HomeMy WebLinkAbout1000-59.-3-35 � m TOWN OF SOUTHOLD
` Rental Permit
0560
Owner Dietl GR Revoc Trust
Occupied as Single Family Dwelling
Located at 560 Kenneys Road Southold 59-3-35
Maximum Permitted Occupancy 9
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.
11/15/2021
oc Uforcr� � (ficial
This Notice must be posted by the main entrance at all times
Town Hall Annex °�" Telephone(631)765-1802
54375 Main Road �� a ;` Fax(631)765-9502
P.O.Box 1179 �",^ y , N c ,
pro " a ( 1
Southold,NY 11971-0959
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
1131 Vw" a
RENTAL PERMIT APPLICATION
Rental Permit Fee $200(Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
560 Kenneys Road, Southold, NY 11971
Tax Map Number: 1000 SECTION 59 -BLOCK 3 -LOT 35
SECTION B.
OWNER INFORMATION:
Property Owner Name: Gregory Ronald Dietl for the Gregory Ronald Dietl Revocable Trust
Property Owner Legal Address: Property Owner Mailing Address:
620 W 42nd Street, Apt 21A 620 W 42nd Street A t 2IA
New York„ ' Y 10036 New York, NY 10036
Telephone Number(s): Daytime 917-580-2861 Evening 917-580-2861 Emergency 917-580-2861
Property Owner Email Address: gregdietl@gmail.com
Maw �5)3
Pagel of S
Town Hall Annex Telephone(631)765-1802
54375 Main Road �i Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any: NA
Address of Authorized Agent (no P.O. 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: NA
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: NA
Address of Managing Agent (no P.O. Boxes):..
Page 2 of 5
W
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Town Hall Annex ° �` Telephone(631)765-1802
54375 Main Roado Fax(631)765-9502
P.O.Box 1179 as `
u
Southold,NY 11971-0959 �^ g
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent:
Telephone Number(s): Daytime Evenin Emergency _, ,, _
Email Address:.
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on property: Onefl)
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: 560 Kenne Road
Requested Maximum number of persons allowed to occupy Dwelling Unit: Aven (1 1)
Number of rooms in Rental Dwelling Unit:'
Use and Dimensions of each room in Rental Dwelling Unit: Kitchen-12'x 12'-6"
Dining Room-12'x 15'-8" Bathroom 1 -5'x 10' Bedroom 1 -13'x 13'-4"
Family Room-23'-6"x 12'-6" Bathroom 2-5'x 8'-10" Bedroom 2-13'x 12'-6"
Living Room-13'x 15'-8" Master Bathroom-10'-10"x 10'-10" Bedroom 3-10'-4"x 12'-6"
Master Bedroom-12'x 15'-8"
Page 3 of 5
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Town Hall Annex Telephone(631)765-1802
54375 Main Road ,� a`�� Fax(631)765-9502
�a.
P.O.Box 1179
Southold,NY 11971-0959
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 Gregory Ronald Dietl 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
Page 4 of 5
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 SOl[TTHOLD
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: Gregory RonaldDietl
Property Owner's Signature:
P Y
Wbere day of 20�gnature and Original Notary Stamp
ANA FEBO-FIGUEROA
Notary Public-State of New York
No. 01FE6332557
Qualified In Bronx ou y
My Commission Expires z�
Page 5 of 5
r^ ° Sept. 14, 2020
Town Hall Annex "dna 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 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 seat re uired fpr Architect or i rl irxeerlicensed'Home Inspector must rcwvl 'e
copy of valid current cent. atign
Rental Property SCTM Number:
Rental Property Address: 560 Kenne s Rd., Southold NY
Owner/Name: Greqory Dietl
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.)
