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Home My WebLink About1000-141.-3-39 TOW N OF S UTH L Rental Permit - 1285 Owner: 12425 Sound LLC Occupied as: Single Family Dwelling Located at: 12425 Sound Ave Mattituck 141.-3-39 Maximum Permitted Occupancy: 7 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: 04/02/2025 ✓ Expiration: 04/02/2027 Uodeo e t official This Notice must be posted by the main entrapoata tim �� i4tl N(k„Ir N TOWN OF SOUTHOLD—BUILDING DEPARTMENT ,R MAR 2 7 2025 ^ � Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971�00'0'1 Telephone(631)765-1802 Fax(631) 765-9502 lita // wwsKaltcali[ov,I�acl everz RENTAL PERMIT APPLICATION t, Rental Permit Fee $300(Application trust be renewed every two years) Section A. Property Information: Rental Property Address: 12425 Old Sound Avenue, Mattituck Tax Map Number: 1000SECTION 141.00 -BLOCK 03.00 -LOT 039-000 SECTION B. OWNER INFORMATION: Property Owner Name: 12425 Sound LLC Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 745 Love Lane PO Box 645 Mattituck, NY 11952 Mattituck, NY 11952 Telephone Number(s): Daytime 631-774-0918 Evening same Emergency same Property Owner Email Address: dkolb(@koibme.chanical.com Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: MARTIN D. FINNEGAN, ESQ. Address of Authorized Agent (no P.O. Boxes):13250 Main Road, Mattituck, NY 11952 Mailing Address of Authorized Agent: P.O. Box 1452, Mattituck, NY 11952 Telephone Number(s): Daytime 631- 15-6070 Evening Emergency, Email Address: mfinnegan@northfork.law Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: Jose Alvizures Address of Authorized Agent (no P.O. Boxes): 15805 Main Road, Mattituck, NY 11952 Mailing Address of Authorized Agent: same as above Telephone Number(s): Daytime 631-255-7153 Evening same Emergency same Email Address: noly76@msn.com 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):... Mailing Address of Managing Agent: Telephone Number(s): Daytime Evening Emergency —� Email Address: Page 2 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: Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: 12 Use and Dimensions of each room in Rental Dwelling Unit: 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 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) ANDREW FOHRKOLB, MANAGING MEMBER I OF 12425 SOUND LLC , 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: 12425 SOUND LLC Property Owner's Signature: B N REWIFOHRKOLB, MANAGING MEMBER Sworn to before me this_day of MARCH , 2025 ti Official Notary Public Signature and Original Notary Stamp ANNALISE OUELLETTE NOTARY PUBLIC-STATE OF NEW YORK No.01 OU6409457 Qualified in Suffolk County My Commission Expires 09-28-2028 Page 4 of 4 Ave,so 0 A TOWN4F S6& OLD BUILDING DEPT. 631-765-1802 r 39 1 NSPECT 100" N [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND j ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE ETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL ( INAL) [ ] CODE VIOLATION [ ] PRE C/O ] RENTAL YU DATE INSPECTOR March 26, 2025 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 1 1971-0959 ,w�.z° . BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a license architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Ero essianal seal required tor Architect or Engineer, licensed dame iris ectar roust grovIde gqpy of valid current certi cation Rental PropertySCTM Number: 1000- I41•00-03.00- 0361•0DO Rental Property Address: 12425 Old Sound Ave. Mattituck NY 11952 Owner/Name: 12425 Sound LLC Rental Dwelling Unit Identifier: Number& Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom #1 -100 sq., Bedroom#2-90 sq., etc.) Bedroom #1 140 S ft Bedroom #3 140 s ft " Bedroom #2 155. agft 1 Qed r Property Description (Include all improvements indicated on survey) I certify that I have done a physical inspection of the subject rental dwelling unit and find that it fully complies with all the provisions of the Code of the Town of Southold,the Residential Code of New York State,the Building Code of New York State, the Plumbing Code of New York State, the Fuel Gas Code of New York