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Home My WebLink About1000-143.-4-28 of so TOWN OF S UTH LD Rental Permit O # � 1262 Owner: 1005 Bay Avenue LLC c/o Kristin Schultz Occupied as: Single Family Dwelling Located at: 1005 Bay Ave Mattituck 143.4-28 Maximum Permitted Occupancy: 4 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: 02/27/2025 Expiration: 02/27/2027 �6�cEinforce entofficial This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax(631) 765-9502 ht:t a if ww sogtholdtownn .Ya°��v RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed eve OFT) 0 l3-aS F E 8 1 2 2025 Section A. �-C BuildiProperty Information: ,n Of� Southold Rental Property Address: 1005 Bay Avenue Mattituck NY 11952 Tax Map Number: 1000 SECTION _J43 _ - _-BLOCK 04 -LOT U,$ - SECTION B. OWNER INFORMATION: Property Owner Name: a t. Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 485 West Mill Road AKHOLMIJILRQal Matfituck,NY 11952Mattituck,NY 11952 Telephone Number (s): Daytime 6 1,252,4505 Evening 631,252,4505 Emergency 631.252.4505 Property Owner Email Address: Ma cam 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 Evening N/A Emergency N/A Email Address: N 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, 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: T Requested Maximum number of persons allowed to occupy Dwelling Unit: 4 Number of rooms in Rental Dwelling Unit: 7 Rooms Use and Dimensions of each room in Rental Dwelling Unit: Bedro m #1 - 9'x '6 Bedroom#2 -J.21x9'6 Bathroom- 5' "W5" Living Roam -21'4"x13'6"• Kitchen - 14'7"x13'10"• Laundry Room- 8'9"x9'2" Fr nt Porch - 6'611x23'4" 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. R 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) Kristin Schultz,Managing Member of 1 1005 Bay Avenue,LIXcertify 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, Mana=naging or Site Manager. Property Owner's Name: �.risti. Member Property Owner's Signature- 11 / Sworn to before me this�2'� day of F-t, n kn4 , 20 Official N a Puublic Si natu r"nd Original Notary Stamp iFFANY J ` , . err vv Notary Public-Slate of l levq York Igo.01 PE6:?r'.1112 udifieJ in Su4ol County { Ply Commission Expires 0 6/1 71'20 2 5 f Page 4 of 4 Town Hall Annex � Town of Southold 54375 Main Road Rental Inspection Report PO Box 1179 � C4 � 4 a Southold, NY 11971-1179 � Tel: 631-765-1802 SUM# - _ Date C7 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 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 presentI 1Prior Rental Comments: t QU* TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 I NA04h� t' EqChkTION [ ] 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 (FINAL.) [ ] CODE VIOLATION [ ] PRE C/O [ eF ENTAL REMARKS: � w. ��r�� e DATE o�� o� INSPECTOR �.....,...._.. ...........�,.. ,,, ,,._... ..,,� ,...,u.,d ....... ....... -------------. ....... ., ...............,,._....,....,. .,.................., ... ..,.. ..,,. ........ ........, 7 I'.r,1. . �AI 1 13 I"v Wla lif f� aO f, 'r0 � X2,�a151a6�V6v"'d�1�J�?�F1 �„J, xu 9 ....-.,.,..�. I' :„�' 1 (Sf'E PIIMS txJ 1�mm S 9' .,..... .....nor ,. ..