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Home My WebLink About1000-143.-4-27 TOWN OF SOUTHOLD 3 Rental Permit 0273 Owner Cacioppo Living Trust Occupied as Single Family Dwelling Located at 935 Bay Avenue Mattituck 143-4-27 Maximum Permitted Occupancy 4 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. 4/22/2022I�L62�41 "--V Code En ent Official This Notice must be posted by the main entrance at all times SOUTHOLD TOWN Town Hall Annex 54375 Main Road PO Box 1179 Southold, Rental Inspection NY 11971-1179 Tel: 631-765-1802 Fax 631-765-9502 SCTM # Date Owner C cn Ze i phone 3 2-1 J_t5_1 Address S Zip S- Hamlet Inspector. Address visible from street? LEVELS SUBm 1 2 3 Smoke Detectors (#-bedroom detectors excluded) Carbon Monoxide Detectors (#) Fire Extinguishers (#) Exits (#) BEDROOMS 1 2 3 4 5 Smoke Detector Alarms (#) , Carbon Monoxide Alarms Egress (windows) (YIN) BUILDING SYSTEMS CONDITION OF PROPERTY Heating system maintained/operational o° „ Building Interior is clean/maintained (� Hot water system maintained/operational „a , ° uilding Exterior is clean/maintained Electrical system maintained/operational °° Property is clean/safe/maintained Mechanical system maintained/operational r°" Handrails&guards present 1✓ POOLS Y/N POOL 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 proof when unattended COMMENTS: TT TOWN OF SOUTHOLD Rental Permit Permit No. 0273 Owner Cacioppo Living Trust Occupied as Single Family Dwelling Located at 935 Bay Avenue Mattituck 143.4-27 Address Village s/B/L Maximum Permitted Occupancy 4 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. 01/15/2020 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 ! JUL 25 2019 BUILDING DEPARTMENT TOWN OF SOUTHOLD BU-7,31=:DEPT, RENTAL PERMIT APPLICATION. T?3�!s,`-oy sOurjjr Rental Permit Fee$200(Application must be renewed every two years) F: Section A. Property Information: Rental Property Address: Tax Tax Map Number: 1000 SECTION.. -B,L'OK � ,L :LOT, B. SECTION B. OWNER INFORMATION: -- --- - - - --------- --- --- ------ ---- ---- -- - -- - - - - - - - - - Property Owner Name: , �� Property Owner Legal Address: Property Owner Mailing Address: ory 111 Telephone Number(s): Daytime, Evening. Emergency, Property Owner Email Address: ,� / m��•®!�' _ Page 1 of 5 bull. so Town Hall Annex Telephone(631)765-1802 54375 Main_ Road ; N Fax(631)765,9502 i P.O.Boz 1179 <' Southold;NY`11971-0959 t UNTy . BUILDING DEPARTMENT _ __ TOWN OF SOUTHOLD � •x RENTAL PERMIT APPLICATION INSTRUCTIONS Rental Permit Fee $200 (Application must be renewed every two years) The items listed below are required to be submitted with the completed y. application. ❑ Floor Plans: Floorplans of each Rental Dwelling Unit, please show location of all smoke&carbon monoxide detectors. +�4 ❑ Certificates of Occupancy and Pre-Certificates of Occupancy: Certificates of 1n occupancy or Pre-Certificates of Occupancy.for_each rental dwelling unit. t ❑ Certification of Code Compliance(form enclosed): Must be submitted by a license architect or engineer or license home inspector if an inspection by Town of Southold Inspector is declined. d' ❑ Rental Permit Fee: $200.00 5�x Yd 4 �5• ., _ ._ _ ... ...-._- •_"-'___ a ., m ,. ..,..,,w. ..,.. k. ..._ a..m. ,rte, -.,.... ,,,,,. ,-«,...�. a4 si Town Hall Annex r, Telephone(631)765-1802 .54375 Main Road Fax(631)765-9502 CA P.O.Box 1 179 G Southold,NY 11971-0959 "°( ' ' 11ou r BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent:. Telephone Number(s): Daytime,- -... -.. -Evening Emergency. . Email Address: r� 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, l; f Unit 1, Unit 2, Unit 3 or Apt A, B, C);the use of each room in the Rental Dwelling Unit t� (for example, Kitchen, Bedroom 1, Bedroom 2, Living Room) and the dimensions of each i -- - room.