HomeMy WebLinkAbout1000-78.-7-32.2 TOWN OF SOUTHOLD
Rental Permit
4
1016
Owner Martin Beller
Occupied as Single Family Dwelling
Located at 380 Private Road #27 Southold 78.-7-32.2
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.
11/3/2023
Code fore est Offi `
This Notice must be posted by the main entrance at all times
Town Hall Annex "' ^: 0 Tele 4one(631)765-1802
54375 Main Road rd „ � �
Fax(631)765-9502
P.O.Box 1179 �
Southold,NY 11971-0959 w �'��� a`n1
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION
Rental Permit Fee$200 (Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address: . �/\(' "/�L-6�2 ,-� Z
Tax Map Number: 1000 SECTION -13LOCI4 -LOT Z-�
SECTION B.
OWNER INFORMATION:
Property Owner Name:
Property Owner Legal Address: Property Owner Mailing Address:
2- V& r� � 4-'r
13
1 4—
Telephone Number(s): Daytime �i "EveningS 3-z Emergency '-C(4-3z q 3
Property Owner Email Address: CKL
(C
Page 1 of 5
Town Hall Annex �" 19Telephone(631)765-1802
54375 Main Road ri Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
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):
Mailing Address of Authorized Agent:
Telephone Number(s): Daytime Evening Emergency
Email Address:
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: I
Address of Managing Agent (no P.O. Boxes):
Page 2 of 5
Town Hall Annex Telephone(631)765-1802
54375 Main Road % Fax(631)765-9502
P.O.Box 1 179 < Er
Southold,NY 1 1 971-0959 d 1'
BUILDING DEPARTMENT
TOWN OF SOUTTHOLD
Mailing Address of Managing Agent: _ 0 t " '�� �� C a 3 J
Telephone Number(s): Daytime (Cl lJ b`�S Evening Emergency
Email Address: ".��. nn
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on property:
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 occupy Dwelling Unit:
Number of rooms in Rental Dwelling Unit: q Of
Use and Dimensions of each room in Rental Dwelling Unit: E COol►rl 1 4 )C
04 l.- O Ir 14 l , u l- 7
a,O M `/ i/
�°"
Page 3 of 5
k� � mgr r
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 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
❑ 1 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 M Ar'�\--N \'15 L , 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
" Z ,
Town Hall Annex ° �• Telephone(631)765-1802
54375 Main Road W Fax(631)765-9502
P.O.Box 1179 `y+
Southold,NY 11971-0959 y 0
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:
LV
2l
Property Owner's Signature:
Sworn to before me this"da V be�r—
.STAfV4
Officia otary Publi ig u e and riginal Notary Stamp Nolan "sw Yak
411 uft
Page 5 of 5
so
TOWN OF 8
631 -765-1802
INSPECTION
C ] FOUNDATION 1ST [ ] ROUGH PL13G.
[ ] FOUNDATION 2ND [ ] INSULATION/CAu
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN!
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE
C ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (EIl
[ ] CODE VIOLATION [ ] PRE C/OI
REMARKS:
0
DATE - - T ��
.p�
Town Hall Annex
Town of Southold 54375 Main Road
Rental Inspection Report PO Box 1179
Southold, NY 11971-1179
Ze
', �`� Tel: 631-765-1802
Date
Phone
Owner .
=Address �l ..... �......� ;�. ., Visible
rvm
Inspector
Hamlet t1 ' �c - _. � �``�-'
Floor Level Quantities Sub 1 2 3
Smoke Detectors(not located in bedrooms)
Carbon Monoxide Detectors /
Fire Extinguishers
. . w
Exits �, .
Bedrooms ..._. i 2 3 4 5 6
_.. .
Smoke Detectors
Egress
Occupant Count
Building Systems Maintained &Operational Condition of Property
Heating Building interior
Hot waterBuilding exterior
.....
ElectricalProperty Pro...........
�.._le
r , maintained &safe ....... aM _, _ ,..
