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Home My WebLink About1000-111.-1-33 TOWN OF SOUTHOLD Rental Permit s 1146 Owner John W. Goeller Occupied as Single Family Dwelling Located at 645 Fishennans Beach Rd Cutchogue 111.-1-33 Maximum Permitted Occupancy 6 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. 6/3/2024 V. Code of r ment o ial This Notice must be posted by the main entrance at all times r l � TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Sout�jold,NY 1197.1'095.9';` Telephone(631) 765-1802 Fax (631) 765-9502 Litttps: wvwv.stll,olel� at� RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: A Tax Map Number: 1000 SECTION -BLOCK SECTION B. OWNER INFORMATION: Property Owner Name: D h Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 0 Telephone Number(s): Daytime_ ( � Evening _ Emergency 1OgV Property Owner Email Address: Page 1 of 4 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: I Name of Authorized Agent of dwelling unit, if any: N I 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): Mailing Address of Managing Agent: Telephone Number (s): Daytime Evening _Emergency Email Address: Page 2 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: CN t T Requested Maximum number of persons allowed tooccupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: `i- !I "1 Use and Dimensions of each room in Rental Dwelling Unit: !� "`� - 15J '-`l " SECTION G. ( x, I -3"} f t3 A-rt`t' r�- 2 �i—o`'x`! oLI INSPECTION: -='Ta- -&tj C " (3r-2-~� J�>PrT4.�L -, ttZ �� -o"��o`) j A$-I/L`7 Pursuant to the Town Code of the Town of Southold Chapter 207 (Rental Properties), a safety � 4� inspection by Code Enforcement Official is required. If the owner chooses not to have said I �, 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. 0 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. 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) 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, Property Owner's Name„ Property Owner's Signature: ?h r Sworn to before me t is day M � Y of ��,, 20 Z`r Official No ry Public Signature and Original Notary Stamp JOHN A.MAKI Notary Public-State of New York No.01 MA6164838 Qualified in Suffolk County My Commission Exp.04/30/20Z7 Page 4 of 4 ? w Town Hall Annex � �� x,, Telephone(631)765-1802 54375 Main Road of zj Fax(631)765-9502 cz P.O. Box 1179 ' Southold, NY 11971-0959 of ° BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a licensed architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Professional seal required for Architect or Engineer, Licensed Horne Ins ector must provide copy of valid current certification Rental Property SCTM Number: 1 0 c d ^ 3� Rental Property Address: �. �� (1 17 36- Owner/Name: �I Rental Dwelling Unit Identifier: CA i'T Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 -100 sgft., Bedroom#2-90 sgft., etc.) s �1� -u'tT''`" Z. — 0 #; Property Description (Include all improvements indicated on survey) rA�J LE � Av--ttL C�NC.0 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 Reside of New York State,the Building Code of New York State,the Plumbing Code of New Yt� 's Code of New York State,the Fire Code of New York State,the Property Mainten tate and the Energy Conservation Construction Code of New York Statesbd - Print Name and Title Original Sign 0 Please place Professional Seal: tit � so TOWN OF SOUTHOLD BUILDING D 631 765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAI [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN; [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FII I l CODE VIOLATION [ ] PRE C/O [ or DATE 6--A-a4 INSPECTOR Town Hall Annex TOW11 Of Southold 54375 Main Road Rental Inspection Report PO Box 1179 µ Southold, NY 11971-1179 y, r Tel: 631-765-1802 SCTM# 3. -. .... ._ _ Date„ . .. ---- MAv � Phone Ow ner s � � le Addres,,.. ... ...