----- ---- - -- - - - - For properties with multiple Rental Dwelling Units use "Rental Permit Application ,f • Addendum." , Rental Dwelling Unit Identifier: Requested Maximum number of persons allowed to occupy Dwelling Un', . Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: . n L IIX f Page 3 of 5 i� p Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 IY 1�S BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent (no P.O. Boxes): �Z, Mailing Address of Authorized Agent: Telephone Number(s): Daytime _ Evening Emergenc-�y - F 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 oxes):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) t Name of Managing Agent of dwelling unit, if any: Address of Managing Agent (no P.O. Boxes);. .2 Page 2 of 5 } Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)76.5-9502 P.O.Box 1 179 Southold,NY 11971-0959 ``; BUILDING DEPARTMENT 'M 'TOWN OF SOLITHOLD SECTION G. INSPECTION: 1 Pursuant to the Town Code of the Town of Southold Chapter 207 (Rental Properties), a safety 3: 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 ae 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. 4. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. :y STATE OF NEW YORK) ), 3S. COUNTY OF SUFFOLK) s 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 Y �e Page 4 of 5 V-30 T Telephone(631 Town Hall Annex P )765-1802 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 ;e 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 Owner's Name: Property Owner's Signature: - - - ' Sworn to before me th' S day of SLA U 20 I q Official N ary Public Signature qd Original Notary Stamp TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2DJ9,— Page 5 of 5 = Ky .. ... .....„„„....w............ .......�..............,.......m.»....... ............-�,-.-,...........,.........................�««..«.a,.0«u... �....,.,..aa.,..<,....w,«��...«...,... ., ur..r.-<vx .a-.s.m vwxia..w`n. .,a ` fjf souryolo # # TOWN OF SOUTHOLD BUILDING DEPT. co 765-1602 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] INAeN0rr�'� A*v� [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY Y INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING KS: paq II miJ� �►l�ov� VA DATE Y? INSPECTOR I 50Ulyo� TOWN OF. SOUTHOLD BUILDING ~DEPT. cou765-1802 SST ,X •� INSPECTION', ] FOUNDATION 1ST _ [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION FRAMING /STRAPPING [ ] INAL L 8 n{. FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION r. . [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) CODE VIOLATION [ ] CAULKING - ROMARKS: o O 6U Awl (q o !� �✓ z¢� �y t, . DATE INSPECTOR �s P� C> > > -7/ as) ao i3 _ TOWN OF SOUTHOLD PROPERTY %00%KD ER � /_ STREET VILLAGE _ DISTRICT SUB. LOT FORMER O NER N E ACREAGE r . js S W TYPE OF BUILDING RES. SEAS, VL. FARM COMM. I IND. I CB. ( MISC. I Est. Mkt. Value LAND IMP. TOTAL DATE REMARKS L/78 k 111cl C'• �a s �, t a fi< <�n�./c S a 9r -+ - a �.- a ° _ o o s•�/7 9 7�5� 1' 343 F�eCEF�es G.�;ar�GC� C�� 3 , / 7�aLo ,3'o-�> �{a o-"v �`'�•. •, ��3,�/q� /s— � /,�i Y/L � � �� l:7 IZ" PPCI OL NEW NORMAL BELOW ABOVE FRONTAGE ON WATER Form Acre Value Per Acre Value FRONTAGE ON ROAD f X � -�-�, 9 0, u 9 Tillable 1 BULKHEAD Tillable 2 DOCK Tillable 3 Woodland Swampland Brushland House Plot Total =--=----- � - _--- �'• I u�-ter 3 r -�}-�-� - - - ` c I � I��1�l1111 �, i f C ti'M�xK t. `---.�. 't S. -----*-- -�---'-;'- -. _-i--� -r---- -.- -----t-t-- - I j�$f��j `,,,....,✓� r TT- 41 L'y { — 1 i 143.-4-27 03/2016 '2– ! f �— 0. Bldg. ,' 1 + p0 171; Foundation r Both � i = :xtension Basement Floors :xtension Ext. Walls Uih ; LAf Interior Finish :xtension !