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HomeMy WebLinkAbout1000-115.-16-13 T OWN OF SOUTHOLD
Rental Permit
1234
Owner NoFo Haven LLC
Occupied as Single Family Dwelling
Located at 1365 Donna Drive Mattituck 115.-16-13
Maximum Permitted Occupancy 6
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.
11/20/2024
Cod Erg r t offiml
This Notice must be posted by the main entrance at all times
. ,.
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 1 1 97 1-0959
410111
BUILDING DEPARTMENTp�
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION
Rental Permit Fee $200 (Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
1 3 6, (-N cw ,, e t-u C k Nam( I I Z
Tax Map Number: 1000 SECTION -BLOCK -LOT
S CTA-f A- /000
SECTION B.
OWNER INFORMATION:
Property Owner Name: 1DO.Vicl
Property Owner Legal Address: Property Owner Mailing Address:
63 i 63 t 631
Telephone Number (s): Daytime 77q-009_3 Evening sI L/-60ri�3 Emergency S1 S- 2n . i
Property Owner Email Address:
Page 1 of 5
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
Cou
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
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
Email Address:
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: / 14-
Address of Managing Agent (no P.O. Boxes):
Page 2 of 5
�Z
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O. Box 1 179
Southold,NY 1 1971-0959 ✓
cou
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent: / L
Telephone Number (s): Daytime Evening Emergency
Email Address:
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: ON
Requested Maximum number of persons allowed to occupy Dwelling Unit:
Number of rooms in Rental Dwelling Unit:
Use and Dimensions of each room in Rental Dwelling Unit:
l
Page 3 of 5
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717 rr
sott4
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
toc
P.O.Box 1 179
Southold,NY 1 1971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
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 la s adopted by the New York State Fire Prevention and Building Code Council.
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.
SECTION H.
DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit.
STATE OF NEW YORK)
)
COUNTY OF SUFFOLK)
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
Page 4 of 5
sou' ,
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 �"
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SO HOLD
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 as to any change to the information
regarding Authorized Agent, Managing Agent, or Site Manager.
Property Owner's Name: �Aw*j
Property Owner's Signature:
Sworn to before me this)Xday of �t 1 20 2-3
Official Nota P a blic Signature d Original Notary Stamp
p
TRACEY I.. %NY1511.
NOTARY PUBLIC„Trg a`OF NEW YORK
N0.01 DW6306900
QUALIFIED IN Si,TFOLK COUNTY
COMMISSION EXPI�iES-JUNE,30,2a&(P
Page 5 of 5
l kwtvje�- 1 4
TOWN OF SOUTHOLD B IL.DING DEFT.
631-765-1802 l�. (v- 13
INSPECTION
[ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING
oe
[ ] FRAMING /STRAPPING [ ] NAL
[ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ RENTAL
REMARKS:
CU
DATE 0 1�A w ANSPECTOR
TOWN OF SOUTHOLD PROPERTY RECORD
OWNER STREET _ VILLAGE DIST. SUB. LOT
E _ _ t
FORMEROWNER N E ACR
S W TYPE OF BUILDING
RES. ;1 SEA VL. FARM i COMM. CB. MISC. Mkt, Value
LAND IMP. TOTAL DATE REMARKS
Vn
r 9 fr
r
f
o
j
f
{
wj
_ e
s
NEW NORMAL BELOW ABOVE
FARM _ Acre Value PerjaIue
Acre
Tillable: 1 a
a _—e
Tillable 2
Tillable 3 L -
e
f
4
Woodland
i �6t � —
Swampland 3 ,_ i /7y � �~ f`
Brushland _ FRONTAGE ON ROAD
House Plot DEPTH
l
BULKHEAD
Total
'DOCK
�A -- -,
COLOR44
e
f
AVM
� TRIM
m
l .
t
f
.. -
l
0
l
M. Bldg a e n ion '' -Fou dat p Bath Dinette
- n Floors
Extension -_ a Basement
Extension a Ext. Walls _
Interior FinishLR
r
Extension Fire Place
Heat DR
i •-3 I
6
a BR
1 s 'Type Roof
I Rooms 1st
Floor
Recreation Roo
n _
Porch Rooms 2 d Floo
Fib g B•.
a _
Dormer
rme r - — - - -
o
Breezewa Driveway
y
Go rage
f
Patio
O. B.
J
Total _ -
__
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold,N.Y.
