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Home My WebLink About1000-113.-7-20 O N OF SOUTHOLD Rental Permit 0657 Owner Deepika Chadha Occupied as Single Family Dwelling Located at 2795 Cox Neck Road Mattituck 113-7-20 Maximum Permitted Occupancy 12 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. 6/1/2022 d rr~ a ural 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 11 79 Southold,NY 11971-0959 v BUILDING DEPARTMENT M AY 2022. TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years) Section A. f)(\ 'A I *T L -1 L) Property Information. Rental Property Address: 2 -7 C OX A) E. Tax Map Number: 1000 SECTION 1 -BLOCK -LOT SECTION B. OWNER INFORMATION: i I A o 14 Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: 42 3 *3 -09 7RLOT T le low ....... Y 14 1 ................ Telephone Number(s): Daytime, _w Evening- Emergency_,__,,,,,,,,,_ 1 5 Property Owner Email Address: v 10 � � 3 ) 5 � i � � �-�� mG,n � I c�Q h � Page 1 of S Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: A Name of Authorized Agent of dwelling unit, if any: ...................._„_....._ Address of Authorized Agent (no P.O. Boxes): Mailing Address of Authorized Agent: .........._.......... ......_...._. _. _.......................__........vw Telephone Number(s): Daytime..,---- __wwwwww w Evening,_.__ Emergency,,_m Email Address:_ _.ww_.._.._......_.__..... Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: a ...... Address of Authorized Agent(no P.O. Boxes): _., Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening Emergency mw EmailAddress: _ _ .....wwwww.............._....._......._......_...wv....v.. ._ ..w ��_..... .,_....w..................._....._� SECTION E. SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units) Name of Managing Agent of dwelling unit, if any: AV) A Address of Managing Agent (no P.O. Boxes)= _ www ... _..... w_...._........... wwv......wwwww_ _..._ 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 1 1971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime Evening EmailAddress:_ �. __...._...._.ww_w..ww_._........ _.M._m,......._ ___ ... a 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:..._................ ........ ....... 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: . 2 wfoomcya X ' _w _ww... .bedroow►s..�......a.14.a x._14 ,.... bedroow, ..__.....9'._..Xw...l. ....... ......_...._10 x IQ. bA�l� Page 3 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 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 ❑ 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) 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 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOU OLD 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:.._._,,,,. h Property Owner's Signature: Sworn to before me thlpday of , 20 a� Official Notary Public Signature re and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.01 BU6185050 Qualified in Suffolk County Commission Expires April 14, 2 Da� Page 5 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 RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: IQ Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: lay_1-1 2 b . ro ovyn _w. 14 x I r0366 w_ww ► wl o X "I ...,..._....._wavy bE clr _ %a. Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit:,__ _... ............._,,,w __ �._...._ ......._._._. Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: o � at*_, AO041 Q�AAV Tr)Oe"WN 0 VSUTHOLD BUILDING DI 631 -765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PTBG. I l FOUNDATION 2ND [ ] INSULATION/CAL [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INE. [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PEI I ] ELECTRICAL (ROUGH) I ] ELECTRICAL I ] CODE VIOLATION [ ] PR / Iw REMARKS: , E -- :T z 2 s SI , _ —�— 4 j a i r � a { r - _ sWS 5 - �t -, 1! u tnl__ t z _ s ti qF= e � t ---------------- 4511 u s ga z -A 5TA WAL X L Uv n OU L �QLADAT:O'N-AICL-T SCTM # � .. TOWN OF SOUTHOLD PROPERTY RECORD CAF OWNER STREET X VILLAGa E DIST SUB LOT p� ACR. REMARKS rt .: _ - TYPE OF BLD. PROP. CLASS LAND IMP TOTAL DATE STI FRONTAGE ON WATER HOUSE/LOT I BULKHEAD TOTAL TOWN OF SOUTHOLD PROPERTY RECORD j�� O"A'NER, STREET VILLAGE DIST. wA. LOT FORMER OWNER E ACR. S w TYPE OF BUILDING RESSEAS. I VL FARM COMM. CB. mics. Mkt. Value LAND IMP. TOTAL DATE REMARKS ----------- r3l j -7, J --A o4f-70 9 Tillable FRONTAGE ON WATER WoodlandFRONTAGE ON ROAD Meadowland DEPTH House Plot BULKHEAD Total 3 7-a0 COLOR _ TRIM --!TF i I -4- 4 ith, 0 —11 51 I I s s 4 _ R V. -3 16 8 113:7-20 3/4/2022I23 ' i 1 i ) 3 s Extension ' Extension — ation d i Fou Bath Dinette SOO ' Pc 3-S Porch — = Basement u Floors K. I Ext.57 Walls x4j,12, Interior Finish LR. t Breezewa /� Fire Place Heat / DR. / y J")� f � POS 6®� es Gar Type Roof Rcoms 1st Floor BR. Patio Recreation Room Rooms 2nd Floor a r i a FIN. B O. B. Dormer L Driveway f 11 ao 5 Total 1 A FL ��t r � ty41Ot 01h, Town of Southold 6/1/2022 P.O.Box 1179 53095 Main Rd "k Southold,New York 11971 CERTIF CA'T E OF OCCUPANCY No: 43098 Date: 5/26/2022 THIS CERTIFIES that the building SINGLE FAMILY DWELLING Location of Property: 2795 Cox Neck Rd,Mattituck SCTM M 473889 Sec/Block/Lot: 113.-7-20 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 12/29/2020 pursuant to which Building Permit No. 45840 dated 2/24/2021 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: igC -fac til ve lliza�v tl hep°mished gtisem cgygred froltt ntry rear ec M of td9pr ca rand,attached r jpppPll tm The certificate is issued to Chadha,Deepika of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-20-1742 12/15/2021 ELECTRICAL CERTIFICATE NO. 45840 5/24/2022 PLUMBERS CERTIFICATION DATED 2/10/2022Vµ ai l emshic h r' ignattire . � ti�t; � Town of Southold 6/4/2022 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CER TIFICA"TE OF OCCUPANCY No: 43126 Date: 6/4/2022 THIS CERTIFIES that the building GENERATOR Location of Property: 2795 Cox Neck Rd.,Mattituck SCTM#: 473889 Sec/Block/Lot: 113.-7-20 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/28/2022 pursuant to which Building Permit No. 47891 dated 6/2/2022 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: qc csso r�pr torAs qd qi.: The certificate is issued to Chadha,Deepika of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 47891 6/3/2022 PLUMBERS CERTIFICATION DATED ..w_. ... _.... .. t rt;r �1 '"gig ...M ............._.v agars