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Home My WebLink About1000-143.-3-9 TOWN OF SOUTHOLD Rental Permit 0762 Owner Jessica Caporuscio Occupied as Single Family Dwelling Located at 410 Bay Avenue Mattituck 143.-3-9 Maximum Permitted Occupancy 5 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. 10/20/2022 Code Enforce e t Offi ' I This Notice must be posted by the main entrance at all times SO Town Hall Annex Telephone(631)765-1802 54375 Main Road cr p� Fax(631)765-9502 F.O.Box 1179 G P Southold,NY 11971-0959 1 SEPI 10 2022 II EUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ' 1 Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION N5 , 00 -BLOCK (93. 00 -LOT-0 0 9 - WO SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: )4 b(bdk- )& Df- b4 b roo61 jeAo u- 62, `RGi-on . W Oq 3 � w A, IVY 117 4 3 Telephone Number(s): Daytime(631)-741- 3�a7Evening (,31 741- Sad Emergency Property Owner Email Address: 165-1 Co-Cap e'-6-I'4 o'-11 . CO Ak GL Page 1 of 5 ere- AL 0, vr-,c d\L'otC r10L` z. ""' . _ soli Town Hall Annex i Telephone(631)765-1802 54375 Main Road cn Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 rou 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: J, 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: 044 yy Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: 9 Use and Dimensions of each room in Rental Dwelling Unit: LiV� \BOOM 13, x L`1'.3'� Sc�s� qo.<- +(�I 15'S'� �In11�9 �O(n g'3« x b�' I 'I U�kl (U6 10" 7'3 go t�ct7och \ 4, 10" x 19 " Page 3 of 5 Town Hall Annex �, Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 � C®UNl�,�� 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 3-e,551 CO` (LkS0 0 , 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 �t� s Town Hall Annex S Telephone(631)765-1802 54375 Main Road c� Fax(631)765-9502 P.O.Box 1179 �, d Southold,NY 11971-0959 p �� N�i,�� 5, 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: �551 C� Q�CI NPS Property Owner's Signature: Sworn to before me this 26 day of s 200- Of ictal No ary Public Signature and Original Notary Stamp ANTHONY PATRICK LUPO Notary Public,State of New York No.01LU6345565 Qualified in Suffolk County �y Commission Expires July 25,20 0 Page 5 of 5 SOUIyo� # # TOWN OF SOUTHOLD BUILDING DEPT. `ycourm, 631-765-1802 4-10 Ott Ave,- INSPECTION /e,-1NSPECTION [ ] 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 C/O [ eRENTAL REMARKS: h s�l 51U,o GSL-W n 4�fd el 1� l� DATE /D- INSPECTOR "T: / 1 Ihr.ry LJ �.�Ywnr 3 y` 'j j OCT 1 7 2022 , TOt... ; ; ql0 6 A-C -- T631CO, CaO WS6.o cc 6AM rn -7 Sir ac) 1-7 a If Vi 00 It' 7u r M6MA s pow brgr( R,�r( i�t3n �Rvr,Y� pbb(Z 4f0 ga. CD �Atd� Q /0 7'3n �jo�co0� 00 ct cs— Vr Town Hall Annex SOUTH®LD TOWN 54375 Main Road PO Box 1179 Southold, Rental Inspection NY 11971-1179 Tel: 631-765-1802 Fax 631-765-9502 SCTM # Date Owner Phone Address Zip CI tYInspector .. LEVELS SUB 2 3 Smoke Detectors (#- bedroom detectors excluded) Carbon Monoxide Detectors (#) Fire Extinguishers (#) Exits (#) BEDROOMS 1 2 3 4 5 Smoke Detector Alarms (#) Carbon Monoxide Alarms (#) Egress (windows) (Y/N) BUILDING SYSTEMS Y/N CONDITION OF PROPERTY Y/N Heating system maintained/operational Building Interior is clean I maintained Hot water system maintained/operational Building Exterior is clean I