Certificate Of Occupancy
No. . . Z 13 6 3 7 . . . . . . . Date . . . . . . .July . .16. . . . . . . .. 19 85.
THIS CERTIFIES that the building . . . . ss"?': . . . t? .Pool.. S. & Fence ). . . , . . , , , , .
Location of Property �A . . . . . . . . . . . . . . . . . . . Donna Bra e µ . . w Matttuck
House No, Street ' . µ Hamlet
County Tax Map No. 1000 Section . . . .1 5. . . . .Block . . . 16 . . . . . . . .Lot . . , 4.13
Subdivision .Dee3? ,Hole ,Creek, Est; , , , , , _Filed Map No. , 4256, ,Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
. . . . . R ?4 w . 19 8 3.pursuant to which Building Permit No. . . , , , 12 2 4 6 Z
dated . , . , April 14 . , + 19 . 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 . . . . . . . . .
------rt-- Swimming Pool & Fence -------
. . . . . . . . . „ . . . . . . . . . . . .SACKS
. . . . . .
The Certificate is issued to . . . . . . . . . . . . . . t GREGdRY . . . . . . . . . . . . . .
of the aforesaid building.
Suffolk County Department of Health Approval . . . » . . .N/A . . , . . . . . . . . . . . . . . . . . . . . . . . . . .
UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . .N6.05137w . . w , . , , ,
yt
« µ . . .
Building Inspector
Rev.1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. 46339. . . . . . . Date . . . . . . . . . . . .Feb. . . .26. . . . . . .. 19.7 j.
Matt. nl t
THIS CERTIFIES that the building located at .5/13. .F,,• •ti 1 • lJoa.d• I-)• • • • • Street
Map No. ?X . . . . . . . . . Block No. .:xz . . . . . .Lot No. .xxx . .Matt ituck . .R.-
conforms substantially to the Application for Building Permit heretofore filed in this office
dated . . . . . . . . . . . . . . . .Oct .2R 1V?+. . . pursuant to which Building Permit No. 7h337.
i dated . . . . . .2Yk.IRQa . . 1 3 . . ., 19 7?+ ., 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 Bu.sine s.s .bu.i ldi.ng . .r. .storaga. A. shop. e.tca . . . . . . . . . . . . . . . . . . . . . . . . .
The certificate is issued to CPLthia. Aaminsk7. . . . . um4m . . . . . . . . . . . • . • . • . . • • , • . .
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval N.it., . . w . . . . . . . . . . • . . . . . . . . . . . . . .
UNDERWRITERS CERTIFICATE No.2121+/.7 5. • hY.J.+. Xuba oki. . . . . . . . . . . . . . . . .
HOUSE NUMBER . . .$p . . . . . . . . Street . F.. .M111.lizad. . . . . . . . . . . . . • . . . . . . . . • .
Building Inspector
i "
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. . . F13637 Date . . . . . . . . . . . . . .July . .16. . . . . . . ., 1985
THIS CERTIFIES that the building . . . . P:K . . nc.r .Pool. ( & ,Fence ). . . . . . . . . .
Location of Property . . . . . . . . . . . . ,. . . . . , , , , Donna Drive . . . . . . . . . . .Matituck
House No. Street w rt Hamlet
County Tax Map No. 1000 Section . . . .115. . . . .Block . . . 16 . . . . . . . . .Lot . . . o i 3. . . . . . . . . .
Subdivision.Deep Hole ,Creek Est; , , .Filed Map No. . 4256. .Lot No. 61 . .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
March 24 , 19 8 3.pursuant to which Building Permit No. . . . . . . 2 4 6 Z. . . . . . .
dated . . , April 14 . . . . 19 .$ ,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 . . . . . . . . .
