HomeMy WebLinkAbout1000-143.-4-12 � � $ TOWN OF SOUTHOLD
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Rental Permit
0543
Owner Travis Sachs & Andrew Borsen
Occupied as Single Family Dwelling
Located at 680 E. Legion Avenue Mattituck 143.4-12
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.
11/1/2023 ��z'��
Code foijrnent off tal
This Notice must be posted by the main entrance at all times
Town Hall Annex
54375 Main Road
P.O.Box 1179
Southold,NY 11971-0959
0CT 5 2023
Building Department
BUILDING DEPARTMENT Town of Southold
TOWN OF SOUTHOLD
RENTAL. PERMIT APPLICATION
Rental Permit Fee $200 (Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
680 E. Legion Avenue, Mattituck, New York
Tax Map Number: 1000 SECTION 143.00 -BLOCK- 04.00 -LOT 012.000
SECTION B.
OWNER INFORMATION:
Property Owner Name:
Andrew Borsen and Travis Sachs
Property Owner Legal Address: Property Owner Mailing Address:
480 Newburgh Court 480 ew gr - _-
West New York, NJ 07093 West New York, NJ 07093
Telephone Number(s): Daytime_201 A06.3857 Evening same Emergency same_____
Property Owner Email Address: borsena@yahoocom
Page 1 of 5
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SO ]SOLD
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any: n/a
Address of Authorized Agent (no P.O. Boxes).- n/a ,.
Mailing Address of Authorized Agent: n/a
Telephone Number(s): Daytime n/a Evening n/a Emergency_ n/a
Email Address: n/a
Section D.
Managing Agent Information:
Name of Authorized Agent of dwelling unit, if any: n/a
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Address of Authorized Agent(no P.O. Boxes): n/a � .
Mailing Address of Authorized Agent: n/a
Telephone Number(s): Daytime n/a Evening n/a Emergency n/a
Email Address: ►/a „�� �� .� .. � _.
SECTION E.
SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units)
Name of Managing Agent of dwelling unit, if any: n/a
Address of Managing Agent no P.O. Boxes):n/a
Page 2 of 5
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
Mailing Address of Managing Agent: n1a
Telephone Number(s): Daytime n/a Evening n/a Emergency n/a
Email Address: n/a . . .�. _... ..... . .............. .�.. _� . . d
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on property.i--.1
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: 680 E. Legion Avenue
� �� ��
Requested Maximum number of persons allowed to occupy Dwelling Unit:._4
2 bedrooms, one living room/kitchen
Number of rooms in Rental Dwelling Unit:
Use and Dimensions of each room in Rental Dwelling Unit:
Living room/kitchen 30'1 x 10
Bedroom 2 12'5 x 10
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Page 3 of 5
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Town Hall Annex
Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOUN 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.
p 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)
w � 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
Town Hall Annex k Telephone(631)765-1802
" 631
Fax 765-9502
54375 Main RoadCC
( )
P.O.Box 1 179
Southold,NY 11971-0959
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: �,Ar e,3
Property Owner's Signature:
�h
Sworn to before me this�day of ' �- _ 202.3
(ficial NotarlylE
k Signature and Original Notary Stamp
Fotary Public,State of New,��y
Comm.#. 596
"y Commission mss M028
Page 5 of 5
Town!lull Annex `
54375 Mein Road �r1 i'elcphone(631)765-18(72
P.U. HOX If 79 1"ax(03 1)765-9502
Southold.NY 1 1971 0959
BUILDING DEPART'P EN-r
TOWN OF sOurnoLD
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
profe ont sell rec rr d 6rArchit r gineer lic ns f jo q /n actor e�razr
PWLQ�cz went r rti kation
Rental Property SCTM Number;
Renta! Property Address:_ E go
Owner/Name: STD e
Rental Dwelling Unit Identifier:
Number&Square footage of each bedroom as depicted in the attached floor plan: ,
(i.e. Bedroom #1 —IDO sq., Bedroom#2-90 sq., etc.)
