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Home My WebLink About1000-123.-5-25 fat `SOWN OF SOUTHOLD Rental Permit a$ 0950 Owner Ellen Rieger Occupied as Single Family Dwelling Located at 4235 Camp Mineola Rd Mattituck 123.-5-25 Maximum Permitted Occupancy 8 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. 7/10/2023 _ Code Enforc met ffiaai This Notice must be posted by the main entrance at all times co Town Hall Annex ' " Telephone(631)765-1802 54375 Main Road 4 Fax(631)765-9502 P.O.Box 1179 mr Southold,NY 11971-0959 6 i � � �� VI IUI Ara BUILDING DEPARTMENT APR 2023 TOWN OF SOUTHOLD J RENTAL PERMIT APPLICATION � AVNOF !w�O)Il�iro 401.' Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: 4235 Camp Mineola Road, Mattituc NY 11952 Tax Map Number: 1000 SECTION 123 -BLOCK 5 .-...--LOT 25 - SECTION B. OWNER INFORMATION: Property Owner Name: Ellen Property Owner Legal Address: Property Owner Mailing Address: 65 Arbutus Road. Greenlawn, NY 11740 Same as Legal address Telephone Number(s): Daytime 917-865-3384 Evening917-865-3384Emergency 17-865-3384 Property Owner Email Address: o1jE ie "r t sn corrw -. " Page 1 of 5 fle,C- I D 4 1 Q C sk-r i Fr Town Hall Annex 7, Telephone(631)765-1802 54375 Main Road U Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 4 l'k BUILDING DEPARTMENT TOWN OF SO"UTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit,if any: Nolle Address of Authorized Agent(no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening Emergency Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: NA Address of Authorized Agent(no P.O. Boxes): 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: NA Address of Managing Agent (no P.O. Boxes): NA Page 2 of 5 Town Hall Annex �� , Telephone(631)765-1802 ti� r 54375 Main RoadZk: Fax(631)765-9502 P.O.Box 1179 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. ❑ 1 am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold 67 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 Ellen Rieger , 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 y^ Telephone(633)765-1802 54375 Main Roads Fax(631)765-9502 P.O.Box 1 179 °wg, Southold,NY 11971-0959 w� Nil' BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: NA Telephone Number(s): Daytime Evening Emergency Email Address: SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: One- Entire Singlef-arnily Home 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:___L" j.j µ Requested Maximum number of persons allowed to occupy Dwelling Unit: 8 Number of rooms in Rental Dwelling Unit:_2 -- Use and Dimensions of each room in Rental Dwelling Unit: Eecire < rn. Ee xo,�orn #2 Vx 101 lie Page 3 of 5 Town Hall Annex P G. Tele hone(631)765-1802 �� 54375 Main Road ? Fax(631)765-9502 P.O.Box 1179 r Southold,NY 11971-0959 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: Ellen Rie er Property Owner's Signature: , „ Sworn to before me this 0 day of March ,2023 +M. NOMW ROW.STA►e OF New YORK N0.01KO6310%5 " aMUFWD IN NASSAU CWNT'i Official No ry Public Signature and Origina" otaryStamp C1x*AWA*ExPwsSEPT.02,20 240 Page 5 of 5 ��,CtF QCIT�; r k !" TOWN OF SOUTHOLDDEPT. 