�._.... µ .... ...... .. Visible .. ....... ... Hamlet Inspector -.. . ::.. .. ..... ._ ...... . �._ - �.._.�mm.. . Floor Level Quantities Sub 1 2 3 Smoke Detectors not located i�.�.�.�.��..�w...�..��. ��,...... .... . ....�,.�� .. �......�.� .......�...� .....,,.� ., �. . .,, ..� ( bedrooms) n Carbon Monoxide Detectors.. „� ..........., . �� .,.�.-.. �rc. .. �.' � . . .. _ ... . �.�...... .W_� �.. ...�. Fire Extinguishers ... Exitso ....... .. .,,. ..w.. .._... ._ �...... __...! . „www w...._......' ......_.,�..... . _.. ....w,..M......,_............................ ..............., ....µ_........_ . ............ ........,�. .. .. .,.,.,............... _.... ........ . ..w,,..._.......w............ . .. ...................... .... „�. .. ��.... .� .. ._ 3 5 6 Bedrooms. ®, . 1 2�� 4 Smoke Detectors Egress -��. . 1-1 ............... � .�.._ _......... ..�.,.�,., �. .. _. _ _ _..... .......�,._..... ..... _.... Occupant Count Building Systems Maintained&Operational Condition of Property Heating Building interior ., .. Hot water Building exterior Electrical ..... _.,. ..w�...�..a..._....�a.�,...... �._�� _.w. ..m,...� �._.........M.......a..........,..d..�...��....�,.��.�w�.��. ......... _�ww�................ P.....r...o.._....p..e,r..t_y....clean, maintained aintaine d� &s...a..f..�..e .�.. . ��da ils&guardinstalled secure.. .�..Mechanicsl ...............,_ ........ . .... .�..�.......................w��' .......... . Pool Safety Pool on Site ..... . . . . ... .... ._.-a....�,�. ..v� .. ....... _....... . .,.�.- �......., .. .. . ,,..�� , ... . .. ......�........ Surface water alarm Date of CO issuance .Door alarms. _� ....._. Pool completely enclosed Self closing/latching gates Pool fence to code requirements ... ._ . l,. ....µ .p ...... _. ..,..... _ ,. CO's for all items resent iPnor Rental Comments........ .... _._ _. _...... ..............._....... ....rv...._........... ......... ... .....................�.....-.._...,.,....... ......__.._.............. _.._..._. _.................. .............. ,..,.,...._.. .... .......__. .. .................. ....................... �... ....,.. �........,............,..... ...........................,, t 1 I 3 DINING ROOM 11'-10'X 11'i' I 1� [ } LIVING ROOM 1 %21'3' _ I KRCREN _� EI e'<•z 1 rs• r �_ _ 9EOROOM k2 - 3 4S'X a... ] I BEDROOM n ' OL CL CL � - I x = ENIRV � - - FOYER = ' REDR00M41 3a-s Pam` - 10'J'XT% € Fr l SS'XB'-0' Ll ] _ l ( i it STORAGE € I LEGEND _ COMBINATION SMOKE ANDr _- - CARBON MONOXIDE DETECTOR �I „F PROJECT DRAWING SCALE 1/8"= 1'-0" ,"' �� 645 FISHERMANS BEACH ROAD EXISTING FIRST FLOOR PLAN y DATE 03.12.24 ........ ....... ..... ........ ------------ ------------ ------------- FAMILY ROOM 01 I3'-9.x lvJ FROOF BATHROOM N3 E I LL G ,- r LEGEND COMBINATION SMOKE AND x., CARBON MONOXIDE DETECTOR SCALE 1/8" V-0" PROJECT DRAWING 645 FISHERMANS BEACH ROAD EXISTING SECOND FLOOR PLAN DATE 03.12.24 Formwot*s Ir TOWN F SOUTHOLD PROPERTY RECOPS el OWNER ,�. ' STREET VILLAGE : DISTRICT Sursz -JT� �' J: S` i=GRI.i E ; OWNER N E ACREAGE I fi i- � F S W TYPE OF BULL DIW , a� RES. j,( SEAS. VL,, FARM COMM. IND= MISC. LAND ifv>,P_ TOTAL DATE R-E&AARKS s � -f7e-0 let z, - E b , 1 AGE BUILDING CONDITIONAl- x tf tt ® 1 Tillable 1 ADS Tillable 2 Ti{lcbie 3 _ � y � ;`00 ,. W4 adland cc) Swampland Srushland _- �t�'11 House Plot -:t,. i E I s COLOR z - a _ 1771 TRIM 3 o - 3x _ e , r 0 z a� I 111A-33 to/ Effi--. 