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Home My WebLink About1000-143.-4-17 TOWN OF SOUTHOLD g Rental Permit Permit No. 0403 Owner Cacioppo Living Trust Occupied as Single Family Dwelling (Front) Located at 495 Riley Avenue Mattituck 143-4-17 Village 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. 3/15/2021 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD Rental Permit Permit No. 0404 Owner Cacioppo Living Trust Occupied as Single Family Dwelling (Rear) Located at 495 Riley Avenue Mattituck 143-4-17 Village Maximum Permitted Occupancy 2 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. 3/15/2021 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times 8�0 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(63 P.O.Box 1179 w7 Southold,NY 11971-0959 JUL 2 5 2019 BUILDING DEPARTMENT TOWN OF SOUTHOLD 1"U'DII)EIT'GlIr rAEP-117, TOW, OF sofif ,RENTAL PERMIT APPLICATION RentalPermit Fee$200 (Application must be renewed every two years) Section A. Property Information: Rental Property Address Tax Map Number: 100dSECTION'. --K ALM -LOT_Iqj SECTION B. OWNER INFORMATION: Property Owner Name:.- Property Owner Legal Address: Property Owner Mailing Address: 7 Telephone Number(s): Daytime jZ/ Evening Emergency. Property Owner Email Address: Page 1 of 5 �g� ► v� ii�4 � : (j'�:sIIUT Town Hall Annex Telephone(631)765-1802 -� 54375 Main Road -' Fax(631)765-9502 P.O:Box 1179 - " Southold,NY 11971-0959 t BUILDING DEPARTMENT TOWN OF SOUTHOLD 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 application. ❑ Floor Plans: Floor plans of each Rental Dwelling Unit, please show location of all smoke &carbon monoxide detectors. ❑ Certificates of Occupancy and Pre-Certificates of Occupancy: Certificates of occupancy or Pre-Certificates of Occupancy for each rental dwelling unit. ❑ 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. ❑ Rental Permit Fee: $200.00 t Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 ZI'Coin l BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. " Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: SWI►► Address of Authorized Agent (no P.O. Boxes):= �im�� Mailing Address of Authorized Agent: _ Telephone Number(s): Daytime 5�4� 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: Address of Managing Agent (no P.O. Boxes): Page 2 of 5 !F i SO 01 Town Hall Annex Telephone(631)765-1802 54375 Main Road CA 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_ ,,Emergency _ _ 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 7e "Rental Permit Application Addendum." Rental Dwelling Unit Identifier: Requested Maximum number of persons allowed occup D 1 Unit. Number of rooms in Rental Dwelling Unit: —- Use and Dimensions of each room in Rental Dwelling t. Page 3 of 5 �l ;z Town Hall Annex 4 Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959`' ' coil 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. ❑ 1 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 W. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFOLK) s I , certify under penalty of perjury,the following: t 1. 1 am the owner of the property identified in "Section A" of this application. .7 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 5 p€� Ir Town Hall Annex Telephone(631)765-1802 54375 Main Road c 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 'F Building Department of any changes of address within five (5) days of any changes 1= f 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. z 4. 