_......,_.,..,, .... ............._ ... .. .w e...,...v.._,......._,.. . _ �.� y clean
Handrails &guards instalMechanical led &secure
Pool 5:�.........
afety J Pool on Site
Surface water alarmDate of CO issuance
_Door alarm...,.,_.."... . . . .. .�, e Pool completely e . .._ . .��...�.._ -.._.
enclosed
Self closing/ latching gates Pool fence to code requirements
CO's for all items present j Prior Rental
Comments
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TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER STREET A,_, VILLAGE DIST SUB LOT
P .
ACR REMARKS
TYPE OF BLD,
PROP. CLASS
LAND IMP TOTAL DATE
I 1
i
I
i
1
FRONTAGE ON WATER HOUSE/LOT
I ,
BULKHEAD
_ TOTAL
TOWN OF SOUTHOLD PROPERTY RECORD
OWNER ISTREET VILLAGE DIST. SUB. LOT a
i
FORMER OWNER
N E -
;
_
e
S W = TYPE OF BUILDING -
-
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RES SEAS. VL. FARM COMM. CB. MICS, Mkt. Value
LAND IMP. TOTAL DATE i REMARKS
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Woodland FRONTAGE ON ROAD
Meadowland DEPTH
House Plot BULKHEAD
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MAY 1 2022
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COLOR
TRIM
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' f } 11 Fire Place Heat I ��,.r/ DR.
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— `
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ruu
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Total3,
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-25715 Date: 05/08/98
THIS CERTIFIES that the building NEW DWELLING
Location of Property: 380 PRIVATE RD 427 SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 78 Block 7 Lot 32.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 13 1996 pursuant to which
Building Permit No. 23258--Z dated FEBRUARY 23 1996
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 ATTACHED OPEN PORCH AND TWO CAR GARAGE
UNDERNEATH AS APPLIED FOR.
The certificate is issued to ANDREW K LUTKOWSKI
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL RIO-95-0080 04/08/98
ELECTRICAL CERTIFICATE NO. H3430 04/29/98
PLUMBERS CERTIFICATION DATED 04/13/98 TIMOTHY HORTON PLUMBER
Building Inspector
Rev. 1/81
——----------
Town of Southold Annex 7/16/2014
P.O.Box 1179
54375 Main Road
Southold,New York 11971
.................
CERTIFICATE OF OCCUPANCY
No: 37026 Date: 7/16/2014
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 380 Private Rd#27, Southold,
SCTM#: 473889 Sec/Block/Lot: 78.-7-32.2
............ .. ............
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
9/3/2013 pursuant to which Building Permit No. 38326 dated 9/17/2013
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:
ACCESSOR"YIN-GROUND SWR4AMjjN[ QP0QL AS APPLIED FOR
The certificate is issued to Lutkowsid,Andrew&Horton,Deborah ............
............
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 38326 05-21-2014
................
PLUMBERS CERTIFICATION DATED
A
inn ro
"tom` Town of Southold 10/26/2021
P.O.Boa 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 42485 Date: 10/26/2021
THIS CERTIFIES that the building ADDITION/ALTERATION
Location of Property: 380 Private Rd#27,Southold
SCTM#: 473889 Sec/Block/Lot: 78.-7-32.2
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
9/27/2021 pursuant to which Building Permit No. 46931 dated 10/6/2021
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:
built add' ` nand alt r tiffs n a .n i:� 'r rL ca d c a el w" h din to a , Xtan inle,,, ;p�cugl
dwelling a liedos
The certificate is issued to LutkowsK Andrew&Deborah
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF BEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 46931 10/13/2021
PLUMBERS CERTIFICATION DATED,
A edSignaituWrce
,�yte�M Town of Southold 6/1/2022
P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 43110 Date: 6/l/2022
THIS CERTIFIES that the building AS BUILT ALTERATION
Location of Property: 380.Private Rd#27,Southold
SCTM#: 473889 Sec/Block/Lot: 78.-7-32.2
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
_ ....,-.. _w._..._-
5/16/2022 pursuant to which Building Permit No. 4783535„ V mm dated 5/19/2022
2022m�
was issued,and conforms to al l of the requirements of the applicable provisions of the law. The occupancy for
which this certificate is issued is:
tilt"`t ill'- lit air co tditi nin s a. lied for.
The certificate is issued to Castelforte LLC
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 47835 5/31/2022
PLUMBERS CERTIFICATION DATED
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