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Home My WebLink About1000-141.-4-23 TOWN OF SOUTHOLD co CP Rental Permit rVV s�� 0482 Owner Manfred & Lydia Marcus Occupied as Single Family Dwelling Located at 570 Pacific Street Mattituck 141-4-23 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. 6/24/2021 ` e E orc met fficial This Notice must be posted by the main entrance at all times f r."�7 Town Hall Annex ,, Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold NY 1'1971=0959 i• .,�r ,?1 `,r APR 2 2 2021 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years) Section A. 'Property Information: Rental Property Address: Tax Map Number: 1000 SECTION.._ a�� BLOtR,0+ LOT.DL3 a®O SECTION B. OWNER INFORMATION: Property Owner Name: �� + C�S- W �G�l�- Property Owner Legal Address: Property Owner Mailing Address: ke✓l� Lvtf= J 964- �e-4+ kve Telephone Number(s): Daytime Evening_ Emergency -403-341A Property Owner Email Address:. 14a �=q L ( c, ma; ► Co. rte...... ., Page 1 of 5 �k Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 it Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: N Address of Authorized Agent (no P.D. Boxes):, Mailing Address of Authorized Agent: Telephone Number(s): Daytime 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 Town.Hall Annex ,+.? Telephone(63.1)765-1802 54375 Main Roan N Fax(631)765-9502 P.O.Box 1179 ; Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: l j Telephone Number (s): Daytime_ Evening Emergency . Email Address: SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property:-- For roperty: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: CcC SSO Requested Maximum number of persons allowed to occupy Dwelling Unit:. Number of rooms in Rental.Dwelling Unit:. 6 0mvdairs o .; Use and Dimensions of each room in Rental Dwelling Unit:; Page 3 of 5 Town Hall Annex Telephone(631)765-1.802 54375 Main Road :St ;, Fax(631)765-9502 P.O.Box 1179 ,t Southold,NY 11971-0959 a foul:ga. 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. I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ I am submitting a completed Town of Southold certification form from a licensed architect or a licensed professional engineer. SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFOLK) I WJAA 4certify 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 Page 4 of 5 Town Hail Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-09.59 out, r BUILDING DEPARTMENT TOWN OF SOUTHOLD 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 as to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager. Property Owner's Name:. _eta R0, 0,u S ol Property Owner's Signature: Sworn to before me this.\� day of. 2rl $.20-Z Official Notary Publicat re and Original Notary Stamp BRYAN JOSEPH DRAGO Notary Public State of New York No.02DR6247742 Qualified in Suffolk County Commission Expires August 29, Page 5 of 5 laf so # # TOWN OF.SOUTHOLD BUILDING DEPT. 765-1802 IN" SPECTION ' [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND-. [ '] INSULATION/CAULKING [ ] FRAMING /STRAPPINGXFIRE INAL i-�'FIREPLACE & CHIMNEY SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O RE KS: &YK V% • t� h e (Al ?h, 0cW DATE ?iOv1 INSPECTOR i trrt r t Smoke and carbon monoxide alarms 'tSNOhF�IAhN SMOFF PIMM SN01116 Gtt0N MONONItI RIPXFI Bedroom 1 — Bedroom 2 Cellar i r = w e, 000 MAL- _ . PIA ry 1 0 1 1 . 10151 1 � `NQQJ I i TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET j VILLAGE DIST. SUB. LOT FORMER OWNER N E ACR. �, a - � - ,. .