HomeMy WebLinkAbout1000-107.-9-24 T ORN OF SOUTHOLD
Rental Permit
g
1201
Owner Kristin Schultz
Occupied as Single Family Dwelling
Located at 905 Bayer Road Mattituck 107-9-24
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.
9/17/2024
Code tor
tent o '
This Notice must be posted by the main entrance at all times
� C E WE
r F TOWN OF SOUTHOLD—BUILDING DEP .RT'MC
Fown Flall Annex 54375 plain load P. . Box l 179 Southold, NY 11911*0 t
Telephone (631) 765-1802 Fax(631) 765-9502 Litt s: /ww,aw.southoldto �wn�
�ado
RENTAL PERMIT APPLICATION
Rental Permit Fee $300 (Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
905 Bayer Road Mattituck NY 11952
Tax Map Number: 1000 SECTION 197 -BLOCK 09 -LOT 024 -
SECTION B.
OWNER INFORMATION:
Property Owner Name: Krisfin z
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
ill Road A&5_WgA_MiU.Raad_
Ma.tt'tuck Y 11952
Telephone Number(s): Daytime 631,252,4505 Evening 631.252.4505 Emergency631�05
Property Owner Email Address:
Page 1 of 4
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any: N/A
Address of Authorized Agent (no P.O. Boxes):N/A
Mailing Address of Authorized Agent: N/A
Telephone Number(s): Daytime N/A EveningN/A Emergency N/A
Email Address: /
Section D.
Managing Agent Information:
Name of Authorized Agent of dwelling unit, if any: N/A
Address of Authorized Agent (no P.O. Boxes):N/A
Mailing Address of Authorized Agent: N/A
Telephone Number(s): DaytimeN/A Evening N/A Emergency N/A
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: N/A
Address of Managing Agent(no P.O. Boxes):N/A
Mailing Address of Managing Agent: N/A
Telephone Number(s): Daytime NIA_ Evening N/A EmergencyN/A
Email Address: N A
Page 2 of 4
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on property: 1
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: 10
Number of rooms in Rental Dwelling Unit: 10 Rooms
Use and Dimensions of each room in Rental Dwelling Unit: Bed o m#1 - 'Vx7' `
B d om#2 -9 5"x7 '1 ! Be o m -9' "x7'1"• Bedr m 4- '5"x '1"
Bathroom#1-710190'10"• Bathroom#2 -915"x7'1"• Kitchen- 13'11"x9'11"
DinjAg Room-10'3"05'0"• Livine Room - 1 18"x151• Sun Room - 12'11"x '5"
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.
[it I am 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 Kristin Schultz 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 Agen ,,,dr`Site Manager.
0
Property Owner's Name: KIril►t:i Bch
Property Owner's Signature:
mw m i�'iwwwa'+way
1ESSICA BARROS
W)M` iMY PUBLIC,STATE OF NEW YORK
Sworn to b re e this 3D�d 20 ay of , Registration No.UI BA6382670
Quahfiv.d in Suffolk County
Comrnissin, ry Expires October 29,2026
Official Notary b41, re and Original Notary Stamp
Page 4 of 4
TOWN OF SOUTHOLD BUILDING DEPT.
631-765-1802 i07
INSPECTION
[ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FIN L)
[ ] CODE VIOLATION [ ] PRE C/O [ RENTAL
REMARKS: �� � �d� OCG�
DATE INSPECTOR
S�FF01�- Town Hall Annex
' Town of Southold 54375 Main Road
Rental Inspection Report PO Box 1179
Southold, NY 11971-1179
Tel: 631-765-1802
71
SCTM # Date
;Owner Phone
;Address Visible
Hamlet Insector
!'FloorSmokeeDeetectors not located in bedrooms 1 2 3 `Quantities Sub C
Carbon Monoxide Detectors _
Fire Extinguishers
Exits
Bedrooms 1 2 3 4 5 6
Smoke Detectors
Egress
Occupant Count CAI_,
Building Systems Maintained &Operational Condition of Property
Heating ' Building interior }
water Bu
ilding i Hot tuilding exterior
Hot _... ._.m ._._ .... .. . ___.,..._. _ . .� . ..w_.. _ ..... n_ .. _ �__ .._ ._ .....,._._...�. _.
Electrical Property clean, maintained &safe
s........ ....._.. . .
Mechanical Handrails&guards installed secure&
Pool Safety Pool on Site
Surface water alarm Date of CO issuance
Door alarms Pool completely enclosed
Self closing latching gates _._......... .... ...... ._ w . _
.. ........__. ,.�.�.,. l coderequirements
Pool fence to re ui.r.,. . ._.�..e..w... .,� ..w...w��,_... ..m�....... .....
CO s for all items present Prior Rental
Comments:
TOWN OF SOUTHOLC" PROPERTY REi a s 'm -
OWNER STREET ` VILLAGE DISTJ SUB. LOT
FORMER OWNED,, s N E ACR.
