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HomeMy WebLinkAbout1000-121.-3-5.2 i TOWN OF SOUTHOLD Rental Permit ® Permit No. 0142 Owner William Sokol & Jody West Occupied as Single Family Dwelling Located at 4250 Sound Avenue Mattituck 121-3-5.2 Village S/B/L 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. 8/5/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times 80 Town Hall Annex ,}: = Telephone(631)765-1802 54375 Main Road con Fax(631)765-9502 P.O.Box 1179 , " Southold,NY 11971-0959 tea? BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every t` o_'ears. ? JUL 2 5 2019 �" r Section A. Property Information: B ITT ,1)"E',G DE4F" Rental Property Address: IA250 501MA Tax Map Number: 1000 SECTION Z I BLOCK 3 LOT SECTION B. OWNER INFORMATION: Property Owner Name: vJ���;aM S o o ar A J ody\est Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) q- j j8 6 �ye nye F--- 5an�e ��ace55 Aot 5- S Loriq 1 Ia✓ta (;+y F 01 11109 Telephone Number (s): 11-7 - 6 ` 1 - 2853 a✓1l 1 1 7- 5 8 3 - 409 5 Property Owner Email Address: �ijj, GADo @_Jb j,� .CoM a.n �v���SA��A R'`.CaM � o Page 1 of 4 `'� ✓ Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: A 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: q 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: r1 1 A Address of Managing Agent (no P.O. Boxes): Mailing Address of Managing Agent: Telephone Number(s): Email Address: Page 2 of 4 Y SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: one 6USe - y »ec�roonn� 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: A CC Requested Maximum number of persons allowed to occupy Dwelling Un! : X 3 Number of rooms in Rental Dwelling Unit: 4 beAOQe 2,5 b reo c e Use and Dimensions of each room in Rental Dwelling Unit: To+-ql ; �$p� � n, RoDK5 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 f�' 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(LSUFFOLK) 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: I L Property Owner's Signature: Sworn to before me this oay of . 20// Official Notary Public Signature and Original Notary Stamp FRANCIS SHERIDAN NOTARY PUBLIC-STATE OF NEW YORK Page 4 of 4 No 01 SH6352366 Qualified In Queens County My Commission Expires 12:27-2gag i �.��1% SoU�y®l4 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 G $O Southold,NY 11971-0959 �® BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: 0'I r, Requested maximum number of persons allowed to occupy each dwelling unit: �M6'X Number of Rooms in Rental Dwelling Unit:! iooms� 2,5 �o&fyoorns . 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: 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 Hall Annex rrOW�_ Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 ' Southold,NY 11971-0959 . BUILDING DEPARTMENT TOWN OF SOjUTHOLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a license architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Professional seal required for Architect or Engineer,licensed Home,lnspectormust provide copy ofvalld current certIicatfon- Rental Property SCTM Number: ®1 D®® - t?`1 ^03 — Rental Property Address: (47-5'8 SO-vND Ayf"VC nM?'Tervch Owner/Name: '3®A� w�.3li fi I.✓ILI.l�r1 S®h®A.. Rental Dwelling Unit Identifier: Number&Square footage of each bedroom as depicted in the attached floor plan: (Le. Bedroom#1-100 sq.,,p4droom#2-90 sq., etc.) st 'I (315'g Nth rL% 11O',Saggkoom *-L - 107 S Q'R r0XV®� � 5_- SQ , Wr Property Description (Include all improvements indicated on survey) ; 51VGLF ' fCAnoLY ,pu0ELL111164 Pelf- 6mjr##/G Co 26940 Na VM141 STA-.TC0&r S. '� Co�ctirJ� �pof�cF{. I certify that I have done a physical inspection of the subject rental dwelling unit and find that it fully complies with all the provisions of the Code of the Town of Southold,the Residential Code of New York State,the Building Code of New York State,the Plumbing Code of New York State, the Fuel Gas Code of New York State, and the Energy Conservation Construction Code of New York State. �or4 s 0'V L-WA P Print Name and Title 4�of RAN, Y� Original Signature Please place professional se �o 0946 'b ` � s SOVIA �pF SOUTH # TOWN OF SOUTHOLD BUILDING DEPT. `yco 765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING/STRAPPING [ ] F NAL xwrW Gwliq [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: aoK A- ro s Ix .GL DATE INSPECTOR 7/ 19119 SCTM # A�i Fx�o—�;- /,7-), - �-,5-,= TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET VILLAGE DIST SUB LOT v -f;jnc� A r, ACR. / REMARKS 7 ✓Ql?r.