HomeMy WebLinkAbout1000-70.-4-16 a TOWN OF S UTHO D
t Rental Permit
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Owner Matthew F. Stanton
Occupied as Single Family Dwelling
Located at 2725 Wells Avenue Southold 70.4-16
Maximum Permitted Occupancy 7
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.
5/5/2023
Code o c ment Offic`
This Notice must be posted by the main entrance at all times
15-
a fe e,4f 1 W3
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
s
BUILDING DEPARTMENT
TOVIN +Out'" SOUMOLD
RENTAL,PERMIT IT APPL,ICA"TION �,� kn
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Rental Permit Fee$200(Application must be renewe re tw crap 2023
Section A. .
Property Information:
Rental Property Address:
-' , "` -��.... ,� � ►J Y «�X11
Tax Map Number: 1000 SECTION� B O -LOTI ,''3 QQ0c� � o
no 4 IIo
SECTION B.
OWNER INFORMATION:
Property Owner Name:. lei v, `,P�J-TV r`1
Property Owner Legal Address: Property Owner Mailing Address:
Cos
0611601
Telephone Number(s):Daytime q 114 -" -V4vening Erhergen "i -3 8 6 0
Property Owner Email Address: '&r A-N To iJ .+ : . O
Page 1 of 5
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Town Hall Annex - Telephone(631)7654802
54375 Main Road Fax(631)765-.9502
P.O.Box 1179
Southold,NY 11971-0959
u�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling.unit, if any: I�"
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:
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
VAN "
Town Hall Annex Telephone(631)765-1802
54375 M4 in 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, Unit13 or Apt A, B, C);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: L�0 & vp iT
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:
L.�,✓t�a�- i�c,,�t� 1�. 2 i�r�»t�� 1�' n l� !�-.,�+�►� to'k ��� 0� 4 �F 11
A*'s W-h 0-0m-N m"t j C1D�mo►�t 1 lS a r x 11. 2 1.��+ � lt?� L n
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Mn�+- P'M-A-eosm 'I t 2' &VS5T P�hfir�•9A'I '1�(o"x IZ'4 �i a;T $an-' oo*'1 &r r
Page 3 of 5
Town ball Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 1197I-0959
C
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.
l 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 a! s�' �"� certify under penalty of perjury,the followi.ng:.
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 rely legal
address and I understand the Town will use the address for service pursuant to all
Page 4 of 5
A
So
,n
Town Nall Annex Telephone(631)765-1602
54375 Main Road Fax(631)765-9502
P.O.Box 1179.
Southold,NY 11971-0959
XX
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
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.
1 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: "
,
Sworn to before me thk; day of '/,>1-120.,-)3
Loll,
Official Notary Public Signature and Original Notary Stamp
CONNIE D. BUNCH
Notary Public,State of New York
No.01 BU6185050
Qualified in Suffolk County
Commission Expires April 14, 2 04
Page 5 of 5
TOWN OF SOUTHOLD BUILDING DI
631 -765-1802
IN PEC 10N
[ ] FOUNDATION 1ST [ ] ROUGH PLBG,
[ ] FOUNDATION 2ND [ ] INSULATION/CAL
[ ] FRAMING / STRAPPING [ ] FINAL
I l FIREPLACE & CHIMNEY [ ] FIRE SAFETY WE.
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PEI
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (Fit
[ ] CODE VIOLATION [ ] PRE C/O [ eF
REMARKS: /�Jl
0 1'e- 1. 11 1-11 1
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DATE
= 5- , INSPECTOR
Town Hall Annex
d
SOUTHOL® ®WN 54375 Main Road
PO Box 1179 Southold,
Rental I�1��tion NY 11971-1179
it 9 iµ Tel: 631-765-1802
Fax 631-765-9502
SCTM # _� - - �� Date a
,�
Owner T. Phone
Address Zip w.....�.._..�.. :. �. , , s �
City Inspector
LEVELS SUB 1 2 3
Smoke Detectors (# - bedroom detectors excluded)
Carbon Monoxide Detectors
Fire Extinguishers (#)
Exits
BEDROOMS 1 2 3 4
Smoke Detector Alarms (#) _....w .. __.w_. _w... ..._w._ _.........M..._ _ .. _..._.. _..__w_.
_._ w...._ _,.. ..._. .ww.._
Carbon Monoxide Alarms
Egress (windows) (Y/N)
BUILDING SYSTEMS Y/N CONDITION OF PROPERTY Y/N
Heath s stem main Interior is clean /maintained
�: ...� M�n. at i o n a I Building
Hot waters sten°a maintained/aperational Building Exterior is clean/maintained
"�
Property is clean / safe/maintained
Electricalr maintained/oi �µational p y -- -� �-
Mechanical s steno maintai¢ied/o 'erational Handrails & guards present
COMMENTS;
Rental Inspection Form 4/7/2021
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TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER STREET VILLAGE DIST_ SUB. LOT I
AGR. REMARKS
TYPE OF BLD.
