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HomeMy WebLinkAbout1000-113.-6-7 AV TOWN OF SOUTHOLD } Rental Permit 1222 Owner 775 Holbrook Ln LLC Occupied as Single Family Dwelling Located at 775 Holbrook Lane Mattituck 113-6-7 Maximum Permitted Occupancy 3 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. 11/1/2024 Code E rto,rc et offi ' i This Notice must be posted by the main entrance at all times .94 E C E Ni TOWN OF SOUTHOLD-BUILDING DEPARTMENT - C)f 0 2024 � Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY ll971-0V a. Ga{v ft �"'kart ent Telephone (631) 765-1802 Fax (631) 765-9502 litt.s://www„sou�tlioldtownt) .��OV T `uthold $ •30.2`f RENTAL PERMIT APPLICATION kC4 Rental Permit Fee $300(Application must be renewed every two years) t V eD Section A. Property Information: Rental Property Address: 775 Holbrook Lane Mattituck NY 11952 Tax Map Number: 1000 SECTION 113 -BLOCK Q6 -LOT_ -- SECTION B. OWNER INFORMATION: Property Owner Name: 775 Holbrook Lane. c/o Kristin ScbLiltz Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) MattitUrck NY 11952 ` .. Telephone Number (s): Daytime 631,252,45o5 Evening 631.252.4505 Emergency 631.252.4505 Property Owner Email Address: Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: NIA Address of Authorized Agent (no P.O. Boxes):N/A Mailing Address of Authorized Agent: N/A Telephone Number(s): Daytime N/A Evening N/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 N/A Evening N/A Emergency N/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: 3 Number of rooms in Rental Dwelling Unit: 7 R m Use and Dimensions of each room in Rental Dwelling Unit: 11e r om#1 - 1(I'4"x "• Bedroom #2-8'6"x1 '5"• 11 traum- 7'4"x7'1 " Living Room-211x11'• :Kitchen-9'11"xll'611- Dining Room- 12'4"x6 V La,undr Room -915"x711." 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 ❑ 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) Kristin Schultz,Managing Member of 1 775 Holbrook Lane,LLC 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, �fte Manager. Property Owner's Name: .Krist Sc' r . i11a gin, gVlember Property Owner's Signature, Sworn t f me this 3o day of ��'l�-WST , 2QM Off I Notary bl c Signature and Original Notary Stamp c JUSICA BARItos P�mg f,ARY PUBLIC,STATE O,r N�1"!d)I:K� ,HCOStration No.01©A .382610 �kklt�'In SaI3o1l��OL1��}' ('oiv-f"t S,514)0,Expires(k'tobc1 2q,2t)26 Page 4 of 4 TOWN OF SOUTHOLD PROPERTY RECC, OWNER 77--,7 , STREET` -7 -7 VILLAGE OWN DIST.! SUB. LOT L(jjST -4h 14� f iv -v- -- FORMER OWNER N E ACR S �w TYPE OF BUILDING J < ....... L RES. SEAS. VL. FARM COMM. CB. mics. Mkt. Value LAND IMP. TOTAL DATE REMARKS 4c 0 .4 VV4. 0, c-;-c) 7 i -7 0 -. 1 ;4-7 ' --JAn jr *oJes 5-7........... '3 cl C)C) 7 0 (2 Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH House Plot BULKHEAD Total I - �, - J�oo- ►►�- -cam -�- . XOR 73RO1nlIV TRIM 13Z4o_K _I € I � € t I :.. € F { } 1 € E , € i 3 1 i 113:6-7 1/2016 M. Bldg. Extensi - - - - - € _ - E a € Extension I 3 E € € Extension i !Foundation =Both 'Dinette C �' � _ ✓FRS 1 Porch �� a Basement Floors JK. rR,iYi _S-_t-Ngrdr7.