HomeMy WebLinkAbout1000-40.-5-21 TOWN OW SOUTHOLD
Zvi Rental Permit
1107
Owner Estate of Judith Walker C/O Meaghan Walker
Occupied as Single Family Dwelling
Located at 630 (aka27) Madison St. Greenport 40.-5-21
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.
4/15/2024
Code �r et Offi al
This Notice must be posted by the main entrance at all times
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 ht_t as://www,southoldtowm �
RENTAL PERMIT APPLICATION
Rental Permit Fee $300 (Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address: � n
10 �so Sk
Tax Map Number: 1000 SECTION -BLOCK -LOT—Z—t--
SECTION B.
OWNER INFORMATION:
Property Owner Name: W(
0 maxb*Am ux��
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
Rib com- un.......... 14 Doa
s : Daytime_ Venin Emer enc
Telephone Numberg g
Property Owner Email Address: p
Page 1 of 4
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: 9.
Use and Dimensions of each room in Rental Dwelling Unit:W "0 (Cv ,�\)I
Vre"(4 ��PC4 Ck X �0 XQ,
) Ocw c-1 C,21� C1
�.
SE ION 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 So hold, the laws and sanitary and housing regulations of the County of Suffolk and
by the la 's adopted by the New York State Fire Prevention and Building Code Council.
i:i I am requesting a fire safety inspection to be performed by a Code Enforcement Official
from the Town of Southold
0 lam submitting a completed Town of Southold certification form from a licensed
architect or a licensed professional engineer.
Page 3 of 4
SECTION H.
DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit.
STATE OF NEW YORK)
COUNTY OF SUFFOLK)
IU,—),qu-VZ 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
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 s to any change to the information
regarding Authorized Agent, Managing Agent, or Site Manager.
d �
Property Owner's Name:
Property Owner's Signature
Sworn to before me this o a day of Iq OY VI , 20d y
, -1A aaq, 9 f)UUV
Official Notao Public Signatur nd Original Notary Stamp
` iACEY t.. D YER
T,AIRY PUBLIC,STATE OF NEW YORK
NO.UIDW63o goo
C0114 ISSI0Ng PIE E S A COUNTY a Page 4 of 4
fat so
TOWN OF SOUTHOLD BUILDING C
631 765*1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PL13G.
[ ] FOUNDATION 2ND [ ] INSULATION/CA
L l FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INI
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PI
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI
[ ] CODE VIOLATION [ ] PRE C/O [
REMARKS: PVC,
TE "" � INSPECTOR
`� Town Hall Annex
Town of Southold 54375 Main Road
Rental Inspection Report PO Box 1179
Southold, NY 11971-1179
°aY"` Tel: 631-765-1802
....�..a .... . ......... . ..... Date .. ....
CTM # I
Owner Phone
. .......... ..
Address °� ..... .... "" _.._ Visible
�w. ......w.w .� . ��� .... .... .... sib RR
HamletInspector
[Floor Level Quantities Sub 1 2 3
Smoke Detectors(not located in bedrooms)
_w ..._ ........... ,..�. R �m��w.n�......�............... �. ..�
Carbon Mo
noxide Detectors
Fire Extinguishers f
.... Exits .
.. .. ..�.,..�_ - ....�.. a.. .w.�.�,.,.. ..............w . ... �� � .�.. ....w. �....�
B. .. ml �._ _.....__. 6....�� N. ..... .
edrooms ...._ �1 . 5 j 6
co
f.�. Smoke Detectors
�. �...�„.. ..,..,.,o e,m. �..m� .a. ,,.,,, ,.,.. / w ._ ....... . �. �.....e..., w, f.. ,.... . . ....... .. ...m.... ,. . ... �. ....oG
Egress V
�,"", Occupant�Count � .. ..� ..
Building Systems Maintained &OperationalCondition of Property
Heating Building interior
..,
Hot water Building exterior
� �..... .m� ... ..� �..,.. �. ....". .��.. m. ." �,,,,�,e,w
ectrical Property clean, maintained &safe "
,... .,.. ....w . ........m,
Mechanical Handrails&guards installed &secure
.�.
