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Home My WebLink About1000-126.-2-15.3 TOWN OF SOUTHOLD 40 Rental Permit 0409 Owner Catherine Leidersdorff& Claire Marin Occupied as Single Family Dwelling Located at 9985 Gt. Pec. Bay Blv Laurel 126.-2-15.3 Maximum Permitted Occupancy 8 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. 11/16/2022 } Code E ement 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, Z;!: Rental Inspection .r r NY 11971-1179 d , ,� Tel: 631-765-1802 " ✓ Fax 631-765-9502 ,, , , � / ,�, �// ( % r�I///��%%////r�//��//l//�% ��////�r�D/., // tri i ��,r� /. Phone �� -L 7 / l/%��G/��/ ii%/��f%D%r%irl/%/% Add""" r� %,!,%ll �S G-T" ec 6a Zlp Q4a° //%/�� /// I ". ec �r �� r�✓��iv�r��or,/l y/g, L E 1/E L S f , Smoke Detectors (#- bedroom detectors excluded) Carbon Monoxide Detectors (#) Fire Extinguishers (#) Exits (# BEDROOMS ,,fi, r ;, , , Smoke Detector Alarms (#) Ll Carbon Monoxide Alarms (#) Egress (Windows) (Y/I`' ) BUILDING SYSTEMS CONDITION OF PROPERTY N Heating system maintained/operational Building Interior is clean /maintained Hot water system maintained/operational Building Exterior is clean/maintained Electrical system maintained/operational Property is clean /safe/maintained Mechanical system maintainecaperational Handrails &guards present POOLS N POOL BARRIERS /N Pool present Pool is completely enclosed Pool surface alarm and/or door alarm Barrier is a min. 48" high resent POOL GATES 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. � iri � TOWN OF SOUTHOLD Rental Permit ' a Permit No. 0409 Owner Catherine Leidersdorff& Claire Marin Occupied as Single Family Dwelling Located at 9985 Gt. Pec. Bay Blv Laurel 126-2-15.3 Village Maximum Permitted Occupancy 8 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. 3/24/2021 John Jarski Code Enforcement Officer This Notice must be posted by the main entrance at all times so 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 1 1 J U L 1 2 2019 Section A. Property Information: ,I4 Rental Property Address: �v Tax Map Number: 1000 SECTION Z.. BLOCK 2— LOT S -3 SECTION B. OWNER INFORMATION: Property Owner Name: � Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) , 15� w 13'M C' Sa,� V4 ((yy Telephone Number(s): Property Owner Email Address: C) Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent(no P.O. Boxes): k4k'A Mailing Address of Authorized Agent: Telephone Number(s): V'a YY C'� �.. Gos�na�►et�s @ awie q� ,e, co u.� 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): 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): Mailing Address of Managing Agent: Telephone Number(s): Email Address: Page 2 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." RentalDwelling Unit Identifier: Requested Maximum number of persons allowed to occupy Dwelling Unit 1 ' Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: 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 t ❑ 1 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) COUNT(Y�OF SUFFOLK) QQ I �G�'c1itQX� \.I�7�(l id�,dY _ 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 t9 b fore Te this day of 201 LYDIA COFCHADO Notary Public,State of NQ-w trk. ,, NO.01 C06190981 Official Nota ublic Signature and Original Notary Stamp Qualifiad Cour . p Commission Expires August 4, Page 4 of 4 Town Hall Annex 2, s`te Telephone(631)765-1802 54375 Main Road c� Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 ' 1 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM �w .Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy eac4 dwelling ni Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: a 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: t i 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: ,yam May 2, 2020 a o Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 �J MAY 2 0 2020 BUILDING DEPARTMENT TOWN OF SOUTHOLD 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 Enaineer, licensed Nome inspector must provide copy of valid current certification Rental Property SCTM Number: Rental Property Address-9985 Peconic Bay Blvd., Mattituck NY 11949 Owner/Name; Cathy Leidersdorff Rental Dwelling Unit Identifier: Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom,#1 -100 sq., Bedroom#2-90 sq., etc.)VU vok FOW14 I.Vl Property Description (Include all improvements indicated on survey) 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. \�) a� Victor Cornelius III CEO Inspector Print Name and'fitle._ 1.21 ,.-p � Original Signature Please place'pr®fessional seal: solft, f I1+✓rrt "I0 1,y0 # TOWN OF SOUTHOLD BUILDING DEPT. °`ycourm '' 765-1802 - INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINALb,,M [ ] FIREPLACE & CHIMNEY - - - [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING - 'REMARLai); O` ✓lf= trA Alw os 69 _QC4A-AA 4 �X,04011 DATE 7 INSPECTOR Of so # # TOWN OF SO THOLD BUILDING DEPT. 'rnu►m � 765-1802 INSPECTION- [ ] FOUNDATION IST [ ] ROUGH PLBG. ] FOUNDATION 2ND [ ] INSULATION/CAULKING - [ ] FRAMING/STRAPPINGXFIRE INA [ ] FIREPLACE & CHIMNEY SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE'RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: n 4r/ cir) i � �7.✓ ilk -1-4 �)w i /i r\ A DATE o-A INSPECTOR O�aOF SOUIyo lgss # * TOWN OF S UTHOLD BUILDING DEPT. cnu765-1802 INSPECTION ' [ ] FOUNDATION 1-ST [ ]— ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING [ ] FRAMING /STRAPPING [ ] INAL ^ V�c� [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARK 7 Ayx DATE INSPECTOR ir _-r Jill �1114n ' - - -' J_ wL.,! s � _ I Project: °r- D 51te: Subject: s '` _ -_ ,'"` ":• D je Date: :intact: _ ' v, .'.. v.,_ NUM Del. Proaeci. Date. Subject: ht«'!> ,� 'b= TOWN OF SOUTHOLD PROPERTY-- RECORD CARD OWNER STREET VILLAGE DIST.I SUB. LOT a errn.P L-e; 41 _ FO ER OWNER N E ACR. S W TYPE OF BUILDING RES. SEAS_ VL. ` FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS i t/ �� u .i � '%/� `�r/�y j.r./ �• Qr?,•, �•,',t/ � ,�'iC `tif:i /`11��J7 b�.s-�� I � a✓u o 40 Q ' Z s / i G J 11 00 0T�Afw t a l h&')f V010 '2100 o (coo /Z7 - Lel&r gmo Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH House Plot ,- BULKHEAD Total I �'�� r :�_:. - ■■■■■■■■■■■■�i1■t�1�/olio 1�1In7■■■ f� , .� . . = ■■■■■■■■■■■■■■ ilk■■■■1l■i■■■■■ � - -�� _ ■■■■■■■�ii�■■■i��l■■■■ilii■!a■■■■ mmou r ;� ,: .� � ��: ` ■■■■■■■�I■■■■Q►,��1■■■111■%■®■■■■ - - ■■■■■■■111■■■�i�!■I■■■■/■■■■■■■ - mlt■■■lei■ml■■■■■■■■■■■■■■■■■ f!"■■■■■■mmol■®■■■■■■■■■■■■■ ■■■■t MEMO■■■■■■■■■■■■■■■■■■■■■■■ • i S • r I. , .. fLly'�` ►st �- �t i i _y M. Bldg• = 7/`-7„ Foundation Bath Extension Basement Floors Extension Ext. Walls Interior Finish Extension Fire Place / Heat Porch Pool Attic Deck Patio Rooms 1st Floor I Driveway Rooms 2nd Floor Garage s , O. B. i T FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building inspector Town Hall Southold,N.Y. Certificate Of Occupancy No.211312 . . . . . . . . . . Date . . . . . . November 23, , , , , , , , , , , . 198?. , THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property 9985 Great Peconic Bay Boulevard . .Laurel /o&6 No. Sireei . . . . . . . . . .Namlei County Tax Map No. 1000 Section . . 