1 will notify the Town within five (5) business days as to any change to the information s regarding Authorized Agent, Managing Agent, or Site Manager. ' Property Owner's Name: f ro ` Property Owner's Signature: ' - - - I Sworn to before me thi day of 20 F am Official No y Public Signature a d Original Notary Stamp TRACEY L. DWYER , NOTARY PUBLIC,STATE OF NEW YORK NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2D&�— Page 5 of 5 4 tl 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 ADDENDUM F Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy ach dwellinfCite:'61,-4vL Number of Rooms in Rental Dwelling Unit: S- i A� Use and Dimension of each room: f 8 } t `W Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling it: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: E Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: a Use and Dimension of each room: _ _ E L i° b9 .j s 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 PROPERTY CERTIFICATION Form is to be completed by a license architect, licensed engineer or licensed home inspector r Separate form is required for each individual Rental Dwelling Unit ' Professiondl,seal"required forArchlte t,ar-Engineer,,licensed Hvme,inspector-must provide copy of.validCurrent cert rkcitlon. _ f Rental Property SCTM Number: Rental Property Address: Owner/Name: Rental Dwelling Unit Identifier: Number&Square footage of each bedroom as depicted in the attached floor plan: ` (i.e. Bedroom#1-100sq., Bedroom#2-90sq.,-etcj 4 Property Description (Include all improvements indicated on survey) E i 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. Print Name and Title Original Signature F Please place professional seal: f z; f OE Sohl # =TOWN OF SOUTHOLD BUILDING DEPT. cou765-1602 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] NAL mm, gm, [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)- [ ] CODE VIOLATION [ ] CAULKING REMARKS: n�Mkt., gt �o �04 . 0A � lFriAl �. uj MR/ - r44, . • vV� Ir DATE 8 Y3 INSPECTOR do ,46 (ipTrA 1S,� o RCCA SShPs �. .CA ,s 6 b 9 e � owE ITK .rte � 23' rh •r+iL;p1� - I - r-1 j- TOWN OF SOUTHOLD PROPERTY KC%.VRV %.ARD OWNER TSTREET VILLAGE DISTRICT SUB. LOT j FORMER OWNER N E ACREAGE t t' 1 fji` { : ,� S W TYPE OF BUILDING `-., RES. r D SEAS. VL. FARM COMM. IND. I CB. I MISC. Est. Mkt. Value LAND IMP. TOTAL DATE REMARKS ),. ,ge 3 95 .7 AGE 3lao r •/ BU I C DI .f, '`tbra M :{..�1 ct%F vl L�� ? ��c3..CtL1ct►< - FRONTAGE ON WATER - Farm Acre Value Per Acre Value FRONTAGE ON ROAD Tillable 1 I BULKHEAD Tillable 2 DOCK Tillable 3 Woodland Swampland '�+��' Brushland =' l 6 281 p I t�,,rca o House Plot Total -70Sl' �W 'WOWN OF SOUTHOLD VROPERTY OWNER STREET VILLAGE DISTaICT SUB. SOT FORMER OWNER N E Y,\r--REAGE S W j TYPEOFBUILDING RES. SEAS. VL. FARM comm. IND. CB. misc. 1--- 1 LAND IMP. I TOTAL DATE REMARK AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE Form Acre Value Per Acre Value Tillable I Tillable 2 Tillable 3 jj Wccd[and Swampland Brushlond ---------------- House Plot Tota I i >-. ter""""- �,a�/f• 1 yy 1�11�•: •h A• • i u. :.' i a1 (> 1 a r tp 143-4-17 accessory 2/04 j J fo �Y � Av W Bldg. j Foundation I –�— 7 Extensio " (-• �. Basement I Floors .vti " Extensiona , Ext. WclIs Y. Extension Fire Place Heat 1--- - --- - ------- -- Porch Q Atti —Porch Room�stF Breezeway Patio Rooms 2nd Floor Garage Driveway O. B. r Trr I1 • - � i •rte� '� �� , � .. • - i 1 -F_..��--t-_ i -_-T-��_ _ -, � • e r - r - -- -- - na --7 • 1 a j 143- 4-17 2/04 - I ---� - - M. Bldg. Foundation ��j Bath � xtension -,Xy -�,,. Basement J� ; Floors �t� si.tow� Extension .274 Ext. Walls Uf;,),l Interior Finish _xtensio. 100 Fire Place Heat Porch Roof Type E Porch Rooms 1st FI Z. -----------,- -- - -- - - - 3re f Patio f Rooms 2nd F oor -v3/ 7 Driveway — _ Dormer --- �' e- 5 0, 10 0 stir � - 'I 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-22349 Date MAY 21, 1993 THIS CERTIFIES that the building TWO ONE FAMILY DWELLINGS Location of Property 495 RILEY AVENUE MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 143 Block 4 Lot 17 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-22349 dated MAY 21, 1993 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 TWO ONE FAMILY DWELLINGS'FRONT & REAR YARDS The certificate is issued to ESTATE OF MARY SULLIVAN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. /Plld' g Inspector Rev. 1/81 FRONT HOUSE BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 495 RILEY AVE. MATTITUCK, N.Y. number S street municipality SUBDIVISION MAP NO. LOT (s) NAME OF OWNER (s) ESTATE OF MARY SULLIVAN OCCUPANCY A-1 RES. OWNER (type) (owner—tenant) ADMITTED BY: BERNICE (BOOKMILLER REAL ESTATE) ACCOMPANIED BY- SAME KEY AVAILABLE SUFF. CO. TAX MAP N0. 