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Home My WebLink About1000-120.-3-8.15 OF SO TOWN OF S UTHOL i Rental Permit 1265 Owner: North Fork Lane Holdings LLC Occupied as: Single Family Dwelling Located at: 270 Harvest Ln Mattituck 120.-3-8.15 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. Issued: 02 28 2025 Expiration: 02/28/2027 Code En cent Official This Notice must be posted by the main entrance at all times u TOWN OF SOUTHOLD—BUILDING DEPARTMEN" F E ,n + Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax(631) 765-9502 igp,0/ w,southoldtown r .gov 1 K sp 2�p RENTAL PERMIT APPLICATION r e c # '6 93 Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: l� . k `tv1 Tax Map Number: 1000 SECTION -BLOCK -LOT - SECTION B. OWNER INFORMATION: Property Owner Name: %� I_ !> L L Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) Telephone Number(s): Daytime(114( '(,OiLing Emergent ,, ° 25 Property Owner Email Address: Page 1 of 4 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, 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: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: t 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. 1 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) I 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: ,. Property Owner's Signature: Sworn to before me thdiMay of , 20 -S7 Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.01BU6185050 Qualified in Suffolk County r Commission Expires April 14,2,-�() ,aV Page 4 of 4 so TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 /,;�?- 3 -8/ s INSPECT1400' N [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI AL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL OE RKS:PLO OCGU } DATE INSPECTOR Town Hall Annex Town of Southold 54375 Main Road 1 `; Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 .zz. SCTM# e --,3— e43 Date -;1 41.02 S Owner Phone Address Visible Hamlet Inspector Floor Level Quantities Sub 1 2 3 Smoke Detectors (not located in bedrooms) Carbon Monoxide Detectors Fire Extinguishers Exits Bedrooms 1 , 2 > 3/ 4 5 6 Smoke Detectors I Egress Occupant Count Building Systems Maintained &Operational Condition of Property Heating Building interior Hot water Building exterior Electrical Property clean, maintained &safe 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 Pool fence to code requirements CO's for all items present I Prior Rental Comments: i TOWN OF SOUTHOLD PROPERTY RECORD OWNER STREET n rl n VILLAGE DIST. SUB. LOTLLq f i ACR. Z REMARKS _z `! `, _ N�iGI�►�! TYPE OF BLD. PROP. CLASS jt / a _ e f DATE LAND IMP, TOTAL A g c� O J3 F 0 /Z FAG' 124�� - 5Ij� Isle a rZ-<"a i FRONTAGE ON WATER TILLABLE FRONTAGE ON ROAD 1(VgODLAND I DEPTH MEADOWLAND BULKHEAD HOUSE/LOT TOTAL I i COLOR 66 —ttl I 3 ti TRIM I ' L 120.-3-8.15 3/10 ®� I Bldg- _ gay 1 Foundation ce Bath Dinette FULL Extension t / Basement CRAWL L , Floors Kit, f:, Extension / �. � z Ext. Walls Interior Finish L.R Extension Fire Place 0 Heat a� D.R. u/ rPatio Woodstove gR. Qm .So 3 Dormer F-+�►--E1- l a Deck , /Z xZ o = Z y o Z S /Q Attic Breezeway Rooms 1st Floor Garage Z 3 = y663 /ss' 6oy Driveway Rooms 2nd Floor I s .y L 00 e� TOWN OF SOUTHOLD PROPERTY RECORD OWNER STREET VILLAGE DIST. SUB LOT - ACR. REMARKS TYPE OF BLD. ti ALi , I i /Jo;, PROP. CLASS Y� LAND IMP, TOTAL DATE ` _ =3 d f J 7 } f 199 S z I I s — i t FRONTAGE ON WATER TILLABLE FRONTAGE ON ROAD WOODLAND ? MEADOWLAND DEPTH _ t e BULKHEAD HOUSE/LOT TOTAL ti ] �I COLOR a - ,_ t TRIM s _ L 120:3-8.15 3/10 I 5 Bldg, �y _ qrn Foundation C B PE Bath Z Dinette FULLExtension �� Basement CRAWL Floors Kit. '78$ � Sb'!I sLAe �+ lExtension � Ext_ Walls �� Interior Finish L.R, Extension Fire Place U0 Heat D.R. Patio Woodstove BR. P foS So S3 Dormer s}-fir lir.v Decke, /1 XZ o = Z y .Z S n D Attic Breezeway Rooms 1st Floor Garage Z le 3 = _ laS— 60� Driveway Rooms 2nd Floor s Z00 I.LVS FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-25638 Date: 04/10/98 THIS CERTIFIES that the building NEW DWELLING Location of Property: 270 HARVEST LA MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 120 Block 3 Lot 8.15 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated TOBER 23 1997 pursuant to which Building Permit No. 24537-Z dated DECEMBER 5, 1997 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 ONE FAMILY DWELLING WITH ATTACHED 2 CAR GARAGE AND FRONT .PORCH AS APPLIED FOR. The certificate is issued to SCHEMBRI HOMES, INC. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-97-0148 04/08/98 ELECTRICAL CERTIFICATE NO. 19896� 02/11/98 PLUMBERS CERTIFICATION DATED 04/09/98 G.A.H. PLUMBING ilding Inspector 4��7 Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-26475 Date: 05/24/99 THIS CERTIFIES that the building ADDITION Location of Property: 270 HARVEST LA MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 120 Block 3 Lot 8.15 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 2, 1999 pursuant to which Building Permit No. 25632-Z dated MARCH 22 1999 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 DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to EUGENE R & RUTH SCH NN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A —//Bu ding Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33904 Date: 08/18/0 THIS CERTIFIES that the building ACCESSORY SHED Location of Property: _ m w„ 270 HARVEST LA MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473B89 Section 120 Block 3 Lot 8.15 Subdivision Filed Map No_ _ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 17 2009 pursuant to which Building Permit No. 3493 - dated aW AUGUST 17, 2009 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 APPLIED FOR. The certificate is issued to EUGENEyR & RUTH SCHUMANN .. �... (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 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