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Home My WebLink About1000-114.-7-14.2 TOWN OF SOUTHOLD Rental Permit Permit No. 0306 z�a _- Owner Mason WM & Carusos A LLC Occupied as Single Family Dwelling Located at 1200 Westphalia Rd. Mattituck 114-.7-14.2 Address Village 5/13/1. 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. 3/17/2020 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times Town Hall Annex ,; ,�,d a�m� �� ` Telephone(631)765-1802 54375 Main Road 1, Fax(631)765-9502 , P.O.Box 1179 Southold,MY 11971-0959 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: Tax Map Number: 1000 SECTION 1 BLOCK LOT_ SECTION B. OWNER INFORMATION: Property Owner Name: ' . , i Wim.. _ ....S W .. e.. _.._m........ C✓a'`Lolo �'�'_..__._ Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) LI .....................w _............ Telephone Number(s): Property Owner Email Address: clo�-J � Page 1 of 4 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): Email Address: ID Section D. Managing Agent Information: Aj Name of Authorized Agent of dwelling unit, if any: CA— nA tJ Address of Authorized Agent(no P.O, Boxes),,_._,_ Mailing Address of Authorized Agent: Telephone Number(s): 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)':__.... Mailing Address of Managing Agent: Telephone Number(s): Email Address: Page 2 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, 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." Rental Dwelling Unit Identifier: Requested Maximum number of persons allowed to occupy Dwelling Unit: w-(Q---( ticty (0 Number of rooms in Rental Dwelling Unit: ; ! w ,°°" Use and Dimensions of each room in Rental Dwelling Unit: — k.01 AlMiW4 oo�,V VIA — Ctx� A— 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 from the Town of Southold. Page 3 of 4 0 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 . . ac TY OF SUFFOLK) J—.-., i W 1 ] – -17 `'_,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: � n S� �` C '-�� i L L` Property Owner's Signature: , t Sworn t before me this 202-,1 usa M W64 nO cAamw gal otary Public Signature and Original Notary Stamprn ta, Page 4 of 4 1 � Town Hall Annex �i� � G' `D �� „ �� //�� Telephone(531)785-1802 54373 Main Road �y�� %�� Fax(531)765-9502 ��✓��i;if%�//i�' P.O.Box 1174 ►►l � 7.. �i /�ioi/ m BUILDING DEPARTMENT JUL 26 2019 TOWN OF SOZJTHOLD RENTAL PROPERTY CERTIFICATION Form to be completed by a NYS licensed architect, NYS licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Ro essional sea/refired mar Architect or bra freer licensed home teas ectar must rovide q copv of a valid New York State ttni orris Fire Prevention Build in Code Certification. Rental Property SCTM Number: 4w Rental Prner A p t� Address: OwnerNan�dW'_ A e.*.3J-as ja 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.J pct Z= 7- b. _... 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 the unit 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. Print Name and Title Original Signature AZZA Please place professional seal: kAl TOWN OF SOUTHOLD BUILDING DI 7651802 INSPEC ION [ FOUNDATION 1 ST ROUGH PL G- [ ] FOUNDATION 2ND [ INSULATION/CAI [ ] FRAMING / STRAPPING [ �ORE L FIREPLACE & CHIMNEY [ SATE` ""Y 111 [ FIRE RESISTANT CONSTRUCTION [ ' FIRE RESISTANT PE ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI [ ] CODE VIOLATI N [ ] PRE C/ :RErKSL* oo .-�4------ It Vx 06,pkv-4-:0t I DATE c)-00" INSPECTOR � (4- a A Y\o*t+vv� 11q . * ' TOWN OF SOUTHOLD BUILDING N 765-1802 IN PECTION [ ] FOUNDATION 1ST [ ] ROUGH PEBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAI [ ] FRAMING 1 STRAPPING [ ] FINALkvjw [ ] FIREPLACE'& CHIMNEY [ FIRE SAFETY IN! [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII [ ] CODE VIOLATION [ ] PRE C/O v- I hah 4- r S t . TOWN SOUTHOLD BUILDING . 765-1802 INSPEC ION FOUNDATION 1ST ROUGH PLBG. ] FOUNDATION 2ND [ ] INSULATIO CAl FRAMING / STRAPPING [ ] AL4&vw i [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY IN [ ] FIRE RESISTANT CONSTRUCTION ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI [ ) CODE VIOLATION [ ] PRE C/O REMARKS: C ............. N 0 r DATE I hof INSPECTOR ,� .