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Home My WebLink About1000-113.-11-13 TOWN OF SOUTHOLD Rental Permit 0577 Owner Rita Schmidt Occupied as Accessory Cottage Located at 4500 Westphalia Road Mattituck 113-11-13 Maximum Permitted Occupancy 3 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. s 1/20/2022 Cod n orc m n Official This Notice must be posted by the main entrance at all times Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 BUILDING DI PARTMENT L9 Z UD TOWN OF SO OLD AUG 3 0a) RENTAL PERMIT APPLICATIONBUILDING, 'HOLD Rental Permit Fee$200(Application must be renewed every two years,) Section A. Property Information: Rental Property Address: H500 We i-io- Rc. aitii-VO Aly. //95'9- Tax 195'9Tax Map Number: 1000 SECTION '173 889 -BLOCK 113 -LOT---i 1 - 13 SECTION B. OWNER INFORMATION: J Property Owner Name: to- sG Mi 01.fi Property Owner Legal Address: Property Owner Mailing Address: l6,0 Westyiew Dr. s8tir G31 - a98 - A1441 65 Telephone Number(s): Daytime Evening A E..: .T Emergency 51 '4"s5 58'y7 Property Owner Email Address: Page 1 of S Town Hall Annex y� Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 ` Southold,NY 11971-0959 BUILDING DEPARTMENT "TOS"OF SO OLD Section C. Authorized Agent Information: "" `'" ` � ' r 'o. , zc.�" Name of Authorized Agent of dwelling unit, if any: WjUim $ahrnl Address of Authorized Agent (no P.O. Boxes): 5*''O 0 - 1 �' " ° 5" Mailing Address of Authorized Agent: —14W4 5 Telephone Number s�Daytiime� � EveningSAHE ...,..�Etrlergenc s 1 - 5 5 314` 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 Emergenty 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(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 � QU 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: I 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." Rental Dwelling Unit Identifier: -500 Q Requested Maximum number of persons allowed to occupy Dwelling U it:11..............................�/ 4 Number of rooms in Rental Dwelling Unit: 5 ' Use and Dimensions of each room in Rental Dwelling Unit: n � n 9'y,r x 7 r4 room = i X 3 Cry_ Lrvina Room = 13'x I rr7ox-r, Roo� earoo,rn = 13 9 X Porn l = 17 Page 3 of 5 s �/'�1 , Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 Y.O.Box 1179 Southold,NY 11971-0959 NV% BUILDING DEPARTMENT TOWN OF SOUTHOlLD 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. X I 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 H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFOLK) POA I SC Vi rn t` certify under penalty of perjury,the following: SON of the 1. 1 am thehowner 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 SO OLD 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. No'T NOT" 3. 1 haveread and received a copy of Chapter 207 of the Code of the Town of Southold and 'V0-" 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: i 0. chmlc " Property Owner's Signature: po•A. Sworn to before me this day of 20 90 LYNDSEY BARKER NOTARY PUBLIC,STATE OF NEW YORK Official Notary Public Signature and-Original otary Stamp No. BA6151 Qualified in Suffolk Co unly Commission Expires November' 7,20 m P Page 5 of 5 q<#DU)eA*kw OTOWN OF SOUTHOLD BUILDING DEPT. 765-11102 - [(- 1'� INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] F L&AC [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: ( ;4600 3 ) 4500 Wes bol i OIL G L . 