HomeMy WebLinkAbout1000-87.-3-10.1 §t of
TOWN OF SOUTHOLD
Rental Permit
0731
Owner Jennifer Handau
Occupied as Single Family Dwelling (second floor is storage only)
Located at 3385 Minnehaha Blvd Southold 87.-3-10.1
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.
10/4/2024 `
ode c mere Official
This Notice must be posted by the main entrance at all times V( I
t tea NAV�64A- NO
OWN OF SOUTHOL.D BUILDING DEPT.
631-765-1802
INSPECTION
[ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INS LATION/CAULKING
[ ] FRAMING /STRAPPING [ ] NAL
[ ] FIREPLACE & CHIMNEY 14 FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTA7PETRATION
ELECTRICAL (ROUGH) [ ] ELECTRICAL)
CODE VIOLATION [ ] PRE C/O NTAL
DA rE _ 111 SPE CTO
TOWN OF SOUTHOLD
o Z& Rental Permit
�j
0731
Owner Robert Holzer
Occupied as Single Family Dwelling (second floor is storage only)
Located at 3385 Minnehaha Blvd Southold 87-3-10.1
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.
8/24/2022 %A
de E orc m nt fficial
This Notice must be posted by the main entrance at all times I
Town Hall Annex 1�i Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 Or • `,�4 S E r
�,VnU
JUL 1 5 2022
Lam`
BUILDING DEPARTMENT
T.
TOWN OF SOUTHOLD BUILDINGtN
'I"OWfV OF SOUTNOLD
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 7 -BLOCK -LOT D -�
SECTION B.
OWNER INFORMATION: J) rr
Property Owner Name: - ����J /V_' Zn=,'��Lf
Property Owner Legal Address: Property Owner Mailing Address:
nlg�i1 , r=C.,-�i - e- -
&12- - -
Telepahone Number(s): Daytime,c_� 6/2 . Evening Emergency, ge3 Z-
Property Owner Email Address: e__'�Oknc 'fell eyGrte'
Page 1 of 5
WS0
1
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1 179
Southold,NY 11971-0959 coumv '
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent:
Telephone Number (s): Daytime Evening Emergency
Email Address:
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:
i
vQ cow r l 3LA.tq
is a-��LJ VI x I� P F�. ` % x /.3
Page 3 of 5
j s°
Town Hall Annex ` Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179ISS
Southold,NY 11971-0959 `
elf,
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.
X1.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
so
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: PC6,tk
Property Owner's Signature:
Sworn to before me this r day of 20 aa,
Official Notary Public Signature and Original Notary Stamp
CONNIE D.BUNCH
Notary Public,State of New York
No.01BU6185050
Qualified in Suffolk County
Commission Expires April 14,2
Page 5 of 5
OF soUTyO 77
# # TOWN OF SOUTHOLD BUILDING DEPT.
cou631-765-1602 �'�. ��.,� 10. 1
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] PKAL
[ ] FIREPLACE & CHIMNEY [ IRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI L)
[ ] CODE VIOLATION [ ] PRE C/O [ RENTAL
REMARKS:
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DATE Y INSPECTOR
6'-0 184' 28'-512• 34'
II -51/4'
A9 606BSGD O� 2852 A7 I A6 24218 Tag MemWr
Al (3)2x8 SPF 92
A2 (3)1 1/Y x 5112'LVL(E=1.8)
1 I A3 (3 1 l..x 5112'LVL(E=1.8)
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FIREPLACE AND HEARTH I R'S A6 (2)2x8 SPF 92
PER MEPLACF MANUAC R'S —
INSTALLATION INSTRUCTION A7 (2)2x6 SPF 02
® BATH WIC A8 (1)2(6 SPF#2
1 NOOK LIVING ROOM >® A9 (3)11/2"x 5 112'LVL(E=1.8)
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U—SBr#1 223 17.8 8.9 22.8 12
Al 2/210M1R1ED O 2852 MUUED A} dWS�ELIGIfTS A6 2857M�D Diring 156 123 6.2 228 �12
Nook 161 11.3 5.6 46.5
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tra _I t7a' I I� s-t D• ( e'-oj' 1sa • STATE MODULAR LABEL
■ NTA LABEL
I 25'-0'J 4X-9"JDATA PLATE
6 DORMER CA. 6'DORMER C& 6'DORMER CIL �✓),
/.AM CpQ
TO THE BEST OF MY KNOWLEDGE,BELIEF,AND PROFESSIONAL I I i11'
JUDGEMENT,THESE PIANS AND SPECIFICATIONS COMPLY WIT THE C
ENERGY CONSERVATION CONSTRUCTION CODE OF NEW YORK(ECCCNY).
