HomeMy WebLinkAbout1000-98.-3-27 FF01 TOWN OF SOUTHOLD
4. Rental Permit
1189
Owner Xavier Amador
Occupied as Single Family Dwelling
Located at 1150 Smith Rd Peconic 98-3-27
Maximum Permitted Occupancy
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.
8/29/2024 . r/�
Code foj
et Offie'
This Notice must be posted by the main entrance at all times
r4f so�t
TOWN OF SO THOLD BUILDING DEPT.
631-765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ 94ENTAL
,14, 6xto1c4.tzAo1, 9
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7 POW 4, .
DATE �- -a NSPECTOR
Town Hall Annex
Town of Southold 54375 Main Road
Rental Inspection Report PO Box 1179
za
o Southold, NY 11971-1179
Tel: 631-765-1802
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Owner, 12
Phone
Address .w.. .. _-m- .... _. .Wµ.. .._ ..... .. .. ... ........-__. iVisible
Hamlet
..
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Ins
mm __...__ _ .... ..__.�_. p. ....a.- .. ..... .__. ..__...w.'
Floor Level Quantities Sub 1
2 3
-.............��,.-...�....,..�,�........,..�,,,_......�....,..,�w.,�-..�.,...,....�.._...�..,...._..�.�...,.......,.. .....,ry,.......�,...._...,.�.._.,...,,,..,..,....�µ.,..�.�.................. ...�._. ...-. .�__... _...,....�. . ..... .....�. �.....
Smoke Detectors(not located in bedrooms)
Carbon Mono. .... . . � _ �a. . M. ��.M. __ . ��.., � � .... _..._..�_. ....�... .
xide Detectors
Fire Extinguishers
Exits
-. ... p._... .......... ..m. .._..... .,.. . �. ............. ... .. a e�a....... .... _. .. .._ .... .. ........ .................. .. _.....
BeSmokesDetectors
1 2 ......�� �. ,....�. . . .- ..
Egress
�....w.w .. ...._ . _. .......w .. .... .......................
pant Count Occu....... . .. a.. . .A_ ... .. �_.. ...........
Building Systems Maintained&Operational Condition of Property
Heating Building interior
Hot water Building exterior .....
Electrical Property clean, maintained &safe
Mechan.a. _... ...... .._..w., ._.. _._... �. � �. .. .._._. .. .
mama . .
ica I
..�...�.....�.....� ..........��.........��..�.�...�. ....�............�..._._.�..��.� ..��....._�,�,� ..a,..M..�. ��.�andra�.�....a...�.�..-�..�s.&guards into..w�s�.._�.Iled &secure..�.....��.__..........._.._..��_..... _ ....... .._......�
Pool Safety.......__,.�...�..�...._._��.�.��_. ...�..........�.._..-...�_.._.�.��........ .�......�.-,...mm..�.�.......�.�.�....�
Pool on Site
Surface water alarm. � M,�.w .-. ......m....... W� ��..w. ..�m..�..- ...... ........a_�. Date of CO issuance.Mw.
Door alarms Pool completely enclosed
I Self closing/latching gates �� -.��....A... .�._ ..._._.........�.�......_�.�w........Pool fence to code requirements...,... ...��. ......��_ . ......�.��..�..-........�..�
CO'sforall items present Prior Rental -.. ._..:.._��,�...: _..... .-._�^��
Comments: _., .__. .., ... .._...... ._ ....._.__.. ..._.M.�. ...µXM..... Y.M . .. . ._N _.. ..... _...µ.w .. ... �.. ...... . _ u.
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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 htt s:
l/www— �:l/wwwsouthol&QW11py
RENTAL PERMIT APPLICATION
Rental Permit Fee $300 (Application must be renewed every �e&
M Y 2024 A
Section A.
Property Information:
Rental Property Address:
05c) Sm4k focck Rp—c-o�k-
Tax Map Number: 1000 SECTION -BLOCK -LOT
SECTION B.
OWNER INFORMATION:
Property Owner Name: KqV V- Awj�doy-
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
145 Crre_rk,'-ew Ccd.-P_ lqs CV-P_4V)'\QW Cf-dc
Park Cf+-v , UT ?1091 P-qrk CO-4 01 Kqol�
Telephone Number (s): Daytime5l"12 I Q64 Even i nRS140L-'1e IHErn ergen cy q342*31 06o
Property Owner Email Address: aroma or � �'1Q corn
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: V��
Requested Maximum number of persons allowed to occupy Dwelling Unit:9
Number of rooms in Rental Dwelling Unit:
Use and Dimensions of each room in Rental Dwelling Unit:» " _��'3X l��•
W)-boy 111 Or I10.8x 20. I 5Ar rA 119. 157.`4 rIA1. 1.22 • �x
rrA ) • bx 1`4y•3 nn183,9 % 8s. Dn% (70.0x 2iS,� >^M3 212.sx 123.9
V )SC�K (a1.`1 Clo�c� l+W f�tinace �13 5�1.1 M7-1'D�.�y 87.0 LAuh� �s.SX 111
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.