Property Description {Include all improvements indicated on survey)
,rte iii.✓ 0 ' a
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.
.7-ho s'.._.. 'moi /� , . ". r '� �
Print Name and Title "
�C�rlginal Signature
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Please place professional seal:
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TOWN OF SOUTHOLD BUILDING 1)
631 -765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CA
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PI
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI
L l CODE VIOLATION [ ] PRE C/O [
REMARKS: &L�g............... ............. ............ ..................
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INSPECTOR
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Town Hall Annex
Town of Southold 54375 Main Road
Rental Inspection Report PO Box 1179
Southold, NY 11971-1179
,', ,"��'w I Tel: 631-765-1802
.._ . ..a..... _. . .mm_,.�" ....... _ Date
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Owner Phone
Address 60 �, 4dIl/ Y'7 Visible
'Hamlet Inspector
...._. __ , . .._..... .. .. . .
._... .__�. ... ..mm... ...."�.. ..._ . ... .. ... .�_.. _... . .." ..
;Floor Level Quantities Sub 1 2 3
Smoke Detectors (not located in bedrooms)
Carbon Monoxide Detectors { ��
Fire.. . ..._._..�._� . �. ......_� ... ..
Extinguishers
Exits
2 3 4 �
Bedrooms 6
Smoke Detectors
m. ." -
Egress
Occupant Count 62 c
Building Systems Maintained &Operational Condition of Property
Heating Building interior
Hot water I Building exterior
ElectricalProperty clean, maintained &safe
Mechanical Handrails &guards installed &secure
Pool Safety
Pool on Site
.. ............. ... . ... . .. ... . .. .. ae .... _ .. .._
Surface water alarm Date of CO issuance
Pool, w...
Door alarms_ .. . .. ..�..._ _ . ... � ,.. comp)etely enclosed."".....� . . . ._. _ ._ ._..� . . .,. F
Self closing/latching gates Pool fence to code requirements
CO's for all items present Prior Rental ��
Comments: Or �..
410944 s AiAlf,___ . SAA-
680 E. Legion Ave
A Living Room
ii I
Bedroom 1
Bedroom 2 Kitchen
Bathroom
T-11"X 2-2 1/2"DH
�.,BATHROOM 2�-4 v2•X 4'-2
._........ �. 2'-4 1/2"X 2'-D"DH
6'-1O"X 6_10' ...�w_, ......�,_..
Area:47 5q Ft SCM
Ceiling Height: �C 4� _.....r.,........,._�.........
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BEDROOM #1 a
c ° 7-6'X 12-6" � N
Area:93.75 5a Ft
c6k.g Height: N N
a ° KITCHEN
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Are.:170.81 5q Ft
Gelling Height:
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20689",
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�t BEDROOM #2
7-VX 1T-3"
LIVING ROOM Are.:84.51 5q Ft r 1 x
Celling Helght: ry
111-6"X 91.8"
.;.Area:111.47 5q Ft
N Ceiling Helght: N
7-6"
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Q SITTING ROOM o
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Area:154.29 Sq Ft Y
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Geiling Height: x Q
x 19-4"
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1 EXISTING FLOOR PLAN��� :1d4'x
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TOWN OF SOUTHOLD PKOPERTY RECORD Gl#.�23
OWNER EFS` VILLAGE DISTRIL, LOT
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FORMER OWNER N E 1 ACREAGE
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TYPE OF BUILDING
RES SEAS. �� VL. FARM COMM. IND. CB. MISC. Est. Mkt. Value
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LAND IMP_ TOTAL DATE REMARKS
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AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE FRONTAGE ON WATER
Farm Acre Value Per Acre Value FRONTAGE ON ROAD W
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Tillable I € : BULKHEAD
Tillable 2 DOCK
Tillable 3
Woodland I
Swampland
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Brushland
House Plot I
Total
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143:4-12 3/11/2022
M. Bldg Foundation Bot:
Extension Basement Floors �
tension Ext. Walls _ f Interior Finish
Y_
Extension Fire Place Heat
Porch Roof Type
Y y Porch ' Rooms 1st Floor _
Breezeway p do Rooms 2nd Floor
o Driveway Dormer
Q. B,
�,tFfllt Town of Southold 10/5/2021
53095 Main Rd
Southold,New York 11971
1
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: 42393 Date: 10/5/2021
THIS CERTIFIES that the structure(s)located at: 680 E Legion Ave.,Mattituck
SCTM#: 473889 Sec/Block/Lot: 143.4-12
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- 42393
dated 10/5/2021 was issued and conforms to all the requriements of the applicable provisions of the law.
