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Home My WebLink About1000-97.-1-1 r. s, TOWN OF SOUTHOLD Via MIA S Rental Permit 0795 Owner Amelia Jealous-Dank & Stephen Amiaga Occupied as Single Family Dwelling Located at 800 Cox Lane Cutchogue 97.4-1 Maximum Permitted Occupancy 8 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. i 12/21/2022 Cod fo c t Official This Notice must be posted by the main entrance at all times Town Hall Annex Telephone(631)765-1802 (l � 54375 Main Road ' � � � Fax(631)765-9502 P.O.Box 1179 ` �'� 6' �,OYr� Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years) Section A. AL)G 3 2020 Property Information: %M'TqrjGDF'PT- Rental Property Address: TC" nu ROL COQCox Lane_. "1� �? ��_�,�.��. .......�.......�.,o�..�....�........�.._..�_��.. ��.......�_.__�w........�...�..,.��.a-._.,�..._... Tax Map Number: 1000 SECTION. 097 . _ _-Ol.('CK 1 SECTION B. OWNER INFORMATION: Property Owner Name: Amelia Jealous-Dank& Stephen AmiagawwwW�� Property Owner Legal Address: Property Owner Mailing Address: 131 Sterling Place same Amit ville NY 11701 . _......... ....� ,., .�_ 631-943-6501/6504 Telephone Number(s): Daytime_..__._ Evening µw mm ..- Emergency_ ,,,,._._ ...... Property Owner Email Address: atjdank(a�gmaiLcom or steve a()ari�ja�con 0 boa � C1 S Page 1 of 5 �N 1 �I��Jkyiai�J,f Town Hall Annex Telephone(631)765-1802 54375 Main Road �� ' Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 00�m ' eoj BUILDING DEPARTMENT TOWN OF SO OLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: NA Address of Authorized Agent (no P.O. Boxes): „ __.......... q .,,,.................... .µ. _... . .� . Mailing Address of Authorized Agent: ....... _„ .. ._..........__.,.....__..m......_....__.. � . Telephone Number(s): Daytime, ........,�.Evening.._._.._ Emer en Y�.._...._ ...___. EmailAddress: ._....... ......._ww...._................. .........._.._......_..........__ �._. ...._. _._ _......�.� ._...._ _._. Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: NA Address of Authorized Agent(no P.O. Mailing Address of Authorized Agent: �........ ......��W...... ,,.,..._„ ,__....... . Telephone Number(s): Daytil to M ,..µ .....Evening Emergent . ...... 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 an NA w.,,,,, .... .ww_._. _ ......._._..... ....._... . Address of Managing Agent (no P.O. Boxes): w,.._w_ . _._ ww. ....._.._.�_........... ..._. _...ww..........M.M ._ ......w_. .._..__.. Page 2 of 5 a Town Hall Annex t Telephone(631)765-1802 i � 54375 Main Road � ' f Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 61 BUILDING DEPARTMENT TOWN OF SO THOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime-..._,,.,., . .Evening_......_—. ... ,....._-Emergency_._.,_,_,,,,_, _. Email Address: SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property:-W„www]_ _ -,_ .___._._._..._, 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:___.NA Requested Maximum number of persons allowed to occupy Dwelling U, t ,,,........,. .._..., ...,. Number of rooms in Rental Dwelling Unit: µWW8 main rooms and multip]e anciliaf. )OMS . Use and Dimensions of each room in Rental Dwelling Unit; ___.,_ ..,_._ ""�...,-o.. . . g _ .. '-0"x16'-7";Living Room 19'-11"x17-2";Family Room 12'-4"x17'-2" Kitchen 13-9x16-7 ;Dining Room 15 N.._.................._.www�._�, _ _. ......... ..._. _.._._..._.. _..._ Mud Rm and Toilet 7'-7"x10'-8";Powder Rm 3'-6''x5-6""; Bedroom 0201 l4'- "x1 " 1” edroea t 0202 15'-2"x16" ?"'�� Bcdr>rru (1203 1 ". "'a (t` 7` N ed� n0QA.2, -11"x]7'-2" Bath 0205 6' " ' "" -0"x8'-5";Laundry 0210 9-11Hx6-8 ;Bath 0208 7-9 x9'-5",- Bath 0207 6'-0"x5'-5" Page 3 of 5 Town Hall Annex 11 /I �v Telephone(631)765-1802 �r 54375 Main Road ` , � ! ,Q, Fax(631)765-9502 '1 P-0.