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Home My WebLink About1000-108.-3-8.8 -a TOWN OF SOUTHOLD ,4 Rental Permit a _ 1156 71 4 Owner Timothy & Chelsey Kirby Occupied as Single Family Dwelling Located at 1515 Evergreen Lane Mattituck 108.-3-8.8 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. 6/24/2024 ode E rc r Ufficial This Notice must be posted by the main entrance at all times �w,yCRfJ.A,� y rG TOWN OF SOUTHOLD—BUILDING DEPARTMENT mw Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax(631) 765-9502 h t :J/ �soutlloIdto rr Gov RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two yes)�� ( Section A. , Property Information: 81l oot -town o Rental Property Address: I 15 F_VerArAA^ �N Tax Map Number: 1000 SECTION -1_ .___ BLOCK -LOT - SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) �v u Telephone Number(s): Daytime µ I ' '1 �vening �,^AL Emergency 5_V_k Property Owner Email Address: ` ^'� �`c� , to tom. 'w^ 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: 54.(. l• _24 't5ti 1. Telephone Number (s): Daytime Evening tw.L Emergency h Email Address: IMA n.0 tl 1 Q c c f tA 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): 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, 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: Requested Maximum number of persons allowed to occupy Dwelling Unit: (u Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: �nc SECTION G. INSPECTION: tc,.fi�r,�r►, j Ciu 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. Xm 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. 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) i i r ; 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. i Property Owner's Name: , i+M k%r Property Owner's Signature: Sworn to before me this day of . , 202-- Official Notary Public Signature and Original Notary Stamp Wtvy P ,state Nowt N00 0 ,1 QualtOwd hi O�MM CM* n J In NOW�c Page 4 of 4 3 I s x 17 E , - --_ - - i f - - _ _, imp -`2 g ' 0 , .-,..- fit' T T f PRIM RY = _ ffi} oaoE - — = � l � WING ROOM � aa� ma BEDROOM J� t � 3 z CEi P a I , , , I KIR ND - BY RESICENCE t• MPTiITVCK M i�B52 WALL IEGEMO 3- } FIRST FLOOR PLAN Fwau MGM A•3 scat I�.ro ---_ ' 3 x _ •i I I 1 I FT1 ----------------- ------------- ki J? A- I wo Mm" 9 1 t-Ji-, 10 Eh 44 -f IN 77 -17 i KIRBY RESIDENCE NY 11RS2 2 SECOND FLOOR PLAN -------- n � >-_ ---- - _ _a__--- _�an�_----��__=ae - _�m-__ =a as _s_ _. a .� i 3_ _ { i(4 -- ------ ,-------- ----- { e_a_ eve - _a e �_ea_naae=ea. v a a _r_e_e____ -- MW----a E a " , f fit` as e_ - __ ---------- -------------- e r� e ---- mv Mal Ins�.-_+� - - M4TTITUGK,NV 51452 < 5 BASEMENT&FOUNDATIO FLAN 1-04 EACH STEP - _ ' .;' «F �,�." .�._.•... .a....-_ � -a�..�.g. __. � 4, OTE 11HISH _ 9 -STPcEDF.pTt4�DFT—A71L ! se a� _ [ 6 4 I ' TOWN OF SO RH RD BUILDING DI 31 -765-1802 lim PIEC ION [ ] FOUNDATION 1 ST / REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAl [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN: [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F [ ] CODE VIOLATION PRE C/O [ I _d TOWN OF SOUTHOLD PROPERTY OWNER I STREET VILLAGE DIST.1 SUB. LOT FORMER k_NER ' N E ACR. 7`7 W TYPE OF BUILDING RES� - SEAS. VL. FARE COMM. CB. MICS. Mkt. Value If LAND IMP. TOTAL DATE REMARKS _7 2 Z A 4— I y 41, 00 o r, T' J v fac q1- ET W -1 - c 0z: e t'�v ae Tillable -2"' FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowlond DEPTH House Plot r BULKHEAD Total 5 P. . _ A E a � ; a — 2 la, i IN I f 108.-3-8.8 .11/07 l 4 M. Bl r }¢ ' Foundatio l n Bath ' b DA 3 Extension`° Basement el ��` Floors { E E x tef,sibb ; A Ext. Walls Interior. Finish ' I y" w,Fr Extension Fire Place Heat t ,sir I d = } jy 'i Porch _ Pool Attic yn � Patio Rooms 1st Floor �- AJ Breezeway`` Driveway Rooms 2nd Floor eR ` Garage Y } / t el g< { FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z1900 Hate MAY 4 1990 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 20692 MAIN ROAD TTITUCE House No. Street Hamlet County Tax Map No. 1000 Section 108 Block 8 0 .00 hot .08 Subdivision TUT' A 8 Filed Map No. 107 Lot No. 1 conforms substantially to the Application for Building Permit heretofore filed in this of ice dated FEB. 21z 1989 __pursuant to which Building Permit No. 17860Z dated FEB. 23, 198 was issued, and conforms to all of the requirements of the applicable provisions of ZZLY law. The occupancy for which this certificate is issued is ONE LINO ATTACHED GARAGE AND DECKS. The certificate ' s issued to MICHAEL A. & TERU ANN LORING (owner) of the aforesaid building. SUFFOLK COUNTY DEpARTMENT OF HEATH APPROVAL 4 17 90 89-g204 UNDERWRITERS CERVIFICATE NO. N118073 MARCH 12 1990 PLUMBERS CERTIFI "PION DATED LISO 'P'L ING & HEATING 121 89 ild. ng Ir�spectar Rev. 1/81 A" Town of So thold Annex 6/17/2014 P.O.Box11 9 to N� 54375'Main Road Southold,N' York 11971 CE " ""IF CATS OF OCCUPANCY No: 36961 Date: 6/16/2014 THIS CERTIFIES that the build IN GROUND POOL Location of Property: 20692 R ute 25,Mattituck, SCTM#: 473889 Se lock/Lot: 108.-3-8.8 .-3- �. Subdivision: Filed Map No. Lot No. conforms substantially to the Appli titan for Building Permit heretofore filed in this ofiiced dated wM5/13/2014 pursuant to hich Building Permit No. 38882 dated 5/13/2014 was issued,and conforms to all of t c requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: in around switmning1 with a i Cqrreq*6jljaQj4 -, pplicatita date 1/mil/19 c a�rec__tom t LL J 4 The certificate is issued to B-u s,William&Burns,Patricia of the aforesaid building, SUFFOLK COUNTY DEPART ENT'OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 31592 9/13/09 PLUMBERS CERTIFICATIO DATED t S"ignature �� , tl ro Town of Southold 4/11/2024 P.O.Box 1179 ¢ 53095 Main Rd Southold,New York 11971 CU CERTIFICATE OF OCCUPANCY No: 45118 Date: 4/11/2024 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 20692 Route 25, Mattituck SCTM#: 473889 Sec/Block/Lot: 108.-3-8.8 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/3/2023 pursuant to which Building Permit No. 49156 dated 4/24/2023 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 and alterations. includipgmcove,dpcIrol.ntcaµexit pg.sigg q,f4mi �vgl�in&with unfinished basement as alapiq "r1� The certificate is issued to Kirby,Timothy&Chelsey of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 49156 8/4/2024 PLUMBERS CERTIFICATION DATED 4/5/2024 A 11timbing .y th r . ignaturo