2.4 . . . . . .Block . .92. . . . . . . . . . .Lot . .Part.of Am minor Marilyn C. Hickey 2 0 Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . .Fitt MBjrNo. ?. . . .Lot No. 2 . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated Apr 31 3 0 10?.pursuant to which Building Permit No. . 1A6 8 0 Z dated . . . May, 20 . . . . . . . • . • . . . _ . . . 19 .$?,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 . . . . . . . . . a.private. . .one-famil.y .dwelling. ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . . . . . . . John W. h Susan H. Fallon • of the aforesaid building. Suffolk County Department of Health Approval 12-S 0-32,�. .1 '!/7 2/8 2 .lt ob t. Ai.. Yl11a P.E. UNDERWRITERS CERTIFICATE NO. . . . . . . . .N 5$Q21 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . oe Building pector Rev.1/61 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z18616 Date DEC. 5, 1989 THIS CERTIFIES that the building POOL Location of Property 9985 PECONIC BAY BLVD LAUREL House No. Street Hamlet County Tax Map No. 1000 Section 126 Block 02 Lot 15.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPT. 14, 1987 pursuant to which Building Permit No. 16466Z dated SEPT_ 25, 1987 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 INGROUND POOL & FENCE. The certificate is issued to JOHN & SUSAN FALLON (owner, ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N848367 DEC. 29, 1987 PLUMBERS CERTIFICATION DATED N/A �L. Bui i.ng Inspector Rev. 1/81 �offfi(t(Cp Town of-Southold �o a 3/24/2021 0 P.O.Box 1179 Go 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41897 Date: 3/24/2021 THIS CERTIFIES that the building ALTERATION J Location of Property: 9985 Great Peconic Bay Blvd.,Laurel SCTM-#: 473889 Sec/Block/Lot: 126.-2-15.3 Subdivision: Filed Map No. Lot No. conforms,substantially to the Application for Building Permit heretofore filed in this office dated 2/22/2021 pursuant to which Building Permit No. 45896 dated 3/9/2021 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"air conditioning and pergola addition to existing single-family dwelling as applied for The certificate is issued-to Leidersdorff,Catherine&Marin,Claire of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45896 3/18/2021 PLUMBERS CERTIFICATION DATED Aut riz gnature S MAY 2 0 2020 �°M' �khPx�ti �i ct `�E� t a �1At,�' OtV1,� 5�1D+cv►�Gc` N` a vcc��er�e_ ��-�,�y o��s�e�r- c�w�e ou�� l�a�e� aft- h� �,►.� v V \ 4 "w oes as 1� oto se °[gq 5 s. °1g1g5 � e owe c� s-e�s� a5 �� 0.�2 so Sc�. \ Vow•�� ,cptl, AoT Sp V1eC&Ag.e, Yee a.�ce �, ��`,[ Hca r 4 • assrjjm 4PON ckc vlo� � e A �,�� ah ct. �o•i� v► �q ON 90-�-Aj I8 o►w cavwe . S,Ac 4-,g �0",►AI was sl � l�owvt v CoJLcQ k V44 r17 o WA kf c P,tn. elIvleev VN o(7e- y l o 65 we 2vv'U Sed� l aw` 15k SoA64 VnSpP,cLrn — � I l WV ,v� l )m , �e� ifs`' 1 STATE OF NEWYORK { Be it known that �( 4\1 f Victor Cornelius I has successfully completed the requirements of a Basic Code Enforcement Training Program established by the Minimum Standards for Code Enforcement Personnel (19 NYCRR Part 1208) in the State of New York as a: j f I Z \� ` CODE ENFORCEMENT OFFICIAL ` 4 Wk t ` f I I NEW YORK STATE . ■ ■ ! ' i DEPAit1'ME[Yl' � � t i John R,Addario,PE,Director OF STATE sand Codes 51'AiVDARD5 AND CODES Division of Building Standard i �l\, , i l' t Certification No.1216-0283 issued Date:December 13,2016 -service training requirements.To maintain this certification,such person must satisfy annual in-service training requirements and advanced m I � I