The occupancy for which this certificate is issued is:
seasonal wood-fra n singLe family,dweffi1,l&-
The certificate is issued to 25 Adams Place Inc
_ ,. .,..... (OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
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nature
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING' CODE INSPECTION REPORT
LOCATION: 680 E Legion Ave.,Mattituck
SUFF.CO.TAX MAP NO.: 141-4-12 SUBDIVISION:
. . ....... ....
... ...... ... ... .. .. .....
.. ... ...
NAME OF OWNER(S): 25 Adams Place Inc
OCCUPANCY:
ADMITTED BY:
SOURCE OF REQUEST: 25 Adams Place Inc DATE: 10/5/2021
DWELLING:
#STORIES: I #EXITS: 2
FOUNDATION: posts CELLAR: CRAWL SPACE:
BATHROOM(S): I TOILET'R66M'(S)': —.UTILITY ROOM(S):
PORCH TYPE: DECK TYPE: PATIO TYPE:
BREEZEWAY: FIREPLACE- no GARAGE:
DOMESTIC HOTWATER: no TYPE HEATER: electric AIR CONDITIONING:
TYPE HEAT: WARM AIR: HOT WATER:
4 BEDROOMS: 2 #KITCHENS: I BASEMENT TYPE:
OTHER:
ACCESSORY S�ELtk)CT[JRES;
GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST:
SWIMMING POOL: GUEST,TYPE OF CONST:
OTHER:
VIOLATIONS:
REMARKS:
INSPECTED BY: JOHNJ DATE OF INSPECTION: 6/1/2021
TIME START: 10:47am END: 11:15am
Town of Southold 10/5/2021
P.O.Box 1179
" 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 42392 Date: 10/5/2021
THIS CERTIFIES that the building AS BUILT ADDITION
Location of Property: 680 E Legion Ave.,Mattituck
SCTM#: 473889 Sec/Block/Lot: 143.-4-12
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
6/10/2021 pursuant to which Building Permit No. 46834 dated 9/16/2021
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:
slam qlc"":_r r ca�vere f latarc,� r pla m r t,.yvtra s P aryl, .l J rar v r . �NµrrtfrO s is l tc yc r c ,rtd)cca alt
ear ti,r _ Nt lq familym, �y llic�
The certificate is issued to 25 Adams Place Inc
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 46834 9/29/2021
PLUMBERS CERTIFICATION DATED
At: or e S griature
Horton, LisaMarie
From: Horton, LisaMarie
Sent: Wednesday, October 4, 2023 4:04 PM
To: 'borsena@yahoo.com'
Subject: Rental - 680 E. Legion Avenue
Hello Mr. Borsen,
The Rental renewal was received 10/4 for 680 E. Legion Avenue. They rental would need to be
applied for as a New rental being it has changed owners. We will need the Application, along
with all the supporting paperwork.
If you should have any questions, please feel free to call the Building Department. I will apply
this payment to the new application.
Kind Regards,
Lisa
Zi�ra.Wa,rii?.Morton
Town of Southold Building Department
Annex Building
54375 Main Road
Southold,NY 11971
(631) 765-1802