.Pool Safety Pool on Site [ 1
Surface water alarm Date of CO issuance
_. ..� .....,. _. .w ..��wRR..., �.R.�... . ....... an. .......... I
,Door alarms Pool completely enclosed
w,
eI� �a..., ,. ..�. .�.....� ��. ..w ..rvrv .. .�.....,�.� a. . w� ...�.. m... .. W,. .. .....�
g ��_... ._ . ements
f closing/hatching gates � Pool fe.. .. nce to code requir�
-CO's for all items present Prior Rental
.. ...W.. ....._... .... ... ..
omments
.._.....w .,...,.... .................
........... .......... .......
. .......
.......
....., . �. ... u. .. . ........ ............
... ...�.. .......m.... ..._ . .......... .......�...�
f
.. .. ........ ... ......... ...............� ..,..,...,.... .....«. .......w .... ... »««.,,.,....,..... ....
Main Floor
9.1,f_ T 6" -25'5" '
Bathroom
= N Dinette Kitchen
o c
Rear Left Bedroom - '6' 2,4'
l etf
j st
- T e
1 'n
4" all l Cl c �"(I)
N 19'4 ,9„—1
Clot 1) e
VT
- )
12'6' _ i# � n
Living Room F2'4'
Front Left Bedroom
n
4'4` Garage
IT
36'3f
1� 8
Main Floor
WALKER—CONTENT—DEB-1 12/5/2023 Page:7
Second Floor
' 20' "
1 4' 10"
ir
Bathroom loset f
00
Left Bedroom Hallway Right Bedroom �O
d r
oset 61
et 20'
101 12' Tv 21-1 711 --
1
a
Second Floor
WALKER—CONTENT—DEB-1 12/5/2023 Page:6
Basement
=t 11
5' 3"
Unfinished Area
61 It'
f II
-1 11 I
Closet (2)r ' 11II174
Ct ti 91811
�
81,
A,t n
t II
Oc
oe Main Area
tt
341811 L�J
Basement
WALKER—CONTENT—DEB-1 12/5/2023 Page: 8
I
OF SOUTH-OLD PRIPERTY R1EC( S //(0//8
OWNER I STREET _ VILLAS DIST. SUB. LOT
l
FOR R WNER N E ACR.
- � l
S TYPE OF BUILDING
F
a. .
SEAS. YL. F Rim � -` COMM. CB. MISC. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
ro
t
-
.
AGE BUILDING CONDITION
RMAL BELOW ��.,
s
N N41ff�� - a t
FARM— - i - Acre Value Per value � E _ z
Acre 3
Tillable 1
Tillable
Tillable 3
Woodland
Swampland ' FRONTAGE ON WATER '
Brushland FRONTAGE ON ROAD s
House Plot � DEPTH l
BULKHEAD
Tit DOCK
1.,
€
i
g t
l OLOR
E _
I
I
40.-5-21 4/11
t
T n.
M. Bldg p g`' Fation Bath
Dinette
Extension Basement € Floors ; K.
Te _
Extension Ext. Walls � � Interior Finish LR. I
Extension - Fire Place f Heat i. DR.
Tyke 1 Rooms 1 st Floor BR,
s
Porch 3 3; E R kreotion n I Rooms 2nd Flo= FEI B
Porch Dormerp
y
Breezeway- 1 Driveway i
Garage
Patio ° 1
i
O. B= i
i
Total
F
FORM W0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLEWS OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No. A.A99............ Date .............................4=0....IQ.... 19-05.
THIS CERTIFIES that the building located at ....X/ Noi.1son-st............................. Street
.. ....... .....
Map No. ..J,..».».......... Block No. .....XPM...... Lot No .........Q:rA1R4P9;ftt.....
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.1.——.I"... ........--........APY.MNM......U' 19... pursuant to which Building Permit No. ...Z579..X
dated ............... ...........NoVembp��.A3, 19... was issued, and conforms to all of the requirements
.............
of the applicable provisions of the low. The occupancy for which this certificate is issued is ........
