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Home My WebLink About1000-115.-4-31 T "WN OF SOUTHOLD 0 g Rental Permit 0662 Owner Scott & Michelle Fritscher Occupied as Single Family Dwelling Located at 5375 New Suffolk Ave. Mattituck 115.4-31 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. 6/9/2022 ode E �r e ficial This Notice must be posted by the main entrance at all times rzw b Town Hall Annex Telephone(631)765-1802 54375 Main Road a? Fax(631)765-9502 P.O.Box 1179 P Southold,NY 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: I I P l k._w 4.:ve ..�J,1 to n/L19 5,�, Tax Map Number: 1000 SECTION d -BLOCK ? LOT _" f SECTION B. OWNER INFORMATION: Property Owner Name: 111 Property Owner Legal Address: Property Owner Mailing Address: a � m .. Telephone Number (s): Daytim 4`- 12-14—'V"Evening i�- Emergency �&er1e Property Owner Email Ad ress: /Vl Page 1 of 5 Town Hall Annex t y°, Telephone(631)765-1802 54375 Main Road j` Fax(631)765-9502 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: �,, ___w,w, __...w .._.. Address of Authorized Agent (no P.O. Mailing Address of Authorized Agent:,................mm........� _ ___ _._._..._ Telephone Number(s): Daytime,,µW, ......... 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):mww _ _MM Mailing Address of Authorized Agent: �._. .... Telephone Number(s): Daytime Evening Emergency 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. Page 2 of 5 Town Hall Annex "3 Telephone(631)765-1802 54375 Main Road �� Fax(631)765-9502 P.O.Box 1 179 sl Southold,NY 11971-0959 k ,ty 1"T BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM 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: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling un 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 each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 d` P.O.Box 1 179 All, 4 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent:..,_,_-... Telephone Number(s): Daytime Evening .....____Emergency_,,_,,,,_, EmailAddress:...._ww__m.... ........ _..................................... ............. .......... _. . 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:�. . Number of rooms in Rental Dwelling Unit: ggMe Use and Dimensions of each room in Rental Dwelling Unit: w�,_ w Page 3 of 5 ,off iiCe i Town Hall Annex Telephone(631)765-1802 54375 Main Road �`} Fax(631)765-9502 P.O.Box 1 179 Southold,NY t 1971-0959 V41rr. 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 C� 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) 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 qq' Telephone(631)765-1802 54375 Main Road k Fax(631)765-9502 P.O.Box 1179 x duo- Southold,NY 11971-0959 T .,i BUILDING DEPARTMENT TOWN OF SOUTHOLD 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: 5co, {µ� L�?P�' ww.._......... _.... Property Owner's Signatures _..... � Sworn to ore me thise4 day of , 20a� Official Notary Public Signature and Originalrat« ?Stamp ar o�"*,. Damb orloww "Nev Y S,F�w aaFFkFFFe '-° p 1�o.f�IO'1 '80392 OVEI/XM. Mm01j0vxwd .``y �t ' k ( low Cit 3ull�11r county AWCOVWS !PRO ��*es�y'�S ""'`ar!''�""~ ,,y �* per/ y 41Gk1unOssim "' m 'SWY1t110JL&WtV Page 5 of 5 N sv,w� �gWgN T� UT TD BUILD14G DI 631 -765-1802 INSPEC ION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. C l FOUNDATION 2ND [ ] INSULATIOWCAL ] FRAMING f STRAPPING [ FINAL Z ] FIREPLACE & CHIMNEY [ FIRE SAFETY INS FIRE RESISTANT CONSTRUCTION [ FIRE RESISTANT PE l ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII [ ] CODE VIOLATION [ � PRT C � � 1 DATE � � INSPECTOR ` hone(631 765-1802 Town Hall Annex b` r': Telephone ) 54375 Main Road k? Fax(631)765-9502 P.O.Box 1179 Southold,NY 1 1971-0959rc 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 F'ro essional seal re iced or architect or n inset ticened ltorrme In etor mast rovide CoPV of valid current certi ication Rental PropertySCTM Number: r Rental Property Address: ' ew � � Owner/Name: , Rental Dwelling Unit Identifier: �. w Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 —100 sq., Bedroom#2-90 sq., etc.) �014 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 it fully complies with all the provisions of the Code of the Town of Southold,the Residential Code of New York State,the Building Code of New York State,the Plumbing Code of New York State, the Fuel Gas Code of New York State, and the Energy Conservation Construction Code of New York State. ,rpt W Pr t i1e " ` � Original Signature Pleas ace`pr slynal ea 61,x 014 18 6 OF °M' -711 G 113 TOWN OF SOUTHOLD PROPERTY IMAJKLO %. KU OWNER 'STREET PILLAGE GrE DIST. SUB. LOT � FORMER OWNER N E ACR S W 1 TYPE OF BUILDING RES ' SEAS. VL. FAW COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS fif S� UA f Ank 7�, 2 AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH 1 House Plot BULKHEAD Tota` DOCK i i COLOR TRIM e F 0 a i M. Bldgst lz Extension -- -- Extension Extension Foundation Bath Dinette 4 Porch - Basement Floors _ '� K K, t Porch > Walls Interior Finish - LR. Breezeway Fire Place Heat Garage Type Roof —-- Rooms 1st Floor BR. Patio Recreation Room '. Rooms 2nd Floor FIN. B , 0. S. Dormer Driveway Total �� FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Z.:!-23.76....... Date ......................... .......... .. 19.66.. THIS CERTIFIES that the building located at -ff/6....New.-S folk.4vo.-W/.-Wt.,Rdtreet Map No. ...XXX........... Block No.XXX............... Lot No. ...X.7M.........Natti..Wokp...N.Yo............ conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................September.....29., 19.-60, pursuant to which Building Permit No. ��$�•.,`�,.• dated .................................$;ept.-29...... 19:65..,, 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 ........ Er.ivate..4fte..;&Ml y..d-V$11isig................................................... ... .................................. The certificate is issued to .-Ger-tr .dffi.-Bold Jin.......... e!..............,... .. ..........................•.. (owner, lessee or tenant) of the aforesaid building. H.D. Approval March 22t 1966 by R. vile. .............. ��Buildin4tllnpectc��,,,. : a F � I 1 BEDROOM #1 BA-r? 4 KITCO-4EN n4> � } BA-r14 x a 91x11' 0 , Q ! 1 U < X107 S.F. SD/GO f,�¶O w. _ LN. t I U GL, [! ® DN MH LI V i NG ROOM BEDROOM #2 15`x1o° Ii�E � 0 (200 !5.F.) EjI GL. o x w W z FE � - PLAN � - 3 D.-HY, 7e E � 3 1 i I Ec E i 3 I 3 � F U i ail H y 0 —Z- 1z,Al O O a SD/CO SDlCO � d (,) d GARAGE I ® i PLAYROOM r tEcw k H Fly � E Ell UP O X z F � FOUNDATION PLAN E = ' Davin By: SCALE: t14��It—O° x r term+ Date OF 2 SHEEis