HomeMy WebLinkAbout1000-114.-7-12.3 Je UWV
T"IAIN OF SOUTHOLD
Rental Permit
£ 0771
rO
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.
11/21/2024
Code E for e- ent OI
This Notice must be posted by the main entrance at all times
TOWN OF SOUTHOLD BUILDING DEPT.
631-765-1802 /N- �- /a 3
INSPECTION
[ ] FOUNDATION 1ST/ REBAR [ ] 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 [ RENTAL
REMARKS:
&vs
As
DATE INSPECTOR
( � Town Hall Annex
Town of Southold 54375 Main Road
Rental Inspection Report PO Box 1179
Southold, NY 11971-1179
Tel: 631-765-1802
SCTM # a ........ ... .. a�.._ ., .. .�. ._....__ . ...�. ., Date
Owner Phone
Address
Ham ) l✓UGSG�-. .... ...__.. ... ...._ ...... .. ........ _ Visible. �� _.. ... . �...._
le ^ .,
t 4J 1Inspector f
Floor Level Quantities } Sub 1 2 3
Smoke
�.. Detectors not located i.. _ �._( , . _.�n bedrooms)..... .. ..,._��_.,.�_ .�.�. m.. ... .., ,.� ,�.. ..w.....
n
Carbon Monoxide Detectors
Fire Extinguishers
Exits l
o i
Bedrooms 10-.. . 2 � 3 - 4 1 5 6,
.. ...... _ . _a .._. . .. _ .
Smoke Detectors i �
Egress �.._. .� •_�
Occupant Count .
Building se Maintained &Operational Conditio of Property
�_ ._Sy._ ...t_�..ms _bm,... va.. .,.w. _..,...w ...w... �w.. _ n ..._ ..
Heating ......
g Building interior
Hot water Building exterior
Electrical .... _r,. ....w. Property clean, maintained &safe d __.. . ..
Mechanical Handrails &8Laards instal led &secure
Pool Safety !Pool on Site _ . .-.. . i..... �� e.., m.... ._
Surface water alarm Date of CO issuance
� Pool completely enc
losed
:Door alarms latching gates
Pool fence to code requirements
Self closing �I_ .�n.... .. ....�.� .�..�.�, ..n_.� . pp
.... . ._.
COs for all items present Prior
._ ......- _._..� � Rental,_ ...... .... .�... m...__...m. .. . �. ��........r
Comments LM . _._...
{ 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
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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
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OF N
NY
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eda
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3
oS
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5E,�CONP FLOOP�PLAN
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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 �
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'Dormer
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-
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Driveway
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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