HomeMy WebLinkAbout1000-120.-3-8.36 TOWN OF SOUTHOLD
Rental Permit
0872
Owner 4270 Aldrich Ln LLC
Occupied as Single Family Dwelling
Located at 4270 Aldrich Lane Mattituck 120.-3-8.36
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.
4/21/2023
d fo rpt Official
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 1179 �.
Southold,NY 11971-0959 y flu
BUILDING DEPARTMENT 4
TOWN OFS
RENTAL PERMIT APPLICATION
Rental Permit Fee$200(Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
2 &L R,(C N PI;--rV1VC
Tax Map Number: 1000 SECTION . ZO -BLOCK � � -LOT a `
SECTION B.
OWNER INFORMATION: 1-1a70
Property Owner Name: ftK�CR�t �l.. N (�`(S'.� - •• -.
Property Owner Legal Address: Property Owner Mailing Address:
Telephone Number(s): Daytime_,_-—----, Evening._----_ Emergenc. _„ ___ --
Property Owner Email Address: _ � r—C-CL 0. � lG CO Wl
L �
c0aC/ o
Page 1 of 5
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. fV1�1fYuw, 7. °"'"w
Town Hall Annexe„i Telephone(631)765-1802
54375 Main Road t Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
2 r,
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any: .w �, .. .� " .... _._.._..
Address of Authorized Agent (no P.O. Boxes) m ° o. .. . r v ' A Id
67
Mailing Address of Authorized Agent:.-PUB
Telephone Number(s): Daytimemm m vening < fd Emergency, .
Email Address: .._.. .� '._. t .. ww . _. .... _�
Section D.
Managing Agent Information:
Name of Authorized Agent of dwelling unit,if any:
Address of Authorized Agent(no P.O.
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: _ , .,,_ _..._........
.�,M__ ._. _...�.� _....
Address of Managing Agent no P.O. Boxes):,,,,, .._...._ __. _.. _.. .... ......._. __ _....... _..�...,,._.. _._.._._ w_.
Page 2 of 5
Town Hall Annex i^ Telephone(631)765-1802
54375 Main Road , Fax (631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUIvHOLD
Mailing Address of Managing Agent:.,_,,,.......
Telephone Number(s): Daytime Evening
EmailAddress:......._. . . �__ , . ....._ _..._.......... .. _ ...._. .._.. .._. ..._._ ._._-. _...._.... ...... .-
SECTION F.
PROPERTY DESCRIPTION: i
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: _ to
Use and Dimensions of each room in Rental Dwelling Unit:
14 V_` SeDRm *3 13'-4c ID1-6if
y
R,edc-M#4- 8`S�x t16.4.. SAiv ;0 - 5-Ox—j " 6" JV-RC"' ...(?!"D_`_.12 .
IZ-tT A DIN RM 2�t -9 x 121-toy bEN W-v�c L3`-(O" BAT- H-*l 5�b& cl `-Oy
L kV `I
Page 3 of 5
Town Hall Annex Telephone(631)765-1802
54375 Main Road � " Fax(631)765-9502
p
P.O.Box 1 179
Southold,NY 11971-0959 , 91
BUILDING DEPARTMENT
TOWN OF SOD 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
V/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)
ertify 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
54.375 Main Road Fax(631)765-9502
r.
P.O.Box 1179
Southold,NY 11971-0959 ��
BUILDING DEPARTMENT
TOWN OF SO OLD
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. I 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 Signature: ..."
MEZAN S KEGAZY
Sworn to before me this kday of 7 • 20
NOTARY PUBLIC-STATE OF NEW YORK
Queens
In
No. 01 HE623
9uallflw�s nsns County
Official Notary Public M1Signature and Original Notary Stamp MY Commission Expires Aare 25, 20 ,
Page 5 of 5
INSPECTION
j ] FOUNDATION 1ST [ ] ROUGH PL13G.
j ] FOUNDATION TND [ ] INSULATION/CAl
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN!
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (TII
[ ] CODE VIOLATION [ PRT C/O [ ] I
RE a
cc, r
DATE INSPECTOR
4
5
Town Nall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 7 ,'
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
f!ro + nc l seal re ale dor rc ltect or F� n +e (( n aw In p c or rpwq r vide
Cpm s tfr
Rental Property SCTM Number: 1000 - 12,D 3-8'3,
Rental Property Address: 4 2 W I--OR(CtF L-A NE-yy tylA-- I-uc_K- _- W
Owner/Name: " A-K15 `14—eN. (5FKt s
Rental Dwelling Unit Identifier: t
Number &Square footage of each bedroom as depicted in the attached floor plan:
(i.e. Bedroom#1-100 sq., Bedroom #2-90 sq., etc.)
