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Home My WebLink About1000-104.-12-6.2 TOWN OF SOUTHOLD Rental e I P rm it £ Permit No. 0189 Owner Scott & Erin Worth Occupied as Single Family Dwelling Located at 555 Broadwaters Rd Cutchogue 104-12-6.2 Address Village S/B/L 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. 9/30/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times Town Hall Annex i'• Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 f r P.O.Box 1179 ° Southold,NY 11971-0959 ion BUILDINGOF SOS MENT TOWN LD JULL 3 2019 RENTAL PERMIT APPLICATION "'T FIT", s h Rental Permit Fee$200 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION_�� BLOCK LOT SECTION B. OWNER INFORMATION:: rr � Property Owner Name: sw.x aid ��n W O(�� Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) Telephone Number (s): Property Owner Email Address: NNA- �ai CO&N Page 1 of 4 , 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: ��'' ,,,,, '°'° µ �� 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: P-J Cook 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 NYS licensed architect, a NYS 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 v`from the Town of Southold. Page 3 of 4 ❑ 1 am submitting a completed Town of Southold certification form from a licensed architect, a licensed professional engineer, or a licensed home inspector who has a valid New York State Uniform Fire Prevention Building code Certification. SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) ) COUNTY OF SUFFOLK)' I 45C04- 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 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 s to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager. Property Owner's Name: Property Owner's Signature: Sworn to before me thi � day of 2-0 20 OfficialNotaryPublic Signature and Original Notary Stamp k;uNNIE D.BUNCH Notary Public,State of New York Page 4 of 4 No.01 BU6185050 Qualified in Suffolk Ceunt ° Commission Expires Andl 14, Aow& 'rats . �,- TOWN OF SOUTHOLD BUILDING 785.1802 , INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. FOUNDATION 2ND I SULATIO CA FRAMING / STRAPPING INAL FIREPLACE & CHIMNEY FIRE SAFETY IN ] FIRE RESISTANT CONSTRUCTION [ FIRE RESISTANT PI ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI [ ] CODE VIOLATION [ ] PRE C/O REMARKS: INSPECTORAle DATE 55 s b roQl Wa it.5 e I� II S GO-U- V11Q ' a►I 1n/q Y c I ov 39 o ri r 4 S+► M"r5 G�(b0n TOWN OF SOUTHOLD PROPERTY RECOF7/0 OWNER STREET VILLAGE DIST; SUB. LOT 4 FORMER OWNER N E ACR. I S W TYPE OF BUILDING RES. SEAS. VL. FARM COMM. CB. MISC. Mkt. Value ' / LAND IMP. TOTAL DATE REMARKS f y- - c - �.`' may' 7 ] f g - / _ f _ m - r AGE - -,.•, B JIL I � " DIT g NEW : �� I ;i f 1 F FARM Aere Value Per ( Vogue Tillable 1 ; I , ` — .; 0 j Tillable 2 _ I Tillable 31v4L=:j LJ F Woodland Swampland 1 FRONTAGE ON WATER - Brushfand FRONTAGE ON ROAD € House plot 1 7` '/ ` DEPTH BULKHEAD _ Tota I DOCK ' I 1 TOWN OF SOUTH LD PROPERTY RECORD X15 I OWNER STREET VILLAGE DIST.$ -SUB, LOT l ? s _ e, n t _ e FORMER OWNER N E e _ ACR. - c S W TYPE OF BUILDING RES. SEAS. VL. 'FARM ;COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS I ` I t } may 1 AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE F ARIv1 Acre Value Per i Value Acre Tillable 1 i Tillable 2 I Tillable 3 Woodland Swampland 1 FRONTAGE ON WATER Brushland FRONTAGE ON ROAD DEPTH House Plot BULKHEAD Total DOCK e. l r. s s COLOR t r t _L� 1 s 3.. 