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, ❑ ] am requesting afire safety inspection to be performed by a Code Enforcement Official from the Town of Southold DK 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) Stephen Amiaga .w.. . WWYYY u m 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 ;, Telephone(631)765-1802 54375 Main Road Jf Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 ,n BUILDING DEPARTMENT TOWN OF SO HOLD 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: Property Owner'$Signature: Sworn to before me this a9 day of , 20 'av Official Notaryublic Signature and Original Not Stamp 13ARBARA H.T'ANDY" Notary Public,state Of New York No. 01 TA 086001 Qualified In Suffolk oun F Commission E:p" Page 5 of 5 s 00 co ic L�wl CAI 6au t ve00000e pTOWN OF SOUTHOLDTMT 765-1802 2 IN FEC;-ulON [ ] FOUNDATION 1ST [ ] ROUGH PLE3G. [ ] FOUNDATION 2ND [ ] IN ILATIONICAI [ ] FRAMING STRAPPING [ ] INAT [ ] FIREPLACE CHIMNEY [ FLIRT SAFETY IN! [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT" PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL FI [ ] CODES "NOTATION [ ] PRE CO REMARKS: (0171--aow nsl.. ' ►-' DC7 t #-Yon)noov ` y DATE I A INSPECTOR i y y i Town Hall Annex i ? �9� 11 �- Telephone(631)765-1802 rlrr 54375 Main Road Fax(631)765-9502 P.O.Box 1179 F a Southold,NY 11971-0959 fi� 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 r c f ssionat seal °e lulred !r °chitect or Fn ar e rlicensed Home Insptor t ttst i eopyo, valid current certi is ti; n Rental Property SCTM Number: 097-1-1 Rental Property Address: g.0...0..,..Co..o...x..x.LL...net...C_..utchoguw'e.... NY-.1.1,935 Owner/Name: Amelia Jealous-Dank and Ste hen Amiaa Rental Dwelling Unit Identifier: NA .. .......... ........_.. ... �.... ._....-..� Number &Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 -100 sq., Bedroom #2-90 sq., etc.) Bedroom 0201 =239 SF;Bedroom 0202=249 S;Bedroom 0203=221 St' Bedroom 0204= 168 SF� w... Property Description (Include all improvements indicated on survey) This is a two story, wood frame residence with an asphalt shingle roof and attachedaraeeThere are 4 second floor bedrooms with 3 full baths and 2 half baths on first floor. New windows were installed in 2020. „ Smoke and CO detectors are as indicated on plans and six(6)fire e xtxrl , isiresare located tl)rr1 hout the residence. 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. Amelia Jealous-Dank,RA MPA _ �.�......_ Print Name and Title _ ON ih l ignature ED q R� ! 1 Please place professional seal: * SFr . / OF NEV I f° r+—; FA1LY I ++ 0101 0102 RA-E t21 S I° - HALF BATH EI 0107 �' R , 0108 , I t RM I 0106 I, BILCO LIVING RM DINEI0 HALL 010 010 0104 ,� F 1 1t1 I ERIC Seal&Signature ED I J E 5 'Vx IM 4U LEGEND: SMOKE AND CO DETECTOR so SMOKE DETECTOR O EXISTING+ 1 St FLOOR PLAN Amelia Jealous-Dank NYS RA-Lic#: 029350 True Amityville,NY 11701 1 St FLOOR PLAN 631.943,5501 - Date 07.28.2020 Proj.No. ZOOZ-OZ ArchitectureAf�Lf_51 G N 5 , NTS S K' Interiorseriors Faclllty Planning ADDRESS: ATJD ARCHITECTURE&PLANNING P.C. Master Planning 800 Cox Lane,Cutchogue,NY 11935 1 of 2 8Et1RM 0 { ±168 F BE 1 BATS RM 1117 02t}3 0207 1 SF 15x1 CL - BATH RM ' CL CL ; 0 f ;3CLi HALL 1AS R 0209 8E}Rv1 Q0 S� I� wri EE 157x1 �-— ICL ° I' Seal&Signature D p, LAUNDRY FtY � R 0 ' V£ I ` 0210 0205 (}2 LEGEND: ' SMOKE AND CO DETECTOR so SMOKE DETECTOR EXISTING SOF �2nd FLOOR PLAN -- Amelia Jealous-Dank NYS RA-Iic#: 029350 Title Amityville,NY 11701 2nd FLOOR PLAN 631.943,6501 No.5 I ^ ,N 1 IntDate 07.28.2020 Proj. 2002-C2 rv' Architecture � eriors Scele NTS ^ .2 \K Facility Planning ADDRESS; ��+++ ATJD ARCHITECTURE&PLANNING P.C. Master Planning 800 Cox Lane,Cutchogue,NY 11935 2 of 2 Ia II �� of of fr Illi ue Io P^ II o T CELLAR G�� II Ir ,.�• I t y A Or ME 2 MCE Ili wr� � p ...... � ....,Nn a .. .....,. p 4F[fgu II 40 YI tP i &¢ id EMST1NG �^ E3AIIENT`pLA�lV A,'irnmrvv.IluT,NV X9'7M A'Lrsai v�'z�^aor E51GNS nru,r,ccre INI�,a� AtTJD ARCHI"f ECTURE&PL.ANNNG IP.C. 141uewr I'll-nhq I A 3 SCTM # TOWN OF SOUTHOLD PROPERTY R 51akb OWNER STREET VILLAGE DISI- SUB. LOT ACR. REMARKS - > TYPE OF BLD. le PROP.CLASS 10, Lf LAND IMP. TOTAL DATE §_ 4 FRONTAGE ON WATER HOUSE/LOT I f I BULKHEAD TOTAL TOWt4 OF SOUTHOLD PROPERTY RECORD DIST. SUB. LOT OWNER ISTREET z FORMER OWNER 1 N E S W TYPE OF BUILDINd P�-6 jo-e;-f-1/4,!