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Home My WebLink About1000-114.-7-12.3 { TOWN OF SOUTHOLD Rental Permit 0771 Owner David Hall & Suzanne Charnas Hall Occupied as Single Family Dwelling Located at 1800 Westphalia Rd. Mattituck 114.-7-12.3 Maximum Permitted Occupancy 12 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. 11/14/2022 ode c rce t fficial This Notice must be posted by the main entrance at all times Town Hall Annex �� Telephone(631)765-1802 54375 Main Road w ��J Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 � 0, BUILDING DEPARTMENT TA OF SOUTHOILD RENTAL PERMIT APPLICATION Rental Permit Fee $200(Application must be renewed every two � ,.. " MAY <_ 5 2022 Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION t �-BLOCK -LOT SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: Telephone Number(s): Daytime �'IEvening Emergency Property Owner Email Address: A D,D' d Page 1&5 34+0/J maulAuau P.O.Box 1179 I , Southold,NY 11971-0959 g ° r° BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent(no P.O. Boxes): L a G Mailing Address of Authorized Agent: Telephone Number(s): Daytime A i l ° Evening Emergency Email Address: ix- �ra,r.S , &V * 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: 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:, Address of Managing Agent (no P.O. Boxes): Page 2 of 5 m Ad Town Hall Annex � Telephone(631)765-1802 54375 Main RoadFax 63l( ) 765-9502 P.O.Box 1 179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: 0 Telephone Number(s): DaytimeEvening Emergency Email Address: vM A, SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: , `�` -ase' For each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier(for example, Unit 1, Unit 2, Unit 3 or Apt A, B, Q 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: e-e- �Abo Page 3 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road � U. Fax(631)765-9502 ' ry P.O.Box 1179 Southold,NY 11971-0959 A i� 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 W 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 0yw 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 R Town HaII Annex �R 1,w Telephone(631)765-1802 54375 Main Road j° Fax(631)765-9502 P.O.Box 11791 Southold,NY 11971-0959 BUILDING DEPARTMENT TONW OF SO 7E OLD 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: � �x Property Owner's Signature: 4 Sworn to before me this&. day of . 2022 Official otary Public Signatur nd Original Notary Stamp N IPINKNEY YI"61AT OFtRAN OOMMINION EV.OV2612026 M1M1 N0.723190 Page 5 of 5 � f igeD v)OOM Or4111v�TOWN OF SOUTHOLD BUILDING I 631 -765-1802 ar INSPECTION a [ ] FOUNDATION IST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATIOWCAI [ FRAMING 1 STRAPPING [ rFIRE AL [ ] FIREPLACE & CHIMNEY SAFETY INS [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII [ ] CODE I E TION [ ] PRE C 1 0 W ()/7aAt 4: 10 DATE INSPECTORXAA( rr, Telephone(631)765-1802 Town Hall Annex Fax(631)765-9502 54375 Main Road P.O.Box 1179 Southold,NY 1 1 971-0959 BUILDING DEPARTMENT TOWN OF SOUTH:O 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 Fero essicrnal seal re aired c+r Architect gar ai n sneer licensed dome Ins actor rnust rovide co o valid ccrrrent cerci cation Rental Property SCTM Number: y Rental Property Address: gU i} V44 esVLM r , .. .. , Owner/Name: Rental Dwelling Unit Identifier: Number &Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1-100 sq, edroom#2-90 sq., etc. - �� . Property Description (Incl , � r�o�vemen s i�n�dicated �surveY ) i ... � ( t 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 Conservation Construction Code of New York State. Pri t Name a Orig nal Signature Wil � Please e p seal c 0' 1 A . OF N NY o eda t 3 oS � STPr-Z 2 301 o MI'v IM :7'y Zi 5E,�CONP FLOOP�PLAN f TOWN 'OF SOUTHO D PROPERTY F q1--(c(aa XRD �. OWNER a STREET VILLAGE DIS,i.i SUB. LOT 77 rYl, Zlan�►C � 5 v 3 E FORMER OWNER N _ . — E F ACR. i W TYPE OF BUILDING -r „` ' F RES. f SEAS. VL. FARM COMM. CB. MISC. Mkt. Value LAND IMP_ TOTAL DATE REMARKS r t e AGE BUILDING CONDITION }r7 v FARM Acre i Value Per Value Acre Tillable 1 Tillable 2 Tillable 3 Woodland Swampland FRONTAGE ON WATER Brushland FRONTAGE ON ROAD House Plot DEPTH i - -BULKHEAD f DOCK Total 3 e e = _ — - , . - - —A�3 'RAM 01fi -3 .. - 114.-7-12.3 1/10 Both Dinette Id q FOUndatlOn �b far" Ea t� !452 ti =Basement P r� ✓ F z4v z loos K. Ext. Walls -' Vit -nterior Finish L AR_ Fire Place y:.`> Heat s_ Type Roof T �� =Rooms 1st Floor ;Recreation R �1 Rooms 2nd Fl a � f 'Dormer � - - D Driveway era t- 1 1 �J L_ of 3 okss E r .z o C lipl Town of Southold 11/14/2022 53095 Main Rd Southold,New York 11971 PRE EXISTING CERTIFICATE OF OCCUPANCY No: 43586 Date: 11/14/2022 THIS CERTIFIES that the structure(s)located at: 1800 Westphalia Rd,Mattituck SCTM#: 473889 Sec/Block/Lot: 114.