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Home My WebLink About1000-141.-4-39.3 4'<4. TOWN F SOUTHOLD Rental Permit 0773 Owner Chad Mello Occupied as Single Family Dwelling Located at 11875 Route 25 Mattituck 141.-4-39.3 Maximum Permitted Occupancy 6 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. 11/16/2022 ' cue En r m ht ffcal This Notice must be posted by the main entrance at all times o- •u,. S�J� J �^ Telephone(631)765-1802 Town Hall Annexabw Fax(631)765-9502 54375 Main Road M ,l P.O.Box 1179 „ Southold,NY 11971-0959 BUILDING DEPARTMENTI TOWN OF SOUTHOLD RENTAL PERMIT AIPLIATION (u; Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: IMEW- ism A.1), Tax Map Number: 1000 SECTION -BLOCK � LOT�`� �J :. SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: M A-Tr t'i'p c-it— Telephone Number(s):Daytime l° �` Evening+p, � 5 � Emergency Property Owner Email Address: 000d � a(2(PI 2 (2a& `o a�� + )-00 Page 1 of 5 ��` Telephone(631)765-1802 Town hall Annex �`° �� Fax(631)765-9502 54375 Main Road P.O.Box 1179 • NFA 4 -0959 Southold,NY 11971 ..w, BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Telephone(631)765-1802 Town Hall Annex Fax(631)765-95M 54375 Main Road P.O.Box 1179 Southold,NY 11971-0959 ]BUILDING E>EPARTMENT TOWN Op 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. five(5)business days as to any change to the information 4. 1 will notify the Town within regarding Authorized Agent, Managing Agent,or Site Manager, 1 :✓b U t—LG Property Owner's Name: -�, Property Owner's Signature: 20 Sworn to before me this LI daY OA Official Notary Public Signature and Original ot'ary Starnp oma fer *Z p A '�' '4EMMIAWR� page 5 of 5 earµ Town Hall Annex Telephone(631)765-1802 54375 Main Road G Fax(631)765-9502 P.O.Box 1179 µ Southold,NY 11971-0959 f� � BUILDING DEPARTMENT TOWN OF SOUTHOLD 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 l ro essional seal re red for Architect or Engineer, licensed"lame leasectar ray ravide copy of valid current cerci ication Rental Property SCTM Number: Moo-- W l - 4 3�) Rental Property Address: 4� M01 eKM 4MI Owner/Name Rental Dwelling Unit Identifier: Number&Square footage of each bedroom as depicted in the attached floor plan: e. Bedroom#1 -100 sq. Bedroom#2-90 sq., etc.) +�1- Property Description (include all improvements indicated on survey) 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. Print Name and Mtle Origi t A Please place professional seal: cis w a OF tq W'N OFSOalHOLD WILDING I 631 -765-1802 I ,.�.1�.. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. I l FOUNDATION 2ND [ ] INSU TI N/CAL [ ] FRAMING / STRAPPING [ ] AL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY WE. [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI I ] CODE ""V'IO'LATION [ ] PRE / [ , REMARKS: T f 1,J It uk, oul --A JIL CA 0 ej Cj-4ArD AA M i iv R p All -17 E D t F S �`T OL PROPERTY �� _ SUB, LOT OWNER STREET VILLAGE DIST; e a a' a FORMER,OWNER N c E ACR. s - TYRE OF BUILDING _ .- �f >r r s' RES. : } SEAS. VL. FARM �� r COMM. CB. MICS. Mkt. Value LAND IMP, TOTAL DATE REMARKS u a Li e t n t P , <,3 �€ 4 e � z� KA s \; Y v _ t � AGE BUILDING CONDITION NEW NOR;,AAL BELOW ABOVE --------- a FAR-',A T6 Acre Value Per Value _6 Ac re _ Tillable FRONTAGE ON WATER ; r Woodland FRONTAGE ON ROAD a Meadowland DEPTH 3 House Plot BULKHEAD I Total DOCK SCTM # is TOWN OF SOUTHOLD PROPERTI OWNER STREET _; VILLAGE DIST. SUB. LOT ACR. REMARKS TYPE OF BLD PROP. CLASS LAND IMP. TOTAL DATE I FRONTAGE ON WATER HOUSE/LOT BULKHEAD TOTAL i e� a , z � ORTRIM LAe s L e f E d 141.4-39.3 2106 M 1d _ r n re F ension NA i3 , r 77 v �. �tension € ;T Extension Foundation r Bath Dinette Porch Basement ;Floors _ C K. Fit. WallsE , Interior Finish R. Breezeway Fire Place 1 Heat PR. °. Garage Type Roof Rccros 