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Home My WebLink About1000-113.-7-19.18 :.; TOWN OF SOUTHOLD Rental Permit 0820 Owner Andrew Borsen & Travis Sachs Occupied as Single Family Dwelling Located at 1475 Cox Neck Road Mattituck 113.-7-19.18 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. 2/15/2023 ode o c e t Official This Notice must be posted by the main entrance at all times f � ryf Town Hall Annex rv�y 're-le 1' ' 1)765-1802 54375 Main Road .- ax(631)765-9502 P.O.Box 1 179 � Southold,NY 11971-0959 Cam irk 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: 1475 Cox Neck Rpad, Mattituck, New York 11952 Tax Map Number: 1000 SECTION 113.00 -BLOC 07.05 LOT 019.018-- il3 IC) SECTION B. OWNER INFORMATION: Travis Sachs and Andrew Borsen Property Owner Name: �..•. .� Property Owner Legal Address: Property Owner Mailing Address: �5 228 Park Avenue S 98207 New York, NY 10003 Telephone Number(s): Daytime,201.406. 857 Evening Emergenc°y�� ,,,� ,,�—, Property Owner Email Address:_ borsena@yahoo.com Pagel of S Town Hall Hall Annex ( )631 765-1802 ��9, Telephone 54375 Main Road r� 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.__...____,..._ „ Emergen ___,____. Email Address Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: nla Address of Authorized Agent(no P.O. Boxes):, �_..,. Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening Emergency Email Address- SECTION ddress 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):__..,__ ..mm . ..ro .... .......- .. d. Page 2 of 5 Town Hall Annex �. Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 e Southold,NY 11971-0959 �w BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime Evening Emergency Email Address: �. ... ww . _� . �.... 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, 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: Unit 1 .�.��.. .��.. .� Requested Maximum number of persons allowed to occupy Dwelling Unit: 6 Number of rooms in Rental Dwelling Unit: 7 Use and Dimensions of each room in Rental Dwelling Unit: Bedroom 1 11 x 13; Bedroom 2 11x ` Bedroom 3 11 x10- Kitchen 8x11 w � Iv1r; ►om g x 12 Mudroom 10 x B and Den 12 x 2 Page 3 of 5 � X'1?1=44" t„ Town Hall Annex SO', Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 Ali V 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. I 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 Andrew Borsen 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 Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SO .SOLD 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: Andrew Borsen Property Owner's Signatu �..._._ . Sworn to before me this day of 20a� 0 lcial Notary P b Signature and Original Notary Stamp m lldL�ls.U� arnzi °46��eaua;e�au„sues 14 Yf`f fd`w f�P➢d"fi��r�.�,i"iad�� , ,,, r r �, Mwt duaeursri '.S,;Q4'k hW �".4�:1tlU�tl:tl' ,N&p,Gy4�e� �Y�.&r,y�9j�[ r ttt a1 $” " �'NAHe". pRri➢6DBA "M vaatauairwa rw'"�'„, Notary y Puulhl n.,State ou° evv"�'a:ar➢ti` -r "w"I„YL„ i�do DIJ66349053 53=�9�5 Page 5 of 5 o�aOF SOUl� ��Y� �K �I \ `� ( PAW+v(/Y L/ "I✓ TOWN OF SOUTHOLD BUILDING DI 631-765.1802 1 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAI [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN: [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F}I [ ] CODE VIOLATION [ ] PRE C/O REMARKS: ou j�t�t/v l DATE INSPECTOR 475 COX NECK RD MATTITUCK, NY BECOOOM I \ \ \ \\ \ rn , Wrkir K-01$ OX , a AM cps V A \ti \\ �. ti -A l --.... fw pww#mm lumom .mss Nft- p JUNE 8, 2022 SCTM # TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET VILLAGE DIST. SUB. LOT Cr-4 9 ACR. REMARKS (,- 14 L TYPE OF BLD- 11-3112--2 - Z P-H- 1-1-7qO3 - ZA SZC2umd _P001 PROP. ah I LAND IMP TOTAL DATE 400D 113 �aoo _570 0 0 J FRONTAGE ON WATER HOUSE/LOT BULKHEAD TOTAL TOWN OF SOUTHOLD PROPERTY RIECONu a AD 4g a * OWIE ST f VILLAGE DISTJ SUB. LOT .. 