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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 e an ` " 0�" c 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 r 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 1 �b"� x 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 � � 3 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 � 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 YY�e csAa ��pv� f� �� oo�( q,� �J V` `� �� C°� �� x \35 �I � � a 1 � l� �� ,5 h 11� S Foci rS �1' x�o�" SCa, NDSScTm 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 ZZ 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. N-- $ 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 i�v 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 'A 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 _ � ." 1 y � Tillable [ FRONTAGE ON WATER23 k Woodland FRONTAGE ON ROAD Meadowland DEPTH ' V ,s House Plot BULKHEAD Total TRIM u ---vim =-- 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 _ . _ E E ' 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 (' j 4 l 1 * SEE SURVEY a � a a q a r a, n R � Y p tl h A tl tl N 4 Io rypry fl tl Y 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.