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HomeMy WebLinkAbout1000-114.-6-15 s TOWN OF SOUTHOLD
Rental Permit
�'
1190
Owner Anthony Stalters
Occupied as Single Family Dwelling
Located at 970 Village Lane Mattituck 114-6-15
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.
8/30/2024 %4--
'cle E orc Official
This Notice must be posted by the main entrance at all times ( I
7--9 -�
w
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
W Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax(631) 765-9502 htt s://\v\ .�o'ut ioldtoAnn . ov
RENTAL PERMIT APPLICATION
Rental Permit Fee $300 (Application must be renewed every ZrspE E
JUL 1 6 202
Section A. Building Department
Property Information: Town of Southold
Rental Property Address:
Villages Lccvr\x, c :-, ,+k,
Tax Map Number: 1000 SECTION 114 -BLOCK 06 -LOT 15.0 _
SECTION B.
OWNER INFORMATION:
Property Owner Name: Anthony Stalters- new owner
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
1040 Scuttlehole Rd PO Box 1895
Brid eham ton ICY 11932
631-278-6482
Telephone Number (s): Daytime Evening, Emergency
Property Owner Email Address: ajstalters@hotmail.com
t2)C)b
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
Ema)I Address:
Section D.
Managing Agent Information:
Name of Authorized Agent of dwelhng unit, if any
Address of Authorized Agent (no P.O. Boxes):
Mailing Address of Authorized Agent: I°"
Telephone Number (s): Daytime Evening Emergency
Email Address:
SECTION E.
SITE MANAGER INFORMATION: (required for rental properties containing 8 or rare rental units)
Dame 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 Eveping Emergency
Email Address:
Page 2of4
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
Adderrdttrrr."
Rental Dwelling Unit Identifier: 970 Village lane
Requested Maximum number of persons allowed to occupy Dwelling Unit: 6 persons
Number of rooms in Rental Dwelling Unit:
Use and Dimensions of each room in Rental Dwelling Unit:
Ft, Bedroom #3- 206 s . Ft, bedroom #4 -172
sq. Ft.
SECTION C.
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.
XI am requesting afire safety inspection to be performed by a Code Enforcement Official
from the Town of Southold
❑ 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)
i AnthonyStalters ,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: AnthonyStalters
Property Owner's Signature:
Sworn to before me thisM day of JU L4 ----,,� 20a4
Official Notary Public Signature and Original Notary Stamp
Alison M.Grunewald
Notary Public State of New York
Suffolk County
#01 GR6029132
Term Expires Aug.9,20i5 Page 4 of 4
SCTM #
- TOWN OF SOUTHOLD PROPERTY REO 31a,{j
OWNER STREET CpC- VILLAGE uia i. SUB LOT
ACR. REMARKS L.
TYPE OF BLD. NCI_
�bm
PROP. CLASS
LAND IMP, u TOTAL DATE
�--
FRONTAGE ON WATER HOUSE/LOT
BULKHEAD
TOTAL
TOWN OF SOUTHOLD PROPERTY RECOR �
OWNER STREET STREET VILLAGE DIST> SUB. LOT # �'
014
FORMER OWNER Kuhn 4 ,tea N E - ACR.
S W TYPE OF BUILDING
RES. D SEAS. IVL. IFARM -COMM. CB. MISC. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
i
m -
AGE BUILDINZOND1 N t`t0 _
ts�
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NEW NORMAL F BELOW ABOVE
FARM Acre I Value Per Value
Acre =
Tillable I
-
3
Tillable 2
l
Tillable 3 ? i
Woodland
Swampland (FRONTAGE ON WATER
Brushland I FRONTAGE ON ROAD
House Plot DEPTH
.� ... I BULKHEAD
Total DOCK i
ti
l 71,e
- fa
COLOR
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TRIM
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3
114.-6-15 10/2/2023
M. Bldg. X L _ 7 �S ��' Foundation S G. Bath a3� ( Dinette
Extension K.o -
Extension Ext. Walls Interior Finish 'LR.
Extension 'Fire Place Heat .,' / S CDR.
[may{/�/{ =
o 'A
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Garage 3
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Buildina lie artmeut Appligation
AUTHORIZATION
(Where the Applicant is not the Owner)
I,A--4 .... residing at
Print ro er"s name (Mailing Address
( P PAY ) (M g )
do hereby authorize AI*1661, � .
(Agent)
to apply on my behalf to the
Southold Building Department.
�y oZ.0�
(Owner's Si atore) (Date)
An, h0n
(Prial Owner's Marne)
soft y WIA
TOWNOF Ti�O .Ct BUILDING LEFT.
631-765-1802
INSPECTION
[ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. -
[ ] FOUNDATION 2ND [XFIRE
LATION/CAULII''NG
FRAMING /STRAPPING [ L
FIREPLACE & CHIMNEY [ SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PEN TRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F AL)
[ ] CODE VIOLATION [ ] PRE C/O ] RENTAL
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VORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. . . �° f . . . . Date . . . . . . . . . . . . . . . . . . . . . .. 19.73.
THIS CERTIFIES that the building located at ." #kg . . . . . . . . . . . . . Street
Map No.Y * lock No. . . . . . . . . . .Lot No. . IS . . . . . 1tti Y..► . . . . .
conforms substantially to the Application for Building Permit heretofore filed in this office
dated . , . . . . . . . . . .;1 . q. . 9., 19.73. pursuant to which Building Permit No. . .
dated . . . . . . . . . . . .; 11. ., 19.73•, was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
'issued is me . " y. 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The certificate is issued to . 1r, A .ra .B. . . . . . . it . . . . . . . . . . . . . . . . .
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval Q . . . . 9?.3. .14 Ao. 74 . . . . .