S W TYPE OF BUILDING
r. ce Z _
RES,�/Q ' SEAS. VL. FARM COMM. CB. MISC. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
,'�OC
�r7a low i 0 ` V — 5 — L i
JL-
1 _
AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE
FARM Acre Value Per ; Value
Acre
i €
Tillable 1 '
Tillable 2 -
Tillable 3 -
Woodland
Swampl,and FRONTAGE ON WATER
Brushland FRONTAGE ON ROAD -
House Plot DEPTH
i
I IBULKHEAD i
3
Total ! DOCK I
i
i 1
T
COLOR
I
,
-
i
TRIM
it
ti
, 3
r ,
€
�.
3
3
[ f
5 � €
, i 3
3
I
y ,
l
i I
3
,
M. Bldg. Foundation i I Bath i Dinette
Extension / Basement F ,i ! U Floors , K. lc R
Extension 3 Ext. Walls _ ; Interior Finish �L 3 3 LR.
i — Heat DR.
Extension Fire Place S s l
I Type Roof ' 'l = Rooms 1 st Floor BR,
Porch Recreation Roorr, 1 Rooms 2nd Floors ' Fl N. B i
Porch Dormer
: I
�
Breezeway 3 ;Driveway I r
Garage
,s' '7 G
,
3 =
Patio I
0. B
TotalSSFsS U f,14 .£ =7 - 5.41 !F Ll Loo
f
Town Hall Annex �� Telephone(631)765-1802
� � �a 631
54375 Main Roads Fax( )765-9502
P. O. Box 1179
Southold, NY 11971-0959
oy
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 En ineer Licensed Home Inspector must
provide copy of valid current certification
Rental Property SCTM Number:
Rental Property Address:
Owner/Name:
Rental Dwelling Unit Identifier:
Number&Square footage of each bedroom as depicted in the attached floor plan:
(i.e. Bedroom#1 — 100 sgft., Bedroom#2—90 sgft., etc.)
Property Description (Include all improvements indicated on survey)
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 Residential Code of New York
State, the Building Code of New York State, the Plumbing Code of New York State, the Fuel Gas Code of
New York State, the Fire Code of New York State, the Property Maintenance Code of New York State
and the Energy Conservation Construction Code of New York State.
Print Name and Title Original Signature
Please place Professional Seal:
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Cierk's Office'
Southold,N.Y.
Ceilficate Of O mupancy
No. . 7971 . . . . . . . . . . Date . . . . c tcbex° 19. . . . . . . . . . . . . . . .. 1979
THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . • . .
905 Location of Property .Bayer Road M . . * . * .Ma. . . . . .k
Hai . . I'No. . . �l'�rerrrr%t
County Tax Map No. 1000 Section 07. . . . . . .Block . . . .0 . . . . . .. . .Lot . . . . . . . 024. . . .. .
Subdivision .. Mattituck, Heights, , , , , . , _Fd�Map No. 11 1' No. . 42. . » . • • ,
R:equir tst fora * * i dv011 It prior to
conforms substantially to the
C ificata of Occupancy Z9719
. . . . .April.2 f . . . . . . , 19 . ?pursuant to which No. . . . . . . . . . . . , .
dated . . October .19. . . . . . . . . . . . . . 19 ?9,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 . . . . . . . . .
. . .. . . . . . . . . . . µ . . . . . . . One.Family, Rw!4lAng. .w/Aaaeasorry•Garage . • . . . . .
The certificate is issued to . . . . . Charl.eis,A., ,P#9 ` T; . . . . . . . . . . . . . . . . . . . . . .
( , 61
of the aforesaid building.
Suffolk County Department of Health Approval .. . . . . . . .. . . . . .UP . . . . . . . . . . . . . . . . . . . . . . .
UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . . .N/R . • . • . t
.Building Spector
Rw 400
can... .,. .... .. ........_.. ...,. . .,... .. ,,..,...,. ... .. ._. ....,..,.. ....... .,.,..,.,..... .,«....... .......,..„,e.......e � .............. ....,...,.. ..�..
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location
number s re °t (Municipality)
Subdivision !ja Nap No. ^Z Lots) 5�Z
Name of Owner(s)
Occupancy type ownertenant)
Admitted by: Accompanied by: Z,%F&
Key available IQ /rc/J�% Suffolk Co. Tax No./duo-/07-09-4 Z�
Source of request EL�fG ��' Date /p
DWELLING:
Type of construction #stories / �L
Foundation15/oc Cellar%!/ Crawl space
Total rooms, 1st. Fl 2nd. Fl_ r3Xt 3rd. Fl
Bathrooms� ��z Toilet room IV
Porch, type Deck, type Patio, type
Breezeway CCaraAL4.. Garage Utility room
Type Heat `Warm Air Hotwater4j,,QSf=iiz�
Fireplaces) L •/2. No. Exits Twd Airconditioning
Domestic hotwater 3r Type heater
Other
ACCESSORY STRUCTURES:
Garage, type const.a--z u 194v ck-Storage, type const.
Swimming pool, Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Location Description Art. Sec..
Remarks: / ;=g&A,/ fir°1o1-A 1Q
Inspected by: of Insp. /O 1 -_
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