E3E0�?m ?.- ... � ± # 3 !4oar s C!n
1-i V 'Z'0(V tk Kt-r- COW. Rrh. 38oth DEQ! .(413 ._
Property Description (Include all improvements indicated on survey)
I FA IL. w T"I 2 C' � � CoV e9ev PoRCb
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.
Print Name and Title 4g�inalnature
Please place professional seal: �
SCTM #
TOWN OF SOUTHOLD PROPERTY RECORD CARD 3�� f
OWNER STREET �� _'` VILLAGE DIST SUB LOT
F474I
CR REMAR KS
JI I
TYPE OF BLD.
PROP. CLASS n _
1 44 LLC
LAND IMP, TOTAL DATE
FRONTAGE ON WATER HOUSE/LOT
BULKHEAD
TOTAL
t
w
TOWN OFQUTHQLD PROPERTY RECORD CARD
OWNER STREET VILLAGE DIST L SUB. LOT
7
ACR REMARKS
aa
f TYPE OF BLD_
T � e
n
vu
PROP CLASS
jif
LAND IMP, TOTAL DATE 1 _1
15
J
42
s
i FRONTAGE ON WATER TILLABLE
FRONTAGE ON ROAD OODLANDC.
k
DEPTH MEADOWLAND
I BULKHEAD HOUSE/LOT
t _
TOTAL �
3
,2�
-TTF 7-17
_ [
COLOR
qy
51
i
l r
i
l
� � _ `• TRIM
120.-3-8.36 1/08 ` 77
`
f
M Bldg- _ � �� � _ �" �" � �� S� � Foundation Ce Bath � �' Dinette
[ � ; �-
-. - �� .FULL -
Extension �' <. � 210 Basement CRAWL
ne L , v Floors Kit.
ExtedsionIy! f 3 `2 Ext. Walls �,4 Interior Finish L.R. t
Fire Place
Heat D.R.
rstorT ; .
-
l Woodstove I BR.� �
Po
Dormer in_
en= -
Dec Attic l
°_
Breezeway ?C ( x ` IQ Rooms 1st Floor
Garage
Driveway Rooms 2nd Floor
sm
-
f E
Pool 1� --
y
- -� _ ,.a4:!✓tf:A ,,5'ifa C,�'�'`'�C4•�'td �''s�aC. �t F
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1i
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-25434 Date: 12/16197
THIS CERTIFIES that the building NEW DWELLING
Location of Property: 4270 ALDRICH LA MATTITUCK
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 120 Block 3 Lot 8.36
subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 26 1997 pursuant to which
Building Permit No. 24240. 2. 2 dated JULY 30 1997
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 WITH ATTACHED TWO CAR GARAGE & COVERED PORCH AS
APPLIED FOR.
The certificate is issued to SCHEMBRI HOMES,1 INC.
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEP ENT OF HEALTH APPROVAL R10-97-0102 12/10/97
ELECTRICAL CERTIFICATE NO. 18483 12/07/97
PLUMBERS CERTIFICATION DATED 12/06/97 G.A.H. PLUMBING
ole
\ r-
BuildiqVInspect,or
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: 5-27129 Dates 06/09/00
THIS CERTIFIES that the building ADDITION
Location of Property: 4270 ALDRICH LA M&TTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473389 Section 120 Block 3 Lot 8.36
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 2 2000 pursuant to which
Building Permit No. 266,18-f-f dated MAY-23t 2000
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 REAR STOOP WITH STEP ADDITION TO EXISTING ONE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to CHARLES H & MARGARET A. TYLER
( R)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE. NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Au ria signature
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: Z-30612 Date: 1.2 08 0
THIS CERTIFIES that the building ADDITION
Location of Property: 4270 ALDRICH LA MATTITUCK
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 120 Block 3 Lot 8.36
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 15 2003 pursuant to which
Building Permit No. 29656-Z dated AUGUST 18 2003
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 REAR DECK ADDITION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to ROBERT & MONICA KULL
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. NIA
PLUNSM CERTIFICATION DATED N/A
ri Sig attire
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: Z-33286 Date: 03 2OB
THIS CmirrIFIE.S that the building ACCESSORY �kww
Location of Property: MATTITUCK
4270 ALDRICH LA w..�
(HOUSE NO. ) (STREET) _ (HAMLET)
County Tax Flap No. 473889 Section 120 Block 3 Lot 8.36
subdivision Filed Flap No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 17, 2007 pursuant to Which
Building Permit No. 32905-Z dated _ APRIL 17, 2007
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 ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR.
The certificate is issued to ROBERT J & DENISE KULL
..._._ (OWNER) ...........
of the aforesaid building.
SUFFOLK COUnY DEPART14ENT OF HEALTH APPROVAL N/A_ �..
gLSCTgICAL CERTIFICATE NO. 4008284 08 0
PIMA CERTIFICATION DATED . .................N.,
�A
Authorized Signature
Rev. 1/81
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