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Home My WebLink About1000-115.-16-18 TOWN OF SOUTHOLD Rental Permit Permit No. 0167 Owner John Stewart Occupied as Single Family Dwelling Located at 3495 Deep Hole Dr Mattituck 115-16-18 Address Village 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. 8/27/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times Town Hall Annexe " "�` Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 " Jti Southold,NY 11971-0959 raw qq k w,.�J" 9 fhiM1�Ph p�Y BUILDING DEPARTMENT TOWN OF SOXY]P:OOLD AUG - 2 2019 RENTAL PERMIT APPLICATION 7 4-u Rental Permit Fee $200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: r �: ,�t,&Tri r'u c-K// N ys a Tax Map Number: 1000 SECTION BLOCKby d SOT /Y,OOC SECTION B. OWNER INFORMATION: Property Owner Name: J Gj S7-w417— Property wlrProperty Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) Lo e ei- A E� /6 6 /- Q(-4 :, r o Telephone Number(s): r.-71 ` Property Owner Email Address: % e. 3F Vo noo �� 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." Rental Dwelling Unit Identifier: Requested Maximum number of persons allowed to occupy Dwelling Unit. Number of rooms in Rental Dwelling Unit: s Use and Dimensions of each room in Rental Dwelling Unit: 42 X/ 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. ❑ I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold. Page 3 of 4 Fl- 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) )�e.� k COUNTY OF i -b 4.1 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: Property Owner's Signature. Sworn to before me this of� � , 20 Officia' otary Public Signature and Original Notary Stamp Page 4 of Q MCMM .� Gid Town Hall Annex Telephone( 1)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179f' Southold,NY 1 197 1-0959 CERTIFICATIONBURDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY Form is to be completedi c i ,licensed engineer or licensed inspector Separate form is requiredfor each individual Renta!Dwelling Unit Professional seal'Leguired Lor Architect ora ireerliceasel glome iris ector m ^st roviri copy of valid current cernfikotion Rental Property SCTIVI Number: i C) .>c> �n Rental Property Address: S"4' '« DeCfc i L Owner/Name: v m Ltx- Rental Dwelling i Identifier: Number&Square footage of each bedroom s depicted in the attached floor plan: (i. . Bedroom#1—100 sq., sq., etc.) 17") S . F. Property s ri i (include improvements indicated I certify that I have done a physical inspection of the subject rental dwelling unit and find that it fully compliesi visaSouthold,the Residential Code of New York its Plumbing r , the Fuel Gas Code of New York State, and the Energy ConservationConstruction State.York -TD)A� Print Name and Title rOrt SiJhature t" tiq0' Please place professional seal: il'01 „ . OF IN TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING /STRAPPING ' ] FINAL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION ] [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING RrARKS-.,,- 1 Qi DATE 6 IT Fi,_C3ORPL.AN BOdiONerl JOHN H.ST ARI �®. FAA Np 2799 Piwertv Addrew 349s DEPP HOLE DRIVE Case No. Cid mxrT17LIC Lelld—Leads DRAWING NOT TO SCALE 5 60.0' Bath v Dining l(ridienBedroom 25.0' a ,0�.. 's/ l c l e� �a oL"dR m 400 2.0 20,0" Co . ( , ' ? 6" SKETCH CALCULAMONS Fxerimelor Area Llr ing Area First Roar Al:60.0 x 25.0= 1500.0 A2:20.0 x 2.0= 40..0 Attached Garage ,.262 a l2'F7.5 Total Idx ing Area 1277.5 Garage Area Aftowhe d Garage A4:10.5x25.0= 262.5 262,5 Total Garage Area 262.5 f 1 1 PrCLW ►� „a Q� @ � �,v i .nn �o r m I ` ro lei Z m- i Y (D �� 6� m r w�a r A,%i) � ,,” _p .... . - .:. ,...... . ro r "wl V A. 171 G) Vil kAj Ln s ,m i� f J r I. ...... r _ f w r 6 CA s`ti• >ll�v� G,,,y,A I� � riC, �WV ' �" 1 ��" r r Ie .... ...nim Y Y.F r r, l r- CD In rD ggi 1 ' ni a q 1I �_ � _._......... ... r U ._. . � .�. r7 m C� 4 m 3 - O m o Ln 3 ,.� . EA 66 T O V r rvk C � b „ ....._.... ...'�mm f u 7oCD T1 W � FORM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. .Zb� �. . . . . Date . . . . . . . . . . . . . .tMt 3. . . ._ .1., 19.75. THIS CERTIFIES that the building located at . .V/S .Deep .holy .Ar. . . . . . . Street Ck Est Map NoDee,P.iiAlq. . Block No. . . . . . . . . . .Lot No. .56. . .. YnAUt11A.k. .RJ P. . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . . . . .April .31975 . pursuant to which Building Permit No. .7 Wiz. dated . . . . . . . . . ..4ril. . 0. . . ., 19.75., 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 . Private .one fam11y. dwelling . . . . . . . ., . . „. .. . . The certificate is issued to . .Ren.Hand ozzA. . . . . .Owner . . . . . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval P.t. . . . . . . UNDERWRITERS CERTIFICATE No. W237.902. . . . . . ..u1Y. . .29. . 1.975. . . . . . . . . . . . . HOUSE NUMBER . . . . . . .349J�. . . Street . . . . . . . . p' Hole Driv® . . . . . . . . . . . Building Inspector z r A� FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. . .z i i.a6 0. . . . , „ . . Date . . . . .December .16 . . . . . . „ . . . . . , 1982. THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . , . . . . Location of Property 39.5 .Deep .$P1.e .D-ive, Mattituck. . . . . . . . . . . . . . . House No. Street Hamlet County Tax Map No. 1000 Section . 118 . . . . . . .Block . . . 16 . . . . . . . . .Lot . . . 18 . . . . . . . . . . . Subdivision .Dep-p .Ho.Le .Creek. . .Filed Asap No. 4256 . . .Lot No. .5.6 . , . conforms substantially to the Application for Building Permit heretofore filed in this office dated Septemher .. 10. . . , 19 82, pursuant to which Building Permit No. 119122. . . . . . . . . . . . . dated September . 1.6. . . . . . . . . . . . . . . 1982. ,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 . . . . . . . . . . . . . c.onstr.uat. deck. additi.an. to. .eXiSAil? g, W94 .ng:. . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . Raymond .and .Cbr� Sit i vl , . . . . . . . . . . . . . . . . . . . . . of the aforesaid building. Suffolk County Department of Bealth Approval . . . ?`?/.?k. . . . . . . . . . . . . . . . .. . . . . . . . . . . , . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . .NIA. . . . . . . . . . . . . r / "Building Inspector Rev. 1/81