The URL can be used to link to this page

Home My WebLink About1000-143.-4-12 r O O CD 0 0 0 O 3 (DD 14, CLfi N o CD a) M01 '""" ro" 0 00w .. o � � 3 CD CD- � � r Cao CD o � o X• m � O 3 [n Q (n � H cn 0 CCD rr CD CCD --fa- Q CD C 3 CD O -0 �:$ X K -0 =r CCD (D CSD CD CD z 3 O O � CD r+ ar+ N rw < R0 (D �. -0 77, =QCL D 0CD 3 = macO ¢, v ETON ('1 (D m < 3 . `G CD 0 c0 CD i--� cn CD m O =3 0 n CO N � v v Q =3 CD 0_ cn 0 0 _0 -P.CD c ccnn _ W 0 -0 N O '. 0 0 0 W =$ C) — in' o d 'I'uwn Hall Annex 54315 Main Road � " „u s� Tdephune(16-11)765-1,402 Southold,NY 1 Y.O.BOX 1 171 Ftlx (6;31)765.9502 1 971-0959 � w ,' " BU1LUINC DEPARTMY-WF 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 ) `i 3 BLOCK, SECTION B. OWNER INFORMATION: Property Owner Name: o� `� G q l• -�- Property Owner Legal Address: Property Owner Mailing Address: 5 Telephone Number(s): Daytime_ ,Evenin Property Owner Email Address: CC C 0 ti 1 J i o,rN O --- _ �- n I 1 rye. nt4 Page 1 of 5 Town!hill Annex to 54375 Main Road �; � u � Telephone(631)765-1802 "r�� Fax(631)765-4502 ,u, A °� ( a, P.O.Box 1 179 q ,. Southold.NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any:Z.' Address of Authorized Agent no P.O. Boxes):, -��t ��G�r1G� 0 l g .., ..m.M _.. _._ l-_..m Mailing Address of Authorized Agent: 79 „�' ._�'"��n HC MLLE- ►\ ��-bS �-`l I rJ� _lc,^�v� x°31 C.a'.4- Ddb"�Emergency Telephone Number(s): Daytime_" Evening______ C C-C_0 t : 1 � :>>'1 ,� Email Address: � Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: c Address of Authorized Agent no P.O. Boxes): OL-i Mallin Address of Authorized Agent: L�1rlC�-� nh� Mailing g .__.. . _ . w Telephone Number (s): Daytime Evenin Emergency___ Email Address: C GL.,�> I 1 l 5 ,'1 F% .� p lon I Irye -/ 4- SECTION E. SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units) Name of Managing Agent of dwelling unit, if any: mw�C v c-1 LQ Address of Managing Agent (no P.O. Boxes):, ` c 06vl pc V- L—n o �J �u �)D Il ( I ` Page 2 of 5 Town I htii Annex �� °��F' f"�� Tclvphunu(631)7655-1802 54.375 Main Roetd � � Fax (631)765-9502 Y.O.Box 1 179 Southold,NY 11971-09.59 BIJU nING DFPAR'I TENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: _3Icid .b ( 9SV0o Jap 131 cid t oaa� Telephone Number (s): Daytime Even ingEmergency_... l 1'S YJ 1/� DJ YX1nk Email Address; C.C--(—;:) � _..�.�.,._...,,... _ 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, Q 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." 0,00--, Rental Dwelling Unit Identifiertj . Requested Maximum number of persons allowed to occupy Dwelling Uni ,. Number of rooms in Rental Dwelling Unit: _ _. ... Use and Dimensions of each room in Rental Dwelling Unit: ,, ,µ,,,,.,..,..,_, Page 3 of 5 Town I lull Annex e Ind , r Telephone{631)765-1802 A : 54375 Main Road p �YfFax(631)765-95(12 P,0.Box 1 179 r " Southold.NY 1 1971-0959 �� BUILDING 1'aLiPAR`I'MFNT 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 ) I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold l I arr) 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 ? 11�� !dQ va( � 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 4 Town Hall l Annex r w' '� � Telcphone(631)765-1802 oar rr✓ m�R 54:375 Main Road �� tab✓ � Fax (631)765-9502 P.O.Box 1 179 ►YP� W", Southold,NY 1 1 971-0959 WILDING DEPARWE:N7' 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 (S) 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 m is y of 20 O..ffl'ciI ._ow t,Pn m.. c Signa and�Original Notary Stan�p._. ...._ JOSEPHINE MARTIN NOTARY PUBLIC STATE'OF NEW YORK NO.0 MA6075291 TERM EXPIRES JUNE 3,20_'-2 Page 5 of 5 TOW11 Ikill Annex 54375 Main RuudTelephone(631)765-I802 P.O. Box 1179 r Fax(031)765-9502 SoaMbold,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 ssioncd seal re hired ?rOf or Architect or Rn 0eer lieerrse!LH orae/nstaectc r rt r t r" emy o valid ctrrrerrt cerci ication Rental Property SCTM Number, /2 Rental Property Address: SO Own er/Name: c e r e r Rental Dwelling Unit Identifier: /1/ ,y Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom #1 —100 sq., Bedroom #1-90 sq., etc.) 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. Print Name and Title v a Original Signature 0" , Please place professional seal: j 1� A ro Y � U " �""� e✓,l` YW, a� u� I r Inwrr Iiull Annex 54375 �yW M;rin rtcr;d P.