Bedroom #1 1 QQ SO Bedroom #4 120sciff
Bedroom #2 185 sqft Bedroom #3 160 s ft
Property Description (Include all improvements indicated on survey)
5ingle family home
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.
s
Victor Cornelius III CEO Inspector e1j,
I CL-
Print Name and Title ceo# 1216-0283 Original Signature
Please place professional seal:
"Q
i
Telephone(631)765-1802
Town Hall Annex
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION ADDENDUM
Rental Dwelling Unit Identifier:
Requested maximum number of persons allowed to occupy each elling unit:
Number of Rooms in Rental Dwelling Unit:
Use and Dimension of each room:
Rental Dwelling Unit Identifier:
Requested maximum number of persons lowed to occupy each dwelling unit:
Number of Rooms in Rental Dwelling U it:
Use and Dimension of each room:
.....
Rental Dwelling UYin
ientifier:
Requested maximnumber of persons allowed to occupy each dwelling unit:
Number of RoofRental Dwelling Unit:
Use and Dimen ion of each room:
-------------f
_. .. _..._..._. ..........._........ ._.... _.
o Ke 1h ,-, pr'18, ;,VA(j,
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] INAL P044-11�/-O-VO4 I+-
[ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:
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FORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-32824 Date: 01/07/08
THIS CERTIFIES that the building NEW DWELLING
Location of Property: 560 MNAS RD SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 59 Bloc[ 3 Lot 35
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 12, 2007 pursuant to Which
Building Permit No. 32809-Z dated MARCH 15, 2007
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 SINGLE FAMILY DWELLING WITH ATTACHED 2 CAR' GARAGE & COVERED FRONT
PORCH AS APPLIED FOR.
The certificate is issued to THOMAS FISCHCER
of the aforesaid building. (OWNER)
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL RIO-04-0130 11/21/07
ELECTRICAL CERTIFICATE No- 117687C 11/16/0
MUMMS CERTIFICATION DATED 01/03/08 V&V PLYING & HEATING
Auth razed signature
Rev. 1/81
Town of Southold Annex 8/13/2013
P.O.Box 1179
54375 Main Road
Southold,New York 11971
0I
CERTIFICATE OF OCCUPANCY
No: 36441 Date: 8/13/2013
THIS CERTIFIES that the building DECK
Location of Property: 560 Kenneys Rd, Southold,
SCTM#: 473889 Sec/BlocklLot: 59.-3-35
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this of6iced dated
7/13/2012 pursuant to which Building Permit No. 37401 dated 7/27/2012
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:
deck addition to nisting one family.dwellinglLgp
plied for.
The certificate is issued to Schultz,Thomas&Schultz,Karleen
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
A ir:at re
BARGAIN AND SALE DEED WITH COVENANT AGAINST GRANTOR'S
ACTS(INDIVIDUAL OR CORPORATION)
STANDARD N"TU FORM 5007
CAUTION:THIS AGREEMENT SHOULD BE PREPARED BY AN ATTORNEY AND REVIEWED BY ATTORNEYS FOR SELLER AND
PURCHASER BEFORE SIGNING.
\Z
THIS INDENTURE,made the Z� day of l 2020
between
THOMAS H.SCHULTZ and KARLEEN M.SCHULTZ,his wife,
residing at 560 Kenneys Road,Southold,NY 11971
party of the first part,and
GREGORY RONALD DIETL,as Trustee of the Gregory Ronald Dietl Revocable Trust
residing at 620 West 42ed Street,Apt 21A,New York NY 10036
party of the second part,
WI7NESSETII,that the party of the first part,in consideration of Ten Dollars and other lawful
consideration,lawful money of the United States,paid by the party of the second part,does hereby grant and
release unto the party of the second part,the heirs or successors and assigns of the party of tile second part
forever,
ALL that certain plot,piece or parcel of land,with the buildings and improvements thereon erected,
situate,lying and being at Southold,`1"own of Southold,County of SutTolk and State of New Yorh,.
SEE SCHEDULE`A'ATTACHED HERETO AND MADE A PART HEREOF
Being and intended to be the same premises conveyed to the party of the first part by deed in Liber 12603 page
301.
