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Home My WebLink About1000-107.-7-26 a 1O6'WWWN OF SOUTHOLD 4- 4 -i� E cm Rental Permit 0865 Owner James & Rachel Seaman Occupied as Single Family Dwelling Located at 255 Woodcliff Drive Mattituck 107.-7-26 Maximum Permitted Occupancy 5 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. a 4/19/2023 Code tnf r rent MOW This Notice must be posted by the main entrance at all times rt 01 Town Hall Annex ;, Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 ,p Southold,NY 11971-0959 " ry HCl BUILDING DEPARTMENT TOWN OF SOUTHOLD MAR 1 12023 � �, k,.rrr d :u xiNJ RENTAL PERMIT APPLICATION + O)m 01=st g i'pr' t") Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: 255 Woodcliff Dr, Mattituck, NY 11952 Tax Map Number: 1000 SECTION 100 -BLOCK 7 -LOT 26 - IDS o� SECTION B. OWNER INFORMATION: Property Owner Name: Rachel E. King (Seaman) Property Owner Legal Address: Property Owner Mailing Address: 255 Woodcliff Dr 255 Woodcliff Dr. Mattituck NY 11952 Mattituck, NY 11952 Telephone Number(s): Daytime 5» 1- 155BEvening� Emergency Property Owner Email Address: Belterv1221 @yghgq&gM Page 1 of 5 Town Hall Annex °' « Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 � n Southold,NY 11971-0959 u 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: t 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: 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 1179" Southold,NY 11971-0959 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: Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: Page 3 of 5 Town Hall Annex � Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 "w Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTIH:OLD 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 ❑ 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) 1, Rachel E. King 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 r Town Hall Annex dk Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 'tt Southold,NY 11971-0959 V;, BUILDING DEPARTMENT TOWN OF scw<" JTHOLD 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: Rachel E. King Property Owner's Signatu� Sworn to before me t day of December , 2022 Official Notary Pu lc sign ure an glna "N ary tamp STEVEN E HORTON NOTARY PUBLIC STATE OF NEWYORK SUFFOLK COUNTY LIC.#01H 4 COMM.EXP. Page 5 of 5 v T �� Y'c��m S UV ( �► h � joy rev ►aSc� � ee) t � ►Y14� 1 Ov 1 to, . )e-z> bods c (e SYllake ct 6 r►M5 J��" *` TOWN OF SOUTHOLD BUILDING D1 631 -765- 1802 INSPEC ION [ ] FOUNDATION 1 ST [ ] ROUGH PL13G. [ ] FOUNDATION TND [ ] INSULATION/CAl [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE &. CHIMNEY [ ] FIRE SAFETY IN! [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII [ ] CGDE VIOLATION [ ] PRE C/O [ I REMARKS: DATE INSPECTOR FORM NO. 4 N� TOWN OOFSOUTHOLD PLAN5 BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No, ........A...3.41.... Date ....,,....».......,.».............».Jul........w...6....»....., 19........ THIS CERTIFIES that the building located atv/4...�4C 4? �i •• 3 ..R... � >tak Street Weetvi.e MapNo. ........................ Block No. ,....,,....,...,..,......Lot No. ....».........,.........,...,....................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated r 6 � X39 .............»...,........ ......... 19...,...., pursuant to which Building Permit No. ....,.... . .....,,,.... dated ...«........................... ? .. �..., i9..�E..,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 .............. PRIVATE 01JE FAMILY DWBUING This certificate is issued to .......:! ..» .»... *?C 1 !...owner .................. ..... .....».............. (owner, lessee or tenant) of the aforesaid building. H,&R*Dq AnSPIMIRY FORM X0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy NoZ7. 107. . . e . , Date . . . . . . . . . . . . . .July. THIS CERTIFIES that the building located at to doliff .Dr. . . . . . . . . . . . . Street Map No. =. . . . , . . . Block No. XX . . . . . . .Lot No,I=. . . .M4tt5,tUck . .WAX«. . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office June. .?4., 19.7.6. pursuant to which Building Permit No. W1 Z dated . . . , . . . . , . . . Z. . dated . . . . . . . . . . June. . - • • ., 19. x., 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 fem3ly John & Carolyn Dunowski Owners . . . . . . . .ere The certificate is issued to . . . . . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .`R' . . • . . • . . • „ UNDERWRITERS CERTIFICATE No. N.R. . . . . . . „ . HOUSE NUMBER . . 9 . . . . . . . . Street . . .Wpsade liff 3 . . . . .ylotj wok . . , . . . Building Inspector 71 C / 18 y TOWN OF SOUTHOLD .PROPERTY RECORD CARD ER� I_STREET ILA E DISTRICT SUB. LOT F _ " IA, - - ACREAGE E ;. E , S A- V PE OF BUILDING TY ILD RES, SEAS. VL. ' EA comm. IND. CB. MISC. _ LAND .MP. TOTAL DATE REMARKS 3P 63q C,0 3�t - _ - - - - _� z v= o es1 z� aAx EUILD CIL _ ' - NEW � NORMAL BELOW � ABQV__ Farm Acre Value Per Acre Vdlue e T il'able W ood'on Swampland House PI& ;`oM P 3 ,a � r - s t- —t— z � _ k ` F ^ i T t3 - 2 107.-7-26 3113 rte. M. Bldg Foundation Bath �� — _ — Exfansien Basement Floors - — x Extension 'Ext, Walls Interior Finish -_ F Extension Fire Place Heat Parch Attic Porcn Rooms . �,st Floor Breezeway' Y Patio Rooms 2nd Floor Garage Driveway - f eF O. B. _ E