HomeMy WebLinkAbout1000-141.-3-43 � N OF SOUTH0L
Rental Permit
Uc
1270
Owner: Chris Scholtz
Occupied as: Single Family Dwelling
Located at: 11850 Sound Ave Mattituck 141.-3-43
Maximum Permitted Occupancy: 5
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: 03/12/2025
Expiration: 03/12/2027 Cod Eno en ca
lU
This Notice must be posted by the main entrance at all times
TOWN OF SOUTHOLD—BUILDING DEPARTMENT F E B 1 1 202
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Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone(631) 765-1802 Fax(631) 765-9502 jfts:Hwww south.gl ,t�Ywnp gqy
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RENTAL PERMIT APPLICATION r� I o�13Z�
300°=
Rental Permit Fee $300 (Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address: .
19-0 S 0 v a4 kjtA V-0_�
Tax Map Number: 1000 SECTION -BLOCK 0 -LOT
-
SECTION B.
OWNER INFORMATION: L
Property Owner Name: 0 �
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
?> s-4 N V Owe �o
A ,
Telephone Number(s): Daytime Evening Emergency.3j--'�)-C q—jY23
Property Owner Email Address: -�C o h a 0, to PA
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, 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: U niT
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:K ):�LQ2
3 Ix10 �Dk \, G �sx3)
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
0 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)
11 -SA 0 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 (S) business days s to any change to the information
regarding Authorized Agent, Managing Agent,or Site Manager.
Property Owner's Name: l�� ��� S �� 0 2—
Property Owner's Signature:
Sworn to before me this S-day of
Official Not Public Signature and Original Notary Stamp
NANCY LIEBERMAN
Notary Public, State of New York
Qualified in SulToLk Coun
Term expiresNovember 5,2 a
Page 4 of 4 No.01 LI6271515
TOWN OF SOUTHOLD BUILDING DEPT.
cou 631-765-1602
limziPECTION
[ ] 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 [ �ENTAL
REMARKS: /22440ye, of�o(� � k07�'{0
DlL �2 Jt- �� OC�v •
DATE INSPECTOR
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� Town Hall Annex
Zoe-
Town Of Southold 54375 Main Road
Rental Inspection Report PO Box 1179
Southold, NY 11971-1179
Tel: 631-765-1802
SCTM# - 3- Date
Owner L o/f Phone
Address O O✓ Visible
Hamlet � Inspector
Floor Level Quantities Sub 1 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 v2
Building Systems Maintained &Operational Condition of Property
Heating Building interior
Hot water Building exterior
Electrical --lProperty 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 Prior Rental
Comments:
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TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER BEET VILLAGE DIST_ SUB. LOT
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FORMEP, OWNER N E ACR.
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TYPE OF BUILDING
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SEAS. VL FARM comm. co. MICS, Mkt. Value
LAND IMP. TOTAL DATE REMARKS
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AGE
BUILDING CONDITION
NEW NORMAL BELOW ABOVE
FARM Acre Value Per Value
Acre
Tillable FRONTAGE ON WATER
Woodland FRONTAGE ON ROAD
M&odowkmd DEPTH
BULKHEAD
House Plot
Tatar DOCK
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COLOR _ M�� � �' TI'�144
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Extension
Foundation :Bath L ir,2ite
Porch :Bosement Floors
Parch Ext. Walls Interior Finish LF<_
Breezeway Fire Place Hcot �. l n.
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Garage Type Roat� [?-orrs ist Floor GF;.
Patio Recreation Room Rooms 2nd Floor FiN. B
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PRE, EXISITNG
CERTIFICATE OF OCCUPANCY
No: 45464 Date: 8/19/2024
THIS CERTWMS that the stracture(s)located at: 11850 Sound Ave,Mattituck
SCTM#: 473889 Sec/Block/Lot: 141:3-43
Subdivision: Filed Map No. Lot No.
conforms substantially to the requirements for a built prior to
APRIL 9,1957 panuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 45464
dated 8/19/2024 was issued and conforms to all the requriements of the applicable provisions of the law.
The occupancy for which this certificate is issued is:
The certificate is issued to Funn,Alice
(OWKU)
of the aforesaid building.
SUFFOLK COUNTY DEPARTWNT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
A
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
LOCATION: 11950 Sound Ave,Mattituck
SUFF.CO.TAX MAP NO.: 141A-43 SUBDIVISION:
NAME OF OWNER(S): Funs,Alice
OCCUPANCY:
ADMITTED BY:
SOURCE OF REQUEST: Flinn,Alice DATE: 8/19/2024
#STORIES: 2 #EXITS: 2
FOUNDATION: brick&block CELLAR: full CRAWL SPACE:
BATHROOM(S): 1 TOILET ROOM(S): I UTILITY ROOM(S):
PORCH TYPE: coves&enclosed DECK TYPE: PATIO TYPE:
BREEZEWAY: FIREPLACE: closed up GARAGE:
DOMESTIC H A TYPE BEATER: baseboard radiators AIR CONDITIONING:
TYPE HEAT: oil WARM AIR: HOT WATER: oil 1lunace
#BEDROOMS:3 #KITCHENS: I BASEMENT TYPE:
OTHER:
GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST*
SWIMMING POOL: GUEST,TYPE OF CONST:
OTHER:
VIOLATIONS:
REMARKS:
INSPECTED BY: NANCYD DATE OF INSPECTION: 8/12R024
TIME START: END:
Town of Southold
P.O. Box 1179
33095 Main Rd
Southold,New York 11971
CETFICATE OF OCCUPANCY
No: 45828 Date: 12/13/2024
THIS CERTTF'TES that the building SINGLE FAMILY DWELLING-ALTERATION
Location of Property: I I IN agod Ave
Sec/Block/Lot: 141 -3-4
Conforms substantially to the Application for Building Permit heretofore,filed in this office dated: 10/01/2024
Pursuant to which Building Permit No.51409 and dated: 11/21/2024
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:
replacement boiler and windows in-kind to existing single-family dwelling as applied for.
The certificate is issued to: Alice Funn
Of the aforesaid building;.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL:
ELECTRICAL CERTIFICATE: 51409 12/06/2024
PLUMBERS CERTIFICATION:
AutfiorbW Si tttt't: