HomeMy WebLinkAbout1000-122.-2-15 TOWN OF SOUTHOLD
} Rental Permit
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Permit No. 0144
Owner Thomas Mercier
Occupied as Single Family Dwelling
Located at 10530 Sound Ave. Mattituck 122.-2-15
Address Village S/13/1-
Maximum
/B/LMaximum 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.
8/8/2019 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 OF SOUTHOLD
RENTAL PERMIT APPLICATION
Rental Permit Fee $200 (Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address: Lk
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Tax Map Number: 1000 SECTION `7 .--BLOCK ` _ _-LOT 2 -
SECTION B.
OWNER INFORMATION:
Property Owner Name
Property Owner Legal Address: P rt Owner Mailing Address:
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Telephone Number (s): Dayti � . ._��.�. E e g_ Emergency
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Property Owner Email Address: _ � _ .,w
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Page 1 of 5 � m ��
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 OF SOUTHOLD
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if an
Address of Authorized Agent (no P.O. Boxes):
Mailing Address of Authorized Agent:
Telephone Number (s): Daytime eM
Evening_ Emergency,,,,___
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): 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: —IV
Address of Managing Agent (no P.O. Boxes):._
Page 2 of 5
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax (631)765-9502
P.O. Box 1 179
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent:
Telephone Number (s): Daytime,-,-- Evening„ Emergencyw
Email Address: _ .. ... .... ..._... . .,
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."
Rental Dwelling Unit Identifier: . ho' M 1 � ,, w
Requested Maximum number of persons allowed to occupy Dwelling Uni
f
Number of rooms in Rental Dwelling Unit: w :..: �qS
Use and Dimensions of each room in Rental Dwelling Unit:
c �
Cl ( Page 3 of 5
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Town Hall Annex Telephone(631)765-1802
54375 Main Road 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.
SECTION H.
DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit.
STATE OF NEW YORK)
'1
COUNTY OF SUFFOLK)
1 tet 4o" certify under penalty of perjury, the following:
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 Telephone(631)76.5-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
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.
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Property Owner's Name: —,,-�. �..._ .......... . _s �. a � .. �
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Property Owners Signature:
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Sworn to beforeme this da'y of � ,
2019
Official Nod rSi 4 , d Original
y Public na g tureq, Notary Stamp
Page 5 of 5
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1 179
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION APPENDUM
W
Rental Dwelling Unit Identifier:
Requested maximum number ofpersons allowed to occupy each dwelling un t:
Number of Rooms in Rental Dwelling Unit: _
Use and Dimension
room:
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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:
TOWN OF SOUTHOLD
13UILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND
[ ] INSULATION
[ ] FRAMING /STRAPPING [ ] INAL
4ivrW
[ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION
[ ] CAULKING
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.X.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-23415 Date DECEMBER 15, 1994
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 1555 FACTORY AVE.&10530 SOUND AVE. MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 122 Block 2 Lot 15
Subdivision Filed Map No. Lot No.
conforms substantially to the Requirements for a One Family Dwelling built
Prior to: APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z-23415 dated DECEMBER 15, 1994
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 BUILDING
The certificate is issued to BLAISE DiPAOLO
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*THIS UPDATES CO Z-5415 DATED AUG. 31, 1973.
ilding mnap ctor
Rev. 1/81
HOUSING CODE INSPECTI0N
August 30, 1973
19530 Sound Ave. , & 1555 Factory Ave. R-1
Mattituc, I.Y.
Tax Roll: E. Russell Johnson & Wf.
0:_cupied: Owner
Upon request of the Southold Town Building Department,
I made inspection of this two story framed dwelling and
found the following violations of Local Law #1, Housing Code,
Town of Southold. I was admitted to east side, front entrance
by rears. Johnson who accompanied me on inspection which began
at approximately 10:40 a.m.
The first floor consists of enclosed front entrance poach
which is unheated, living room, dining room and kitchen, heat
is furnished to' these rooms. Near enclosed porch, unheated,
access to cellar through trap door in porch floor.
Kitchen: gas range, no shut off valve at unit-Section 500
Front Entrance: no switch to control light in room on
entry. Section 529b.
Cellar; water supply pipe to kitchen sink leaking at elbow
to riser. Section 502b. Ceiling light in sectioh of
cellar near furnace wired with lamp cord. Section 528a.
The second floor contains three bedrooms and bathroom and
walk in closet-heat is snpp lied to bedrooms only. The ceilings
are under seven foot six inches, in violation of The Building
and Zoning Ordinance, Article I, Section 101, Floor area
livable.
Accessory building-stable, tool and work shop with hay loft.
Roof has several missing shingles. Section 302C.
Inspection completed at approximately 11:05 a.m.
Respectfully submitted,
Edward Hindermann
Building Inspector
EH: jk
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
UPDATED
CERTIFICATE OF OCCUPANCY
No Z-23414 Date DECEMBER 150, 1994
THIS CERTIFIES that the building_ ADDITION & ALTERATION
Location of Property 1555 FACTORY AV13, & 10530 SO AVE. TTITJJ N- .
House No. Street Hamlet
County Tax Map No. 1000 Section 122 Block 2 Lot 15
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 27, 1960 ____pursuant to which
Building Permit No. 1117-2 dated • JUNE 24, 1960
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 EXISTING ONE FAMILY DWELLING
The certificate is issued to BLAISE DiPALOLO
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED /A
*THIS UPDATBS CO Z-918 DATED NOV. 25, 1960.
02
B ding Inspector
Rev. 1/81
Town of Southold 8/8/2019
P.O.Box 1179
53095 Main Rd
' qy Southold,New York 11971
CEIT'IFICAE OF OCCUPANCY
No: 40602 Date: 8/8/2019
THIS CERTIFIES that the building AS BUILT ALTERATION
Location of Property: 10530 Sound Ave.,Mattituck
SCTM#: 473889 Sec/Block/Lot: 122.-2-15
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
8/1/2019 pursuant to which Building Permit No. 44047 dated 8/8/2019
was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for
which thi's certificate is issued is:
as built,alterations to,ap emsting dwellingat,gpplip
The certificate is issued to Mercier,Thomas&Barbara
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
_. Auer ped S" attire .