Loading...
HomeMy WebLinkAbout1000-113.-7-1.3 TOWN OF SOUTHOLD Rental Permit 0770 Owner Aristides Barrios Occupied as Single Family Dwelling Located at 4300 Bergen Ave Mattituck 113.-7-1.3 Maximum Permitted Occupancy 4 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. 11/7/2022 E rc o �ci This Notice must be posted by the main entrance at all times Yde -E rq so 0, Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT aTOWN OF SOUTHOLD t U(i 2 2022 N`CAL PERMIT APPLICATION Br Bbl�"7NN'wl�'r l��1""x .cin TOW'l�R Ot I,P*rTilt Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: Z4 3�r� (3_-r�.c��2�I o�-vc , i�T�s�i�+ "��e--'°S, ►�t I I � S 2 Tax Map Number: 1000 SECTION 3 -BLOCK c) LOT---I---7 3 SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: tA t�661.�- ml -l. r cf Telephone Number(s): Daytime _Evening- �;AtK Emergency ' Property Owner Email Address: -- Page 1 of 5 �op a So Town Hall Annex Telephone(631)765-1802 54375 Main Road � Fax(631)765-9502 P.O.Box 1179 ;y Southold,NY 11971-0959 a aF BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit,if any:_Aoz- paS �sA-rl� ZS �a I�PQ-� Address of Authorized Agent(no P.O. Boxes): L 6`I -L Mailing Address of Authorized Agent: � ..t Telephone Number(s): Daytime „ ._...Evening Emergencyf'i Email Address: ` " �.t ( C-'C' Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit,if any: Address of Authorized Agent(no P.O. Boxes): Mailing Address of Authorized Agent: �.......M.... 4 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: " /'-- s Address of Managing Agent (no P.O. Boxes):_,,,-..-... _.,_ ...ww......_w.._� �_. Page 2 of 5 Soo d0 Town Hall Annex ' ocouw� Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 C P P.O.Box 1 t79 ,k "` Southold,NY 11971-0959 w�f 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: _ ._.w........_..�. 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 occu::rtn U lt: S Number of rooms in Rental Dwelling Unit: r ri Use and Dimensions of each room in Rental Dwelling Unit. _y Page 3 of 5 Zt 4V, �P 141 0t Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 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. Nd 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 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 4of5 qf so Town Hall Annex Telephone(631)765-1802 54375 Main Roads w Fax(631)765-9502 P.O.Box 1179 ary k � Southold,NY 11971-0959 �� ; �rz-rs wM n`< 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: a ( A L L Property Owner's Signature:, �ST`t��S �LA Sworn to before me this day of�`'�e_ C 20?Z Official Notary Pub igI"iture and iaai Stamp JOAN HENDIIIK BISCHOFF VAN HEEMSKERCK NOTARY PUBLIC-STATE OF NEW YORK No.02B16423609 Qualified in Suffolk County My Commission Expires 10-18-2025 Page Sof5 a "r i w F � G' x � GLt33 I "' }p PGATFb2M - to `' r I t" r7 �a J 2MIL it R T ' Alitl 6 -- P� I 5 I € oNa 3� M [r. t. rr�arTArt n``<•L - €� 9- ,a; L l,-© .-' �'* - � , , N C - --rTc+/ J1 Qj y'R ` t E L/.V6 0LSWI } aw 77 Vim.._. i �G`• _ -74 ' ® SES/F.�Erc/CE of M2�l�hs. clJL/UGV MATTI TUU< ,/J.Y, t TrTLe - l LOOIL F�L4�(! C.7A Tom - rL • g6d to• _-- ,�Lri� rC/EfL9L OTE I � r '7'_ / -AI-e y T om = A'ZE oho 3. A4-, s eaTstt S T IT t �,I � � s t `�— �.� s� �,I �_ mss.. v� .-may „� � t 3*- .. ALL G .Q .vlo!✓.v..d `.:a�.�iP 1 THE /t/sT.4LL.4T/vh/OFAGL ffi r ' - ELEGTFZ/GAL GJo2K ' -o° E4U/�MEtiTs SNitLt coM�tY 6✓/T/+1 �7AT6 A410 ��_ Gac L 3" c2oe5 3rzr�ci.vc � 9 . i A e _ - --- - 2CeuLATio v 5 41u0 THE N"TIOrvAL ,C3oA2/J GF F/rIB ¢„co,crc, 6CA6� I / T �j _ UrVF06/z/,✓2/d 25, I- - nv - .: tr, G, fiLL �LC1M/3/vG Augrst s CA[aY Cu TD &F 11V/v74LLET) `2' 0'r= -F'7--z+ F'7—€ E Lo2M�TY wr 7,11:>TA7E - 1 a -. _. F -. :- c t I� z * 7, 4 Z L co,41c1Z67E .5//.4LL AIA VS 40111117r35=1 � 1= or Q500 1'3/ AT 26 CU -4 Z-4 /✓/.VOOkl; TO (iE 40��2�d.lo Fre T g 7 d 9, sxr?tca �� �-�-_ • _ �. -� � _, �� -� � moa 3` c/7o.5sss .rc .. . ? TFO< A.V1 1E'.