TOGETHER with all right,title and interest»if any,of the party of the first part in and to any streets and roads
abutting the above described premises to the center lines thereof;
TOGETHER with the appurtenances and all the estate and rights of the party of the fust part in and to
said premises,
TO HAVE AND TO HOLD the premises herein granted unto the party of the second part,the heirs or
successors and assigns of the party of the second part forever.
AND the party of the first part,covenants that the patty of the first part has not done or suffered anything
whereby the said premises have been encumbered in any way whatever,except as aforesaid..
AND the party of the first part,in compliance with Section 13 of the Lien Law.,covenants that the party of
the first part will receive tite consideration for this conveyance and will hold the right to receive such
consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will
apply the same,first to the payment of the cost of the improvement before using any part of the total of the same
for any other purpose,
The word"party"shall be construed as if it read"parties"whenever the sense of this indenture so
requires.
IN WITNESS WHEREOF,the party of the fust part has duly executed this deed the day and year first
above written.
i'HOMAS SCHULTZ
EN M.SCTZ
NYSBA Residential Real Estate Forms on HotDocs°(9100) Copyright CapsoftO Development
-1-
d
STATE OF NEW YORK )
ss.:
COUNTY OF 401 (�,_ )
Ort the T' day of IJ t. ,in the year 2020,before me the undersigned personally appeared
Thowas l3. chintz and Kar ecn M.Schultz,personally knownto me or proved to cote on the basis of
satisfactory evidence to be the individuals whose re nes are subscribed to the within instrument and
acknowledged to me that they executed the same in their capacity,that by their signature on the instrument,the
individual,or the person upon behalf of which the individual acted,executed the instrument.
NOTARY PUBLIC
vperof A t taufoa�.lc
*Wy twdlo.Stato of New Yak
W
at
DEED
Section 069.00
Block 03.00
SCHULTZ Lot 035.000
To County or Town SUFFOLK
DIETL
Return By-Mail To:
Chrysa Pasqualone,Esq.
35 Bank St.
Center Moriches,NY 11934
Resin'v a This S ace For Use 01 ,11l ua Office
NYSBA Residential Real Estate Forms on HotDoce(9100)
.Z Copyright Capsoti®Development •`�+
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Schedule A Description
Revised: 05127/2020
Title Number EA2563-S Page 1
ALL that certain plot, piece or parcel of land,situate, lying and being at Southold,
Town of Southold, County of Suffolk and State of New York, bounded and
described as follows;
BEGINNING at a point on the northeasterly side of Kenney's Road distant
491.05 feet northwesterly from the corner formed by the intersection of the
northeasterly side of Kenney's Road and the northwesterly side of Middle Road,
said point of beginning also being where the division line between the premises
de-scribed'herein and land now or formerly of Sharon F, Fulfrost lntersects the
northeasterly side of Kenney's Road;
RUNNING THENCE from said po€nt of beginning along the northwesterly side of
Kenney's Road, North 41 degrees 57 minutes 50 seconds West,10'7.00 feet to a
point;
THENCE along land now or formerly of Kodros Spyropouios, North 48 degrees
02 minutes 10 seconds East, 352,06 feet to a point;
THENCE along land now or formerly of Suffolk County Water Authority,South 42
degrees 16 minutes 20 seconds East, 107,00 feet to a point;
THENCE along land now or formerly of Sharon F, Fulfrost, South 48 degrees 02
minutes 10 seconds West,352,63 feet to a point on the northeasterly side of
Kenney's Road, the point or place of BEGINNING,
Gregory Dietl
560 Kenney's Road
P.O. Box 1543
Southold, NY 11971
October 9. 2020
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, NY 11971-0959
To Whom It May Concern:
Enclosed, please find my completed rental permit application along with the required documents
including:
1. Floor Plans
2. Certificate of Occupancy
3. Certificate of Code Compliance
4. Rental Permit Fee in form of personal check
Please let me know if anything additional is required. Thank you.
Sincerely,
A ��d
Gregory Dietl
Property Owner