I am requesting afire 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)
1 qv t;-e r AmQJ t,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.
Property Owner's Name: ' ckvl e v- `',do
Property Owner's Signature: Ll—
Sworn to before me this day of 20z� JOHN A. MAKI
Notary Public-State of New York
No.01 MA6164838
�rw QYlY Qualified in Suffolk County
Official Lary Public Signature and Original Notary Stamp My Gommission rxpi 9412OIR027
Page 4 of 4
t
t TOWN F SOUTHOLD PROPER OT ) CARD
OWNER STREET VILLAGE E ESRICT l SUB. LOT
FORMER OWNER f N E ACREAGE
V /15
, f _
W TYPE OF BUILDING
RES. SEAS. ZL,O VL. FARM COMM. IND. CB. MISC. Est.Mkt. Value
LAND IMP. TOTAL DATE REMARKS
r
a,
� _ a
-
s
Cif3 c
�ri�1EW N0RJv1AL FLOW ABOVE FRONTAGE ON WATER
Farm Acre Value Per Acre Value FRONTAGE ON ROAD - f - €
Tillable �1 BULKHEAD
Tillable 2 I DOCK
Tillable 3
a ffi
a
tv
Woodland �er 'ID>f
Swampland '
Brushland
House Plot
_ Pffi
Total
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AZ
kry
a b -
a
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f
98.-3-27 3/10
i
M. Bldg. Foundation Both
i
- - -- - -
Extension Basement _ Floors z
r�
,
ctension - % Ext. Walls ; Interior Finish
�< el
Extension Fire Place Heat
Porch : Roof Type
Porch Rooms 1st Floor
Patio Rooms 2n d Floor
- r
Driveway Dormer
O. B.
` ✓ !J ��_- �✓fin -
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z--23763 Date JULY 12 1995
THIS CERTIFIES that the building ADDITION
Location of Property 1150 S1! ITB ROAD PE IC YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 98 Block 3 List 27
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 28 1989. ursuant to which
Building Permit No. 17797-Z dated FE ARX 2 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 L.P. GAS HEATING SYSTEM & BLOCK FOUNDATION UNDER EXISTING
ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to DONALD A. DOHRMAN
{owner}
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. PENDING - JULY 10 1995
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 Z-20358 Date NOVEMBER 19 1991
THIS CERTIFIES that the building ADDITION'
Location of Property 1150 SMITH ROAD PECONIC N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 98 Block 3 Lot 27
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 19 1989 ----Pursuant to which
Building Permit No. 18710-Z dated DECEMBER 27, 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 BAY WINDOW ADDITION IN EXISTING ONE FAMILY DWELLING
AS APPLIED FOR.
The certificate is issued to DONALD DOH MAN
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N A
UNDERWRITERS CERTIFICATE NO. N A
PLUMBERS CERTIFICATION DATED N A
is ing 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 5-23690 Date JUNE 8, 1995
THIS CERTIFIES that the building ADDITION
Location of Property 1150 SMITH ROAD PECONIC N.Y.
House No. Street _ Hamlet
County Tax Map No. 1000 Section 98 Block 3 Lot 27
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 30 1995 _____pursuant to which
Building Permit No. 22804-Z dated JUNE 6 1995
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 TO EXISTING ONE FAMILY DWELLING AS APPLIED
FOR "AS BUILT".
The certificate is issued to DONALD A. DOBRMAN
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building fnspectY
Rev. 1/81
. .........
� ���
Town of Southold Annex 10/26/2011
54375 Main Road
Southold,New York 11971
... ........ ...........-
CERTIFICATE OF OCCUPANCY
No: 35257 Date: 10/26/2011
...........
THIS CERTIFIES that the building AS BUILT ALTERATION
Location of Property: 1150 Smith Rd, Peconic,
.......... .... ....
SCTM#: 473889 Sec/Block/Lot: 98.-3-27
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
9/2/2011 pursuant to which Building Permit No. 36721 dated 9/28/2011
..........I....................
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:
"as built"fiLijghg?d_bascment in gp_existjqg,qqq.fhmily_dw(Zjj or,
The certificate is issued to Amador,Xavier
.........
(OWNER) ..
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 36721 10/21/11
................