{.Tr2 _ a RLL A1021< z,6.4LG COMP-r ✓O/STS L� tG r T BurLryvl- i i /z'Tarce A2IT t-lee t i AS k#tO e T/O.V{./dLL KEY t 4041-EV 70A c-o"r1 I t " OeVC, FaoTivC a r� l ltdF AL { 37 .CU?AKY OR : � If copper tubing is used E ILAWFUC�'A for water distributing � T60`8 4 CEREFICATE is iY5 o system;piping L on be J OCCUPANCY l S v of types K or L only 9h S,o 10UAI1--lATIC" �3 litl SCALE 7'lU=W P#=ER IF'IC47701V IZES//JE/LCE OF- a CERTIFICATE OFOXUPANCY MllAi1Tr/Tc1cK N?s. GUL�/CN va l9 37 z I SOLDER USED IN WATER T 7C SUPPLY SYSTEM CANNOT s EXCF.F,D 2/I0 of I%LEAD. . � 1W/Pckfiz )S LE i -77 1 V4,r/-o 7 :ter e TOWN OF SOUTHOLDPERT _*ECO STREET VILLAGE - DIST, SUB. LOT 3 FORMERW NIR E AG a � a R N ,�, � ._ S W TYPE OF BUILDING _ � s, � s RES. SEAS, VL. FARM COMM. CB. MICS. Mkt. Value i LAND IMP. TOTAL r DATE REMARKS s C_a p� ! G � 3 md 4t If 77 czt�., —700 44 s e f p f a M F $ s � E s e I Tillable �� ��- e 0" -, = FRONTAGE ON WATER Woodland FRONTAGE ON ROAD 3 Meadowland DEPTH House Plot BULKHEAD Total tf N. I X H+ 113,74A 2/06 m Foundation Bath ld M. Bg. t a t k !(o 1'7& 1 / 75 3,1� );11 9 C-. 71 Extension Basement = ►_,t,L Floors Extension Ext. Walls Interior Finish �s . Extension Fire Place - Heat 1# - c Porch ,� c� Pool Attic I _ 3 Patio Rooms 1st floor I Breezeway Driveway Rooms 2nd Floor i Garage z — . = 11 O. B. x�t2 i ! FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. .71.U95. . . . . . Date . . . ay .14... . . . . . . . . . . . . . . . . . . . 19 .8 6 THIS CERTIFIES that the building . . . . . ,One. .family dwelling. Location of Property . . . 4399. Bergen Avenue Mattituck rt » House No. Sweet Hamlet County Tax Map No. 1000 Section . 113, . . . . . .Block . . .0 7. . . . . . . . . .Lot P °. . . . . . . . . . . . Subdivision . . . . . . . » . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . Kay. d. . . . . . . . . . . , 19 ,8A pursuant to which Building Permit No. 13 0 9 3 Z. , * , . . . » dated . . AM LY. .? . . . . . . . . . . . . .. . . . , . . 19 PA ,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 faming ily dwe11' .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. The certificate is issued to . . . . . . . .WILL.ZM. CIWDIAK townea Y4i XX of the aforesaid building. Suffolk County Department of Health Approval . . . .1 _54793. . . . . . .. , . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . w 6.57973 . . » » . . . . . . . . . * . µ n » PLUMBERS CERTIFICATE Feb. 20, 1986 04-ry 04'-V�- » » » » » » » Building Inspector Rev.1181 . � r FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. . .Z12905 „ . . . . . . . Date . . . . . . . . . . . . . . October 18, . . . . 1984. THIS CERTIFIES that the building . . . .AccessorX . w . „ . , , . . . ... . , , , „ . , . „ . , , „ Location of Property 4 3 0 0, , . , , , . , , Bergen Ave. „ Matt. M House Na. rrer` arrrfer County Tax Map No. 1000 Section . .113. . . . . , .Bloch . .07. . . . . . . . . . . Lot . .P��. .� . . . . . . . . . Subdivision . . . . . X . » . . . . . . . . , . . „ . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . ,Auq. , , , , , ,3P. , , , , , , 19 A 4 pursuant to which Building Permit No. . . 13 4 0 0 Z. . . . . . . . . . . . dated . . . „ . . . . , , . Aug;, . . , 3P. , . , . , 19 84 ,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. Farm Building. . . . „ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . „ . . . . . . . . . . . . . . . The certificate is issued to . . . . , , „ „ , , , a WILLIAM CHUDIAK „ w . (e�wner,-0� Vr r 'rrt)„ of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . . . N/A. . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . « N/A „ . . . , , . . . Building + Inspector „ „ Rev.1/81