......j�*" 1%u...QAe..XAr.;Uy"d!d"ealm............I............................ ......................... .................
AV.
The certificate is issued to .... ........... ......(were.....................
(owner, lessee or tenant)
of the aforesaid building
H.D. ApproVal Jelly 19, 1965 by R. Vi a
.......... ........... .. .................
uilding Inspector
Allow.
�EFtat , Town of Southold 4/6/2024
P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIF CATS OF OCCUPANCY
No: 45103 Date: 4/6/2024
THIS CERTIFIES that the building ALTERATION
Location of Property: 630 Madison St, Greenport
SCTM#: 473889 Sec/Block/Lot: 40.-5-21
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
9/30/2010 pursuant to which Building Permit No. 50497 dated 4/l/2024
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:
1tcr t c n .Lg ex,L t ing 4tkara r ,g p,plied..for.
The certificate is issued to Durking,Ruth
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 35927 3/11/2011
PLUMBERS CERTIFICATION DATED 12/14/2010 Mattitu Win- g& deatin
.utho rize i . . r
Certificate# 268011
Surrogate's Court of the State of New York
Suffolk County File#: 2023-1655
Certificate of Appointment of Administrator
IT IS HEREBY CERTIFIED that Letters for the Estate of the Decedent named below have been granted by
this Court, and such Letters are unrevoked, are valid and are in full force as of this date.
Name of Decedent: Judith E Walker
Date of Death: October 15, 2022
Domicile: County of Suffolk
Fiduciary Appointed: Meaghan Walker
Letters Issued: LETTERS OF ADMINISTRATION
Letters Issued On: August 23, 2023
Limitations: NONE
THESE LETTERS, granted pursuant to a decree entered by the court, authorize and empower the
above-named fiduciary or fiduciaries to perform all acts requisite to the proper administration and disposition
of the estate/trust of the Decedent in accordance with the decree and the laws of New York State, subject to
the limitations and restrictions, if any, as set forth above.
and such Letters are unrevoked and in full force as of this date.
Dated: August 30, 2023 IN TESTIMONY WHEREOF,the seal of the Suffolk
Riverhead, New York County Surrogate's Co,,.art has been affixed.
WITNESS, Honorable Vincent J Messina Jr, Judge of
the Suffolk County Surrogate's Court.
M
5
Doreen A. Quinn, Chief Clerk
Suffolk County Surrogate's Court
This Certificate is Not Valid Without the Raised Seal of the Suffolk County Surrogate's Court
DOH-1961(NO11) A)EMPOED DJSrRXT NEW YORKSTATE
5151 DEPARTMENT OF HEALTH
RECMFER NUMBER 131-2022-00086626
2605 CERTIFICATE OF DEATH STATE FILE NUMBER
1 NAME,IRRU MIDDLE LAST 7 SEX: F%k fDAI�l MATH, 1 38.HOUR:
--F-i022 i5
Judith E.Walker ............I.Female 10
j 01:58 AM
4A.PLACE 0 DEATH: HOSPITAL HOSPITAL HOSPITAL NURSING PRIVATE HOSPICE OTHER 48 IrFACII-11Y,DATE AbMIr0'.-'-
F(Check Ong) BOA ER OUTPATIENT INPATIENT HOME RESIDENCE FACILITY (SpecRyi., mum MY
El 0 El IN 11 El 09 19 2022
4C,NAME OF FACILITY:(1ftotbrhVy give address) " 40.
LOCALITY:(Check One and specify) 4E.COUNTY OF DEATH:
CITY VILLAGE TOWN
Long Island Community Hospital I 11 El E] Brookhaven Town I Suffolk
L-tt- ...................... .
