HomeMy WebLinkAbout1000-107.-3-11.6 TOWN OF SOUTHOLD
Rental Permit
Ilk
0588
Owner Kevin Keyser
Occupied as Single Family Dwelling
Located at 1356 Grand Avenue Mattituck 107-3-11.5
K _W i CL* t.z>4 # i 5
Io-7-3— I1 .0
Maximum Permitted Occupancy 6
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.
1/31/2022
rrce � fflisl
This Notice must be posted by the main entrance at all times
Town Hall Annex ��}'�� t y Telephone(631)765-1802
Fax(631)765-9502
54375 Main Road �F
P.O.Box 1179 o�
Southold,NY 11971-0959 Y
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
A r a.
RENTAL PERMIT APPLICATION
Rental Permit Fee $200(Application must be renewed every two years) _
Section A.
Property Information:
Rental Property Address:
-Ay
Tax Map Number: 1000 SECTION 101 -BLOCK DJ -LOT -
SECTION B.
OWNER INFORMATION:
Property Owner Name: ' ° r"
Property Owner Legal Address: Property Owner Mailing Address:
Telephone Number(s): Daytime I Evenings IU 8 Emergency
Property Owner Email Address:
q
Page 1 of 5
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an ` " 0�"
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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
Section C.
Authorized 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 D.
Managing Agent Information:
_,
Name of Authorized Agent of dwelling unit, if a
Address of Authorized Agent(no P.O. B es):
Mailing Address of Authorized Ag t:
Telephone Number (s): Dayti d 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 a.
Address of Managing Agent (no P.O. B es):
Page 2 of 5
Town Hall Annex u� �'�� Telephone(631)765-1802
54375 Main Road g � Fax (631)765-9502
P.O.Box 1 179
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M V
Southold,NY 11971-0959 Ap�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
a ,
Mailing Address of Managing Agent:_
Telephone Number (s): Daytime Evening�, _________Emergency
Email Address:
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."
Rental Dwelling Unit Identifier:----
er of persons allowed to occupy Dwellin Unit:
Requested Maximum numb p PY g / �
Number of rooms in Rental Dwelling Unit:
Use and Dimensions of each room in Rental Dwelling Unit:
L 11
12
dy0t?VYI
fed ►�o� � 3 l2' � �2'
Liv(nq doom 2-oo x �-V
y Page 3 of 5
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tri �, . ee hone(631
Town Hall Annex l� ��� � �� �-� -Telephone )765-1802
54375 Main Road be t Fax(631)765-9502
.
P.O.Box 1 179 Y
Southold,NY 11971-0959 4%
o f
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)
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
1,V
Town Hall Annex 6tI'1 14 Telephone(631)765-1802
54375 Main Road s,y Fax(631)765-9502
P.O.Box 1 179
Southold,NY 11971-0959
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: :...
Property Owner's Signu,re:
Sworn to before me this
OV:
Official Notary a lic Signature and Original Notary Stamp
PATRICIA C MOORE
NOTF.R F n:,GC,STATE OF NEWYORK
Rc� r apt(9n 0iuAC1A861668
QLIJ,ied in sufloV° county
My Commission Expires June 16,
Page 5 of 5
�q soonlA4 III-`
0 Tr�Oil k0pF C OLD, BUILDING DEPT.
7651802 p
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INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING
[ ] FRAMING /STRAPPING [ ] FINAL '
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE, " C/O
.. C 1 �
a ..�..
v
DATE IINSPECTOR
' June 5, 2021
Town Hall Annex , Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Az
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Southold,NY 11971-0959 re
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
Pro ssic«r c l sear/reguiredLor Architect or freerlicensed Home irls +actor 17rllar rovicde
copy of valid current cerci icatior
Rental Property SCTM Number: 10 00• ' 0-7 • 0�
Rental Property Address: 1356 Grand Ave. Mattituck NY 11952
Owner/Name: Kevin Keyser
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.)
