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Home My WebLink About1000-139.-1-21 TOWN OF SOUTHOLD Rental Permit 0590 Owner Mina Agarabi Occupied as Single Family Dwelling Located at 575 Westview Drive Mattituck 139-1-21 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. 2/2/2022 ode n orc ent Official This Notice must be posted by the main entrance at all times _f. SDU ryQ Town Hatt AnnexrTelephone(631)765-1802 54375 Main Road N 4 Pax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 ',,�p ��X34' ��:;��.L=3'1 �x/� BUILDING DEPARTMENT TOVIN OF SOUTHOLD J U L - 9 2019 RENTAL PERMIT APPLICATION Bua DI G DEPS': Rental Permit Fee$200(Application must be renewed every two years) g r f UY'SPOU"''I"!jt Section A. Property Information: Rental Property Address: A iJ U— l��l LLePG Tax Map Number:1000 SECTION �� -BLOCK �.31, -LOT SECTION B. OWNER INFORMATION: Property Owner Name: ) AJ rT I Property Owner Legal Address: Property Owner Mailing Address: �- ' '/15S 01-62,3,tig�� Telephone Number(s):Daytime Evening Emergency Property Owner Email Address: rh I A a, 62A Vh"-e, � C�1'✓� Page 1 of 5 �-z� Town Hall Annex , Telephone(631)765-1802 54375 Main Road �# Fax(631)765-9502 P.O.Box 1179 , Southold,NY 11971-0959 e�fC®Ur � .,V BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit,if any: 5� 1 Address of Authorized Agent(no P.O.Boxes): 1.�7�1 Mailing Address of Authorized Agent: PD. Telephone Number(s):Daytime Evening Emergency Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit,if any: A &4-;,L� I Address of Authorized Agent(no P.O.Boxes): (r l.J CST U 1 6W Mailing Address of Authorized Agent: D. ) � i'(71 Y►'),Y-�7�i-rLk-qC" Telephone Number(s):Daytime 5!6 60 33 00- 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: Address of Managing Agent(no P.O.Boxes): Page 2 of 5 =Y1' shr`�`�Zp�SD�r Town Hall Annex �,�t L 2s S Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold.NY 11971-0959 N ?� COU 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: 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: P M T Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: W�J1 N� � o a1 X11 1 V_ryLA(W 11 x12 ' 'X 1o' OCVAzipA z Page 3 of 5 •,gyp': l�.'t�: Town Hall Annex t t *,'� Telephone(631)765-1802 54375 Main Road }_ t` Fax(631)765-9502 P.O.Box 1179 ' Southold,NY 11971-09590 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 ❑ lam 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 I'I � 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 c `pF S0,y Town Hall Annex n� ��-t,�}S Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 ,, Southold,NY 11971-0959 � •o w�,.dr BUILDING DEPARTMENT TOWN OF SOUTHOLD applicable laws and rules. I further acknowledge that 1 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 noYlfy 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: sh +� ``,IIIIt�ID/��s • Sworn to of re me this day of 20 �a♦: �, �i dF . - Official No ary Pu lic Signature and Original Notary Stamp 0 Page 5 of 5 S�- jv� V, I\a�krc l- �o��pF SOUTy�Io # TOWN OF SOUTHOLD BUILDING DEPT. `ycourm 0 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] INAL/e.� [ . ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: com v Y DATE INSPECTOR ' osoU ~ Town Hall Annex Telephone(631)765-1802 54375 Main Road s Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 UWN' D RCEIVE �z D BUILDING DEPARTMENT S E P 1 3 2021 TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION 1RL'J1LD :G DP/'T, TO I'VI OF SaOUTYTTOLD 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 seal required for Architect or Engineer, licensed Home Inspector must provide copy of valid current certification Rental Property SCTM Number: '<'— 2_� Rental Property Address: az� weS V,6 . lz4ye Owner/Name: G`I/Lal 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.) b"rrx -A/- / �ty a r-7- _ &J4v ' /9'3 f--f leo F9 Property Description (Include all improvements indicated on survey) AID NG A) llna v 6x�v7.S SlIVC-6 -)�V/ 6 r-iv rte, 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. n � + Print Name and Title OF NFJ� Original Signature y'`Q•\ ,A�� `r Please place professional seal: 09135 "Jl r. .......... r. ------- ---- ----------- 4 > 7W/ 13 TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER S REET VILLAGE DIST SUB. LOT FORMER OWNER S . , N E ACR.. y .. S4 C�L�. '` W ,� ' ` ` TYPE OF BUILDING ,x ' RES. �` SEAS. VL. FARM COMM. CB. MISC. Mkt Value v LAND IMP. TOTAL DATE REMARKS v t� .2-4� . -! oZ-� o .2 Q a f C S c ILDING ON I NEW NORMAL BELOW BO FARM Acre Value Per Value Acre Tillable i Tillable 2 Tillable 3 Woodland Swampland FRONTAGE ON WATER " Brushland FRONTAGE ON ROAD ( , House Plot DEPTH BULKHEAD Total ; DOCK > 1 7f X31 c g 1 TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET VILLAGE LIST. SUB, LOT m RMER OWNS O IN E ACR. )IJ S w TYPE OF BUILDING RES, SEAS. VL. FARM COMM. CB. MICS. Mkt. Valve .4. 4r.. LAND i lmpe TOTAL DATE REMARKS 0 yzo.6 e -17 S7" C !r Z� /3 P �C7813,v I' J.2417.3 11,jf1S_4 ----,7 2,:;-,�2.243r. -3——S T5 e;!t 94it L 1 . AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre �Lo Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH /0 House Plot I BULKHEAD Total MMEEMMM11 an SEEN mom ammwmmmmm ONE ON M i ■iii � m■ ■MEN■■ z iiii :Rim �M= MEMO [log IBM ME so ME mom mom M M MEN m m m Mir 0 mom ILE ME MA -ULSE m 0 dation r Basement Ext. Walls ire Place W ' U I I I I W > Lo N� 1 I NI O w o I I o } I I W W Z BEDROOM > Y I I F- U BEDROOM ; ; m w F=- � Q Q Q I I I I 1 BATHROOM I �) , o I " I o I I o ------ qp CLOSET I I I I I i I I I i W Z I I Wg , I I I I I I I nwweRw.w�"e."ree�.s".w I I I 1 I 1 I , I I LIVING ROOM ; W °~' WL--------------------J w r ~ Z Z 0 KITCHEN LAUNDRY LAUNDRY = W p O O MECHANICAL MECHANICAL _I c4 O U) z o z o ►° O O t% O U' E�l WASH W W O W u- 00 O � C5 STEP ^^ c� LL 5}"STEP SUN ROOM STORAGE/WORKSHOP DRAWN BY:ZN OCTOBER 24, 2021 j �,� `jJ� y SCALE :AS NOTED + + ' Lc� SHEET NO: EXISTING FIRST FLOOR PLAN p�0 St4N�� •J 1 ��,..