1 st 2nd _ M. Bldg, I v - , c t _ Foundation Pc ce Bath Dinette _ OTHER---_ - - _.... .COMBO -- - Extension t Basement PARTIAL Floors Kit_ Extension T C I l Finished B. Interior Finish L.R. 6t�nsion Fire Place -, Meat D_R= Garage Ext. Walls ;' 7 BR. Porch Dormer Baths ma`s Deck/Patio I � �� F am. R M. 2.5 t Foyer Laundry Library/ O.B. Study Dock � 37 , 1GIPC Town of Southold 6/3/2024 53095 Main Rd Southold,New York 11971 PRE EXISTING CERTIFICATE E OF OCCUPANCY No: 45244 Date: 6/2/2024 ..................... ......__..................................._m_ THIS CERTIFIES that the structure(s) located at: 645 Fishennans Beach Rd, Cutchogue SCTM#: 473889 Sec/Block/Lot: 111.-1-33 Subdivision: Filed Map No. Lot No. conforms substantially to the requirements for a built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 45244 dated 6/2/2024 was issued and conforms to all the requriements of the applicable provisions of the law.. The occupancy for which this certificate is issued is: Original„pq 9n_9fa seasonalm,wood frame_single farm vmdwelling.,* The certificate is issued to Goeller, John (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. . . � � . �a � riA " Si nature BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 645 Fishermans Beach Rd, Cutchogue ............ ....... ..................... SUFF.CO.TAX MAP'NO.': - E61"V ISION: ............... . ....................... NAME OF OWNER(S): Goeller, John OCCUPANCY: ADMITTED BY: : SOURCE OF REQUEST: Goeller, John DATE 6/2/2024 DWEIjL-1NG' #STORIES: 1 #EXITS: CRAWL SPACE: FOUNDATION: piers CELLAR: .................. .............. ........... BATHROOM(S): TOILET ROOM(S): UTILITY ROOMS): PORCH TYPE: DECK TYPE: 0 PATIO TYPE: ................BREEZEWAY: FIREPLACE: GARAGE: - .... "" ........ ......................... .... ............ ... DOMESTIC HOTWATER: TYPE HEATER: AIR CONDITIONING: TYPE HEAT: none .......... WARM AIR: HOT WATER: electric tank . .................. BEDROOMS: KITCHENS: BASEMENT TYPE: OTHER: ......... ACCESSORY S'IRI)C'TIJRES: GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: SWIMMING POOL: GUEST,TYPE OF CONST: OTHER: ............... .......... VIOLATIONS: REMARKS: .................... .................. INSPECTED BY: NANCYD DATE OF INSPECTION: 5/29 1 2 1 024-.111.1------ TIME START: END: FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ...... Date .......................A409—Ako............. 19-10., THIS CERTIFIES that the building located at ...Isla toxmAk o..Aaac h-Roadl.........I...... Street Mop, No.E 00,QtUCOAY Block No. ...................... Lot No. ..................... Properiidi conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... , ................ .3.......I........... iq..§! .. pursuant to which Building Permit No, AP4-A dated .....-.1...I......... 19..:W, 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 ........ piva one..,.,f ............r........ ...... ................ ................. ......__._...... The certificate is issued to ..... (owner:}..................................... ................... .. .... .... ......GoslLer ........n.....rl (owner, lessee or tenant) of the aforesaid building. ............................" ....... .......— Building Inspector FORM NO.2 TOWN OR SOUTHOLD' BUILDING DEPARTMENT •TOWN CLERK'SOFFICE- SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON.THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZFb} N3822 Dime ........ ......ww».. ............ ., 19.. Permission is hereby granted`to .. D .. i ....................... ..................... ..................................... to ..' o: l ks-...*.,.'.44 ............... ..... .......................................................................... ......,................ .................................. ... ........ at premises located o .., l .. ............ ..�! � 4......................... ................. . ......... .................... d � l.r .� ..� .. .... w, .. " ro.... ...........................:........:................................. ................ .......... ........::............................................... pursuant to application dated ....................... .... :+i4. T 9 . ., and.approved by the Building Inspector..' Fe .. eq"a.w .wwwk.r«n wwawwx •� - 9•n^" 4' ..... ,. . .......... . :4p ...... ... ............ , Billing wlnsectar �. FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z18747 Date JANUARY 29 1990 THIS CERTIFIES that the building ALTERATION Location of Pro,pert 645 FISHERMAN'S BEACH RD. GUTCHOGUE House No. Street Hamlet County Tax Map No. 1000 Section Ill Block al Lot 33 Subdivision filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 16, 1989 ______pursuant to which Building Permit No. 18434Z dated AUGUST 29 1989 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 REPLACE EXISTING DOOR WITH SLIDING DOOR. The certificate is issued to JANE P. GOELLER (owner, ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N A Building Inspector 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 Z19615 Bate DECEMBER 27 1990 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property 645 FISHERMANS BEACH ROAD CUTCHOGUE House No. Street Hamlet County Tax Map No. 1000 Section 11.1, Block 01 Lot 33 PECONIC BAY Subdivision PROPERTIES INC. Filed Map No. 786 Lot No. 10 conforms substantially to the Application for Building Permit heretofore filed in this office dated DULY 17, 1990 _______pursuant to which Building permit No_ 19219Z dated�JIULY 23 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 ADDITION AND ALTERATION TO SEASONAL DWELLING. The certificate is issued to JANE B. GOELLER (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N161091 NOV. 15, 1990 PLUMBERS CERTIFICATION DATED NIA §'Buflding Inspector 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-31818 Date: 09 14 THIS CERTIFIES that the building ADDITIONS/ALTERATIONS Location of Property: 645 FISHERMANS BEACH RD CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 111 Block 1 Lot 33 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 4 2005 pursuant to which Building Permit No. 30944-Z dated FEEBRUARY 8 2005 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 ADDITIONS & ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR & AS PER CONDITIONS OF ZBA )#5597 DATED 11 4 04. The certificate is issued to JANE P GOELLER (OWNER) of the aforesaid building. SUFFOLK COUNTY DEFAK"T " 'I' OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2091286 06 29 06 PLUMBERS CECtTIFICATION DATED 09 01 MATTITUCK PLUMB.&HEATING l uthorized 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 11985 . . . . . . . . Date . . . . Qet ob.e-v-6. . . . . . . . . . . . . . . . .. 19 .g3 THIS CERTIFIES that the building .AUDITIM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property F-i.shew-mans• •Beach •Rd • • Cutel�ogt e House No. Street Hamlet County Tax Map No. 1000 Section . . . . . . . .Block . . . . . . . . . . . . . .Lot . . . .'>.�. . . . . . . : . . Peconic bay prop• 7 '10 Subdivision . . . . . . . . . . . . . . . Filed Map No. 86. . . .Lot No. . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated September 8 19 8 pursuant to which Building Permit No. :1 2596Z dated . . . . . . September• 14. . • • . • . 1983. ,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 . . . . . . . . . A deck addition to an existing one family, dwelling. . . . . . . . , • , , , The certificate is issued to . , ROBERT .GOELLER . . . . . , . , , . , .(owner,lessee or�tenanil of the aforesaid building. N/A Suffolk County Department of Health Approval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . » . . , . . . . UNDERWRITERS CERTIFICATE NO. . . . » . . , . . / . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Building Inspector ReV. 1/81