BedrQQM #1 144 qnft Bedroom #3 110 sgft
Bedroom #2 130 s ft
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.
Victor Cornelius III CEO Inspector
Print Name and Title ceo# 1216-0283 g1nA Si atu
Please place professional seal: V11)n
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3 TOWN OF SOUTHOLD PROPERTY RECORD CAF
OWNER STREET VILLAGE DIST. SUB. LOT
(�;ra"( v G
' i es 3 Z� /U�/i4 ACR. J- REMARKS
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TYPE OF BLD.
Zt � 8 g
X57 - 7
aL
PROP. CLASS
LAND IMP. TOTAL DATE
/00 36 0
FRONTAGE ON WATER HOUSE/LOT
BULKHEAD
TOTAL
1
TOWN OF SOUTH OLD PkIPPEF 10 CARD
OWNER ISTREET VILLAGE .DIST., SUB. LOT
J4
4- /)1 1 i 11 f2 fe &I
LL-
FORMER OWNER NACR.
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$ w TYPE OF BUILDING
VT
vv 7-f 77-
1
RES. SEAS. VL. FARM COMM. CB. MICS. Mkt. Value
LAND IMP. TOTAL I DATE REMARKS I
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A
5/9
-5 7?-0 0
J7
S' 3 7"
GE 7-
-00 C C 10 11,161
D I T
��
NEW NORMAL BELOW ABOVE /2
77---
FARM Acre Value Per Vclue
Acre
Tillable FRONTAGE ON WATER
Woodland
FRONTAGE ON ROAD
ZZ)
Meadowland 6LJC�6-5 DEPTH
House Plot B,6".H-EAD
z-
I DOCK
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TOWN OF SOUTHOLD PROPERTY RECORD C -
OWNER STREET f VILLAGE DIST. SUB. LOT
s 3 _.—
FORMER OWt*ER, N E AGR
Pu+ep v K 4 arm �.
S W - TYPE OF BUILDING
S; I L. Nom= CF1
RES. ��J SEAS. VL. FARM COMM. CB. MICS. Mkt. Value
LAND IMP. TOTAL DATE t REMARKS
� ? + �
Soo /�O0 SI-3 75 i3 S l D 33sao r : to
[[ 19[[ r4 _
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1
y �
Tillable [ FRONTAGE ON WATER23
k
Woodland FRONTAGE ON ROAD
Meadowland DEPTH '
V ,s
House Plot BULKHEAD
Total
TRIM
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107. 3 11.5 1/2016 1 i.
' Cd
ti
-r
�xteron
e
/� Nr3 3
t
Extension
gi I Foundation ' €Bath ��/ Dinette
Z
S X , Z
pc _ _ 2 � Basement i � ` Floors �� K.
= 3 _
Poro ��,o _ � �� Ext. Walls,, :' `Interior Finish �LR.
Breezeway ;Fire Place Heat I DR.
Garage
Type Roof Rooms lst Floor BR.
Patio `Recreation Room Rooms 2nd Floor I : FIN. B
O. B. Dormer =Driveway
Total b45-135
_
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FORM X0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. . .?�... . . . . . Date . . . . . . . .
THIS CERTIFIES that the building located at , . , . . . , .. . . :' .V L , . . Street
cle
Map No. . . . . . . . . . . . . Block No. , k. . rpt No. .X A .' 7-u - .N�Y,
conforms substantially to the U "b
dated a . . . . .. 19 T pursuant to which e t-No�.G.S
dated 7. . . . . . . ., 19 Zy ., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The ceupancy for which this certificate is
w
issued is
The certificate is issued to . �. ". . . . . . . . . . . . . . . . . . . .
(owner, lessee or tenant)
of the aforesaid building.
u
Suffolk County Department of Health Approval . . . . . , . .
UNDERWRITERS CERTIFICATE No.
HOUSE NUMBER J. Street . .�S t-v!�. . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .
. . . ..'``. . . . . . , . . . . . .
Building Inspector
��M
HOUSING CODE INSPECTION
July 14, 1975
1220 Grand Avenue R-1
Mattituck, N. Y.
Tax Roll: Newell Muttit
Occupied- new owner (Sylvia Pafenyk)
Upon receipt of a request for a Pre-Existing Certificate of
Occupancy, I made an inspection of this two story framed
dwelling. I was admitted to building by Norman Reilly and
Sylvia Pafenyk who accompanied me during this inspection
which began at approximately 11 : 00 A.M.
The first floor consists of an enclosed porch entrance,
eat-in kitchen, living room and half bathroom.
The second floor has three bedrooms and a full bathroom.
Heat is supplied to all rooms from an oil fired hot water
furnace located in full cellar.
Accessory structures include a three car garage and a
utility building.
. I found no violations of The Housing Code, Chapter 52 ,
Town of Southold.
Inspection completed at approximately 11 :20 A.M.
Respectfully submitted,
EH:mm Edward Hindermann
Building Inspector
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. ;75,d5. . . . . . Date . . . . . . . . . . . 'fib . . . . . . . . . . . 19. 7
THIS CERTIFIES that the building located at . . . .RQ.*W.E/a .G1,arxd .Ave .. Street
Map No. . . . . . . . . . . Block No. . . . .=. . . Lot No. . . . A*
conforms substantially to the Application for Building Permit heretofore filed in this office
dated . . . . . . _ . . . . Pot. . 30. ., 19.75. pursuant to which Building Permit No. . .8273
dated . . . . . . . . . . 0.0t. . 30. . . ., 19.75., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
w
issued is reehouse addition
The certificate is issued to . 71 ''w A .ft. yk . . . . . ��`. . . . . . . . . . . . . . . . . . . . . . . . . .
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . !. . . . . . . . . . . ,
UNDERWRITERS CERTIFICATE No. N.9?. . . . . . . . . . . . . . . . . .. , . . .. . . . . . .
HOUSE NUMBER . . . .1.4220. . . . . . Street . .Grand,Ave . Mattittck. . . . . . . . . . . . . .
kk Building Inspector
ti
Town of Southold Annex 4/23/2014
P.O.Box 1179
54375 Main Road
Southold, New York 11971
a
CERTIFICATE OF OCCUPANCY
No: 36871 Date: 4/23/2014
THIS CERTIFIES that the building ELECTRICAL
Location of Property: 1356 Grand Ave,Mattituck,
SCTM#: 473889 Sec/Block/Lot: 107.-3-11.5
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
4/17/2014 pursuant to which Building Permit No. 38786 dated 4/17/2014
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:
200,AMP OVERHEAD ELECTRIC SERVICE
The certificate is issued to Zaloom III,Charles&Michelle,Knox
. ........._ ........ ........ .......... .._..... .......
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
38786 04-22-2014
PLUMBERS CERTIFICATION DATED
-.-_...........
— ------. .....
Authorized Signature
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- 26737 Date: 05/26/96
THIS CERTIFIES that the building STORAGE BUILDINGS
Location of Property 1356 GRAND AVE MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 47.3889 Section 107 Block 0003 Lot 011.002
Subdivision Filed Map No. Lot No.
conforms substantially to the Requirements for a ACCESSORY STRUCTURE
built prior to APRIL 91 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z- 25737 dated MAY 26, 1998
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 WOOD FRAME GARAGE AND STORAGE SHEDS (2) .
The certificate is issued to SYLVIA PAFENYK
(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.
BYVg g Inspec `
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
LOCATION: a_ x&TzlTM9jL--
SUBDIVISION: MAP NO.: LOT (S)
NAME OF OWNER (S) : SYLY
OCCUPANCY: Xr ISN aYeV � 3CK _ ...
