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Home My WebLink About1000-141.-2-11 TOWN OF SOUTHOLD Rental Permit nw 0779 Owner Juan & Alicia Acevedo Occupied as Single Family Dwelling Located at 2775 CR 48 Mattituck 141.-2-11 Maximum Permitted Occupancy 2 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. 11/16/2022 ode Erf c 05friciai This Notice must be posted by the main entrance at all times Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 ' Southold,NY 11971-0959 01 BUILDING DEPARTMENT ^ TOWN OF SOUTHOLD r013(IiL""C;VO4 j RENTAL PERMIT APPLICATION oFSOLI i;� Rental Permit Fee $200 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: 7 T-5- )4 K' Od�I—Ock Im Tax Map Number: 1000 SECTION -BLOCK 0 -LOT„ ,, _ � Nl SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner, Mailing Address: r � M� -29 Telephone Number (s): Daytime_43 —Evening 15f'rW-6 Emergency Property Owner Email Address. ✓ 66 Page Page 1 of 5 h N Town Hall Annex ?' � Telephone(631)765-1802 54375 Main Road 7 Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 Nd BUILDING DEPARTMENT TOWN OF SOUTHOLD UW ham' q Mailing Address of Managing Agent:�Ic � oe) „ (C61 Cl 1&� (o3► gFs3— �� -c(43- Telephone Number(s): Daytime 3(Q%9% Evening'lfn`�x9 Emergency Email Address: 0'ey&-79jQ �a-.Ccm SECTION F. e7 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 dirri®nsions 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... � lX I Use and Dimensions each room in Rental Dwelling Ucnit: � t l�-9P9Ln% Page 3 of 5 04 04 LO 1 C14 N N Z C �, 71 fIf C O C� U cid LO 7 N C'4 � LID U)I C 0) a 3 t Q 0 Ca -------------------- Y U d A Y ". a0 p 0 I Window Y �, WindowLo J C � L N �.m N � L Ca >+ J CT- CIO ED ' = 0. CL o8 o _ E N - L m .. EO P m 3as°lo ,. c y .A9 X..09 °x' Pa9.l71 3 o sofa I 1• front Window entrance Window i 4 } Town Hall Annex �` Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 � N "" ,y n. 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�he 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•ofthe County of Suffolk and by the laws adopted by the New York State Fire Prevention and Building Code Council. 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. a SECTION H. DECLARATION: Signature must be notarized and MUST be the owner pf the dwelling unit. r STATE OF NEW YORK) ) COUNTY OF SUFFOLK) 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 w Town Hall AnnexTelephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 117974 ^F Southold,NY 11971-0959 r BUILDING DEPARTMENT TOWN OF SO "THOLD 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's Signat e: ONNIE 0 BUNCH Notar�puj4 ic,state of New York No01 B1J5185050 ,� Qualifiedin Buffotk County Sworn to before me thi da yof It M 20� commission Expires April 14, .. - " Official Notary Public Signature and Original Notary Stamp Page 5 of 5 Rot A4wzoo, TOWN OF SOUTHOLD BUILDING I 531 765-1502 1q l , INSPEC ION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAL [ ] TEAMING / STRAPPING [ ] INAE [ ] FIREPLACE & CHIMNEY [ EIRE SAFETY INE [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL [ ] CODE VIOLATION [ ] PRE / [ I r DATE Atl°� INSPECTORV14 A - TOS,.- ;F SOUTHOLD OFFICE OF 1317ILDI7\G I1S11LCT0R TO1Vti HALL SOUTIIOLD, NEW YOFtK CEIi.TIFICATE OF OCCUPANCY No,N-cnNFOR.IIIIN'G PP.1 I\lISES THIS IS TO CERTIFY that the pre C.O. n- Z-16924 /x/ Land /X/ Duilding(s) Date- May 27, 1988 /+/ Use(s) located at 2775 County Road #48 Mattituck, New York --� Street Hamlet shown on County tax map as District 1000, Section 141 . Block 02 Lot 11 , does.,not�conform to the present Building Zone Code of the Town of Southold for the following reasons: Insufficient total area; front yard and side yard set-backs; insufficient habitable space - On the basis of information presented to the Building Inspector's Office, it has been determined that the above nonconforming /X /Land A /Building(s) / /Use(s) existed on the effective date the present Building Zone Code of the Tovrn of Southold, and may be continued pursuant to and subject to the appli- cable provisions of said Code. IT IS FURTHER CERTIFIED that, based upon information presented to the Building Inspector's Office, the occupancy and use for which this Certifi- Cate is issued is as follows: Property 1 story, one family, wood framed dwelling, with accessory shed and privy, and all situated in the 'A' Agricultural Residential zone with access to County Road #48; a County maintained road The Certificate is issued to JANICE A. EVANS (owner, l . , Y 5 of the aforesaid building. Suffolk County Department of Health Approval N/A UNDEM1,111ITERS C1lIiTIFIt-:l 1E 1\70. N/A NOTICr•. IS MIREIiY GI17E-N! that the owner of the above premises ILLS NOT COi:SENITED TO AN INSPECTION of the premises by the Building Inspec- tor to deter.mineif the premises comply with all "�pplicaa'ble codas and ordin- ances, other than the Iiuildin on Code, and tl� eret"ore, no such in,pection has been conducted. This Certiricate, therefore, does not. and is not intended to certify that the premises comply with all other applicable codes and rerzula- tions. 5F1ti�C!9 Town of Southold 9/24/2021 P.O.Sox 1179 53095 Main Rd Oyu" Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42346 Date: 9/24/2021 THIS CERTIFIES that the building WINDOWS Location of Property: 2775 CR 48,Mattituck SCTM#: 473889 Sec/Block/Lot: 141.-2-11 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 6/17/2021 pursuant to which Building Permit No. 46492 dated 6/25/2021 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: "as-jj ilt"Windpw re rl ceme is L4p i d or. The certificate is issued to Acevedo,Juan&Alicia of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED ... _. ....... ._........ _ .................. _ ............... thori m igrnature_._____.__.