143-4-17 SOURCE OF REQUEST: ABIGAIL WICKHAM, ATTY DATE:FEB. 12, 1993 DWELLING: TYPE OF CONSTRUCTION WOOD FRAME # STORIES ONE # EXITS 2 FOUNDATION CEMENT BLOCK FOUND CELLAR FULL CRAWL SPACE TOTAL ROOMS: IST FLR. 4 2ND FLR. 3RD FLR. BATHROOM (s) AE TOILET ROOM (s) UTILITY ROOM PORCH TYPE AROUND ENCLOSEIDECK, TYPE PATIO, TYPF� BREEZEWAY FIREPLACE NO GARAGE CAR PORT DOMESTIC HOTWATE S TYPE BEATER LILCO GAS AIRCONDITIONING TYPE HEAT L , WARM AIR XX HOTWATER OTHER: ACCESSORY STRUC S. GARAGE, TYPE OF CONST. STORAGE, TYPE CONST. SWIMMING POOL GUEST, TYPE CONST. OTHER: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION 6 BUILDING CODE LOCATION DESCRIPTION ART. SEC. REMARKS: INSPECTED BY: DATE ON INSPECTION 4/13/93 S 5/19/93 TIME START END REAR JJOUSE.' BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 495 RILEY AVENUE MATTITUCK, NEW YORK number 6 street municipality SUBDIVISION MAP NO. LOT (s) NAME OF OWNER (s) ESTATE OF MARY SULLIVAN OCCUPANCY A-1 RES. OWNER (type) (owner-tenant) ADMITTED BY: BERNICE (BOOKMILLER REAL EST) ACCOMPANIED BY: SAME KEY AVAILABLE SUFF. CO. TAX MAP NO. 143-4-17 SOURCE OF REQUEST: ABIGAIL WICKHAM DATE: FEB. 12, 1993 DWELLING: TYPE OF CONS CTION WOOD FRAME 4 STORIES ONE # EYITS 2 FOUNDATION CEMENT BLOCK CELLAR SMALL AREA CRAWL SPACE %% FOR ZTTETI= TOTAL ROOMS: IST FLR. 4 2ND FLR. - - 3RD FL BATHROOM (s) ONE TOILET ROOM (s) UTILITY ROOM PORCH TYPE DECK, TYPE PATIO, TYPE BREEZEWAY FIREPLACE GARAGE DOMESTIC HOTWATER YES TYPE HEATER ELECTRIC AIRCONDITIONING TYPE HEAT LILCO CENTRAL AIR WARM AIR %% HOTWATER OTHER: ACCESSORY STRUCTURES: r 1 GARAGE, TYPE OF CONST. STORAGE, TYPE CONST. � 1 SWIMMING POOL GUEST, TYPE CONST. OTHER: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION 6 BUILDING CODE LOCATION DESCRIPTION ART. SEC. o ,s REMARKS: INSPECTED BY: - DATE ON INSPECTION 4/13/93 6 5/19/93 G Y ISH TIME START END FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28350 Date: 04/19/02 THIS CERTIFIES that the building ALTERATION Location of Property: 495 RILEY AVE MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 143 Block 4 Lot 17 Subdivision Filed Map No. Lot NO. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 14, 2002 pursuant to which Building Permit No. 28173-Z dated MARCH 14, 2002 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 ALTERATION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ELLEN & VINCENT MCLAUGHLIN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Aut orized S' nature Rev. 1/81 Town of Southold bo OE 3/14/2021 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41888 Date: 3/14/2021 THIS CERTIFIES that the building AS BUILT ALTERATION Location of Property: 495 Riley Ave,Mattituck SCTM#: 473889 Sec/Block/Lot: 143.4-17 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/23/2020 pursuant to which Building Permit No. 45595 dated 12/22/2020 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: "as built"windows,water heater and gas furnace in an existing one family dwelling as applied for (Rear Dwelling) The certificate is issued to Cacioppo Living Trust of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45595 2/24/2021 PLUMBERS CERTIFICATION DATED u ee Signature ;s g�1FfOt,� � Town of Southold 3/14/2021 P.O.Box 1179 53095 Main Rd , off" Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41887 Date: 3/14/2021 THIS CERTIFIES that the building AS BUILT ALTERATION Location of Property: 495 Riley Ave,Mattituck SCTM#: 473889 Sec/Block/Lot: 143.4-17 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/23/2020 pursuant to which Building Permit No. - 45596 dated 12/22/2020 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: "as built" gas furnace and central air conditioning in existing single family dwelling as appiled for (Front Dwelling) The certificate is issued to Cacioppo Living Trust of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45596 2/24/2021 PLUMBERS CERTIFICATION DATED th riz gnature