ADMITTED BY: 5yLU&_E&ZENXL ACCOMPANIED BY: AME
KEY AVAILABLE: SUFF. CO. TAX MAP NO.:
SOURCE OF REQUEST: DATE: 05/26/98
DWELLING:
TYPE OF CONSTRUCTION: # STORIES: 0.0 # EXITS: 0
FOUNDATION: CELLAR: CRAWL SPACE:
TOTAL ROOMS: 1ST FLR.: —2 2ND FLR.: —A 3RD FLR.: —Q
BATHROOM(S) : 0.0 TOILET ROOM(S) : 0.0 UTILITY ROOM(S) :
PORCH TYPE: DECK TYPE PATIO TYPE:
BREEZEWAY: FIREPLACE: - GARAGE:
DOMESTIC HOTWATER: TYPE HEATER: AIRCONDITIONING: w
TYPE HEAT: WARM AIR: HOTWATER:
OTHER:
GARAGE, TYPE OF CONST.: STORAGE, TYPE CONST.: lT52S?D�E,_,�QQ�,,
SWIMMING POOL: GUEST, TYPE CONST.:
OTHER: ,
VIOLATIONS: CHAPTER 95 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
i
* $ BUILDING #1 GOOD CONDITION
C � C
* a BUILDING #2 POOR CONDITION
n
BUILDING #3 GOOD CONDITION ('
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1
* SEE SURVEY a
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REMARKS: pRE-„Q� 2568 ONE_F
f` 4902Z-COZ25733- Heat System & Greenhouse Roof.
INSPECTED BY: DATE ON INSPECTION: 05/12/98
MICHAEL J VERITY TIME START: 10:20 END: 11:15
F Town of S uthold 2/17/2021
P.O.Box 1 79
53095 Main Rd
Southold,New York 11971
C 'T'IVIC: :T OCCUPANCY
No: 41820 Date: 2/17/2021
THIS CERTH( ES that the build' g WOOD STOVE
Location of PropertyjAphe
far Ave.,Mattituck
SCTM#: 473889Se lock/Let: 107.-3-11.5
Subdivision: Filed Map No. Lot No.
conforms substantiallplic bort for Building Permit heretofore filed in this office dated
3/16/2008 o w`"ch Building Permit No. 45796 dated 2/8/2021
was issued,and confof a reuirenr� ts ofthe applicable provisions of the law. The occupancy for
which this certificate i :
roobpi stove ar.
The certificate is issued to 2 loom III,Charles&Knox,Michelle
of the aforesaid building.
SUFFOLK COUNTY DEPART-ENT OF HEALTH APPROVAL.
ELECTRICAL CERTIFICATE 190.
d'I.LiMBERS CER'd'IPKATION DATED
PATRICIA C. MOORE
Attorney at Law
51020 Main Road
Southold,New York 11971
nD Tel: (631) 765-4330
q 2022 Fax: (631) 765-4643
um wic
TOWN or,SbCF446LD
January 7, 2021
By Hand
Connie
Southold Town Building Department
Town Hall Annex, 54375 Main Road,
Southold,NY 11971
Re Owner: Kevin Keyser
Premises: 1356 Grand Avenue,Mattituck
RENTAL PERMIT
Dear Connie:
Enclosed are:
1. Check payable to Town of Southold for application fee.
2. Application signed by owner.
3. Inspection form(notarized) and Certification by Inspector
4. the list of Certificates of Occupancy from DataTrace and attached.
The Certificate of Occupancy dated July 17, 1975, is a Pre-CO for the house;
C of O dated 2/3/77- addition; 5/26/98 Pre-CO for garage and barn; C f O dated 4/23/14
for new electrical service; C of O dated 2/17/21 for wood burning stove.
You also have a building permit/CO application and electrical permit which is awaiting
typing.
Floor Plans of 1St and 2nd floor with smoke & Carbon Monoxide detectors
Very t -Pur ,
ricia C. Moore
PCM/bp
Encls.