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Home My WebLink About1000-113.-7-2.5 3 IM"WN F SOUTHOLD 4 Rental Permit 0094 Owner William Lindsay Jr. Occupied as Single Family Dwelling Located at 4690 Bergen Ave Mattituck 113-7-2.5 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. 4/8/2022 Code Enfor ent Official This Notice must be posted by the main entrance at all times Town Hall Annex SOUTHOLD TOWN 54375 Main Road PO Box 1179 Southold, ti Rental Inspection ection NY 11971-1179 " pro Tel: 631-765-1802 Fax 631-765-9502 SCTM # 1 3,— -7 —2 �' Date Z Owner f/ll( � r So Phone Address 6° ��1 (2 Zip S 2 Hamlet Llo-- l linspector Address visible from street? V ee', LEVELS SUB,A 1 2 3 Smoke Detectors (#-bedroom detectors excluded) Carbon Monoxide Detectors (#) Fire Extinguishers(#) Exits(#) BEDROOMS 1 2 3 4 Smoke Detector Alarms (#) Carbon Monoxide Alarms (#) Egress (windows) (Y/N) BUILDING SYSTEMS yil CONDITION OF PROPERTY N Heating system maintained/operational Building Interior is clean/maintained V 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 POOLSPOOL 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 I proof when unattended COMMENTS: TOWN OF SO THOL Rental Permit s Permit No. 0094 Owner William Lindsay Jr Occupied as Single Family Dwelling Located at 4690 Bergen Ave Mattituck 113.-7-2.5 Address S/B/L 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. 6/25/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times rjf ol/ Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959ijj T� � BUILDING DEPARTMENT , TOWN OF SO HOLD T. RENTAL PERMIT APPLICATION Rental Permit Fee $200 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number 3 BLOCK LOT : 1000 SECTION SECTION B. ERINFORMATION: Property Owner Name: ° Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 2— Telephone Number (s): •........ q ( -7 5- Property Owner Email Address: 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): 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): 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): 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." �.w. Rental Dwelling Unit Identifier: 7, Requested Maximum number of persons allowed to occupy Dwelling Unit: 11- ^ Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: I 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 ❑ I 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) I c lL I �f A , 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.p 01( Property Owners Name: :=m=1C;e-1, Property Owners Signature: Ill jv,; Sworn to before me this day ofe�p� �C�C��— 20_LG -c MELISSA R DEBOER Official Notary Public Signature and Original Notary Stamp NOTARY PUBLIC STATE OF NEW YORK SUFFOLK COUNTY UE 498'198 Page 4 of 4 COMM. � � �� „ ��,� So Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 Uz BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental DwellingUnit Identifier: � UWA- p occupy each dwelling unif Requested maximum number of persons allowed to occu t � Number of Rooms in Rental Dwelling Unit: Use and Dimension of each vroom: 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: So Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 !r Southold,NY 11971-0959 Oro � r e` WEIIS BUILDING DEPARTMENT11) TOWN OF SOUTHOLD F f, P' 1 111 RENTAL PROPERTY CERTIFICATION TOWN O1rSOUTAG1yQ Form to be completed by a NYS licensed architect, NYS licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Pro essional seal re ired or Architect or�"n ineer licensed Frame ins ector must rovide a Co' te Uni orm Fire Prevention Buildini Cade Ce-- iiwation. Rental Property SCTM Number: Rental Property Address: A1490 ��-wu, �°- 41'(& 1 Owner/Name: Rental Dwelling Unit Identifier: Number &Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 -100 sq., Bedroom #2-90 sq., etc.) M . 5 F fro Property Description (Include all improvements indicated on survey) I certify that I have done a physical inspection of the subject rental dwelling unit and find that the unit 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. 0 M IPr-01 Yr � I i"&� Print Name and Title Original Signat re Please place professional seal: (0�� 3S1 (�S) TOWN OF SOUTHOLD BUILDING DEPT. � IO 765-1802 .INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH-PLBG. [ ] FOUNDATION 2ND [ ] INSULATION Af [ ] FRAMING /STRAPPING [ ]' IAL - - „ [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION { ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOL N [ ] CAULKING REMARKS. I VrM JZ Sit-Les µ r c/ ao DATE INSPECTOR floe O'K 17 'CIO, ............ A;rr / Z- sq 'f". .......... . .-1.......... 77 oCD ....... �N y , .. an W I m L � I a » n r � 1 f � M u u X m < f� Ln I m �° `' � 9 TC ' m 0 J Z � J frI s a , r) u e sIJ I ry , ,e 4 r s w ,. a q 0' 11 � y% h wl w� IL o I� s i Li y �. .: � j I (� ^ k MM W g � g o r el ol f ��La? r a, } r. �I M d I I I r.. � � t I m c � a. M � s r T oo p r 7C (� T ,. w I I € _ I I G g 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-19694 Date JANUARY 29 1991 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 4690 BERGEN AVE. MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 113 Block 7 Lot 2.5 Subdivision Filed Map No. Lot No. conforms substantially to the requirements for a Private One Family Dwelling built prior to: APRIL9, 1957 ursuant to which CERTIFICATE OF OCC. #Z-19694 dated JANUARY 29 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 WITH ACCESSORY TWO CAR WOOD FRAME GARAGE AND TWO STORAGE BARNS AND TWO SHEDS * The certificate is issued to WILLIAM A. LINDSAY, JR. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. H-020156 - JANUARY 23 1991 PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. uilding Inspector Rev. 1/81 BUILDI7G DEPARTMENT T0:lN OF SOUTHOLD, N. Y. HOUSI::G CODE INSPECTION REPORT Location, 4690 BERGEN AVE. M.r1'I:"1'OCK, N.Y. �numoer v� street) ci;u�:i.cipality) Subdivision riap No. Lots) Name of Owner(s) WILLIAM LINDSAY JR. Occupancy A-1 OWNER (type Towner-tenan-c) "'" Admitted by: WILLIAM LINDSAY Accompanied by: SAME Key available Suffolk Co. Tax No. 113-7-2.5 Source of request WILLIAM LINDSAY Date 11/10/90 D•TEL LI`1G: Type of construction WOOD FRAME Astories 2 Foundation BRICK Cellar 1/2 Crawl space 2/3 Total rooms, lst. F1 3 2nd. F1 4 3rd. F1 Bathroom(s) )NE Toilet room(s) ONE Porch, type Deck, type REAR DECK Patio,, type Breezeway Garage Utility room Type Heat CIL Warm Air Hotwater Fireplace(s) No. E:cits 2 Airconditioning Domestic hotwater OFF BOILER Type heater Other REAR ENTRYWAY ACCESSORY STRUCTT,.TR,ES: Garage, type const. 2 CAR WOOD PRAHEStorage, type const. 2 BARNS 6 2 SHEDS Swimming pool Guest, type const. Other vIOLAT10DTS3 CHAPTER 45—N.Y. STATE UNIFORM FIRE PREVENTION 6 BUILDING CODE I.dication DP c_-intion Art. j' Sec. 1 9 Remar!cs• BP #11402/C9 Z-13672, Ulf 112819 /CO Z-17873, BP #1958OZ/CO Z-19693 Inspected by: f' r." - Trate o£ Insp. DEC. 13, 1990 AR, F. 11 Time start 9:30 amend 9:50 aro FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N-Y. CERTIFICATE OF OCCUPANCY No Z-19693 Date JANUARY 29, 1991 THIS CERTIFIES that the building ALTERATION Location of Prgperty 4690 BERGEN AVE. MATTITUCK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 113 Block 7. Lot 2.5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 11, 1990 -Pursuant to which Building Permit No. 19580-Z dated DECEMBER 131 1990 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 GIRDER TO ASSIST IN WEIGHT SUPPORT ON EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to WILLIAM A. LINDSAY, JR. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APP110VAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A d Building Inspector 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-17873 Date MARCH 22 1989 THIS CERTIFIES that the building AGRILXLTURAL STORAGE Location of Property" 4690 BERGEN AVENUE MATTITUCK NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 113 Block 87 Lot 2.1 Subdivision - Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 13 1983 pursuant to which g JANUARY 3, 1.984 Building Permit No. 12819-Z dated 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 AGRICULTURAL STORAGE BUILDING The certificate is issued toWILLIAM A. LINDSAY,-JR.� (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL- N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N A Building Inspector Rev. 1/81 � t}t Town of Southold 6/25/2019 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40466 Date: 6/25/2019 THIS CERTIFIES that the building AS BUILT DECK Location of Property: 4690 Bergen Ave,Mattituck SCTM#: 473889 Sec/Block/Lot: 113.-7-2.5 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/11/2019 pursuant to which Building Permit No. 43566 dated 3/18/2019 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: 11AS BUILT" " I�11; UILT `1 ADDITION TO AST E1S"I"1NG ONE FAMILY DWELLING AS APPLIED FOR, The certificate is issued to Lindsay Jr,William of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED atlI s .eel Signature