3 III � ' o Is TRIM I � g s d f i e � E 104.-12-&012/06 F M. Bldg. i Both tte } ine Foundation i _ T Extension > 4— Basement 1 Floors K. Extension !Ext. Wolls nterior Finish LR, _ j Extension c, �# S 6 Fire Place ``� . Heat DR. . '- Roof I Rooms 1st Floor BR. :Recreation Room (Rooms 2nd Floor FIN. B. I Dormer s: ,Driveway u --------------- Patio i O. B, (- r Total 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- 32256 Date: 03 L J07 THIS CERTIFIES that the building __2WffLLING ...... Location of Property 375 BROADWATERS RD CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 104 Block 0012 Lot 006 001 Subdivision Filed Map No. Lot Na. conforms substantially to the Requirements for a ONE FAMILY DWELLING built prior to APRIL 9 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 32256 dated MARCH 20, 2007 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 ACCESSORY COTTAGE* The certificate is issued to ANTHONY SAVASTANO (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. ___N _ PLUMBERS CERTIFICATION DATED .................... *PLEASE SEE ATTACHED INSPECTION REPORT. A hc,r ized Signature Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD amilm. _922—F- INSIT91;_ONMR-MT LOCATION: 375 BROADWATER'S RD CUTCH UE SUBDIVISION: MAP NO.: LOT (s) NAME OF OWNER (S): ANTHONY 'AVJLSLr7C_NO OCCUPANCY: SINGLE FAMILY DWE4LZNG ANTHONY SAVASTANO ADKITTHD BY: JASON SCOTT .,,,,,,,,,,,,y, ACCOMPANIED BY: KIRK $FqRERT xffy AvAiLAi3LB-. SUFF. CO. TAX KAP NO-: 104.-12-6,1 ............ SOURCE OF REQUEST: ANTHONY SAK,�,SIANO . 3JIIL22_ DATE. 03/20/07 DWELLING: TYPE OF CONSTRUCTION: WOOD FRAME STORIES; 1.0 # EXITS: 4 FOUffMTION-. CEMENT BLOCK ........... CHIJAR. PART_ CRAWL SPACE: PART TOTAL ROOKS: 1ST FLR.: 6 2ND FLR.. 0 3RD FLR.: 0 BATEROCK(s): 1.0 TOILET ROOK(S); —0.0 UTILITY ROOK(S) - PORCH TYPE: DECK TYPE- PATIO TYPE: 2-CONCRETE&SLATE&CONCRETF BREEZEWAY: FIREPLACE: GARAGE: DOMESTIC HOTbULTER: YES TYPE BEATER: OIL-H.WATER AIRCONDITIONING: TYPE BEAT: OIL WARN AIR; ........_._ R071"TER: _)LES_* OTHER: *SEPARATE HOT WATER HEATER ........... ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST.: STORAGE, TYPE CONST_: ...... SWIMING POOL: . GUEST, TYPE CONST.: WOOD FRAME ONE BEDROOM* OTHER: *COTTAGE ON SLAB-KITCHEN�BATH kItOCS0 OM FIREPLACE ROOFED_OVER_.PORCH ........... VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION ................... ............... ................ REMARKS: ............ INSPECTED BY: DATE ON imspEcriom: 03/1-9/07 GEORGE GILLSH TIME START: END: /" ttlt Town of Southold 10/26/2017 i P.O.Box 1179 ,� �� ?.... 53095 Main Rd " q Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39317 Date: 10/26/2017 THIS CERTIFIES that the building ELECTRICAL Location of Property: 555 Broadwaters Rd, Cutchogue SCTM#: 473889 Sec/Block/Lot: 104.-12-6.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 7/9/2013 pursuant to which Building Permit No. 38163 dated 7/9/2013 _........w.._.... ..........._..................... .._..........................wwww._._ 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: The certificate is issued to Martz Jr,Theodore of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 38163 10-17-2017 PLUMBERS CERTIFICATION DATED ....... At thorned Signature