COMPLIANCE SHALL BE DEMONSTRATED TO THE LOCAL BUILDING
OFFICIAL BY NY MECH CHECK(ECCCNY CHAPTER 1)AND GENERAL �•u.• r'
COMPLIANCE WITH ECCCNY CHAPTER S.SECTIONS 502 THROUGH 505 'OF'JSI`� 1L
THE PLANS AND SPECIFICATIONS OF THIS PERMIT SET `�j
ARE DERIVED FROM AND CONSISTENr NTH INE PLANS �(
AND SPECIFICATIONS ASSOCIATED NTH APPROVAL
M009-03-021 AND ITS CONDITIONAL APPROVAL LETTER,
DOTH ON FILE NTH THE DIVISION
Integrity Building Systems, Inc. DEALER:FUTURE SURROUNDINGS DATE: 2/9/04 1 REV:6/11/04 4 C171304 FIRST FLOOR
CUSTOMER:HOLZER DRAWN BY: CS/GS CAPE PLAN I Al
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LAND IMP. TOTAL DATE REMARKS -^
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AGE BUILDING CONDITION
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FORM NO. 4 30-7 -7--7 —
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31335 Date: 12/15/05
THIS CERTIFIES that the building NEW DWELLING
Location of Property: 3385 MINNEHAHA BLVD SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 87 Block 3 Lot 10.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 5, 2004 pursuant to which
Building Permit No. 30777-Z dated NOVEMBER 15, 2004
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 COVERED FRONT PORCH & UNFINISHED SECOND
FLOOR AS APPLIED FOR.
The certificate is issued to ROBERT C & PAMELA HOLZER
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF BEALTH APPROVAL R10-04-0094 11/03/05
ELECTRICAL CERTIFICATE NO. 2045519 05/26/05
PLUNIDERS CERTIFICATION DATED 05/16/05 CUTCHOGUE EAST PLUMB&HEAT
Authorized Signature
Rev. 1/81
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 30777 Z Date NOVEMBER 15, 2004
Permission is hereby granted to:
ROBERT C HOLZER
SOUTHWOODS
DANBURY,CT 06810
for
DEMOLITION & RECONSTRUCTION OF A NEW SINGLE FAMILY DWELLING
(MODULAR) WITH COVERED FRONT PORCH & UNFINISHED SECOND FLOOR AS APPLIED FOR
at premises located at 3385 MINNEHAHA BLVD SOUTHOLD
County Tax Map No. 473889 Section 087 Block 0003 Lot No. 010 . 001
pursuant to application dated OCTOBER 5, 2004 and approved by the
Building Inspector to expire on MAY 15, 2006 .
Fee $ 1, 337. 30
J Authorized Signature
ORIGINAL
Rev. 5/8/02
sufrogawg�'G Uff 6ftfte C �' 't
oun y of� Of [k
On. the Date Written Below LETTERS TESTAMENTARY were granted by the Surrogate's Court of Suffolk
County, New York as follows:
File:#: 2021.,-5492
Name of Decedent: Robert C Holzer Date of Death: 10-10-2021
.AKA Robert Charles Holzer
Domicile: County of Suffolk
Type of Letters Issued: LETTERS TESTAMENTARY
Fiduciary Appointed: Ernest Handau
Limitations: NONE
THESE.
LETTERS, granted pursuant to a decree entered by the court, authorize and'empower the
above-named fiduciary or fiduciaries to perform all acts requisite to the proper ad"ministration and disposition
of the estate/trust of the Decedent in accordance with the decree and the laws of:NeW York State, subject to
the limitations and restrictions, if any, as set forth above.
Dated: March 23, 2022 IN TESTIMONY WHEREOF, the seal of the Suffolk County
Surrogate's Court has,been affixed.
WITNESS, Hon Theresa Whelan, Judge of the SuffoJk County
Surrogate's Court
Doreen A. Quinn, Chief Clerk
These Letters are Not Valid Without the Raised Seal of the Suffolk County Surrogate's Court
Certificate# 240619
Surrogate's Court of the State of New York
Suffolk County t=ile#: 2021=5492
Certificate of Appointment of Executor
IT IS HEREBY CERTIFIED that Letters for.-the Estate .of the Decedent named below have been granted by
this Court, and such Letters are unrevoked, are valid and, are in full force as of this date.
Name of Decedent: Robert C Holzer
aka �Robert.Charles Holzer
Date of Death: October 10,X2021
Domicile: County of Suffolk
Fiduciary Appointed: Ernest Handau
Letters Issued: LETTERS TESTAMENTARY:.
Letters Issued On:
March 23, 2022; -
Limitations: NONE
THESE LETTERS, granted;pursUeiit to a'decree-e-ntered.by>the.court; authorize and empower the
above-named fiduciary or fiduciaries to perform all acts requisite to the proper administration and.disposition
of the estate/trust of the Decedeot=in'.:accordan.ce.with the decree and the laws of New York State, subject to
the limitations and restrictions, if'any `as'set forth above.
s -
and such Letters are.unrevoked and in full force as of this date.
Dated: March 23, 2022 IN TESTIMONY WHEREOF,the,seal of the.Suffolk
Riverhead, New York County Surrogate's Court has been affixed.
WITNESS, Honorable Theresa Whelan,Judge of-the
Suffolk County Surrogate's Court.
k
Doreen A. Quinn, Chief Clerk
Suffolk County Surrogate's Court
This Certificate is Not Valid Without the Raised Seal of the Suffolk County Surrogate's Court