PLUMBERS CERTIFICATION DATED 10/25/11 Joseph Kollen Jr
---—---------
A mature
AMADOR RESIDENCE
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-34192 Date: 02/12/10
THIS CERTIFIES that the building ADDITIONS ALTERATIONS �w,m,m,m,m,,,,
Location of Property:
(HOUSElN00) SMITH RD{STREET) PECONIC
(HAMLET)
County Tax Nap No. 473889 Section 98 Block 3 Lot 27
Subdivision _ Filed Map No. Lot No_
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 4, 2009 pursuant to which
Building Permit No. 35152-Z dated NOVFMBER 10_r...._=00'
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is issued
• � SCREENED PORCH TO_AN EXISTING ONE
is ALTERATIONS AND ADDITIONS INCLUDING
FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to XAVIER AMADOR
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NIA _..
ELECTRICAL CERTIFICATE NO_ 09-8914 02/04/10
PLUMBERS CERTIFICATION DATED 0 /',09/20 JOSEPH KOLLEN JR
e
_ ............... ......... uthorized Signature
g re
Rev. 1/81
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%s` Town of Southold Annex 1/7/2014
P.O.Box 1179
54375 Main Road
Southold,New York 11971
................................
CERTIFICATE OF OCCUPANCY
No: 36690 Date: 1/7/2014
THIS CERTIFIES that the building RESIDENTIAL ADDITION
Location of Property: 1150 Smith Rd,Peconic,
-----------
SCTM#: 473889 See/Block/Lot: 98.-3-27
Subdivision: Filed Map No. Lot No.
...............
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
1/18/2012 pursuant to which Building Permit No. 36942 dated 1/25/2012
..........
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:
ALTERAIJ( N AND ADDITION TQ A PRE-EXISTING UNHEATED GARAGE"AS BUILT" RPLIJEV— FOR
The certificate is issued to Amador,Xavier
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
............
ELECTRICAL CERTIFICATE NO. 36942 02-23-2012
............... ...................
PLUMBERS CERTIFICATION DATED
A owM add Si ture
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-23762 Date JULY 12, 1995
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 1150 SMITH ROAD PECONIC, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 98 Black 3 Lot 27
Subdivision Filed Map No. Lot No.
conforms substantially to the Requirements for a One Family Dwelling built
Prior to: APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z-23762 dated JULY 12, 1995
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 ACCESSORY TWO CAR GARAGE
The certificate is issued to DONALD A. DOEDiMAN
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
4
Building Inspect
Rev. 1/81
RIl1LDrN(; 01;PARTHENT
TOWN OF SOUr1l0f.D
]IOUSING CODE INSPECTION REPORT
LOCATION: 1150 SMITH ROAD PECOHfC, NEW YORK
.1.11 , 11"1 (ii-
er A strect utticiplliLy)
HA tl No LOT(s
NAME. OF OWNER 00 DONALD DOHRMAN
OCCUPANCY RESIDENTIAL
t ype (owier-ten
AI)MjrnEj) Ry.- DON DORRMAN ACCOMPANIED BY: SAME
KE.Y AVAILABLI; -TAX MAT' No.
SOURCE OF _DONALD H- DOH DATE: FEB. 15, 1995
�FYFF Oi-` CONSTRICTION WOOD FPAMF I STORIES I I EXITS 2
FOUNDATION CEMENT BLOCK CFI,LAR FULL CRAWL SPACE
TOTAL ROUMS: I ST FLR. 4 2ND FLR- 3RD 171,11.
BATHROOM (s) ONE TOILET ROOM (s) UTILITY Room
PORCH TYPE RFAR&FRONT COVERED SCREENED DECK, TYPE REAR PATIO
RRE.EZEWAY F I R F"I'LA C E NO GARAGE
DOMESTIC HOTWATER YES TYPE lIE,ATI`.R GAS L.P. AIRCONDrTIONING
TYPE HEAT GAS L.P. WARM A I It XX 1101"WATER
OTIIER,
ACCESSORY STRUCTUREIS-,
GARACti, TYPE, Or CONST. 2 CAR WOOD FRAME STORAGF, TYPE CONST. NONE
SWIMFIING POOL GUEST, TYPE CONST,
01 HER
VIOLATIONS: CHAPTrIl 45 N.Y. STATE UNIFORM FIRE PREV17,NTION & BUILDING CODE
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LOCATI ON DESCRI PTION ART. SE.C.
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RE.MARFS: BP 117799Z-Co Z-23763 (FOUND-& GAS HEATING SYSTEM) BP 122804z-(;o 7.-23690
(DECK ADD.)
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IN�111(`.''TED BY �7DATF• or INSPF.CTION MAY 5, 1995
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