�.... i vo � =a�n ea Bedro 13xE( CL 2x5 Hall 13x4 CL Bath 1if x ` Living Room/ . - Dining Room °1 W W-1-C Laundry 21x17 3x5 7x5 F Bedroom = ` _ Kitchen Com - 10x9 10x12 Dere pw 17x�8 - _- l m r r TOWN OF SOUTHOLD PROPERTY RECORD CARE? OWNER STREET 3' VILLAGE DIST SUB LOT s ACR_ RE MARKS � — TYPE OF BLD- PROP. CLASS P LAND IMP, TOTAL DATE r L! 7/-2y)l u In o a -+ 3 FRONTAGE ON WATER TILLABLE I FRONTAGE ON ROAD I WOODLAT DEPTH MEADOWL I � � — HOUSEi LF I BULKHEAD TOTAL l .--� - . a 'OWN OF SOUTHOLDPROPERTY RECORD CARD - - OWNER STREET VILLAGE DIST SUB. LOT -nom FORMER OWNER N _ i E ACR. S W, TYPE OF BUILDING r RES. SEAS. EVL. 'FARM ICOMM. CB. MISC. Mkt. Value LAND IMPs TOTAL DATE REMARKS I ti AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre Ti I table t Tillable 2 Tillable 3 Woodland Swampland ! FRONTAGE ON WATER a BrushlandFRONTAGE ON ROAD f House Plot DEPTH BULKHEAD DOCK Total 1 s - 14 , a LR - t i3 FRIM § r � e a 3 � - . ,, L' � r 114.-7-14.2 t F B M. Bldg. Foundation oth _� Dinette E Flo Extension r:, „ �� _ Bosernent }'/� ors ; K Yr t is Interior Finish W4- «. LR. Extension / c, e - Extension i ''y L, Fire Place �1 �f� H fzl� DR. g 1 Type Roof Rooms 1st Floor 13R. _6 14 .S BRecreation Roam Rooms 2nd Floor! FIN. B. r FF oic ` F,.� 'r£ Dormer j ... i Br exeg a I Driveway A OM -wage Rada_ _ �a Uf � f � r) 0- 11- Total t o TOWN OF SOUTHOLD OFFICE OF BUILDING INSYEC`fOR TOWN I-LALL SOUTHOLD, NEW YORK CERTIFICATE OF OCCUPANCY NONCONFORMING PREMISES THIS IS TO CERTIFY that the F/ Land Pre C.O. #- w....Z- 1`i� 97... ., /x/ Building(s) Date- Jan u_ 1987 F/ Use(s) �- located at 1200 Westphalia Road Mattituck, New York Street Hamlet shown on County tax map as District 1000, Section 1 14 , Block 07 Lot 14.1 —, doesknot)conform to the present Building Zone Code of the Town of Southold for the following reasons: Non-Conforming three dwellings. On the basis of information presented to the Building Inspector's Office, it has been determined that the above nonconforming /_/Land /x/Building(s) / /Use(s) existed on the effective date the present Building Zone Code of the Town of Southold, and may be continued pursuant to and subject to the appli- cable provisions of said Code. IT IS FURTHER CERTIFIED that, based upon information presented to the Building Inspector's Office, the occupancy and use for which this Certifi- cate is issued is as follows: Property contains 2 one story, one family dwellings; one two stor , one family dwelling with attached garage; and all situated in the A Residential Agricultural zone with access to Westphalia Road; a Town maintained road. The Certificate is issued to ROBERT OLMSTED & SIDNEY OLMSTED, JR. (owner, I+�QM)tKL18 XtiXX of the aforesaid building. Suffolk County Department of Health Approval N/A -� UNDERWRITERS CERTIFICATE NO. N/A NOTICE IS HEREBY GIVEN that the owner of the above premises HAS NOT CONSENTED TO AN INSPECTION of the premises by the Building Inspec- tor to determine if the premises comply with all applicable codes and ordin- ances, other than the Building Zone Code, and therefore, no such inspection has been conducted. This Certificate, therefore, does not, and is not intended to certify that the premises comply with all other applicable codes and regula- tions. - uildinc- inspector � Town of Southold Annex 8/28/2014 P.O. Box 1179 g54375 Main Road til Southold,New York 11971 CERTIFICATE , No: 37117 Date: 8/27/2014 TIIIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 1200 Westphalia.Rd, Mattituck, SCTM#: 473889 Sec/Block/Lot: 114.-7-14.2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 1/31/2014 pursuant to which Building Permit No. 38781 dated 4/11/2014 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: tra,sbuilt alteraliogs and covered wrap aroutttl ar�rc�';r cldit on to an i t t'�.8.oi The certificate is issued to North Fork Investors LLC rC7WhJER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 38781 8/13/14 PLUMBERS CERTIFICATION DATED 8/13/14 attituck Plumbing A.__. igtaa re