State, and the Energy Conservation Construction Code of New York State. Victor Cornelius III CEO Inspector Print Name and Title ceo# 1216-0283 Original Signature Please place professional seal: ,1 TOWN OF SOUTHOLD PROPERTY RL _ OWNER a STREET �� VILLt,GE DISTRICT SUB. LOT —�.1 7__ > (11 T E 1 1 UGI� FORMER OWNER N E ACREAGE 5D _ S W. TYPE OF BUILDING aC- R1=S. �� ; SEAS. VLr FARM COMM. IND. CB. MISC. Est. Mkt. Value LAND IMP. TOTAL DATE REMARKS E r- y � � r` / � G � �V � 5�� f//�rr'� `�• f� ,'J,.ffl �41"Y/�/7 a7� �YY '... �J.s 1 917 9 Ccnyo G ,,- L L6'_ AGE BUILDING CONDITION —NEW NORMAL � BELOW ABOVE FRONTAGE ON WATER Farm Acre I Value Per Acre Value FRONTAGE ON ROAD 7- Tillable 1 BULKHEAD Tillable 2 E Tillable 3 ?_1IDIQ4 Ll � a Woodland _ ' <DaD I Swampland Brushland House Plot I Total lie -' 4 F ; r M. Bldg. k, �. G .� 2 Foundation �Jj � Both Extension _ �J ¢� Easement 1/ Floors j X r - !/ �' tom- ' i � w Extension 3 _, Ext. Walls Interior Finish Extension Fire Place Meat r?✓ J Porch Roof Type _ a _ 7 - r 3 = ` "� ' Porch Rooms 1 st Floor Breezeway Patio I Rooms 2nd Floor Garages s Driveway Dormer — --- — --- — Q. B. i . ffi L' Y � FORM No. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 5-23859 Date SEPTMMR 79 1995 THIS CERTIFIES that the building ACCESSORX Location of Property 12425 SOUND AVENUE MATTITUCX NY House No. Street Hamlet County Tax Map No. 1000 Section 141 Block 3 Lot 39 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 1.5 1995 pursuant to which Building Permit No. 22979-Z dated AUGUST 30 1995 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 AN "AS BUILT" ACCESSORY SHED in R!L& IRED REAR Y Off" A ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to SHAWN LATSON (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 w TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TO1WN HALL SOUTIOLD, NEW Y ORK CERTIFICATE OF OCCUPANCY NONCONFORl2ING PRE1\1ISES THIS IS TO CERTIFY that the / Land Pre C.O. #- Z14851 / Building(s) Date- Sept. 4, 1986 Use(s) located at 12425 SOUND AVENUE MATTITUCK Street Hamlet shown on County tax map as District 1000, Section 141 , Block 03 Lot 39 , doesinot)conform to the present Building Zone Code of the Town of Southold for the following reasons: insufficient total area; insufficient rear 7 side yard set-backs on arcessory qarASC,, On the basis of information presented to the Building Inspector's Office, it has been determined that the above nonconforming %/Land /_/Building(s) / /Use(s) existed on the effective date the present Building Zone Code of the Town of Southold, and may be continued pursuant to and subject to the appli- cable provisions of said Code. IT IS FURTHER CERTIFIED that, based upon information presented to the Building Inspector's Office, the occupancy and use for which this Certifi- cate is issued is as follows: Property contains 2 story, one family, wood framed dwelling; accessory garage; irregular fence on rear property The Certificate is issued to MARIE PARRISH (owner,X3jp"7"XWR*R ** of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERIVR"ITERS CERTIFICATE NO. N/A NOTICE IS HEREBY GIVEN that the owner of the above premises HAS NOT CONSENTED TO AN INSPECTION of the premises by the Building Inspec- tor to determine if the premises comply with all applicable codes and ordin- ances, other than the Building Zone Code, and therefore, no such inspection has been conducted. This Certificate, therefore, does not, and is not intended to certify that the premises comply with all other applicable codes and regula- tions. 1-iui"ldin�, inspector _.. .. �p i u r I� ' r-------------------- r 2*r*4 j\ EXIST FIRST c FLOOR FRAMING r P y TO REMAIN F'EMOlff {�T � s _ . 1 IR6T F1h'F_ - - € _------- Li r777 �Fm m ---- DEN0 TO First floor Exist Scale: As Noted i se-a_--am-a---A�-=-saa------A F e-ee- -sa_as-e-m- e-_a--am-� F t , LI _ t ------------------ REMOVE EXIST t SEGONP FLOOR ; t -- ---=sa---a-__ FRAMINC7 �- -_fa¢ ga-a-S$9_a__�C��m® ' EXIST SEGl,NP t TO REMAJN IXmas- ---- - ----___-F__ams--- it ae ��=�a _�_.