� ' N as BATH 2 > ROOM LIM y_..a�.�,,,. .. 2. Axru� 6i 1) , 1 r !c � m r` uaa 2' .. ........._,. .................„ „-_.�_„-.�.�.� LIVING ROOM k�,A rn w„ .w._.. ...... ...... ..,...,,..... e .. N C MA . ,,,...,..'....� ... ._..r ..2,....,, JG. .3 . ...,_ . EXISTING FLOOR,PLAN SCTM#1000-143-4-28 ISSUE/REVISION pAT 1 FOR PERMIT 01117;25 SIZE' YI'f _ 3 1 �..,,.....w...-M, :.�.. m ,Ww 29 ......_._LE HUNG�.. G .. �rwv+na car: L)OIJt39_j=.�.�.�HUN ... .xt" ®® < HUNG ona� DOUBLE H.0 1a-=r-r ."............. E rrarJ.., 1005 BAY AVENUE A�A MATTITUCK,NY 11952 Fi 1 IV Al t-7/ TOWN OF SOUTHOLD PROPERTY %.lvkRD p OWNER STREET ,_ VILLAGE DISTRICT SUB. LOT t Jf FORCER OWNER I N E - - REA E --. E �� - S W TYPE OF BUILDING _ I � o RES. SEAS. VL I FARM COMM. IND. CB. MISC. Est. Mkt. Value LAND IMP. TOTAL DATE REMARKS - I I Ri f 1, 101, t AGE BUILDING CONDITION R NEW NORMAL BELOW ABOVE FRONTAGE O WATER Farm Acre Value Per Acre Value FRONTAGE ON ROAD (�% f Tillable 1 ( BULKHEAD -- e Tillable 2 DOCK Tillable 3 Woodland Swampland i Brushland s House Plot I f Total l E ti i ° ti � r G E _ f s M. Bldg. _ - a2 J D Foundation Bath Extension Basement Floors Extension Ext. Walls Interior Finish Fire Place Extension e�C�(t - mv9 �� Heat a, _ q Porch � �_ Roof Type 1,5 , � da - e= - — o_ Porch Rooms 1st Floor Breezeway f f Patio Rooms 2nd Floor Garage Driveway Dormer D. B. b 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- 25972 Date: 09/15/98 THIS CERTIFIES that the building DWELLING Location of Property 1005 BAY AVE MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 143 Block 0004 Lot 028 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 OCCUPANCY NUMBER Z- 25972 dated SEPTEMBER 15 1998 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 ACCESSORY NON-CONFORMING GUEST COTTAGE The certificate is issued to CARL R HOLFELDER & ORS. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A. PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. Bui ng Inspe or Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD LOCATION: AVE SUBDIVISION: MAP NO.: LOT (S) NAME OF OWNER (S) : w OCCUPANCY: SINGLE FAMILY DWELLING ADMITTED BY: FRANK MURPHY ACCOMPANIED BY: SAME KEY AVAILABLE: SUFF. CO. TAX MAP NO.: a43.-4— Mwv., SOURCE OF REQUEST: $ DATE: 09/15/98 DWELLING: TYPE OF CONSTRUCTION: W,(QR FRAME # STORIES: 1.0 # EXITS: _,Z POUNDATION: ___JIL= „ CELLAR: 25% CRAWL SPACE: 75% TOTAL ROOMS: 1ST FLR. : 2ND FLR.: 3RD FLR.: 0 BATHROOM(S) : 0.0 TOILET ROOM(S) : 0.0 UTILITY ROOM(S) : PORCH TYPE: ZE * DECK TYPE: PATIO TYPE: BREEZEWAY: FIREPLACE: GARAGE: DOMESTIC HOTWATER: YES TYPE HEATER: -OIL AIRCONDITIONING: _ Q TYPE HEAT: JUJ�_ WARM AIR: HOTWATER: OTHER: I *QQ, ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST.: STORAGE, TYPE CONST.: SWIMMING POOL: GUEST, TYPE CONST.: _Q OTHER: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE .M r ......,.....k.__.. 9 1 .w l P *2 ROOMS, 1 FULL BATH, NO HEAT & SMALL KITCHEN. g ALSO ELECTRIC HOT WATER HEATER. SEASONAL �' M OCCUPANCY. n ro ya qtlq 1 M 1 1 � � 1 p� yNy pp gY I MMg f i 8 y� X pq u REMARKS: INSPECTED BY: DATE ON INSPECTION: 09/15/98 TIME START: 10:20 END: 11:00