-7-12.3 Subdivision: Filed Map No. ' Lot No. conforms substantially to the requirements for a built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 43586�mm dated 11/14/2022 was issued and conforms to all the requriements of the applicable provisions of the law. The occupancy for which this certificate is issued is: AQ d frame sin e familv dwelling,* The certificate is issued to Hall,David&Charnas Hall,Suzanne (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. _v............ �_.__.w. ed ° ......... Aut .g attire BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 1800 Westphalia Rd,Mattituck SUFF.CO.TAX MAP.wO N__.._............_.114._...-7-122.3_._... ..................�.._�..�..�...�.�.�.�.�_.�.�.�...�.�.� W._. SUBDIVISION: NAME OF OWNER(S): Hall,David&Charnas Hall, Suzanne ................... ............. .. .. ......... OCCUPANCY: ADMITTED BY: _..�............._.. ... .. .... . - ... ....................... _._... ......_.�,...,� �ww...—...._..ww. SOURCE OF REQUEST: Hall,David DATE: 11/14/2022 DWELLING: #STORIES: 2 #EXITS: FOUNDATION: brick CELLAR: CRAWL SPACE: BATHROOM(S): 1 TOILET R-66"' M( _ _........._ ._._.__. .�._...._._ www......................w....ti........., .._w__ ww_w.... S): 1 UTILITY ROOM(S): PORCH TYPE: DECK TYPE: PATIO TYPE: BREEZEWAY: -_.......�. FIREPLACE: 1 GARAGE: T _......_..._...... DOMESTIC HOTWA.. _.._.._...�._,..__. .�.,_...�.�............._w_........._._....� ER:... y es TYPE HEATER: oil AIR CONDITIONING: TYPE HEAT: oil WARM AIR: HOT WATER: baseboard __ ..... .. ........__ ,,_ ._... #BEDROOMS: 6 #KITCHENS: l BASEMENT TYPE: OTHER: ACCESSORY STRUCTURES: STORAGE,TYPE OF CONST: GARAGE,TYPE OF CONST: ._w....._.............wvwv.....................ww_...................w_ ........ ................��.,,,,_...__...,.._.._...__,� SWIMMING POOL: GUEST,TYPE OF CONST: OTHER: w,__.�___.�....._._... VIOLATIONS: REMARKS: INSPECTED BY: JOHNJ DATE OF INSPECTION: 6/27/2022 TIME START: 9:50am END: 10:20am Town of Southold 11/14/2022 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43585 Date: 11/14/2022 ................................_.......... ...................� THIS CERTIFIES that the building AS BUILT ALTERATION Location of Property: 1800 Westphalia Rd,Mattituck SCTM#: 473889 Sec/Block/Lot: 114.-7-12.3 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 8 P g �w ._..............._- _.3/2022 /8/2022 pursuant to which Building Permit No. 48330 dated 9 23�WIT m_. was issued,and conforms to all of the requirements of the applicable provisions of the Iaw. The occupancy for which this certificate is issued is: "as t? llt"alt mtipons a% dditi rcl_udin finish c o ad floor a d fin eAhasement recr tion roam and flnh teala racarl to acitgwnl faladv+elfta 6 ledrpc plied tsar. The certificate is issued to Hall,David&Charnas Hall,Suzanne of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-12-0023 11/3/2016 ELECTRICAL CERTIFICATE NO. 48330 11/1/2022 PLUMBERS CERTIFICATION DATED ._-_w_.... _ ...... _.. W. ..I..................._. .-...-................ .......... 11 011 gnature Town of Southold Annex 11/17/2014 Al P.O.Box 1179 54375 Main Road � arz w:�' O +��1*,, Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 37275 Date: 11/17/2014 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 1800 Westphalia Rd, Mattituck, SCTM#: 473889 Sec/Block/Lot: 114.-7-12.3 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 10/9/2013 pursuant to which Building Permit No. 38431 dated 10/21/2013 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 POOL FENCED TO CODE PER ZBA DECISION#6535 DATED t -15-201, ., PRIJEI O The certificate is issued to Hall,David&Charnas Hall,Suzanne (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 38431 03-12-2014 PLUMBERS CERTIFICATION DATED 4?X " � /i�gnat' r Town of Southold Annex 9/10/2014 P.O.Box 1179 54375 Main Road Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 37143 Date: 9/10/2014 THIS CERTIFIES that the building ACCESSORY GARAGE ............ Location of Property: 1800 Westphalia Rd,Mattituck, ...... ..................... ........... SCTM#: 473889 Sec/Block/Lot: 114.-7-12.3 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 4/28/2014 pursuant to which Building Permit No. 38822 dated 4/28/2014 ................ 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: g.gmz w�ocp .ggrano&nibin,,&Qr. bathroomAinplied�hor ZeL— –The certificate is issued to Hall,David&Charnas Hall,Suzanne (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 38822 9/9/2014 ............... PLUMBERS CERTIFICATION DATED ca" ignat e FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY 01,000 No Z-18134 Date JUNE 1989 ."'a THIS CERTIFIES that the building ADDITION Location of Property 1800 WESTPHALIA ROAD MATTITUCK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 114 Block 07 Lot 12.3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 12, 1989 pursuant to which Building Permit No. 18133-Z dated MAY 24 1989 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to ESTATE OF RUTH SATTERLY (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. NIA PLUMBERS CERTIFICATION DATED N A r Building I s ctor Rev. 1/81