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Home My WebLink About1000-106.-9-8.2 TOWN OF SOUTHOLD - Rental Permit ,. 0617 Owner Zachary Kilgore Occupied as Single Family Dwelling Located at 1435 Mill Rd. W. Mattituck 106-9-8.2 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. t 4/11/2022 Official This Notice must be posted by the main entrance at all times (jerjrn pad d3 3/30 xL Town Hall Annex d Telephone(631)765-1802 54375 Main Roady r n Fax(631)765-9502 P.O.Box 1179 .!k p�iff Southold,NY 11971-0959 t „ BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: 35 r Tax Map Number: 1000 SECTION 106.00 -BLOCK 0009 -LOT 008 - 002- SECTION 02SECTION B. OWNER INFORMATION: Owner Name: JO C- �nMerty � Property Owner Legal Address: Property Owner Mailing Address: k, ji �S�Z 2 Telephone Number(s): Daytime 1,67 J�� 2Evening Emergency t Property Owner Email Address: ��` �' y �°�� C'6'-V' Pagel of 5 + lli, Town Hall Annex �4- A, Telephone(631)765-1802 54375 Main Road 13f Fax(631)765-9502 zwt .� 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: A Telephone Number (s): Daytime__,__ � Evening Emergency____. Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent (no P.O. Boxes): N Mailing Address of Authorized Agent: Telephone Number (s): Daytime venin g _ Emergency_ � ,_� Email Address: SECTION E. SITE MANAGER INFORMATION: (required for rental properties containing or more rental units) Name of Managing Agent of dwelling unit, if any: �j Address of Managing Agent (no P.O. Boxes): 'A 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 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime Eve i g Emergency ,_ Email Address: SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: ONE 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: 143.6 Requested Maximum number of persons allowed to occupy Dwelling Unit: & Number of rooms in Rental Dwelling Unit: 6 Ir Use and Dimensions of each room in Rental Dwelling Unit: N% ✓ " -5" wt 2 r its Page 3 of 5 � N Town Hall Annexe ,' Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 r Southold,NY 11971-0959 , 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. ❑ 1 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) 1 � L,. 0��, 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 J��" � r u• � � „Y Town Hall AnnexTelephone(631)765-1802 1 54375 Main Roads Fax(631)765-9502 4 P.O.Box 1179 Southold,NY 11971-0959° � f(f 4' BUILDING DEPARTMENT TOWN OF SO HOLD 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 Signature:75 Sworn to before me this `�day of 20 21' DAVO J. Stam NOTARY PUBLIC,:TAI E OF NEW YORK' Official Notary Public Signature nd i i ar y p Registraiion No.07.JAu062585 Qualified in Cuifoik County Commission E:cpirns February 13, Page 5 of 5 Town Hall Annex °�, Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 .f P.O.Box 1179 ° ;A S Southold,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 Pro essional,seal required for Architect or Enyinegrllicensed 1-lome Ins ea for must rolria e copv,of valid current certification Rental PropertySCTM Number: 1000 - 106. 0 - 000 - 0p8-002 Rental Property Address: d 39' MILL, PpAQ, M �1"t.