631.765-1802 1a3-S- 2 Sr INSPECTION [ ] 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 / [ RENTAL o REMARKS: O 1 act DATEw G -a3INSPECTOR _ --wwww. Town Hall Annex vl , SOUTHOLD TOWN 54375 Main Road ' "N' PO Box 1179 Southold, R Rental Inspection NY 11971-1179 Tel: 631-765-1802 rvJw4' Fax 631-765-9502 SCTM # Dates Owner Phone Andress ��3 S ;dip city Inspector --- LEVELS SUB 1 2 3 Smoke Detectors (# - bedroom detectors excluded) Carbon Monoxide Detectors (#) Fire Extinguishers (°#) Exits (#) BEDROOMS 2 3 4 5 Smoke Detector Alarms (#) / --- Carbon Monoxide Alarms (;#) Egress (windows) (YIN)BUILDING SYSTEMS Y/N CONDITION OF PROPERTY Heatin s stem maintained/operational Building Interior is clean/maintained Y/N Hot waters stem maintainedJoperabonal Building Exterior is clean/maintained Electricals stern maintainedlo)erational Property is clean /safe/maintained Mechanical system maintained/o erationai Handrails & guards present COMMENTS: Rental Inspection Form 4/7/2021 Town Hall Annex Telephone(631)765-1802 54375 Main Road +� Fax(631)765-9502 P.O.Box 1179 .w5 Southold,NY 11971-0959 N, BUILDING DEPARTMENT TOWN OF SO SOLD 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 Professional seal required for Architect or Enaineer,licensed Horne Inspector must Provide copv of valid current certi oyon Rental Property SCTM Number: 1000-123-5-25 Rental Property Address: 4235 Cimp Mineola Road Mattituck NY 11952 Owner/Name: Ellen Rieger Rental Dwelling Unit Identifier: Entire Single Fanifly 1'-10m Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1-100 sq., Bedroom#2-90 sq., etc.) Bedroom#1 160 so ft).Bedr ons #2 2:1 l �l ��1 Lui. d.. X 1: 5.. .1 ft) Property Description (Include all improvements indicated on survey) 18 sa tv j r r"— ralt`attcl ra r storage shed 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 ConsJOHin n Construction Code of New York State. fk2Lc�.W—�� 1 Print Name and Title �� I Signature A Please place professional seal: ° f i ?� �,m,.,� I c= L 10 N h CAit ► �rto�a�tr D��Smer��tl�cc�r 4- ?S AN g�� f bnp2 eC.e.. Y4 Z N goo Z � tb A►f y• (r )srou k 4' D��c.c-dot, Ce 44 i �_ los wra� TOWN OF SOUTH LD PROPERTY RECORD OWNER ` STREET VILLAGE DIST ` SUB. LOT 4 FORMER OWNW `.,, NE - ACR. r � e a =. - f : i Y S W TYPE OF BUILDING I RES_ SEAS. VL. FARM COMM. CB, MISC. Mkt. Value LAND _ IMP. TOTAL DATE REMARKS 3-a-� �- �•� I aq a F s } r s_ f AGEL=�N4:�TIO� k Af — �— ,._. FARM Acre Value Per Value Acre _ Tillable 1 -.Tillable 2 tw Tillable 3 F , Woodland I _ - P ;FRONTAGE ON WATER Swampland - _ Br land FRONTAGE ON ROAD t - House Plot - ` DEPTH BULKHEAD s } DOCK Total ; ` e � _ ► _ ate. t 4 - :OLOR T_ - - RIM { c , _ � r 123.5-25 32014 � l r Both Dinette; M. Bldg. `Foundation i r 5 Extension '. a4. Basement ; Floors t K. Extension Ext. Walls _ Interior Finish i LR. - >_ - - / � - DR E Fire Place = Heat Type Roof it Rooms 1st Floor BR= - �. Pore Recreation Roo cr; Rooms 2nd Floors FIN. B <^ ,- ' t f! Dormer Breezeway Driveway e a Garage Patio 2, 0. B. 1 Total .. �. , 1 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No 8-24234 Date MARCH 251_ 1996 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 4235 CAMP MINEOLA ROAD JQ&TTITUCKF N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 123 Block 5 Lot 25 Subdivision Filed Map No. Lot No. conforms substantially to the Requirements for a One Family Dwelling built Prior to: APRIL 90 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z-24234 dated MARCH 25 1996 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 GARAGE The certificate is issued to JOHN & JUDITH LYNCH (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. C" C/Swilding In ector Rev. 1/81 ~ ^ ' ooxu/wn ouxxorxuw` TOWN OF mmomLD /moo/wo cnmE /wuroCr/oo xnnooz z.Ou«zIom. 4235 CAMP wzmmmoA, RD. xAxTzrmoo, N.Y. SUBDIVISION--- mxv NO. �/rr(°) _________�� muus OF nnmuo (") zomzra LYNCH onoo»uw'Y A-x aoo' OWNER -----T�� --- '---7��tenantT-'---------'-- m,mIr,»n BY: zomznH LYNCH x000x,umIoo ur` SAME nnr xvxILmxI........................