The URL can be used to link to this page

Home My WebLink About1000-106.-6-1 #t� � TOWN OF SOUTHOLD Rental Permit 0305 Owner AWC Dockside LLC Occupied as Single Family Dwelling Located at 5505 Mill Road Mattituck 106.-6-1 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. 8/7/2023 C66 Enforcement Official This Notice must be posted by the main entrance at all ti s TOWN OF SOUTHOLD BUILDING DEPT. a 631.765-1802 I N S T 10 N [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLTIO [ ] PRE C/O *f RENTAL U r DATE .� A INSPECTOR ' ` _ rat s TOWN OF SOUTHOLD BUILDING DEPT. 631.765-1602 ()3 0-5, E(Co' T 10 O [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/OORIENTAL INSPECTORleiDATE a �t /�, �; I 0 a, �I�` p II 16��IIII IYlr�l IIY�VIIje�II�I;�N�N�eill �� VI,�ti� r r P A �� rh"��lil�I� I�tli feI " ii,f , TOWN F SOUTHOLD Rental Permit Permit No. 0305 Owner AWC Dockside LLC Occupied as Single Family Dwelling Located at 5505 Mill Road Mattituck 106-6-1 Village S/g/L 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. 3 '11/2020 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times 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. Rental Permit Fee$200 (Application must be renewed else two years) Section A. Property Information: Renta Property Address: Tax Map Number: 1000 SECTION ..: SECTION B. OWNER INFORMATION: Property Owner Name:. . � Property Owner Legal Address: Property Owner Mailing Address: . � F d , µ X03 0 Telephone Number (s): Daytime Evening... Emergeniq, Property Owner Email Address: DOLA °�%�'' ' k-Q Page 1 of 5 P Town Hall Annex a ' � 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 wl 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 Emergenty Email Address: - - . Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent(no P.O.. Boxes} Mailing Address of Authorized Agent, . i Telephone Number (s): Daytime Evening Emergent; _ N 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 Town Hall Annex ��, Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 ti Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime Evening Emergen "y? . 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, Q 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." i Rental Dwelling Unit Identifier: Requested Maximum number of persons allowed to occupy Dwelling Unit ell— Number of rooms in Rental Dwelling Unit: S Use and Dimensions of each room in Rental Dwelling Unite i, _ S ' Azs dm -1 Page 3 of 5 j 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 SECTION G. INSPECTION: Pursuant to the Town Code of the Town of Southold Chapter 207 (Rental Properties),a safety ti 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 z 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 ❑ 1 am submitting a completed Town of Southold certification form from a licensed architect or a licensed professional engineer. S B SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. u STATE OF NEW YORK) COUNTY OF SUFFOLK) Ii r certify under penalty of perjury,the following: 1. 1 am the owner of the property identified in "Section A" of this application. 2. TheY owners r� er l ' legal address set forth in "Section B" of this application is my legal P p address and I understand the Town will use the address for service pursuant to all 6 ) H I Page 4 of 5 �i Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 e P.O.Box 1 179 Southold,NY 11971-0959 '~* BUILDINGDEPARTMENT TOWN OF SOUTHOLD applicable laws and rules. I further acknowledge that I will notify the Town of Southold of address within five 5 days of any changes Building Department of any changes � ) Y thereto. a x 3. 