► Il Owner/Name: ZACk4aV kiI-cio,ace Rental Dwelling Unit Identifier: 14-3S- Number 3S- Number & Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 -100 sq., Bedroom#2-90 sq., etc.) -,W-I — :t Property Description (Include all improvements indicated on survey) rt> 6kPL4"17 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, th Residential Code of New York State,the Building Code of New York State,the Plumbing Code New York State, the Fuel Gas Code of New York State, and the Energy Conservation Constructs n ode of New York State. Print Name and Title Original Sig r IM z Please place professional seal: Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 � BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each d ling 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 ch 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 eac welling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: vgso vjv�l AA'WLl-- TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 lob 9'1 Z/ INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ INALk�r -['.0' [ ] POV FIREPLACE & CHIMNEY ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: 1 ' t SIX, 1 DATE 3 '1/ INSPECTOR . .% . | } � . « « . . . - � OC CL � D . ZA 7 ) . . . ) . $ ¥t& . � E Basement PlanAO { ��. . Pte£ . . Tek.. K1Lao■« RSSIDEQCF- 1 3f HQ Eo&R HATp TU66� Q. R§«2 . CT @. 1000- U6-0-0009 00kco2 SCALR 1=1� D,&-rE2a0-M c 2OI� p,0 3 Gnus0 00 _ M ��° DI N i WG- ROOM. -' ktTc+��u �cc �l1b 4� So. DM ISUl' 1{ i O jj� � I up FoyE>z I LiVtNGr 2.00M. Pti.IDR. RM. cr € i 1 FIRST FLOOR PLAN V {Y} K I L-CTOM IF-,S IDF-O G5T- 1435 I-IIL 2oAD MATr►TuCk IJ 1 i�i52 i S.GT.M. 1000- io6.00-o00q -008.002 Suu.E.:!& = 1 0' DAT6 36"-NI R-W,207.2. P2oF 3. 4 IIS tt%a,.DD { A � Y ' EdQ BOTH }� h BEDROOM 1 SEDROoiy 2. _N " 144 5a.FT Sa 124 sex.FT. _ k .V • 00 I CA- SD, I GL. GL. GL. c I t 3=N YB" W.i.G. tA S&TH o I in 1�,£-D200N1 3. I 237 SQ,Fr. I CC SECOND FLOOR PLAN i x — cc zl 0 k iLCGO21~ R�stD �ac� 1435 HILL 2oA"D, m.&-m UGk, I.Y. 11552 S.G.TM- )000- 10(0.00-0009 - 00O_oo2 SCb,LE:Y4'; i'-0` I)ATF— 36'MAW'H 2022. P3oF 3_ TOWN OF SOUTHOLD PROPERTY RECO, ap OWNER STREET VILLAGE I but$. LOT FORMER OWNER-1 N E ACR. S W TYPE OF BUILDING RES. n SEAS. VL. FARM COMM. CB. a MICS. Mkt. Value LAND IMP. TOTAL 3 DATE REMARKS j/ # F ---w, –7 -c 3 r^ 1 aW L 4w_I i few cq 1 V,f1a; v rY D in lu V Y-11 Zlico (5 4 0 a �t�r 4 wt r7co 10 ju p- ADO 0 L 7 Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH House Plot I BULKHEAD Toto I r I s 106.-9-8.2 11/10 ti. e Foundatio, : _ , Bath M. Bz ., I Extension j � �� _ i Basement a , Floors 11(A Ext. Walls Interior Finish Z i Extension , - ;€ , - �_ Heat Extension Fire Place i I s i Pool Attic Porch or- _ .= - e Deck . ,_ Patio Rooms 1st Floor , I Driveway Rooms 2nd Floor Breezeway - Garage �� a � a 0 - . , FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-26598 Date: 07/ 27/99 THIS CERTIFIES that the building NEW DWELLING Location of Property: 1435 MILL RD MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 106 Block 9 Lot 8.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 29 1998. pursuant to which Building Permit No. 25390-Z dated DECEMBER 9 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 ONE FAMILY DWELLING WITH COVERED FRONT PORCH AND ATTACHED TWO CAR GARAGE AS APPLIED FOR. The certificate is issued to WILLIAM H & OLGA M. TURNER, JR. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-98-0014 07/27/99 ELECTRICAL CERTIFICATE NO. 097295 06/29/99 PLUMBERS CERTIFICATION DATED 07/12/99 RICHARD R. MORANO Building Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28671 Date: 08/12/02 THIS CERTIFIES that the building ADDITION Location of Property: 1435 MILL RD MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 106 Block 9 Lot 8.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 30, 2002 pursuant to which Building Permit No. 28613-Z dated JULY 30 2002 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 DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to WILLIAM H & OLGA M TURNER JR (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF ERALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Aut orie Signature Rev. 1/81