------- xxr NO. mumRnu OF us')ossr: JOHN LYNCHn^zn: MARCH 21 1996 TYPE OFCONSTRUCTION WOOD FRAME x azuaxou o x oo�zn a ruuwoxzIom CEMENT BLOCK oo/./.Ax mamo cuum/. uvunu 'roz^I. nuonx, /uz nt.m. s zm" ru�. 3 am, mn. nxu'xnoom (o) 2 zu/I.cT noou (o) _. wz/I.zTv ROOM PORCH TYPE ENCLOSED PORCH 000n, rxoo 2 WOODcxzzO oxsczswxx rIxopLxco oxx^cu nounor/o uurnuzouYES __ Tnnc xuuzoo mLooTRImxInouno/zIow/mu __________ TYPE IIEA'r ELECTRIC & PROPANE wmRm Alit zz xomWxzs un/nx, ACCESSORY STRUCTURES: GARAGE, TYPE OF CONSTWOOD FRAME WITH sTORAGE, nPE :OHST- owImmIwo Pool, --- -------^ 000ar, zvru xunxr. -----------------------~---------------------------------------------------~-------~ VIOLATIONS: nouprom ^x N.Y. uTum xw/Fuxm xzuc xuuvom,'uw & uuI/.nImu Cnou __ xow^^uu' ar #xxswu-Z - CO z-/u*uy (Addition to Acuy ouug') up 0/2148-z-cm z-/3954 (2nd Story addition u Alteration) s' FORM NO.4 TOWN OF SOUTHOLD BUILD d T Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Omupricy No. Date . . . . . . .6p AI .6 . . . . . . . . . . . . .. . .. 19:S2 THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. . .. ... . . . . . Location of property 4235 . . . . . . . . . . . ,Carry ,Mineola Road. . . . . . , , , , .Mattituck st County Tax Map No. 1000 Section . .?2 3. . . . . . .Block . U 5 .. . . . . . . . . .Lot .o?5. . . . . . . . . .. . Suldivision , . . . mX. . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. x . . . .. .Lot No. X. . ... . . . . . . . . conforms substantially to the Application for Building .Permit heretofore filed in this office dated Jun 8 3 19 PA pursuant to which Building Permit No. 1 7 3 4 2 Z, "dated . . .41R14 s t. 19 . . . . . . . . . . . . . . 19 P.I. ,was issued,and conforms to all of the requiremonts of the applicable provisions of the law. The occupancy for which this certificate is issued is . . . . . . .. . an. addition .to. an. existing,accessarx,structur.et . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . . .John .R,. A .Judith V. Lynch .� srwiw�id of the aforesaid building. Suffolk County Department of Health Approval . . Air. . . . . . . . . . . . . . . . . .. . . . . .. . . .. ... . .. . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . ,a,1,r. . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . Building Inspector Rm.1/af FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. . .Z,�3954. . . . . . . . Date . . . . . . . . . October 24. .. . . . . . . 19 85. THIS CERTIFIES that the building . . . . . ?A4. ptory. aaaition,. . . . . . . . . . . . . . . . Location of Property . . A235. . . . . . . . . . . . Camp, Mineola Rd. , , ,Mattituck House No. Street hlarrrlet County Tax Map No. 1000 Section . . . . 123. . . .Block . „ . . . . . . . . 5 . . .Lot . . . . . . .25. . . . . . . . Subdivision . . . . . . . . . . . . .X. . . . . . . . . . . . . . . . .Filed Map No. . . . X . . .Lot No. . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . .Fabruw y. .:f. . . , 1983.pursuant to which Building-Permit No. . . . .1?148Z. . . . . . . . . . dated . . . . . .February, .9. . . . . . . . . . 1983. ,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 . . . . . . . . . exist ng. dwellings . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . . . . . . . ..TR$19. F, .4. s1, "R. �� %� . . . . . . . . . . . . . . . . . . . . . d'orvrrer; +elf of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . . . . . . . . . . . / . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . . . . . . . .N° 5'!67. . . . . . . . . . . . . . . . Building Inspector Rev.1/81