1 jlyo R€� � O�NR _ �� - ACR € ., �,. S - TAPE OF BUILDING f-6a � - �. - ES. '{ 1 SEAS. YL. FARM COMM. CB. MISC. Mkt. Value LAND IMP= TOTAL DATE REMARKS I 3 z 0 r- _ : rJv 4 AGES E �LNGN� � - _ j _ ._ - L-94 NEW NORMAL BELOW ABOVE � . EARS Acre Value Per Value I Acre Tillable i _ i t Tillable 2 C7 Tillable 3 _ = � Le a Woodland T $warnpltand FRONTAGE ON WAT& E Bruland FRONTAGE ON ROAD Houe Plat DEPTH �� . :BULKHEAD .. �� e F �Total SO �z IDOCK w r _ . f LL . r R r I L �._ .._ Ln ' o a }^ ,3 y � r k r4 o o o 6 y v °' E > Go „ r i 1 cri P IBM, „ Ir�� o cn O CST 'k fLh wj CL m O FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERKS OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. .......... Date ............ .......QQ.t-Qb%r...6........ 19.fil THIS CERTIFIES that the building located at 4...........I................... Street Map No. .., ......... Block No .. ...... Lot No ..3=.......M&ttAtU0—kj,--X*y-&............... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................................xPrIl.......6............ 19.65.. pursuant to which Building Permit No. .269.5.Z dated ................................. 19..fi5,,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 ........ .......... ..iive.U:1 ..................... ............... ............ The certificate is issued to ..R.—Skudlex-ek......................Owner.................................................. (owner, lessee or tenant) of the aforesaid building H.DoAPProVal Oct. 8t 1965 by R. Villa .Building.. Inspector .......................... ....... ............ ............... quTown of Southold Annex 5/2/2014 P.O.Box 1179 54375 Main Road Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 36890 Date: 5/2/2014 THIS CERTIFIES that the building ALTERATION ............ ............. Location of Property: 1475 Cox Neck Rd,Mattituck, SCTM#: 473889 Sec/Block/Lot: 111-7-19.18 ........... ................ Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated I/1/1900 pursuant to which Building Permit No. 38801 dated 4/23/2014 ............ 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: make alteration in existina earat for storege use in aone fad dwelling as o iRnLed for. - The certificate is issued to Vail,Regina&Hart,Mary Anne Wanat ................ (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. N 480740& 2022377 6/3/80&9/13/04 PLUMBERS CERTIFICATION DATED --aorsed Mature f /" Town of Southold 1/25/2023 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERT"IFICA"TE OF OCCUPANCY No: 43789 Date: 1/25/2023 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 1475 Cox Neck Rd.,Mattituck SCTM#: 473889 Sec/Block/Lot: 113.-7-19.18 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ 2/8/2022 pursuant to which Building Permit No. 47538 dated 3/11/2022 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: "as built"'ad i%t o rtc t trer n , including basement eggancejLV — � li ..g nr converted to habitable s pace to eitin� yin [e�"a �il ,.d�vgllala aMlal;fct_,�ar� The certificate is issued to Mike Jacob LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 47538 12/16/2022 PLUMBERS CERTIFICATION DATED _...._w.... .w ... _ _. .n- __..... w ___ ................ ... _ . .......... r._. . .____.........Mw....... d i attire , fiat + Town of Southold 1/25/2023 P.O.Box 1179 53095 Main Rd � �r a Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43788 Date: 1/25/2023 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 1475 Cox Neck Rd,Mattituck SCTM#: 473889 Sec/Block/Lot: 113.-7-19.18 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated P g _.... __...ww.31/2022 12/28/202,1 pursuant to which Building Permit No. 47403 dated 1 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: gcce ury 1-g1" c trcf.. .vlc a a laa lw rjc. ,.tea code as applied for. The certificate is issued to Mike Jacob LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 47403 5/31/2022 PLUMBERS CERTIFICATION DATED _.w............ _.. _.._ wwv _...... ..._ ......... ..w. ___ —_.------w..........M,,-------_....... t1a ri , i nature