,.,� _. �� .,�� •. .., ...I ... ,.,. R::._ �,' � �a ,..,, f, ...„ � �.� �. '.. ;,. k r, �"'u „-.. �.t ..' 1...� �.. C f � �'1i x W �e.,¢ �. fLP c.' a �,�.. � ! F .._ �..,,,� � I I i�.' ° .,� � ...,. � .� �A� .. -.. r>�, .,.,d ..,.._� e. �.. '`. ,. � � r. �n;E r_. ,, ✓� ��, � ��.,,.m, -. � _., _ .. 4 t. .. � , I �� ! .,. �� l E�� ,;,r .�.. ,.._ � � �_ ,. �...� m ', ._��,r,; �;a� a 1 � a C7 G „0 6Z Moo T 5 aW oAz 14 i F1 99 1 - VuTFT n T-1 i7 li{ lot, . . U& .71 k4��3 I .y� y x 14 c ti 41 v Q ' c WIS"1 x+—' ....... .s...,,,._...,.,�...,,...w• .,�... """"gym".."�.,.,.........., �Wo w r � -4 (j w M� W I • u pp x l cr / o a c G x f 07J o-r i h fi nl nt q9 t9 V h. N w -r ea �, 71 it �._., _ � FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ?+3 h. . . . . Date . . . . . . . . .. .Aig� . . . THIS CERTIFIES that the building located at . .Mary t 5 Road. . . . . . . Street Map No. Gard.. lit$,. Block No. . . . . . Lot No. . .28. A. 29 . . Mattituek. . I .Yffi. conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . Mareh . 3,119 71 , pursuant to which Building Permit No. . ?R . dated . . . . . . April . 2 , 19 71, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is P-rivate .orad .family. aW40Iling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . Howard Cam. . . . . .Owner . . . . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . . Aug .26. i971. . .by.R« .vi3.1.a. . . Meuse # 1355 (f�(DER W�c7c RS iCl�Q�q 3�r Building Inspector 7/Q3/TOWN OF SOUTHOLD PROPERTY RECORD CARD� OWNER STREET VILLAGE DIST.' SUB, LOT r r FO<MER OWNER r.� _ I E ACR f - S W TYPE OFSBUILDING _ I f_ RES. SEAS. VL. FARM I COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS t � as 3 � s t , I AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per �Vclue Ac re Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH House Plot I BULKHEAD 1.-s DOCK y COLOR = TRIM i Y I F� f e.o - . 3 _4 - — . r L A. 1E J a ice" - Extension Foundation - Bath Dinette Porch ", �7 - Basement F 3 loors K. I Porch 'Ext. Walls Interior Finish LR. Breezeway Fire Place - Heat DR. Garage l _ e 9 _ _ Type Roof Rooms I-st Floor 8R. Patio Recreation Room. Rooms 2nd Floor I B O• B. Dormer Driveway Total i