� � S W TYPE OF BUILDING ' r RES SEAS, VL. FARM COMM, CB. MISC. Mkt. Value LA D IMP. TOTAL i DATE I REMARKS a . J 4 ,.f _. i �,. _ _._- b( a> ,rv+•� y iii f AGE BUILDING CONDITION —��-- L Z- NEW NORMAL � BELOW ABOVE FARM Acre Value Per Value Acre Tillable 1 t �} �� " + i t xt; Tillable 2 Tillable 3 � � --- Woodland Swampland FRONTAGE ON WATER Brushlond FRONTAGE ON ROAD House Plot DEPTH 36 BULKHEAD Total DOCK TOWN OF SOUTHOLD PROPEP, OWNER STREET 5 VILLAGE SUB. LOT MAI ACR. ✓ REMARKS atTYPE OF BLD?o . /D L- Q0 I 7D �24pon;c- ag--4- 4-o toenda - M PROP. CLASS c e- LAND IMP. TOTAL DATE L 1 Cit ,)Zx) 74� 1 3 300 qKOO Z/<70 0 i, �7q FRONTAGE ON WATER TILLABLE FRONTAGE ON ROAD WOODLAND DEPTH MEADOWLAND BULKHEAD H OUSE/LOT TOTAL /,.S" ,�� -. r � -1 t-$ Aft cj r C LOR - -- - --) _ t TRIM - -- - . r -,-1:7-1 J, nni ti A k , 3 , M. Bldg. Foundation Bath �� ` % Dinette Exte Sion �y.. �),Cf- 0 Basement , Floors K. t Extension ---"4�— nxt. Walls 1,,v Interior Finish LR. s Extension' t Fire Place - / � Heats DR. - Type Roof ;, �� ._ Rooms1st Floor _. . BR. � �.. Porch r. f 0 Recreation Room Rooms 2nd Floor FIN. B. Porch Dormer, _ ----- _ - Breezeway ! Driveway r Garage Total 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- 31744 Date: 08/10/06 THIS CERTIFIES that the building DWELLING Location of Property 570 PACIFIC ST MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 141 Block 0004 Lot 023 Subdivision Filed Map No. Lot NO. conforms substantially to the R- rements for a ONE FAMILY DWELLING built prior to APRIL 9, 1.957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 31744 dated AUGUST 10, 2006 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 WITH ACCESSORY GARAGE The certificate is issued to KAREN WENDA (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. A horized Signature Rev. 1/61 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 570 PACIFIC ST MATTITUCK SUBDIVISION: KAP NO.: IAT (S) 648E OF OMIER (S): KAREN WENDA OCCUPANCY: SINGLE FAMILY DWELLING KAREN WENDA ADKITTED BY: ACCCOMANIED BY: KEY AVAILABLE: SUFF. CO. TAY X&P NO.: 141.-4-23 SOURCE OF REQUEST: ABIGAIL WICKHAM, ATTY 8/1/06 DATE: 08110106 DWELLING: TYPE OF CONSTRUCTION: WOOD FRAME # STORXES: 2.0 # EXITS: 2 FOOBMT3105: BRICK CELLAR: PART CRAAL SPACE: TOTAL ROOMS: 1ST FLR.: 5 2ND PLR.: 2 3RD FLR.: 0 BATBROOK(S): 1.0 TOILET ROM(S): 1.0 UTILITY ROOK(S): PORCH TYPE: DECK TYPE- PATIO TYPE: BRM97Jrd►Y: FIREPLACE: NO r•,•RAGE: DOKE.STIC HOTWXTBR: YES TYPE BEATER: AIRCCNDITIoMXG: TYPE HEAT: OIL BURNER HARK AIR: YES HOTpATER, OTHER: SEPARATE HOT WATER HEATER ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST.: WOOD FRAE STORAGE, TYPE CONST.: WOOD FRAME SRIBG4IHG POOL: GUEST, TYPE CONbT.: OTS: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART SEC I I I I I I I I I I I I I I I I I I I I I I I I i I i i f I REKARKS: INSPECTED BY: DATE ON INSPECTION: 08 03 06 GEORGE GILLEN TI20 START: HND: FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z5502 Date . . . . . . . Oct . 4 , 19 73 THIS CERTIFIES that the building located at 570 Pacific St Street Map No. = Block No. sex . Lot No. .= . Mattitmk N+X• conforms substantially to the Application for Building Permit heretofore filed in this office "—.dated sept 25 19 73 pursuant to which Building Permit No. $$$5Z --~dated . . . . . Bagt , 215 , 19,73-, 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 . . Aacaasory ztorage & .tool .shed . . . . . . . . . . . . . . . . . . . The certificate is issued to • -prank Zupa+ncic •k�wner (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ekl.�. . . . . . . UNDFRWRIT1_RS CI;RTIF1CATE No N.R. 110US1. NUMBER 570 Street PSCjfjC at . 1�4 i BLUIdIng lnSI—WdOl