(..).Bo.x 1 179 Tcie phtrn v D i FgPo+ � 1 (63I)7& .4802 SOUthold,NY 11971-U9S�) z i ��w� 1'Qx (63 1)76.5.9,5112 a 6 MAIDING l)EPART1 E-VI.. TOWN OF SOIJTH61,11) RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: Li Requested maximum number ofoccup ersons allowed to p y each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Rental Dwelling Unit Identifier: _ Requested maximum number of persons allowed to occupy each dwelling unit:Number of Rooms in M Rental Dwelling Unit Use and Dimension o each room. Rental Dwelling Unit Identifier: _ Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: 5 Use and Dimension of each room: f4f so 4P t BUILDINGTOWN OF IOUTHOLD co 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] INAL "w �� [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: T-11"X 2-2 1/2"DH E L BATHROOM 2'-41/2'X 2'-9"DH 2-4,1/2,1/2'x 4,-:2,V7 D°-- V-10, °-6°-10"x 6-1r ".. ".. Area:47 5q Ft ' Gelling Height: „y,.. � % m �} BEDROOM #1 0 7✓G'X 12-6' (V Are.:93.7.5 5a Ft r Ceiur.g He'.ght: ry o ® KITCHEN X N Area:170.81 5q Ft Ceiling Height: nl ry X ry N 2068 PKT SF• g ........ � BIS Ink 2068 PK COUNTER cm o so � m CS Ic�y m W N � BEDROOM #2 _ w LIVING ROOM Area:84.51 5q Ft n; X Celling Helght: n �. 11'_6•X 9'8" r.Area:111.47 5q Ft ` Ceiling Haight.: 7-6" W 0 Z + Q Q SITTING ROOM a Are.:154.29 5q Ft d N 3 `$ Ceiling Height: m X Q X 10_4„ u� N � X (3)2'-41/2°X 4'-5"DH (3)2-41/2"X 4'-5"DH cEXISTING FLOOR PLAN � 1711/4�=1°,0v Id" Town of Southold 10/5/2021 53095 Main Rd Southold,New York 11971 PRE EXISTING CERTIFICATE OF OCCUPANCY No: 42393 Date: 10/5/2021 THIS CERTIFIES that the structure(s)located at: 680 E Legion Ave.,Mattituck SCTM#: 473889 Sec/Block/Lot: 143.4-12 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- 42393 dated 10/5/2021 was issued and conforms to all the requriements of the applicable provisions of the law„ The occupancy for which this certificate is issued is: seasonal wood frame siAgLe fatnm e11i _' The certificate is issued to 25 Adams Place Inc (OWNER) of the aforesaid building. P SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. «• A0z ignature BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPOFIT LOCATION: 680 E Legion Ave.,Mattituck SUFF.CO.TAX MAP NO.: 143.-4-12 SUBDIVISION: ._ ................................. NAME OF OWNER(S): 25 Adams Place Inc OCCUPANCY: .. ......... _ .--........... ..._...... ADMITTED BY: SOURCE OF REQUEST: 25 Adams Place Inc -......._..— .w.._ _ DA ........ .2.._.... ATE: 10/5/2021 DWELLING: #STORIES: 1 #EXITS: 2 FOUNDATION: posts CELLAR: CRAWL SPACE: .......... BATHROOM(S): l TOILET ROOM(S): UTILITY ROOM(S): PORCH TYPE: DECK TYPE: PATIO TYPE: BREEZEWAY: _..._...... FIREPLACE: no GARAGE: DOMESTIC HOTWATER: no TYPE HEATER: electric AIR CONDITIONING: __._ .... ......................... TYPE HEAT: WARM AIR: HOT WATER: #BEDROOMS: 2 #KITCHENS: 1 BASEMENT TYPE: OTHER: _.__m _ .......__ .._....__........ .. ..._. ACCESSORY'ST'RUCTURES: GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: SWIMMING POOL: GUEST,TYPE OF CONST: OTHER: _ ............_........ .�._..................................— VIOLATIONS: REMARKS: INSPECTED BY: JOHNJ DATE OF INSPECTION: 6/1/2021 TIME START: 10:47am END: 11:15am FItlt � Town of Southold 10/5/2021 P.O.Box 1179 53095 Main Rd ,� Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42392 Date: 10/5/2021 THIS CERTIFIES that the building AS BUILT ADDITION Location of Property: 680 E Legion Ave.,Mattituck SCTM#: 473889 Sec/Block/Lot: 143.-4-12 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 6/10/2021 pursuant to which Building Permit No. 46834 dated 9/16/2021 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""rear cove ed ra r h replac qL nt windows and I�VAC Jcoqye rsi n from seasonal to year round to an existing single fammjily dwellin as a :,!jcL or The certificate is issued to 25 Adams Place Inc of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 46834 9/29/2021 PLUMBERS CERTIFICATION DATED Au. o iig,natuure FORIVI NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 0 CERTIFICATE OF OCCUPANCY No. . . ... Date a...a..n.._u.a ry, 19 ....... . 19fk ....... THIS CERTIFIES that the building located at ' !.. ............ Map No. ...**.*........... Block No. ....... ........ .Lot 1",fo. ...... ......... conforms substantially to the Application for Building; Permit heretofore filed in this office dated ... ......... 19AP.. pursuant to which Building Permit No. ....... 4.22 dated ...... 19.. was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is PRIVATE ONE FAMILY DWE"ING issuedis ......11.......".............. .. .... ............ This certificate is issued to o.w'ne,x............. .... ............................ .... (owner, lessee or tenant) of the aforesaid building. /Q" �: - Building Inspector