4F.MEDICAL RECORD NO. I 4G.WAS E W NF7 RED FROM ANOTHER INSTITUTION?(If yes,specify institution name,*or town,counly andswa)
_S
NO YES
'7
5.DAl1UFBIRfHL Ad YEARS: ;66.F UNDER I YEAR 6C,IF UNDER I AY 1A, FY A S A �Of A�rR fArADI'M Fmiyano 1 78.IF AGE UNDER TYEAR:NFAROTREW,1416T
mow DAY YEAR_ YEAR L ENTER: MtEk' fiqio�mmer I BIRTH:
-ontris tw age j
E72 . I
1950 Ins.1
New York
O. 10.DECEDENTS RACE 01not SEA If MED 9,DECEDENT OF HISPANIC ORIGIN?adimba- We Or d&%*0MVAWWd15WWA6W1ftubu-
FORCES?IspecEvywa) AN No.noiS3anishnirsocurort9ho 8 0 Yes.Mexican, American,Chicano
NO YES A[k WftfuZ3� B 0 Mack or Ahkan American C 0 Asian Indian D El Chinese
W 0 of c 0 Yes.P,.Pm Ran 0 0 Yes,Cuban E El firpro F[I Japanese G El Korean H El vienannese
E El Yes,Other SqshAirspani"Ino(Spe*) i ED Native Havana K[:1 Guamanian or Channorm ME:]Samoan
• ILDECEDENT'SEDUCATION:
10 s Sib grade 2 0 NI-12M grade;no d0rna 3 C3 High Schad-rdzm or GED N[I American Indian or Marla Native(speedy)
4 D Sam cuflege credit lartAodegree SElAssomate'sdegree 6[A sem-'es*m P El Due Asian ispaerri) R 0 ozher mrrc isiamer(speciry)
7 1:1 M&qes degree a D onctorme/Proinuctraudegree S D Omer ispecit"I
IT-
12.SOCIMAL FRORMCE_R: 1 AARrRsTATE...... 14.SURVIVING SPOUSE
NEVER MARRIED MARRIED WDOWED DIVORCED SEPARATED Biter birth name of spovse
068-44-707-7 111 El 2 193 C14 EI 5
]�� ----------...I
WU'SUAL-OCCUPATION:(Do nDtanfurntUred) I 1S&KIND OF BUSINESS OR INDUSTRY: .-TT5C-NAME ANOL06-AWYCOMPANY OR FIRM:
Homemaker [Own Home !Own Home
r
"i RESIDENCE: 16B,Coun%or Region/Provm TIED,LOMITt 16F,F CITY 08 WILAGE,iS RESIDENCE
(Seat a C i1not Sk, CrTY VILLAGE TOO MIN CITY OR YRLAGE LWITS?
WWWWW
iWIVISAI NY Suffolk Southold Town :0YES DNO IF NO,SPECTY TOWN!
105W f
27 Madison Street,Greenport
111944
17.BIRTH NAME OF FIRST &0 LAST Ia.BIRTH NAME OF FIRST M1 LAST
FATHER i PARENT. MOTHER/PARBil".
James L.Durking Ruth Wantahous
OR,KM OF INF'OR AWM 198.KULN ADORES&(khear Sp code)
Mee
Walker 14 B!q Gone Lane,Medford,NY 11763
3 n -1,V#A 40KW SCOMIN It DAY YM 120,PLACE OF BURIAL CREMATION,REMOVAL OR OTHER DISPOSITION. i 20L LOCATION.(Cfly or Ithiat ad$060)
6 0 EIM)MEMENT I
10 =8 2022 ! Mt Pleasant Cemetery I Center Moriches,New York
I 21A.NNE AND ADDRESS OF FUNERAL HOME Robertaccio Funeral Home Inc �18.FIEGISTRA11ON NUMBER:
Il
01493
1
85 Medford Avenue,Patchogue Village,NY 11772 l
22A.NAME OF FUNERAL DIRECTOR: 22B.SIGNATURE OF FUNERAL DIRECTOR: I 22C.REGISTRATION NUMBER:
• Cassandra R Caro a 01 Csd.R C= E,(etroiricay Spred 14504
23A.SIGNATURE OF REGISTRAR: 23B.DATE FITI.EO� I 24A_BURIAL OR REMOVAL PERMIT ISSUED BY: f 241,DATE T$SV&
Muffh DAY YEAR-A I NTH DAY YEAR
(DonwLent EkctranicakySigned �_19, -7 Ti'_J':20�=2 Donna Lent 10 18 LO22_
lid ITEMS 25 THRU 33 COMPLETED BY CERTIFYING PHYSICIAN-OR-CORONER/CORONER'S PHYSICIAN OR MEDICAL EXAMINER
A
2 5A
ej
258.Im
c certifier e
coroner R
T
25A.CERTIFICATION:To the best of my knowledge,death occurred at the time,date and place and due to the causes stated.