(22 r /S4/ l "� r I�RI�W1 _ Porgy Bd. Walls „ Interior Finish LR, 61 no Won Breezeway Fire P 6 `Heat DR,5- .o 6 PA ' i Garage I It-ype Roof I ✓ Rooms 1st Floor 1 BR. Patio i ,, �¢._ �� ti{d �, ;Recreation Room lRooms 2nd Floor 1FIN. B O. B. Porter Driveway - ; Total y , 2- 6' t`)( TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 INSPEOCTION [ ] FOUNDATION 1 ST/ REBAR [ j ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING / STRAPPING [ j FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ j FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ j ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ��RENT' AL 4 4gago r.Jzs/� ~s DATES __ •/!a-� INSPECTOR Town Hall Annex Town Of Southold 54375 Main Road Rental Inspection Report PO Box 1179 ^ + Southold, NY 11971-1179 W Tel: 631-765-1802 SCTM.# �,...,,b9 Date Owner Phone Address Visible _.... .... _ « ....,...._., ._a.. _.�.. ... . v.. . ... . ..... ..... Hamlet °s 'Inspector Floor Level Quantities Sub 1 2 ; 3 Smoke Detectors Gat not located i ( in bedrooms) l� Carbon Monoxide Detectors Fire Extinguishers .. ®._.. .. .. , ,_ .. . �._.... m_.. __.. Exits „_.. . . Bedrooms 1 2 3 4 5 6 Smoke Detectors Egress Occupant Count , Building Systems Maintained &Operational Condition ' g y p ition of Property Building interior �..� B _a,...Heating _ g.. a a..� .. Hot water Building exterior F ... �. ...._. . .....�... .e, ..._..._ . .._.w... . ......_._... .,,�...�.._ .._.w..w. , Electrical ° Property cle an, maintained &safe „Mechanical Ma..n.d... ..�. ._,... rails &guards installed &secure m .. m ....�m . ..w e�. ....._�; .Poo ryl Safety Pool on Site �I ate of CO issuance ,Surface water alarm D ._�...�.._��...._...�........ ..... .w_. .._. p,...e.� ... .....�.� Door alarms Pool completely enclosed Selfclosinlatching ... .......... .. ........w,.... _.° ........na ....�.�., ... ...,,�.,.�,.. .... .�.. . .... �.. _ ._.. . . + �..� . ...,. ,. g/ latchin g gates ` Pool fence to code requirements CO's for all items present Prior Rental . 'Comments: S _... "......__.�_ �_. s .. ._...a.. . w 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-19420 Date OCTOBER 4 1990 THIS CERTIFIES that the building SEASONAL ONE FAMILY DWELLING Location of Property 595 HOLBROOK LANE MATTITUCK, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 113 Block 6 Lot 7 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 OCC. #Z-19420 dated OCTOBER 4 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�SEASONA)�LQNE FAMILY DWELLING OCCUPANCY FROM 5 15 TO 9 15 The cert. ss issued to EDGAR A. JAHN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL VA UNDERWRITERS CERTIFICATE NO. N PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. uil ing Inspector Rev. 1/81 B " ` BUILDI_M DEPART:•LirT TO.