HomeMy WebLinkAbout1000-113.-7-19.37 r
TOWN OF SOUTHOLD
t µ;
Rental Permit
"i
0958
Owner Valerie Hanna
Occupied as Single Family Dwelling
Located at 740 Royalton Row Mattituck 113.-7-19.37
Maximum Permitted Occupancy 10
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.
7/26/2023 '�Sc" 0
This Notice must be posted by the main entrance at all timesr)-mrt Ticial le E rc
X-V �� �
Telephone(631)765-1802
Tele
Town Hall Annex P
54375 Main Road Fax(631)765-9502
P.O.Boz 1179
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:
'-4 )q b ED q I�)/V &A)
Tax Map Number: 1000 SECTION IL 3 _-BLOCK
-LOT
B.
OWNER INFORMATION:
Property Owner Name: V A )(Z/e
Property Owner Legal Address: Property Owner Mailing Address:
In
H
09q`p
Telephone Number(s): Daytime jj -0- Evening Emergency
Property Owner Email Address: VLI ) �Cnn� `'✓ h 3 ` ' ��
Page 1 of 5
Or sot .
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
BUILDING DEPARTMENT
TONM OF SOLPMOLD
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any:
Address of Authorized Agent (no P.O. Boxes): g
Mailing Address of Authorized Agent: 3,5
Telephone Number(s): Daytime Evening Emergency
Email Address: to�4 E Ij i ��� ` Cd/*!
Section D.
Managing Agent Information: 'F
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 Emergency
Email Address: `
SECTION E.
SITE MANAGER INFORMATION: (required for rental properties containing 8 or to ental units)
Name of Managing Agent of dwelling unit, if any:
Address of Managing Agent (no P.O. Boxes):
Page 2 of S
SO
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 °{
Southold,NY 11971-0959
WV
3 �
BUILDING DEPARTMENT
TOWN OF SOLr OLD
Mailing Address of Managing Agent:
Telephone Number(s): DaytimeEvening Emergency _
Email Address: 7
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on property: f
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 UI1i :
Number of rooms in Rental Dwelling Unit:
Use and Dimensions of each room in Rental Dwelling Unit: 21
r 4i A4 I Ib- �7 XI
a
5 C 6 -�I W A
Page 3 of 5
o t ,.
Telephone(631)765-1802
To
rp lal Fax(631)765-9502
5 .375 Main R
oad
0.Box 1179
d)95`
�� #1,#Y 11971 �e
Z,
\'
BUILDING DEPARTMENT
TOWN OF SO OLD
'SECTION G.
INS`E "'ION
` pursuant to the Town Code of the Town of Southold Chapter 207(Rental properties),a s fety
nsp
exon by Code Enforcement Official is required. If the owner chooses not to have said
gypIon performed by the Town,a certification from a licensed architect,a licensed
\\ �fe- onai engineer or a home Inspector who has a valid New York State Uniform lire
wention Building Code Certification Is required stating that the property which is the subject
the rental permit application Is in compliance with all of the pro
visions of the code of the
�of Southold,the laws and sanitary and housing regulations of the County of Suffolk and
y the laws adopted by the New York State Fire Prevention and Building Cade Council.
❑ I am requesting a fire safety inspection to be performed by a Code Enforcement Official
from the Town of Southold
V/1 am submitting a completed Town of Southold certification form from a licensed
architect or a licensed professional engineer.
ON H.
TION: Signature must be notarized and MUST be the owner of the dwelling unit.
OF NEW YORK)
\\ OF SUFFOLK)
1
certify under penalty of perjury,the following:
1 am the owner of the property identified in "Section A"of this application.
e Property owner's legal address set forth in "Section B" of this application is my legal
` ddress and I understand the Town will use the address for service pursuant to all
Page 4 of 5
S.10
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r
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
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: Al
Property Owner's Signature:
Sworn to before me thisl,.e2 ty of 2
ii1i 11 qe�--5
officialof P
Notary Public Signature and Original Notary Stamp
Page 5 of 5
FLORMA JURAT"
aS 117 051"3
State of Florida
County of
)4KA& - Sworn to(or affirmed)and subscribed before me by
means of
It/tIvsical Presence,
— p—
f. l Online Notarization,
this __clay of _t T � by
Day Pbntt7 year
� a_i - e Lit a_
Name of Person Sweorir7g or Affirming
g " NAIROBIYALENTIN
wt�I Notary Public,State of Florida
_ Commission 4 HH 259015 ,,g E e o;F Notary Public State of FloFido —�
My Comm.Expires Apr 28,2025
Name of Notary 7)/ped, Printed or Stamped
4r�A_IiRs_sCEl
EJ Personally Known
My Carrr :x
_. roduced Identification
Type of Identification Produced:
Place Notary Sea(Stamp Above
Completing this information can deter alteration of the document or
i
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document:
Document Date: , Number of Pages:
-
Signer(s) Other Than Named Above:
CD2020 National Notary Association
M1304-10(11/20)
i W)
TOWS � 6viSOUTHOLB BUILDING DEPT.
t� 631-7651802 -•
I mNakm S P E(D" T I %AJmhk N
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENE3RATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ RENTAL
REMARKS:
IS �
DATE "AflA, 137 - INSPECTOR
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SCTM # �.� 1 �
TOWN OF SOUTHOLD-PROPERTY RECC1 '
OWNER STREET VILLAGE DIST ' SUB LOT
ACR. REMARKS=
TYPE OF BLD,
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P OP.CLASS
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LAND F IMP- TOTAL DATE Y
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FRONTAGE ON WATER HOUSE/LOT
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Town of Southold 4/11/2023
P.4A
P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CER'T'IFICATE OF OCCUPANCY
No: 44009 Date: 4/11/2023
THIS CERTIFIES that the building SINGLE FAMILY DWELLING
Location of Property: 740 Royalton Row,Mattituck
SCTM#: 473889 Sec/Block/Lot: 113.-7-19.37
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
6/8/2021 pursuant to which Building Permit No. 46451 dated 6/21/2021
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:
single family dwelling with unfinished basement.covered front Dorch. rear deck,rear second floor balcony and
attached garage as applied for.
The certificate is issued to Marratime Cap LLC
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-21-0175 2/27/2023
ELECTRICAL CERTIFICATE NO. 46451 10/25/2022
PLUMBERS CERTIFICATION DATED 8/19/2022 -hard Ca area
A or ed Signature
4k Town of Southold 4/17/2023
P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 44013 Date: 4/17/2023
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 740 Royalton Row,Mattituck
SCTM#: 473889 Sec/Block/Lot: 113.-7-19.37
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
10/18/2022 pursuant to which Building Permit No. 48602 dated 12/15/2022
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:
accessory in-ground swimming ppol fenced to code as apptie-d for.
The certificate is issued to Marratime Cap LLC
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 48602 4/10/2023
PLUMBERS CERTIFICATION DATED
A th ed Sika
OENERAL15Y�-,EBOL <EY.
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