> * 't Fire Place ' Heat F 1 Porch Roof Type G Porch Rooms 1st Floor 3reezeway Patio Rooms 2nd Floor ;arode rivewoy Dormer �. B. ; - - 90 � i o oQ M 7f•y g�gFO Town of Southold 8/11/2015 53095 Main Rd N Southold,New York 11971 d- 0 PRE EXISTING CERTIFICATE OF OCCUPANCY No: 37707 Date: 8/11/2015 TFIIS CERTIFIES that the structure(s)located at: 935 Bay Ave,Mattituck SCTM#: 473889 Sec/Block/Lot: 143.4-27 Subdivision: Filed Map No. Lot No. conforms substantially to the requirements for a built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 37707 dated 8/11/2015 was issued and conforms to all the requriements of the applicable provisions of the law. The occupancy for which this certificate is issued is: wood frame one family dwelling with attic, covered front porch, side enclosed porch and brick patio.* NOTE:BP 14784 chimney with wood stove COZ-17690;BP 15348 accessm garage COZ-17691; BP 18820 accessory 18820 accessory storage shed COZ-18970shed COZ-18970. The certificate is issued to Jackson,Barbara (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. Autho Sign ture BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 935 Bay Ave,Mattituck SUFE.CO.TAX MAP NO.: 143.-4-27 SUBDIVISION: NAME OF OWNER(S): Jackson,Barbara OCCUPANCY: ADMITTED BY: Barbara Jackson SOURCE OF REQUEST: Jackson,Barbara DATE: 8/11/2015 DWELLING: #STORIES: 1 #EXITS: 2 FOUNDATION: Cement Block CELLAR: 3/4 CRAWL SPACE: 1/4 BATHROOM(S): I TOILET ROOM(S): UTILITY ROOM(S): PORCH TYPE: cov front/side enc DECK TYPE: PATIO TYPE: Brick BREEZEWAY: FIREPLACE: GARAGE: DOMESTIC HOTWATER: Yes TYPE HEATER: Nat.Grid Gas AIR CONDITIONING: TYPE HEAT: Oil WARM AIR: HOT WATER: X #BEDROOMS: 2 #KITCHENS: 1 BASEMENT TYPE: Unfinished OTHER: ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: SWE14MING POOL: GUEST,TYPE OF CONST: OTHER: VIOLATIONS: REMARKS: INSPECTED BY: A GARYF DATE OF INSPECTION: 8/10/2015 TIME START: END: FOP14 NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17690 Date JAN. 18, 1989 THIS CERTIFIES that the building WOOD STOVE WITH CHIMNEY Location of Property 935 BAY AVENUE MATTITUCK House No. Street Hamlet County Tax Map No. 1000 Section I43 Block 04 Lot 27 Subdivision GEO. H. RILEY Filed Map No. Lot No. 02 conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 16, 1986 pursuant to which Building Permit No. 14784Z dated APRIL 25, 1986 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 CONSTRUCT CHIMNEY WITH WOOD STOVE CONNECTION. The certificate is issued to HARRY AND BARBARA JACKSON (owner, ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N[A__ PLUMBERS CERTIFICATION DATED N/A Building Ins ector 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 217691 Date JANUARY 18, 1989 THIS CERTIFIES that the building ACCESSORY Location of Property 935 BAY AVENUE MATTITUCK House No. Street Hamlet County Tax Map No. 1000 Section 143 Block 04 Lot 27 Subdivision GEO. H_ RILEY Filed Map No. Lot No. @ conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPT. 24, 1986 pursuant to which Building Permit No. 153482 dated SEPT. 27, 1986 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 ACCESSORY GARAGE. The certificate is issued to HARRY & BARBARA JACKSON (owner, xxxxxxxxxKxxxxxx) 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 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 218970 Date APRIL 16, 1990 THIS CERTIFIES that the building ACCESSORY Location of Property, 935 BAY AVE. MATTITUCK House No. Street Hamlet County Tax Map No. 1000 Section 143 Block 004 Lot 027 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEB. 15, 1990 pursuant to which Building Permit No. 188202 dated FEB. 26, 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 ACCESSORY STORAGE SHED. The certificate is issued to HARRY G. & BARBARA L. JACKSON (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A • � A Building Inspector Rev. 1/81