-nr OF SOUTHOLD, N. Y. HOUSIT-G CODE INSPECTION REPORT Location 595 HOLBROOK LANE MAITITDCK, NEW YORK �numoer 6c street) (Municipality) Subdivision Map No. Lot(s) Name of Owner(s) EDGAR A. JAM Occupancy A-1 type owner-tenant) Admitted by: EDGAR A- JAM Accompanied by: SAME Key available Suffolk Co. Tax No. 113-6-7 Source of request EDGAR A. JAHN Date 8/27/90 D'T°'LLI�rG Type of construction WOOD FRAME #stories ONE Foundation CEMENT BLOCK & PIERS Cellar PARTIAL. Crawl space Total rooms, 1st. F1 S 2nd. F1 3rd. Fl Bathroom(s) 1 FULL BATH Toilet room(s) Porch, type FRONT ENCLOSED Deck, type Patio, type ReOPED Breezew Garage Utility room Type He a ' NONE 'alarm Air Hotwat.er Fireplace(s) NONE No. Exits 2 _Airconditioning Domestic hotwater ELECTRIC e heater Other ACCESSORY STRUCTURES: Garage, type const. Storage, type const. WOOD FRAME Swimming pool. Guest, type const. Other VIOLATIONS: CHAPTER 45—N.Y. STATE UNIFORM FIRE PREVENTION 6 BUILDING CODE Location Descrirtion � Art. j Sec. .r Remarks: SEASONAL ING ONLY OCCUPANCY FROM 15th OF MAY TO 15TH OF SEPT. Inspected by: Date of Insp. AUGUST 31, 1990 Time start 9:45 amend 10:00 an t"r x",TyTT: BRICK STEPS DOUBLE HUNG WINDOW) 31 WX36 H ,f 1/ 3° �.. DINING AREA 12'-4"x6'-8" 2r, DOUBLE HUNG— CH=10'-6" CH= 10'-8" WINDOW BEDROOM#1 34"W x 43"H 10'-4"'x8'-8" �CB CH=B-4 26 WOOD STEPS } PONY WALL-- BATHROOM 7'-4"x7'-10" >DOUBLE HUNG WINDOW ,�, a 31"Wx51"H CH=8 4 2e . SLIDER WINDOW 23"W x 22"H m� W CLOSET LIVING ROOM 21'x11' �__ DN CH=B'-4" 30"WIDE-- 2e' BI-FOLD DOOR O) WOODEN GATE LDOUBLE OOM#2 -42"WIDE x10'-5" BARN DOOR 8'-4" UNG o NON FUNCTIONAL_FIRE PLACE3 H 2 CABINET REF.—� KITCHEN 97-U"x I I'-6" CH=7'4' AWNING WINDOW C7 ) 32"Wx20"H 00 28 n ° SLIDER WINDOW DOUBLE HUNG WINDOW - -- 35 W x 21"H 32"W x 39"H 2 M °a CONC. PATIO NOTE: aw 15'xl3'-7" MECHANICAL ROOM&LAUNDRY ROOM 4 " LOCATED IN BASEMENT ABBREVIATIONS: CB: CIRCUIT BREAKER a CH:CEILING HEIGHT CONC.: CONCRETE REF.:REFRIGERATOR Q S/CO:SMOKE /CARBON MONOXIDE " FLOOR PLAN APPLICANT:775 HOLBROOK LANE,LLC C/o KRISTEN SCHULTZ PREPARED BY: KS SCALE: 1/4"=1'-0" ADDRESS:485 WEST MILL ROAD COSTELLO MARINE CONTRACTING CORP. MATTITUCK,NY 11944 P.O. BOX 2124, GREENPORT,N.Y. 11944 SCTM#:1000-113-06-007 (6 3 1)4 7 7-119 9 (SHEET I of 1) DATE:07/29/2024 SLAB ON GRADE n < n " CONCRETE LEDGE L 0 L SLIDER WINDOW J L Wx2'-11"H 2W w o yr u RECREATION ROOM UP ' 0 O'x14' CH=7'-9" e�i"warEr< ANK L Z« O 6 — u LLJ / UP MECH. ROOM /8-4"x4'-9 L,x3 LAUNDRY ROOM� HW SHOWER CH=6'-1" WASH BATHROOM 2' HALLWAY 2' f 5'-4 x8 0 ,HEwEs 4'-3"x4-9 �"�NCH-6'-1' CH=b DRY 4 ACCESS ACCESS 4 n CRAWL SPACEn CH=3'-0" n ' o a „ A' BASEMENT FLOOR PLAN SCALE:I W-V-0" ABBREVIATIONS: CH:CEILING HEIGHT CONC.: CONCRETE MECH.:MECHANICAL S/CO:SMOKE/CARBON MONOXIDE APPLICANT:775 HOLBROOK LANE,LLC C/O KRISTEN SCHULTZ PREPARED BY:KS ADDRESS:485 WEST MILL ROAD COSTELLO MARINE CONTRACTING CORP. MATTITUCK,NY 11944 P.O. BOX 2124, GREENPORT,N.Y. 11944 SCTM#:1000-113-06-007 (630477-1199 (SHEET I OF 1) DATE:07/29/2024