UNDERWRITERS CERTIFICATE No.. . . . i�02 Oct 2M 1973
HOUSE NUMBER. . !R?0. . . . . . .Street. . . . . ' ':dues .18
Alb�
. . . . . . . . . . .
Building hilt *etor
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold,N.Y.
Certificate Of Occupancy
No. Z 1W5 7 5 5W , . W . . . . . Date . . . . . M a Y. •1.5 . 19 8 7. . . .. . . . . ..
THIS CERTIFIES that the building . . . . ,Dormer a d d i t ion • . . . . . . . . . . . . . . . . • . . . . . . .
Location of Property 970, VILLAGE. LANE W . • • • , , , , MATTIT CK� • . . ��.///�yyy �y
• W Y W • d W N 0. k . '� •T"79.o✓ e�� i
Rouse No. Street
4. . . . . .Block , b .Lot , 015
County Tax Map No. 1000 Section . • - 1 • . . • • • . . . . . . . . •' .
VILLAGE MANOR .Filed Map No. 3669 .Lot No. ].... . . . . . . . ..
Subdivision. . I . . . . . . . , . . .
conforms substantially to the Application for Building Permit heretofore fled in this office dated
Mar. 21�� „1.s S s. pursuant to which Building Permit No. . . . �. . . . . . . . . . . . . . .
. . . . . . . .. . .
dated . . . • May ,2 ,. .19 S 6. , . . . , 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 . . . . . . . . .
Dormer for bathroom & finish 2nd floor � story ; . • , , . , • . . . , . . , . . • .
.. . . . .. . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The certificate is issued to . . . . . . . . . . . .. .'�O NBX J v a , VXXX" ` . , . ". . ' . ` . . . . .
of the aforesaid building.
Suffolk County Department of Health Approval . . . . . . N/A . . . . . . . . • . . . . . • . . . . . • . .• • W • • . W
UNDERWRITERS CERTIFICATE NO. . . . . . . . . W . . . .1,d0 6 9 310 . , . . , ,
FL XaMRS CERTIFICATION -RATED—. 5/ 13/86
. . . W . . • , . . . .'. . . . . . . . . . . .
Building Inspector
Rev.1181
0 ,.
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. . Z 3373 . . . . . . . . Date . . . . . .April.. . . . . . . . . . . . . . . . . . . .. 198. .
THIS CERTIFIES that the building . . . . . . M ition. . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . .
Location of Property 97a . . . . . . . . . . . . . Visl.age Lane Mattituck
House No. .' t tiamlei
County Tax Map No. ]ODU Section . .114. . . . . . .Block . . .96. . . . . . . . . . .Lot . . . . . . . . . . .
Subdivision. . . . . . . . .K. . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
19 .84 pursuant to which Building Permit No. . . .. . . . . . . . .
dated . . .. . . .gi4L,y. . . . . 3 . , . . . . . . . . 19 8 ,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 . .. . . . . . .
,Deg]c, Ac#Ajon, to,pcAgtir1q ,One ,Family, Dwellincj , , . , . . . . . . µ . . . . . .
The certificate is issued to . . . . . . . . . . . . . . . . . A 11N.j. 11 N ; JOB, , . . . » . , , . . . . . . . . .
d`e�tnrraer�i
of the aforesaid building.
Suffolk County Department of Health Approval . . . . . . . . . .N/A. . . . . . . . . . .. . . . . . . . . . . . . . .. .
UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . .N/A. . . . . . . . . . . . . . . . . . . . . . . . . .. .
YON V `
. . . . . . . . . . . . . . . . . . . » . . . . . . . . . . . . . . . . . .
Building Inspector
Rev.11s1
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N..Y.
CERTIFICATE OF OCCUPANCY
No E-19811 Date MARCH 239 1991
THIS CERTIFIES that the building ACCESSORY
Location of Property 970 VILLAGE LANE NATTITUCK N,Y.
House No. Street Hamlet
County Tax Map No. 1O00 Section 114 Block 6 Lot 15
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH iB 1991pursuant to which
Building Permit No. 1972 -E —dated CH 19 1991.
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 ACCESSORY SHED AS BUILT
The certificate is issued to HENRY B. & JOANNE KUHN
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NA
UNDERWRITERS CERTIFICATE NO. N A
PLUMBERS CERTIFICATION DATED N A
Building Inspector
If
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
Nos Z-225517 Date: 02/04/98
THIS CERTIFIES that the building A/G POOL & FENCE
Location of Property: 970 VILLAGE LA 1ATTITUCK
(ROUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 114 Block 6 Lot 15
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 24 1995 pursuant to which
Building Permit No. 22810-Z-Z dated JUNE B 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 ABOVE GROUND SWIMMING POOL WITH FENCE & DECK AS APPLIED FOR.
The certificate is issued to THOMAS A DM40POULOS
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N419457 05/09/97
PLUMBERS CERTIFICATION DATED N/A
w �
Bui ing Ins :tor
Rev. 1/81
REVISIONS:
1
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(ATTIC) U.
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— PROJECT: 202-10
.HAWN BY:RC
CHECKED BY:EW
DATE:JUN.25,2024
SCALE: "=T-0"
SH EE—NO:
SECOND FLOOR PLAN N 04
56' ui
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280 SF 180 S F I 200 SF
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100 SF 116SF
UP
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PROJECT: 2024-010
DRAWN BY:RC
CHECKED BY:EW
DATE: JUN.25,2024
SCALE: T-9'
SHEET NO:
GROUND FLOOR PLAN
03
REVISIONS:
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PROJECT: 2024-010
DRAWN BY:RC
CHECKED BY:EW
DATE: JUN-25,2024
SCALE: A=I-
SHEET NO:
BASEMENT FLOOR PLAN N 02