�a _p--saaa-- ma aR 1t' PEneO ,ST TO IN m= - Second Floor- Exist n - 01 a p. e: As Noted APPLICANVOWNER TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of Interest on the part of town officers and employees.The purnoseo this form is to pr!Lvide information which can alert the town of possible conflicts of interest and,allow it,to take whatever action is necessary to avoid same. YOUR NAME : ANDREW FOHRKOLB, MANAGING MEMBER OF 12425 SOUND LLC (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) TYPE OF APPLICATION: (Check all that apply) Tax grievance Building Permit Variance Trustee Permit Change of Zone Coastal Erosion Approval of Plat Mooring Other(activity) RENTAL PERMIT APPLICATION Planning Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold?"Relationship"includes by blood,marriage,or business interest."Business interest"means a business,including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5% of the shares. YES NO X If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee. Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply) A)the owner of greater that 5%of the shares of the corporate stock of the applicant(when the applicant is a corporation) B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation) Q an officer,director,partner,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitted thi, 45-111*-day of MARCH 7 12025 Signature '4�� 124 5 SOUND LLC Print Name BY:ANDREW FOHRKOLB,MANAGING MEMBER Building Department ApplicatiOn AUTHORIZATION (Where the Applicant is not the Owner) ANDREW FOHRKOLB, MANAGING MEMBER OF 12425 SOUND LLC residing at 745 LOVE LANE, MATTITUCK, (Print property owner's name) (Mailing Address) NY 11952 do hereby authorize MARTIN D. FINNEGAN (Agent) & FINNEGAN LAW, P.C. wwm to apply on my behalf to the Southold Building Department. 3/ i0f; /2025 (Owner's Signature) (Date) 12425 SOUND LLC BY: ANDREW FOHRKOLB, MANAGING MEMBER ............... (Print Owner's Name) G',T M, JV(,). [JI`,bTpd1C;T: 7000 SECTION: 747 (LOCK: „a Ll,JT(5):39 YrK�KII aE >~ I rl r g9.31 LAND N/F OF NNq.�3m00 .rnm„sK`i4 Terre , ',3 b w f INDEFE'JV�N E Ni GROUP HOME „rr m 7rj , NG FkIJCF°AM NO KEY MAP n 11 MAI TIIUCK, N.Y, w r w z'w G �3 a �r^ 1 , V / H.L. � ,.✓ 29, •�a m W IAND N/E OFtia NI j\\S GICUfPGE L PENNY INC' 77 m, ' rrwa a ,"ar ,sr b rrae��c1 .Y„NJ LANE) N/r=of „raA . SMP CAPITAL I..LC A N, ..'� 16 wr.. a r arrru�, O /7.30 W i 3/"6 60 Taus s17*0 6' f p r ri l.Of,F:Of o j�(5 �Av�ue,� Df FIE WATFP SUPPLY, WELLS, DRYWEI_LS AND CF::S,SPOOL FEMA MAP#.:161 f)!U34811-i ZONE X LOCAAND IO S SHOWN HO rnw ARE FRO tirFE DF .S ORSFRVA77ON FRs ANI A:19,2°r4.49 ' (O.FT. or 0,44 ACNES ELEVATION DATUM NAV�y3 UNAUTHORIZED AI TERATION OR ADDITION 70 THIS .SURVEY IS A IAOI..ATION OF SECTION 7209 OF THE NEW YORK STATE FOUCAPON LAW COPIES Or /HIS SURVEY MAP NOT REARING THE LAND !SURVEYOR'S EMHOSSFD .SEAL SHALL NDI BE CONSIDERED TO BE A VALID TRUF COPY GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY 1S F'REPAREC)ANC) ON HIS BEHALF TO THE TITGF COMPANY, GOVERNMfCNTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TIC„) THE ASSIGN[FS OF THE LENDING INSTITUTION, GUARANTIES ARE NOT TRANSFERAIN E. THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM "'I-// PROP(':RIY ONES TO THE S1"RUCTUkE.S ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARP. NOT INTENDED TO MONUMENT THE PROF'FRTY'LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EA'SEMENLS AND/OR SUBSURFACE STRUC"3URF5 RECORDED OR UNRECORDED ARL NOI GUARANTEED UNLI ,i'PHY,':GICALI.Y EVIDENT ON TH! 1 RY M15F:`.;AT THE TIME OF SURVEY E)FVEY OF: DESCRIBED PROPERTY CERTIFIED TO: "12425 SOUND LLC; __ . MAP' OF: FIDELI FY NATIONAL [III E IN URAN(E COMPANY, -- PILED: ]F]L JUDICIAL TILE INSlJIRANCE_AGEN,CY LL(__,,,..,_ ............ ........... SITUATED Al`.MATTITUCI< _,. ---- ....... _. TOWN OF:SOUTHOI..J;) KENNETH M"_WQY( YI,IIIJK LAND SURVENG YLLC , SUFFOL_K COUNTY, NEW YORK Professional Land Surveying and Design P.O. 13.Y 153 Aquebogue, New York 11.931 FILE #2),O-18 SCAI r---1"=30' DATE JAN, .30, 2020 ------ - PHONE (631)138 L5eu FAX (631) „» 15B8 N Y,S LI.SC NO 0.50882 ,mt.in.ng the, —ras <,r Robert J. ll---y r& K,—,,tn M. w„ya,Ulr