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Home My WebLink About1000-140.-1-21.1 TOWN OF SOUTHOLD 1 Rental Permit 0837 Owner Mercier TR Irry Trt Occupied as Single Family Dwelling Located at 1045 Love Lane Mattituck 140.-1-21.1 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. 3/13/2023 U r% f rc nt Official This Notice must be posted by the main entrance at all times Town Hall Annex Telephone(631)765-1802 54375 Main RoadFax(631)765-9502 . i P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee$200 (Application must be renewed every t w� DEC 2 9 2022 LD , f3U1WJW UEPT TOWN OF$0 Lr Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION _ �-�-RLOCK SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: 7 O N cv p, d t �Sdg z Telephone Number(s): i ayt me_a � ) 4ening Emergency Property Owner Email Address: ' ''� �� i �'. e '—� U C-6 Pagel of5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 " Southold,NY 1 197 1-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: 6� ..................� Address of Authorized Agent(no P.O. Boxes): . .......W_wwwww_.... Mailing Address of Authorized Agent: _ Telephone Number(s): Daytime.-- M 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 , . .-.—.......__,....-.._Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening_ ____ Emergeny ___ EmailAddress:_........ ...ww .ww......._ .,.. .... ...ww..._w _ __ ,_. SECTION E. SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units) Name of Managing Agent of dwelling unit, if any: _�...4.�.,wv._,,,,,,,,,,,, , _......_......., � _, Address of Managing Agent (no P.O. Boxes):_,._,__.___._ _�wwww Page 2 of 5 Town Hall Annex � Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 1 1 971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: _ ... .- Telephone Number(s): Daytime-Evening..................�...... Emergency__._..,,,- Email Address:_ - 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: .. ...wwww._ 000 Requested Maximum number of persons allowed to occupy Dwelling Unit(--9---�( Number of rooms in Rental Dwelling Unit:.„� 1 ._ ... ,..... . < < Use and Dimensions of each room in Rental Dwelling Unit: L-`v1��'__ .�d�Jw�.....,........�� Page 3 of 5 Town Hall Annex � Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 4 µ $ 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 , 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 n 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: "N N A,5 �� -M tRClf Property Owner's Signature: � Sworn to before me thi q�1day of� �,�w. , 20 D. Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No. 01BU6185050 Qualified in Suffolk County,),)_ Commission Expires April 14, 2 T Page 5 of 5 # � TOWN OF SOUTHOLD BUILDING DI rcnu631 .765.1802 INSPEC ION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAl [ ] FRAMING / STRAPPING [ ] �VAL ( ] FIREPLACE & CHIMNEY [Vj FIRE SAFETY IN; [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI [ ] CODE VIOLATION [ ] PRE C/O [ I REMARKS: Pon wr VV A- Ct4) kJ �C41f DATE ANSPECTOR 331 r4y �i f a c k' � AL s SOWN OF SOUTHOLD PROPERTY RECO6 GR'a-)�'?-a OWNER T ET VILLAGE DIS. SUB. LOT FORMER OWNER N - E - ACR. S W i TYPE OF BUILDING RES,,;/:) SEAS. ;VL. FARM 'CON+M. CB. MISC, Mkt. Value LAND l IMP, TOTAL DATE REMARKS e - - AGE BUILDING CONDITION x > F NEW NORMAL BELOW^! ABOVE .-= 3 gam= ;t FARM I Acre Value Per Value _ l Acre Tillable l l Tillable 2 l Tillable 3 Woodland Swampland FRONTAGE ON WATER Brushland -FRONTAGE ON ROAD I _ House Plot °DEPTH ;BULKHEAD Tota I DOCK VO. - 3 COLORLA- � e a r I _ - t TRIM - __ - 14 - _- _ f I � � �T I s M. Bldg. _ Fou n— i datan - Bath Dinette Extension EBosement I Floors Kff stenion Fit. Walls Interior Finish LR. Fire Place Heat �- I Extension � � � - 'Type Roof Rooms 1st Floor BR. Porch Recreation Roomy Rooms 2nd Floor' FIN. B- Porch Dormer Breezeway Driveway r Garage Patio O. B. Total 17 Z i � Town of Southold 3/23/2023 P.O.Box 1179 53095 Main Rd qi Southold,New York 11971 liv CERTIFICATE E OF OCCUPANCY No: 43937 Date: 3/23/2023 THIS CERTIFIES that the building ALTERATION p ,Mattituck Location of Prorty: 1045 Love Ln a ._._.......__....wwwww ...._...........................w...... _ __._...__....._.. SCTM#: 473889 Sec/Block/Lot: 140.-1-21.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore • tiled in this office dated 12/29/2022 pursuant to which Building Permit No. 48814 dated 1,/30/2023 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: �t%n m oral otfrce;alt l tc>a rng fa .dwellixa s gVptLe4 f w The certificate is issued to Mercier TR &B Irr.Trt. of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED .................... ......... ...._. w..._ riz i nature FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. . . . . .... . . Date . . . .. . .. . . . . . . .Sept. . . . 20. . . . ., ASA . THIS CERTIFIES that the building . . ProfessionalOf f ice . . . . . . . . „ . ., . .. . . Location of Property . . .4 9 Q 5 . . . . . CtYe. R4. #4 8 . . . , . . .Mattituck Na. �tHsm%! County Tax Map No. 1 o00 Section . . .14;. . . . . .Block . , . . .01. . . . . . ..Lot . . . .0 21. . . . . .. . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. .. . . .. . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . .*sty. . .39. . . . . . . . . .. , 19 PA pursuant to which Building Permit No. ..1318 7 Z . . . . . . . . . . . . dated . . „ . , . , ,Tune 4 . .. . . . . . . . . . „ . 19$4. ,was issued,and conforms to all of the requirements of the applicable provisions of the law.The occupancy for which this certificate is issued is . . . . . ... . . (One Family Dwelling) to a Professional Office The certificate is issued to . . . . . . .MERCIER, THOMAS & BARBARA . . . . y . . . . . ., . . . . . of the aforesaid building. Suffolk County Department of Health Approval . . . .!CA. . . . . . . . . . . .. . .. . . . . . . . . . . . . . . .. . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . N658911. ... . . .. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . Building Inspector Rw.1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z. . , . Date . . . . . . . . . . . . �U#. . . 28. . . . . 19. 73 THIS CERTIFIES that the building located at W/$,L+c TO.L 0 R27 . . . Street Map No.C. BOOT*. . . Block No. . . . . . . . .Lot No. . . . . . . . . . aattit N.Y. requirements for one faaa i,1Y a�"A"WV 1i conforms substantially to the built before rii 23 5? C of oagr~te of occu 7 , 19. pursuant to which No.y . dated . . . . . . . .Aug. . 28 . . . . . .. 19.?3., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Private one fezd ol$. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .a , . . The certificate is issued to . .Charles Abraer ham. . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .prs- .esting UNDERWRITERS CERTIFICATE No. pro. oxtstl . . . . . . . . . • • • . . • . • • . . • . HOUSE NUMBER . 49015 . . . . . . Street . . C8,27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 .ore la Building Inspector �t� f e ti \\ a, �\ � \