. . . -------- Swimming Pool & Fence ----- . . . . . . . . .ACKS
. . . . . .
The certificate is issued to . . . . . . . . . . . . . „ ' ► . ' PY 1 . . . « . . . • . . . . • . . . . .
ar+wne,
of the aforesaid building.
Suffolk County Department of Health Approval . . , , . . .N/A _ . . . , . « • • • .
UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . „ . , ,N 6 0 513 7. 4 . . . . . . . . . . . . . . . . . . . .
Y, z—
B . . .
Building Inspector
Rev.1181
FORM K0. 4
TOWN OF SOUTHOLD'
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. Z"03 Date . . . . . . . . . . . . . ... U y. . . .31 . . ., 19.` V.
. . . . . . . . .
THIS CERTIFIES that the building located at . '. . . . • .. . . . . . . . . • . • Street
Not
Map NoDaep Rol#. Oblock No. . . . . . . . . . .Lot No. . . . . . Id-tt't+'U4jL . .N'Y* . . . .
conforms substantially to the Application for Building Permit heretofore filed in this office
dated . . . . . . . . . .0ea . .21? . . ., 197)+ . pursuant to which Building Permit No. .7673Z.
dated . . . . . . . . . . . . . . V9c. . .39, 19. 14, 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 . Primto . ope .family. dwe3- . . . . . . . . . . . . . . . . . . . . . . . . .
The certificate is issued to .Sp Oflw000. ftrk- HOZO t O. . . . . . . . . . . . . . . . . . . . . . . .
(owner, lessee or tenant)
of the aforesaid building.
by R
Suffolk County Department of Health Approval ' . �. .� .. . . . . . . . villa
UNDERWRITERS CERTIFICATE No. .19183 . . . . A,jptVIX II, . 1.975 . . . . . . • . . . .
HOUSE NUMBER . . . . 1365. . . . . Street . . A * . . . . . . . . . . . . . . . . . . • . • . . . . . . .
Building Inspector
------------
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SCALE: 1"=1'-0" .__....ww �...._�.._.. .. ....._._.�.._�.._.�.�._ ,�___...__....�_..._.�.._...
NO CHANGES PROPOSED
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WINDOW WINDOW PATIO DOOR
EXISTING SLIDING PATIO DOOR I
NEW 2-2x 10 HEADER
j NEW 2x 6 CEILING , S- DW I REF
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I I EXISTING I EXIST Z
I ; VAULTED I I ry°} PANTRY CD
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ALIGN NEW ±26'-32' GIRDER L GTH
EXISTING WALLS
EXISTING WALL WITH TO BE REMOVED
SKYLIGTHS EXISTING
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HSS 32"x 321"x 4'SQUARE HOLLOW STEEL GIRDER.SEE 7'„x
TUBE STEEL COLUMN WITH WELDED DETAIL THIS SHEET.
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3� x 10'x`2"THICK STEEL TOP PLATE EXISTING WALLS PRC
- WELDED TO STEEL GIRDER ABOVE 8
EXISTING_ TO BE REMOVED p O BOIL
w< ° 7''"x 10"x� THICK STEEL BOTTOM STAIR 0 O i.
PLATE WELDED TO CENTERED HSS COLUMN LL_
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PROVIDE 4-1"DIA.x 12"DEEP GRADE SS x
BOLTS DRILLED AND EPDXIED INTO EXISTING @ EXt:
EXISTING FOUNDATION WALL BELOW LIVING Z� FIRE
ExisrlNG AREA 030
FOYER w
UP
EXIST
CLOS
EXISTING �'
_ —��------------------
————— — -----�
NG— EXISTING BOX WINDOW
DOOR
V' t l EXISTING c A2 2 4i/f LI t�j
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PORCH &0 Se-5or.
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✓�l-�//� rJvfeg,-aid Jwl t�/���o�er
IRST FLOOR PLAN
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SCALE: 1''_ / Ex
131=VERIFIED WITH EXISTING CONDITIONS ON SITE. �.�./" JC
•in1.-...__"-___....-.-...av nlerPGnAA�r�Cc �,� I l` /