-Te,-j1 (27 0)( RES. SEAS. VL. FARM comm. CB. MICS. Mkt, Value LAND IMP, TOTAL DATE REMARKS U 7r Y 14a, 71LO 2 -Mk � X, If) , C -7 �o 13 7Z� f7 b AGE BUILDING CONDITION 5-7 -5 -76 ,-) NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre 2- FRONTAGE ON WATER Tillable if Woodland FRONTAGE ON ROAD 7-, Meadowland DEPTH House Plot I l BULKHEAD TotalDOCK f R . TRIM Am .z - ffi r, . . 3 i E i 3 i ' I I � 97:1-1 03/30/2017 �_ I z �2 E Extension E F I Extension I E Extension 111 ` fY � Foundation ! Bath Porch ---------- 'Basement / Floors K. (} Porch Ext. Walls aA Interior Finish 5. P !_R. 8reez �` - - C)U ��.� /'�Ua Fire Place Heat �i��t /_ �c c DR. _ BR. Go rage �( Z _ f .S �_ � Type Roof }Rooms 1 st Floor Patio z/07 Recreation Rooms 2nd Floor _ FIN. B 0. B. j 'Dormer Driveway Total . . . I FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. 21:1.964. . . . . . . . . . Date . . . . . �etobar.�.. . . . . . . . . . . . . . .. 19 83 THIS CERTIFIES that the building .N.EW.DWEn. NG. . . . . . . . . . . • . . . . . . . . . • . . . . . . • ... . . Location of Property . . .89Cq .Cox, *Lane I µ µ r . , . . , Cutchogue House No. Street Nerrrlet County Tax Map No. 1000 Section . . .097. , . . . .Block . . . . ..1, . . . . . . . .Lot . .. . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. , . . . . . . .Lot No. . . . . . . . . .. . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . September. 18 . 19 8'i pursuant to which Building Permit No. . A �9.w dated . . . . Sed?tember. 24 , , , , , , , . . 19 81. ,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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . 1B0ZWW.D... A.B ' . . 4, . A' . . , . . . . . . . . . . . . . . . . . . (owner,lessee or tenant)* . . . of the aforesaid building. Suffolk County Department of Health Approval . .. .. . o-82 . . ` . . . . . . . . . . . . . . . . . . . .. . UNDERWRITERS CERTIFICATE NO. . . N5835(�7. . . . . . . . . . . . . . . . . . . . . . . . . . . . .`. . . . . .. . e;l Z' Building 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. . . . 2.1.3720» „ . . „ . , Date . „ „ . .August, ,? „ . „ . „ , . . . . . . . . . . .,. 1985. THIS CERTIFIES that the building . . . , , Barn „ » . „ » „ „ . * , . . . , „ . , , » , Location of Property . , .QQQ. CMLAN� . . _ , , , , , , , , , C,UTCHOGUE, , , , , , , , . House No. Street Hamlei County Tax Map No. 1000 Section . . o 9? . . . . . .Block . „ . . . »"9 . . . . . . . .Lot . . . . .1. . „ . . . . . . . . . Subdivision . . . . . . » . . . . . „ . . . . . . . . . . . . . . . » . .Filed Map No. . . . . . . . .Lot No. . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated March ,6 , 19$5. pursuant to which Building Permit No. )3742Z. . . . . , „ µ 4y µ „ dated . !4a c h. .$ . . . . . . . . . . . . . „ „ „ „ 190 5. ,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 . . . . . . . . . Barp. . » . „ . » . . . . . . » , . . „ . . „ . . . . „ . . . . . . . . . . . . . . . „ » „ » , » . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . . .LEONARD & BERYL DANK (owner, co'Xefi�1X X X of the aforesaid building. Suffolk County Department of Health Approval . . . . , » . . N/A . , . . . . . . » . , . » , . . . „ . . » . . . . » UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . NAA . . . . . . „ . . . . . . . k ., . . » . „ . . „ . . „ . „ . . Building Inspector Rev.1/81 F. n _�.�.�..._...w_... ._.�._.__ �.._-.......... ................ .........M.�,,..._............. .._ ._�......� _..�.._�_._�..._., �, F1Qt f � Town of Southold 6/24/2020 . P.O.Box 1179 53095 Main Rd + Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41086 Date: 2/18/2020 THIS CERTIFIES that the building WINDOWS Location of Property: 800 Cox Ln, Cutchogue SCTM#: 473889 Sec/Block/Lot: 97.-1-1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 12/2/2019 pursuant to which Building Permit No. 44509 dated 12/11/2019 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: window replacement as a1p ed for. The certificate is issued to Amiaga,Stephen&Jealous-Dank,Amelia of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED ...........�......................... 1 Signatur A e ........._.._...._�_.��.. _.� ho t c'