7 A iia � 0 R 404 3 40 _ H F 9 R 55 r N 17q,� A LRJC ,7, ,e„ a -E- I 0 ELECTRICI .......:..... i . TOWN OF SOUTHOLD, PROPERTY RECORD BARD £# a OWNER STREET VILLAGE DIST. SUB. LOT /41 e . � FN E ACR. 11 MEL07 7777,777, 77 _77,77 S W TYPE OF BUILDING RES, SEAS. AVL. FARM ;COMM. CB. MISC. Mkt. Value RES�= SEAS LAND ' = IMP TOTAL DATE REMARKS r `I f 0 6 ✓ ' 7 72. I s AG,E BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre a Value Per Value Acre Tillable 1 Tillable 2 Tillable 3 E Woodland l Swampland FRONTAGE ON WATER Brushland - FRONTAGE ON ROAD House Plot i DEPTH ;BULKHEAD i Total' --• DOCK k P € l I 5 F � COLOR 3 E- I e l t" i TRIM r _ , I I 3 s .� t e ti I ; i7 4 � e - � 1 M. Bldg. foundation Bath _ Dinette � � Etensi =` y X 7 y% 7 S!� Basement Floors y -p/, K I - - - r - �� s Interior Finish L"'�" �'� LR. Extension J _ r _ Ext, Walls ) L&_S '- 1 ASD , � PIAA�E Extension 't' 4� ,o /o ; _Fire Place Heat DR. i Type Roof Rooms 1st Floor 'BR. Porch ;� � - y_� "Recreation Room Rooms 2nd Floor FIN. B. 7X 1�' - ! , PorchDormer Breezeway Driveway Garage Z x Patio � 1 A- 0. -- - - Total APR 4 2022 .......... ISO mm, 00, 00, oolt� !T, 4 1' _ \ \ \\\ �� - A w�°\� � �,y, � - \\�\ ��\ �� ,\ \\�� \oma \\�� , \ � ��\�� \\ �� _ �_ �._�\.. ��... _` �,. >e: ..�. ......... \moo ..,.:,.....•a�..� �\ ::.r..� �y\�\\\\\`��\�\\�\l��y` vv v y vy�\V\vAy _�,A =mss\\ s, 3. ate, �\ \\�\\ \\\ \\\\\ \\ \\\\\ \\ \ �� t \\ � � ��\ \� V � �.�: �: � Ae � �. �. �. A ,� �. A,, _. � ,. ��. A, �_ � � A �� . �, A �. \ � �� ,� A � � � �� , , , ,� � A A � � \� A ._ _ � A �ti� A \. .. A �� .� � ti � � A� � �. , _ � , A \. A � ., A. .. � � � �, � � � A_ �� . 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" t Town of Southold 1/20/2022 53095 Main Rd Southold,New York 11971 PRE EXIS"T"ING CERTIFICATE OF OCCUPANCY No: 42696 Date: 1/20/2022 THIS CERTIFIES that the structure(s)located at: 4500 Westphalia Rd,Mattituck SCTM#: 473889 Sec/Block/Lot: 113.41-13 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- 42696 dated 1/20/2022 was issued and conforms to all the requriements of the applicable provisions of the law. The occupancy for which this certificate is issued is: nLooCfiaU3 . Lqglerr it l i,�, r it l a ,laLiati ios d up f r place end essory tiyoa frame I 1r2 car a�°a e.* The certificate is issued to Schmidt,Rita (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. A t?iedSignature C BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 4500 Westphalia Rd,Mattituck SUFF.CO.TAX MAP NO.: 113.41-13 SUBDIVISION: .......... .................. _....... NAME OF OWNER(S): Schmidt,Rita OCCUPANCY: ADMITTED BY _._........_._.._.. ............��. _ _�� ...�... SOURCE OF REQUEST:.�..._..__ ,.._......_ .� �._. .. .... ...... ...__....w... w......._ � �� Schmidt,Rita DATE: 1/20/2022 DWELLING: #STORIES: 1 #EXITS: 2 FOUNDATION: cement block CELLAR: partial CRAWL SPACE: .................. __-_._._. BATHROOM(S): 1 TOILET ROOM(S): _ UTILITY ROOM(S): PORCH TYPE: DECK TYPE: PATIO TYPE: BREEZEWAY: FIREPLACE: closed up GARAGE: DOMESTIC HOTWATER: yes TYPE HEATER: oil AIR CONDITIONING• TYPE HEAT: oil WARM AIR: HOT WATER: baseboard #BEDROOMS: 3 #KITCHENS: 1 BASEMENT TYPE: unfmished OTHER: ........ _ ....._._ ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: wood frame 1 1/2 car STORAGE,TYPE OF CONST: .......... .._.._.. SWIMMING POOL: GUEST,TYPE OF CONST: .................._.... ........ OTHER: VIOLATIONS: REMARKS: INSPECTED BY: JOHNJ DATE OF INSPECTION: 10/7/2021 TIME START: 9:20am END: 9:40am 0fai/( "k Town of Southold 6/4/2022 tllf�t� 53095 Main Rd Southold,New York 11971 4 PRE EXISTING CERTIFICATE OF OCCUPANCY No: 42697 Date: 1/20/2022 THIS CERTIFIES that the structure(s)located at: 4500 Westphalia Rd,Mattituck SCTM#: 473889 Sec/Block/Lot: 113.41-13 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 � 42697 dated 1/20/2022 was issued and conforms to all the requriements of the applicable provisions of the law. The occupancy for which this certificate is issued is: wood frame ac .g�s i_ ?cotta with cow ed orch and sc�°c�a°ch. The certificate is issued to Schmidt,Rita (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. L u ozed Signature BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 4500 Westphalia Rd,Mattitack _.� SUFF.CO.TAX MAP NO.: 111-11-13 SUBDMSION: NAME OF OWNERS _..t.. ( ): Schmidt,Rita OCCUPANCY: ADMITTED BY: _.._...,, .�.... .._ ..._._ . ..... ......_ SOURCE OF REQUEST: Schmidt,Rita DATE: 1/20/2022 DWELLING: #STORIES: 1 #EXITS: 1 FOUNDATION: cement block CELLAR: CRAWL SPACE: x BATHROOM(S): 1 TOILET ROOM(S—)": UTILITY ROOM(S): c ............ PORCH TYPE: .,. w .. _ _ ......._ .movered&screened DECK TYPE: PATIO TYPE: BREEZEWAY: .�_ _ ....... .� _._._.�. FIREPLACE: GARAGE: DOMESTIC HOTWATER: x TYPE HEATER: electric AIR CONDITIONING: TYPE HEAT: oil WARM AIR: forced hot air ....HOT WATER: ................ _ #BEDROOMS: 1 # ...... � : 1 KITCHENS BASEMENT TYPE: OTHER: ITITITITITmmm ACCESSORY ST'RUC'TURES: GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: SWIMMING POOL: GUEST,TYPE OF CONST: OTHER: VIOLATIONS: REMARKS: INSPECTED BY: JOHNJ DATE OF INSPECTION: 10/7/2021 TIME START: 9:40am END: 10:00am � iEi1C f� Town of Southold 1/8/2022 P.O.Box 1179 53095 Main Rd ' Southold,New York 11971 41 , CERTIFICATE OF OCCUPANCY No: 42673 Date: 1/8/2022 THIS CERTIFIES that the building ELECTRICAL Location of Property: 4500 Westphalia Rd.,Mattituck SCTM#: 473889 Sec/Block/Lot: 113.-11-13 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/17/2021 pursuant to which Building Permit No. 47118 dated 11/17/2021 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' 100 anin electric service and electrical survey The certificate is issued to Schmidt,Rita of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERT1rICATE NO. 47118 12/16/2021 PLUMBERS CERTIFICATION DATED Authorized tignature Town of Southold 1/8/2022 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42675 Date: 1/8/2022 THIS CERTIFIES that the building ELECTRICAL Location of Property: 4500 Westphalia Rd.,Mattituck SCTM#: 473889 Sec/Block/Lot: 113.-11-13 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/17/2021 pursuant to which Building Permit No. 47117 dated 11/17/2021 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: electrical survey sL sin. Ce family dweilin . The certificate is issued to Schmidt,Rita of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 47117 12/16/2021 PLUMBERS CERTIFICATION DATED Authori7e ' nature � tlOt Town of Southold 1/8/2022 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42674 Date: 1/8/2022 THIS CERTIFIES that the building ELECTRICAL Location of Property: 4500 Westphalia Rd.,Mattituck SCTM#: 473889 Sec/Block/Lot: 113.-11-13 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/17/2021 pursuant to which Building Permit No. 47117 dated 11/17/2021 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: lectri qey aqd""as built"" anal in acccsso ara a. The certificate is issued to Schmidt,Rita of the aforesaid building. 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