Certifier's Name: License No.: Siwiewffi:
'4 awr Ishba4,wo M Day
Ahmer lshtiaq,MD 1294729 1 0 15 2022
t Ef,--ffys-d
Ce Tr1I& 0[A Attending Physician 0 El Physician acting on behal I of Attending Physician I-
E]Coroner 2E]Medical Emamminut/Depuly Medi Examiner Address_
idast9lpital Rd,Brookhaven Town,NY 11772
- ifcorGrWis_n'ot a physician,enter Coroners Physician's name&tific Lime No.: signatunr
25C.11 ce Iffer is not aftenifing physimn,enter Aften"Physician's trahe tdlr Lrarm No.: Adottess:
2W 'no
y
M,Decaeow 40 WA Who 26C.
�qk_ 115�_�9 P"777m
y
2fik AueW2,
road lerceamed", FRgM ion�142�(22 1 15 2022 by 94NOboV 0y%khw 10 �114 2022 Oe'd 10 .5 2022 I.,fnjr-,I:1 AM
od
9 AUTOPSY?
7
BE
27 MANNER DEATH- 28 W i P
UNDETERMINED WAS REFERRED TO 29A..A s�y 293.IF YES,WERE FINDINGS USED TO DETERMINE
NATURAL CAUSE ACCIDENT HOMICIDE SUICIDE CIRCUMSTANCEBS 111111E"RIG" CORONER 08 MEDICAL EXAMINER? NO YES REFUSED I CAUSE OF DEATH?
M NEE,
Y_S
X1 E12 03 04 05 [16 0 1 No I D Y-ts 00 Q L 0 0 NO I OYES
AN
NATURAL CAL ATION BE E
CONFIDENTIAL SEE INSTRUCTION SHEET FOR COMPLETING CAUSE OF DEATH CONFIDENTIAL
..........................
30.OF TH W, MOMMR 11�ff.RVAL
0.DEATH WAS CAUSED BY.(ENTER ONLY ONE CAUSE PER LINE FOR(A),(8),AND C).) IIETWEEN ONSET AND DEATH
PART f,(MMEMM CAUSE
IA)Acute Cardi2gulmonary Arrest secs
DUE 70 OR AS A CMSEOVIKE OP
(a)COVID Pneumonia 11clays
DOE TO DR AS A COMSEMENCE Of I
(c)<<<>>> I<<<>>>
PART 11.OTFIER SrNRCTNT_00 TF16NS CONTRIBUTING TO DID TOBACCO USE CONTRIBUTETO DEATH?
DFAM BUT NOT RELATED TO CAUSE GIVEN IN PART I(A):Esophageal Cancer,Anxiety,Bipolar Disorder a Z No I El YES 2 El PROBABLY 3[1 UNKNOWN
3rA_11 111,B1,11r. HOUR 31 B.INJURY LOCALITY:(lily or to=and county and stale) 31C,DESCRIBE HOW INJURY DCCIJRRER 31D.PLACE OF INJURY: 31 E.INJURY AT WORK?
NTH hr
MONTH y i I i
- - I I i NO YES
I _wwwDo Of
31F.IFTRANSPORTATIDN INJURY,SPECIFY: J32-WASDECEDENTi r-'r IN'%IffAR" i
HOSPrTAL5ZED IN NO yS 0 X w 7wrl ,I�el yo
1 El 01WORW 2 E ❑ LAST 2 MONTHS? I-E]fraunurial who ofm 2 Not proontan.out onegrard V�.U!Q data 1.�d-MM
❑ to Ly Lj III, Pao yw
-Emor I W befttm Otani 4E] 0
W1111D 5L- ❑ ------