maintained Electricals stem maintained/operational Property is clean/safe/maintained Mechanical system maintained/operational Handrails & guards present COMMENTS: Gd � Rental Inspection Form 4/7/2021 TOWN OF SOUTHOLD PROPERTY RECOR6 1-4a1/ at OW R �c � STREET VILLAGE DIST. SUB. LOT FORMER OWNE E ACR. S W TYPE OF BUILDING ` RES. I SEAS. I VL. FARM COMM. CB. MICS. Mkt. Value LAND I IMP. TOTAL DATE REMARKS _ G y"o Z4, 11417.9 /f/ � 3 LSo L'c erf Jtl l 0X _ 1 AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per I Value r �' i Ac re Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD 70r � �0- ��_ Meadowland DEPTH House Plot BULKHEAD .~Toto) ``'�`'' . _^ I '�'' DOCK ti ti AA ■_ oar ` '�� ■� .90 ar. .a,y'. 'Rx-!� M'.'�.^.m.- Yom;-.� a ._.__w.. ' ■■■■� ■�■■■ ■■ .!■!■...■... ■■.■�i■ IN ■■ . IN ■■ ._ • f _� J •• .' M. ••• ms Ist Floor 'f • Rooms 2nd Fl 10, . Driveway f • 1� � s FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. . . 79619. . . . . . . . . Date . . . . .AuguSt. .7. . . . . . . . . . . . . . . . . .. 19 . 79 THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property .490. Bay. Ave.. . . . . . . . . . . . Mattitu?k dV.Y. House No. Street ani%t County Tax Map No. 1000 Section . . . .1.43. . . . .Block . .03. . . . . . . . . . .Lot . . . W9. . . . . . . . . . Subdivision . . . . XX. . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. .X. . . . . .Lot No. . .X. . . . . . . . . . RMU��Fl�NTS FOR AM LY DWIB.LI U T 0 0 conforms substantially to the act�i . . . . . ..Aril. 23. . . . . . 19 .57pursuant tow c i &�CCUPANCYZ9619. . . . . . . dated . . . . .August. 7 . . . . . . . . . . . . • 19 .79,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 . . . . . . . . . . . .Private. one.family. dwelling.with. an .acaessory. .stmature . . . . . . . . . . . The certificate is issued to . . . . . .Karen .C. P.. .Eckert . . . . . . . . . . . . . . . . . . . . . (owner �J of the aforesaid building. Suffolk County Department of Health Approval . . . . . N/.A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . r UNDERWRITERS CERTIFICATE NO. . . . . . . . . . .NIR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Building Inspector Rev 4/79 BUILDING DEPARTMENT TOWN OF SOUTHOLD, N. Y. // HOUSING CODE INSPECTION REPORT Location 4ZfO SAy r9v_ (number 8 streett) Municipality Subdivision Map No. Lot(s) Name of Owner(s) Occupancy (tyPe OXte�nanA2/L Admitted by: c/Ub!/ CX,A/CtE Accompanied by: �A/reE � �uMv,oy Key available Suffolk Co. Tax No.la22-1513-63-009 / Source of request Date —S— DWELLING: Type of construction &/000 Yg:�tA"'!F` #stories Foundation- Erclt/ciyT b;Lc�c� Cellar K&L Crawl space Total rooms, lst. Fl 4 2nd. FI-F �izr 3rd. Fl �-Bathroom(s).-1 Ilio Toilet room(s) Porch, type Fi7a,r/7-- 9MWDeck, type Patio, type Breezeway__------ Garage Utility room 65 Type Heat ,/- FI& ,o Warm Hotwater Fireplace(s) No. Exits 7&- 4�,,:F Airconditioning Domestic hotwater heater Other ACCESSORY STRUCTURES: Garage, type const. Storage, type const. Swimming pool Guest, type const. Other VIOLATIONS: Housing Code, Chapter 52 Location Description Art. Sec. aoE do / a'-3 - 7 66 -:7Z-eV-- V, _ a — 2 ZeVk CG-xff u/a v;/tea N/1-4 o Z)--,v/4z, Z-7?!Ey rrosc Remarks: — /iG� .Qssc j,o2 cc Ds G/ Inspected by: Date of Insp. 7 Time start Z`-'�P` end 3.00 -Xc