1st Floor BR. creion Room Rooms 2 d Floor FJN. B O. B. } Dorpier Driveway _ Total71 _ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No Z-25525 Date FEBRUARY 5 1998 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 11875 MAIN ROAD MATTITUCK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section— 141 Block 4 Lot 38 Subdivision _Filed Map No. Lot No. conforms substantially to the Requirements for a One Family Dwelling built Prior to: APRIL 9 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z-25525 dated FEBRUARY 5, 1998 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 FAMILY DWELLING WITH ACCESSORY GARAGE & STORAGE SHED. The certificate is issued to DONALD F. & MAUREEN SACKER (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. 2;�e2 Build g Insp c or Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 11875 MAIN ROAD MATTITUCr �tl..� .._ww_...... .......... ._..........w_ ralrmha*r 6 street' 64"IcIpaIIty SUIIDIVISION MAP NO. LOT (s) 6 ER NAME OF OWNER (s) DONALD MAUREEN SACK ,..... M.,,.._ .....__, _., OCCUPANCY SINGLE FAMILY (owner-tenant,,.. ADMIT'FEU BY: DONALD SACKER ww ACCOMPANIED BY: .._„_... ............_.,,,�_ ....� ._..,..._....,.. ._.,w_, _, ......SAME...,,_ .,..�.m,�._.__ ..,_... KEY AVAILABLE SUFE. CO. TAX MAP NO. 1000-141-4-38 + REQUEST: : N . SOURCE OF ULSI RE ...._,...wDONALDSACKER DATEOV ,..M._.,_ .__.. ........... ... .._,..�,,... ..._.., ........_ ._...,._.�_ DWELLING: TYPE OF' � ; WOOD FRAME p STORIES 2 A EXITS CHLI.AIt FULL CRAWL SPACE FOUNDATION POURED CONCRETE ,!„�� ... . .,n ....._w,,,.�, �__.w....,,...._,�.............._ .._,..,_._.. .....,,,..,. TOTAL ROOMS: IST MR, 4 2NI") F1.R. 4 3141) FI*. BATHROOM (s) ! _. TOIi.E'T ROOM (x) I (BASEMENT), UTILITY ROOM PORCH fYYI. COVERED FRONT STOOP DECK, 'TYPE --QCA PATIO, TYPE_BRICK___ _ w„RONT 6 COVERED SIDE ENCLOSED PORCH FIREPLACE YES GARAGE DOMESTIC HO ' ' S TYPE HEATER AIRCONDTTIONING 9'YPE HEAT OIL FURNACE (RADIATOR) HOTWA'TER ACCESSORY STRUCTURES: GARAGE, TYPE. OF CONST,„ WOOD FRAME=METAL .SIDING STORAGE, TYPE CONST._WOOD '(? SWIMMING POOI. YES , GUEST, TYPE CONST. OTHER: .,... .,,__w....w. .. _.._m _..._._._........... . .. _.,, ........m,....., VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION 6 BUILDING CODE. LOCATION DESCRIPTION ART. SEC. REMARKS: BP _...#10349-Z-CO Z-17280 (I/G POOL) µ BPP 174637-Z- . 74637- _..._....._.,,._.. INSPECTED BY: DATE'ON INSPECTION 11/14/97—R990SPECTE0 /3/98 MICHAEL J. VERITY TIME START !0:45 END 11:45 FORM N0. 4 s )' TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.X. CERTIFICATE OF OCCUPANCY No 217280 Date SEPTEMBER 12 1988 THIS CERTIFIES that the bui.l.di,ng POOL Location of Property 11975 MAIN ROAD MATT:IT'UCK House No. Street Hamlet County Tax Map No. 1000 Section _. 141 Block 4 Lot 38 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST Ii 1978 _____pursuant to which Building Permit No. 103492 dated AUGCJST 7 1988 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 INGROUN'D SWIMMING POOL W FENCE. The certificate is issued to DONALD SACKER (owner, ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N A UNDERWRITERS CERTIFICATE NO. N445878 PLUMBERS CERTIFICATION DATED N A Bu lding Inspector Rev. 1/81 FORM No. 4 �. �.�� TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: 2-25524 Date: 02/45/98 THIS CERTIFIES that the building ADDITION Location of Property: 11875 MAIN RD MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 141 Block 4 Lot 38 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 28L 1997 pursuant to which Building Permit No. 24637-Z dated FEBRUARY 51998 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 BUILT. w The certificate is issued to DONALD F & MAUREEN SACKER w (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A..�__. 21-V Buildin n,spector Rev. 1/81