(c✓ (!fOU/T, Z- ( UCS / 3 /7 —Z,/a 9 91-3— ac;7Uva Sri vi YEAS -4o- LLC TYPE OF BLD. �j PROP. CLASS Oto �,59' 5ok LAND IMP. TOTAL DATE r IK 00 W co 5 7 00 / i FRONTAGE ON WATER HOUSE/LOT BULKHEAD TOTAL 7/ 19 TOWN OF SOUTHOLD M&OPERTY RECORD CARD C OWNE�V,-& EET VILLAGE DIST.1 _,Stfg-. LOT mJ'ST 7 H) FOR_MER OV)NER 1 E ACR. j /,!;� TYPE OF BUILDING 15 ZP45L) -e s RES. SEAS. VL. FARM C6.' MICS. Mkt, Value LAND IMP. TOTAL DATE REMARKS z Z-�,a L) v 00 0 v M2,71 7-L T U',-, J) 60 1/); z> elfi-) "A 'd-1 1 6 7 L 113t 7- Mr)Ck'W GT'J�D F)�_) "S�1' n �2. lZIC) /z,3/? /10 1A.1.4 1 _4 5,000 0 AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE —�ARM Acre Value Per volue Acre A Tillable NTA4,GN WATER FRO Woodlcnd FRONTAGE ON ROAD 00, Meadowland DEPTH House Plot BULKHEAD Total I/DOCK 1 ■■■���■■■'■11■ 1 Ell111 ■SEEN E■■ - ■■ ■M■ ■■ ■■■ ■ ■■■ Mi■■ I■■C. ■■■■■■■■■■■■■■■ M ■■ =121MM■■■■MM■■M■■ ■ ■MIME■ 0 ■■MMS■M■■■M■■M■M■■� M■■■ 0 MINI■■■■■ ■ NONE MEMO■ - :. - ■■■ ■N■■s■■■■■■■■■Hs■■■■■■■■� ■■■■ ■IKEENE81110 Sum.�t■��� . milli MN S■:�1 MEMO 110//0 •. E ■ ■ IMMINIMMINME 0 RISEN 0 M 101WIMMEMI&MRAM NUNN MWAIMMOSEN&WE MEMO ME Foundation :. © IBasement • . Ext. Wall -•��� Interior ►• Fire Place 01 Type •.. • Rccreation Room Rooms 2nd Floo --� • D.rmer ' Drivewcye ' • �� } �t �y m N -_ \ }. s w �•i.°_ .� ter.. - �►.z �`i .est-.-'��.1i-_.t-.act��-.,:.r_'�+'� ._. , 121.-3-5.2 4/11 121.-3-5.2 03/30/2018 cr Number List of Drawings A-01 EXISTING BASEMENT FLOOR PLAN A-02 EXISTING FIRST FLOOR PLAN&PLUMBING RISER A-03 EXISTING SECOND FLOOR PLAN E-01 EXISTING BASEMENT ELECTRICAL PLAN E-02 EXISTING FIRST FLOOR ELECTRICAL PLAN E-03 EXISTING SECOND FLOOR ELECTRICAL PLAN 0 z 0 (f) (J) I-- --- _ _ _ - - - - - -- - - _� - - -- - ---- __- _ -- -- _J, EXISTING LOT COVERAGE CALCULATIONS w 7, Lu 7- BASEMENT UNFINISHED AREA 922 SQ.FT. EXISTING P.C. FOUNDATION WALL 0 1 ST FLOOR EXISTING HEATED AREA 903 SQ,FT. IfX15TING ---- 0 ELECTRICAL 1ST FLOOR COVERED PORCH AREA 425.30 SQ.FT. C; PANEL Cn 0 L[ 2ND FLOOR EXISTING HEATED AREA 723 SQ.FT. CL LL: T- x FJ UNfIN15HED Q DA5EMENT PLUMBER GER. 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The occupancy for which this certificate is issued is: "as built"window replacements and second floor alterations to an existing one family dwellingas s applied for. The certificate is issued to 87 Sandy Court LLC of the aforesaid building. SUFFOLK COUNT'DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTMCATE NO. 41978 10/4/2017 PLUMBERS CERTIMCATION DATED 10/3/2017 drian K,ppick Oro ature ---- ------- -- 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- 26940 Date: 02/23/00 THIS CERTIFIES that the building DWELLING Location of Property 4250 SOUND AVE MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 121 Block 0003 Lot 005.002 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- 26940 dated FEBRUARY 23, 2000 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 EUGENE F & JULIANA DAVISON (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. PENDING 02/14/00 PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. //1uth&ized Signature Rev. 1/81 BUILDING DEPARTMENT - t TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 4250 SOUND AVE MATTITUCK SUBDIVISION: MAP NO LOT (S) NAME OF OWNER (S) : EUQENE F & JULIANA DAVISON OCCUPANCY: RESTD NT A . EUGENE F & JULIANA DAVISON ADMITTED BY: EUGENE DAVISON ACCOMPANIED BY: SA14E KEY AVAILABLE: SUFF CO. TAX MAP NO. : 121.-3-5.2 SOURCE OF REQUEST: HENRY S. SAXTEIN. ATTX211/00 DATE: 02/23/00 DWELLING: TYPE OF CONSTRUCTION: WOOD FRAME # STORIES: 2.0 # EXITS• 5 FOUNDATION• POURED CONCRETE CELLAR: FULL CRAWL SPACE: TOTAL ROOMS: IST FLR. . i 2ND FLR.: _A 3RD FLR • -9- BATHROOM(S) : _110 TOILET ROOM(S) : 1.0 UTILITY ROOM(S) : PORCH TYPE: 1 SCREEN, 1 COVERED ONLY DECK TYPE: PATIO TYPE: BREEZEWAY: FIREPLACE: ONE GARAGE: DOMESTIC HOTWATER: YES TYPE HEATER: OIL AIRCONDITIONING: TYPE HEAT: OIL WARM AIR: HOTWATER: XX OTHER: PAY OFF THE KITCHEN ACCESSORY GTRUCTMS: GARAGE, TYPE OF CONST. : STORAGE, TYPE CONST.: SWIMMING POOL: GUEST, TYPE CONST. - OTHER: VIOLATIONS: CHAPTER 45 N.X. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION ' DESCRIPTION ' ART SEC, I I I I I � I I I I I 1 1 1 I I I I I ' I I I I i i I � i 1 I I 1 I i I I I 1 I I 1 I I I I 1 j I I ' I I 1 I I I I I I REMARKS: H #46942-COZ4147 (ADD) BP#7139Z&7140Z-COZ-6381 (ACCY AGR. BLDG.) INSPECTED BY: ` DATE ON INSPECTION: Q2111/00 GARY J. PIS TIME START: 9:40 AM END: 10:00 AM