PROP. GLASS
LAND IMP- TOTAL DATE
I
FRONTAGE ON WATER TILLABLE
i
FRONTAGE ON ROAD WOODLAND
I DEPTH MEADOWLAND
3 �T
_- BULKHEAD HOUSE/LOT
TOTAL
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COLOR
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TRIM
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70,41-16 1/12
6
I
Foundation Bath Dinette
M Id _ 3 C -
,a _.... FULL '.- - -.
,--Extension - Basement p-AL Floors Kit.
°T'. � -- SLAB - --
- _-- --
Extension Ext. Walls i Interior Finish , _ L.R.
r
Extension Fire Place Heat — - D.R.
Patio Woodstove BR-
Dormer
Deckx z ;2-2, Attic
s
a
tet. �.�- � _` Rooms 1st Floor
a Driveway Rooms 2nd Floor
Garage
O.B.
Pool
i
a Ea
Z
^4R
COLOR
Xi
T IM t
1-4
{
T
1 _
m_ f
s �
e
44-4-
_
M. Bldg. = -
�' i
Extension e -
Extension
Extension _
1 Foundation jBath Dinette
Porch -�� B Floors I<.
E
Basement '
E
Porch - v
'Ext. Valls = Interior Finish
- � � LR
Breezeway ` I !Fire Piece
'Heat DR.
Garage _ Type Roof Rooms 1 sf Floor BR.
r T-- -
. =,---Recreation Room Rooms 2nd Floor FIN. B
0. B. � `Dormer � � � Driveway
E
i Total
I
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
N a Date .....
4 ,THIS CERTIFIES that the building located at ....... ......... 3Street
Map No. 4.,.ij......... Block No. .......7=..........................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
_0.............19.�]., pursuant to which Building Permit No,
dated •.......—..195-7, 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 ....---
O.W Q'. ...................................................
R
This certificate is issued to ...
....)-I 'n
(owner, lesse or an
of the aforesaid building.
...................%. .......
Building Inspector
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPAR'T'MENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20443 Date JANUARY,3j, 1992
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property 2725 WELLS ROAD SOUTIOLD N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 70 Block 4 Lot 1G
subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEM13ER 19 1930 __pursuant to which
Building Permit No. 19559-Z dated DECEMBER 10 1990
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 GARAGE & DECK ADDITIONS & ALTERATIONS TO EXISTING ONE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to THOMAS KELLY & NANCY IANNICELLI
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N A
UNDERWRITERS CERTIFICATE NO. N-217284 - DECEMBER 1.8 1991
PLUMBERS CERTIFICATION DATED NOV. 15 1,991 - HARDY PLUMBING & HEAT.
taa.lding Inspector
Rev. 1/81
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
210688 September 1611
No. . . . . . . . ,. . . . . . , . » » Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
THIS CERTIFIES that the building . . . . . . . . » . . . . . . . . . . . . . . . . . . • . • . . • » • . , • » » . . . . . . . .
2725 Wella Avenue, Southold, New York
Location of Property . . . . . . . . . . . . . . . . . . . . . . » , . » , . . . . . . . . . . . . . . » » « , . . .Hmrrfei
House IVa 070 S#r. .ei
v 016
County Tax Map No. 1000 Section . . . . . . . . . . . .Block . . . . . . . . . . . . . . .Lot . . . . « » . . . . . . . • . .
Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . .
conforms substantially to the Application' for Building Permit heretofore filed in this office dated
September 4 81 11363 Z
. . . . . . . . . . . . . . 19 . . pursuant to which Building Permit No. . . . , , . , » . . . . . . . . . . . . .
September 9 81
dated . . . . . . . . . . . . . . . . . . . » . . . . . . . . 19 . . . ,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 . . . . . . . » .
Addition of Deck to Dwelling
William Worth
The certificate is issued to , . . . . . w u . . . . . . . . . . . » . . . . ¢ ; ac�ct;
.............
...............
Town of Southold Annex 7/15/2011
54375 Main Road
Southold,New York 11971
..............
CERTIFICATE OF OCCUPANCY
No: 35069 Date: 7/15/2011
THIS CERTIFIES that the building DECK
............
Location of Property: 2725 Wells Avenue, Southold,
SCTM#: 473889 Sec/Block/Lot: 70.4-16
..............
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore Med in this officed dated
9/27/2010 pursuant to which Building Permit No. 35920 dated 10/5/2010
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:
deck addition Lo an cy.isti _qgg fAj elj� for.
dWe 5_4ppfip�
The certificate is issued to Stanton,Matthew
........
_. .....
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
- - -—------------- ------- -
U Si ure
... ....... ....... ....... ...