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Home My WebLink About1000-122.-5-3.5 so "'I'VOONN OF SOUTHOLD Rental Permit 1255 Owner: Ronald Smith , Anne Hession Occupied as: Accessory Apartment Located at: 1530 Camp Mineola Rd Mattituck 122.-5-3.5 Maximum Permitted Occupancy: 2 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 ` annual in ction. Issued: 02/04/2025 Expiration: 02/03/2027 o Enfo en ciai This Notice must be posted by the main entrance 0allmes 3 TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box It 79 Southold,NY 111,9 1-0959 Telephone 631 765-1802 Fax 631 765-9502 Lit /ww r,south ldtowLin ov ^)A RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: r' Tax Map Number: 1000 SECTION 1—i3Vm' -BLOCK tZa - 3.6"-LOT - SECTION B. OWNER INFORMATION: Property Owner Name: AVA e_ a\nGl A i Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 36 Camp �Ai vv of a �_A Telephone Number (s): Daytime -2VS -03 Evening SGAJ Emergency 6 1 40 15- Property Owner Email Address: S e Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: ,_,,, w....................... 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 an : 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 INFORM TION: (required for rental properties containing 8 or more rental units) Name of Managing Agent dwelling unit, if any: Address of Managing A nt (no P.O. Boxes): Mailing Address o anaging Agent: Telephone Nu ber(s): Daytime Evening Emergency Email Addr s: Page 2 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: For each Rental Dwelling Unil Set rorlh 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:equested Maximum number of persons allod to occupy Dwelling Unit: umber of rooms in Rental Dwelling Unitse and Dimensions of each room in Rental Dwelling Unit: 14. 1 to. 2 ' X 13 . Z q ' X 22 ' S 75 ' X 9. 2- 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 _ II • 7�54 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: A S,M Property Owner's Signature: Sworn to before me thi?)C) day of � J—Cj ` Ae,,'W 20J'1 rA Official Notary Public Signature and Original Notary Stamp CONNIE 0.BUNCH Notary Public,State cat New York No.OI BU61850 ail Qualified In Suffolk Ccaunty a O �OWN OF SO UTHOLD BUILDING DEPT. 631-765-18 2 INbrPECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] AL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F AL) [ ] CODE VIOLATION [ ] PRE C/O [ /] RENTAL N MARKS: .... .PN% nz DATE INSPECTOR T ZCLOR TRIM f jig f -V 122.-5-3.5 3/06 ——————- Bo lDinettendationM. Bldg. ------ ---- Ym Extension Easement Floors 'Interior Finish 1LR, Extension 1 Ext. Walls Extension Fire Place Heat CDR, Type Roof Rooms 1st Floor BR. Porch I ecreation Room oorns 2nd Floor FN. B. Dormer ------------ 777Imo Garii& 7 717 0* B. Total 3f Cdyd .L COLOR a i 'I TRIM I Li I i' i I SQ. FT Fin"B" 1 st Floor 2nd Floor TOTAL CB M. Bldg. Foundation Pc OTHER Bath Dinette FULL COMBO Extension Basement CRAABWL PARTIAL Floors Kit. SL Extension Finished B. Interior Finish L.R. Extension FP/WBS Heat D.R. Garage Ext. Walls BR, Porch Dormer Baths Deck/Patio Roof Fam. Rm. Poo ` ypci t Foyer p Solar y A.C./GEN GAY`" G5 Laundry i P�pf-ors Library/ 4 �(70�' i-PL a.S /.G705 Study lti(ti Town of Southold 9/27/2020 P.O.Box 1179 53095 Main Rd !00,1ta,0. ,4, Southold,New York 11971 CEIITIFICATE OF OCCUPANCY No: 41469 Date: 9/27/2020 THIS CERTIFIES that the building AS BUILT APARTMENT Location of Property: 1530 Camp Mineola Rd,Mattituck SCTM#: 473889 See/Block/Lot: 122.-5-3.5 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/20/2019 pursuant to which Building Permit No. 44471 dated 12/3/2019 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: $,ass b.u.A""accessory,,.g is a it with du:k and outdo Slip er additions to an e Sting a s c r r� ua��Un aka lied for per ZBA#7283SE, clotted 5/23/2019. The certificate is issued to Smith,Ronald&Hession,Anne of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-19-0040 7/8/2020 ELECTRICAL CERTIFICATE NO. 44471 7/10/19, 8/31/20 PLUMBERS CERTIFICATION DATED 8/14/2020 Brad P ueh _....... . ,•. Signature ..... ... _._......... Town of Southold 9/27/2020 ' '" 4` P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41470 Date: 9/27/2020 THIS CERTIFIES that the building GENERATOR Location of Property: 1530 Camp Mineola Rd,Mattituck SCTM#: 473889 Sec/Block/Lot: 122.-5-3.5 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 7/7/2020 pursuant to which Building Permit No. 45104 dated 8/13/2020 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: The certificate is issued to Smith,Ronald&Hession,Ann of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45104 9/22/2020 PLUMBERS CERTIFICATION DATED _ ............... _.. _ __. . __ .ww.................._..www. . dSignature 8 0 � � Town of Southold 8/13/2020 lk P.O.Box 1179 53095 Main Rd 101 i Southold,New York 11971 ---------------- CERTIFICATE OF OCCUPANCY No: 41347 Date: 8/13/2020 THIS CERTIFIES that the building SHED Location of Property: 1530 Camp Mineola Rd.,Mattituck SCTM#: 473889 SeeBlock/Lot: 122.