1 have read and received a copy of Chapter 207 of the Code of the Town of Southold and a reed to abide b the same. g Y _ 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: ... . w a 1 Property Owner's Signature: •, r i Sworn to before me this day of 20. w Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.01 BU8185050 Qualif led in Suffolk County 11 Commission Expires April 14,21d,l� t Page 5 of 5 . r TOWN F SO&TWOLD BUILDING 1) 765-1802 r IN PECTION [ ] FOUNDATION 1 ST [ ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIO CA FRAMING / STRAPPING INAL X14k [ ] FIREPLACE & CHIMNEY FIRE SAFETY IN [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PI [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI L ] CODE VIOLATION [ ] PRE C/O REMARKS: TOWN OF SOUTHOLD PROPERTY RECO OWNER , RE VILA�E 3 D1STa 'WL3. LOT _ E � F DORMER OWNER � � = � ACR. _ ' TYPE OF BUILDING S - F c RES '" SEAS. VL. FARM OM.W" CB. MICS. Mkt. YQfus =_ _ T LAND IMP, TOTAL DATE REMARKS - JL z d _ s I - - f i l = I Tilln[3ie FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowlcnd DEPTH E House Plot BULKHEAD Total m } r a Af i 3/23/2020 05 7 Extension Basement zF r_ Extension g walk ExtensionFro Place eat- Porch r`Porch 3 PO l st Floor -2-C!' r � = -C Floor . a O. B. .A it Town of Southold 3/11/2020 53095 Main Rd c Southold,New York 11971 FRE EXISTING CER'T"IFICATE OF OCCUPANCY No: 41128 Date: 10/22/2018 THIS CERTIFIES that the structure(s)located at: 5505 Mill Rd,Mattituck SCTM#: 473889 Sec/Block/Lot: 106,64 Subdivision: Filed Map No. Lot No. conforms substantially to the requirements for a built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 41128 _...._.._____.. dated 10/22/2018 was issued and conforms to all the requriements of the applicable provisions of the law. The occupancy for which this certificate is issued is: cerraent b�rtl . a � r enat udor cwraaw _a es �a rit es�el— Cat F31? 41)2alpratcn ("( 4 127. Prolaaq. as disconnected andwallfurnace disabled. The certificate is issued to AWC Dockside LLC (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. A o � _ re BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 5505 Mill Rd,Mattituck SUFF.CO. —SUBDW1--S,1-0 N-:................. ................ NAME OF OWNER(S): AWC Dockside LLC .................._........... OCCUPANCY: ............-—------------- -- ---------------------................................... ............... ....... ADMITTED BY: - ...... ..... ............... SOURCE OF REQUEST: AWC Dockside LLC DATE: 10/22/2018 ................................ .......................... ............. DWELLING: #STORIES: 1 #EXITS: 2 FOUNDATION":——- slab CELLAR: CRAWL SPACE: BATHROOM(S): TOILET ROOM(S): UTILITY ROOM(S):.,,,...... PORCH TYPE: enclosed__ .w DECK TYPE: PATIO TYPE: cement BREEZEWAY: FIREPLACE: GARAGE: DOMESTIC H6TWAThk TYPE BEATER: electric AIR CONDITIONING: TYPE HEAT: Propane Gas WARM AIR: HOT WATER: #BEDROOM§_. _-'T__ #KITCHENS—:-—--------I..................... BASEMENT TYPE: ........... OTHER: ............................ .......... ............... ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: wood frame shed ...... SWEVEVIING POOL: GUEST,TYPE OF CONST: OTHER: 11........................ ....................................... VIOLATIONS: ............... ... .... REMARKS: .................. .............. ........... ....... ...... INSPECTED BY: JOHNJ DATE OF INSPECTION: 10/2/2018 ............. TIME START: 9:57am END: 11:05am " fat/(, Town of Southold 3/10/2020 P.O.Box 1179 53095 Main Rd 'u Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41127 Date: 3/10/2020 THIS CERTIFIES that the building WINDOWS Location of Property: 5505 Mill Rd.,Mattituck SCTM#: 473889 See/Block/Lot: 106.-6-1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 8/20/2019 pursuant to which Building Permit No. 44112 dated 8/29/2019 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: lteraltrns arm gzst:igrrr arilym.11lat; lmlac for. The certificate is issued to AWC Dockside LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF BEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 44112 1/2/2020 PLUMBERS CERTIFICATION DATED 11/22/2019 tti Plumb" LLC a u , raature s