-5-3.5 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/10/2019 pursuant to which Building Permit No. 43764 dated 5/20/2019 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: accessoM d as a lied�r,, The certificate is issued to Smith,Ronald&Hession,Anne of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED u ignature � t �x Town of Southold 8/13/2020 n P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41347 Date: 8/13/2020 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 1530 Camp Mineola Rd.,Mattituck SCTM#: 473889 Sec/Block/Lot: 122.-5-3.5 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/10/2019 pursuant to which Building Permit No. 43766 dated 5/20120 1 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: accessca ie round swimntin cal n pdp gigpplied for,, The certificate is issued to Smith,Ronald&Hession,Anne of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAI, ELECTRICAL CERTIFICATE NO. 43766 7/20/2020 PLUMBERS CERTIFICATION DATED .. ..._......... ........... ._...._.w Signature_............._-..._......�..._ r F � Town of Southold 8/18/2020 P.O.Box 1179 53095 Main Rd Southold,New York 11971 ` . wo -------- CERTIFICATE OF OCCUPANCY No: 41358 Date: 8/14/2020 THIS CERTIFIES that the building POOL HOUSE Location of Property: 1530 Camp Mineola Rd.,Mattituck SCTM#: 473889 Sec/Block/Lot: 122.-5-3.5 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/10/2019 pursuant to which Building Permit No. W mmmm 43772 dated _ 5/21/2019m -LL 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: pon t4bit kal wp?u- 1 Ln With;sagpa alk: t a? d a shgyv r c l d sttaclkgd st a q s acc as a liccl for. The certificate is issued to Smith,Ronald&Hessian,Anne of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-19-0040 7/8/2020 ELECTRICAL CERTIFICATE NO. 43772 2/5/2020 PLUMBERS CERTIFICATION DATED 5/5/2020 Brad lei u h _.. _ ut r:mil Si...w.�turc ._._._.._....�.._ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31612 Date: 06 '13. 06 THIS CERTIFIES that the building ACCESSORY POOL HOUSE Location of Property: 1530 CAMP MINEOLA RD MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 122 Block 5 Lot 3.5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 21 2004 pursuant to which Building Permit No. 30882--Z dated JANUARY 6 2005 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 POOL HOUSE IN THE REQUIRED REAR YARD AS APPLIED FOR. The certificate is issued to RONALD SMITH & ANNE HESSION (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-04-0142 05 25 06 ELECTRICAL CERTIFICATE NO. 6659 08/25 LC 5 PLUMBERS CERTIFICATION DATED ¢ 1 20 06 MIKE JACOBI PLUMB.&HEAT. uthorized Signature Rev. 1/81 xa a TOWN OF SOtrMOLD WELDING DEPARTMM Town lc's Office Southold, N. Y. Certificate Of Occupancy No. 264 . . . . . . Date . . . . . . . . . . . J1- 16. . . . . .. 19-7.5 2/8 010 JU10 La THIS CERTIFIES that the building located at .WIS.Camp.Xissola A. . . . . Street Map No. . . . . . . Block No. . . .= . . . .Lot No. . .KattitQ43t. . x 6Y.0. . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . *. 14. . ., 19. .73 pursuant to which Building Permit No. . 69872 dated . . . . . . . . .VAT. . J) . . . . .. 19. .73 was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this carUficate is issued is .1' .dVX1 . Mitb. 4dd1-Uo4. A The certificate is issued to . joba, .8 ejoh . . . . . . . . . err . . . . . . . . . . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . . . .FA t. . . . . . . . . . . . . . . . .. . . . . . . . . UNDERWRITERS CERTIFICATE No. —approval. by.J.& xUb i. . 4/1 . I. • • . . HOUSE NUMBER . . . .1205 . . . . . Street . .Ola .J .La. . . . . . . . . . . .. . . . .. . . . . . . . . . .. . . . . .. . . . . . . . . . . 1539. . . . . . . . . . . . . 91W. 91A . . . je4ctor . . . . . . . . . . . HC�t addition on 8/11 corner to be conpl*tod. A�X� . . . . . . . . . . . . . . . . . . . . fit. Building FORK NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. .Z7369 . . . . . Date . . . . . . . . . . . Sov. . . .1$ , 19. !7-6 THIS CERTIFIES that the building located at 9/8. .0le Orle La.&'W/8S r `ftp fie; Map No.24C . . . . . . . . . Block No. 3X Lot No. . . . Xattttuak. . .N.Y.. . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . April. 1519 76. pursuant to which Building Permit No. . .7821+Z dated W14. 16. . . ., 19.75 , 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 Acoaasory .bUildin& .(barn & .others) with. ,foneing. . . . . . . . . . . . . . . The certificate is issued to doU, 3WCUIX. . . . .QVAQr . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval X*R* . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE No. 1t.R. . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . HOUSE NUMBER . I ZQ5 . . . Street . .Ole. Iuia 1ane . . . . Xa.ttl.tu ek. . . . . . . Building I ector I - EEEIVED FEB 012019 -oviplom WOOD ZONING BOARD OF APPEALS a 6ATHROOM, i LAUNDRY 5.751x92' 104 6.2'x132' 53 sf 81 sf L14.1'x OM 4.5'0 —OQ W 0f REF 0C1 ".)60 0 GREAT ROOM C1 421 sF �. 0/' )F 7 ,$ RA '7 �a wood IINAL MAP off` vt ,# STOOP EVI E Y?I(A E® BY ZBA ®ECiSI®N # � ®ATE® !a TOTAL LIVABLE FLOOR AREA-S 30 SF M E R Y L K R A M E R a r c h i t e c t t SMITH RESIDENCE ACCESSORY ART ' " L "` L 260 HORTONS LANE 1/4'I= 1'-011 POST OFFICE BOX 1600 SOUTHOLD. NY 11971 6 3 1 - 4 7 7 - 8 7 3 6