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Home My WebLink About1000-123.-5-27 of so TOWN OF S UTH LD mac' Rental Permit 1288 Owner: Eugene Bozzo , Georgene Bozzo Occupied as: Single Family Dwelling Located at: 4135 Camp Mineola Rd Mattituck 123.-5-27 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: 04/10/2025 Expiration: 04/10/2027 cod Eo tentoffici This Notice must be posted by the main entrance at all times rea't'd,een 1 1/ Ck319- 43M asp TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 1197P,0"9 �r, , 66 t U Telephone (631) 765-1802 Fax(631) 765-9502 FES 2 4 202,E RENTAL PERMIT APPLICATION Rental Permit Fee $300(Application must be renewed every two years) Section A. Property Information: Rental Property Address: °z Tax Map Number: 1000 SECTION / Z,5 -BLOCK -LOT 2-7 - SECTION B. OWNER INFORMATION: /7 Property Owner Name: C9 Pv/i (A/ ze, zz 0 Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) s Le L Telephone Number(s): Daytime Y Evening Emergency Property Owner Email Address: e .3 IY-sti e Page 1 of 4 u SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFOLK) I4 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: CC),e_0 v' ' "i�� - � �� -. � Property Owner's Signature: Sworn to before me this_day of S 20 c� M� Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of Neva York No,0 1SU618 ill 0 Qualified In Suffolk County oMrnission ExPires April 14, Page 4 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: t�' � 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 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- Use and Dimensions of each room in Rental Dwelling Unit: "' /' ' e o a 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 -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. Cif I am requesting a fire safety inspection to be performed by a Code Enforcement Official `iro.,i LiIC fi,7wvi 0, aoui� 5jj ❑ 1 am submitting a completed Town of Southold certification form from a licensed architect or a licensed professional engineer. Page 3 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent (no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening Emergency Email Address: Section D. "V Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent (no P.O. Boxes):, Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening Emergency Email Address: SECTION E. N/a SITE MANAGER INFORMATION:(required for rental properties containing 8 or more rental units) Name of Managing Agent of dwelling unit, if any: 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 - '` TOWN OF SOUTHOLD BUILDING DEPT. 31-765-1802 � INSPECTION [ ] 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 [!,] -RfENTAL REMARKS: 9A, to leo e DATE 5 INSPECTOR Town Hall Annex Town Of Southold 54375 Main Road a Rental Inspection Report PO Box 1179 r"t Southold, NY 11971-1179 Tel: 631-765-1802 SCTM # a - s_ Date --5- Owner Phone Address ( Visible Hamlet /K 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 present 113rior Rental Comments: TOWN OF SOUTHOLD PROPERTY R COR& wwwaso OWNER STREETLIJ VILLAGE DIST.� -SCT13—.-- LOT ;f FORMER OWNER ( N E ACR. - . - _ TYPE OF BUILDING W RES. SEAS. VL. FARM COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS i = _o- a e z _ r A�-E �", ,�, n BSJLLf�IN�-CONDITION NEW � AL 2 _. FARM Acre I Value Per Value Acre �� t • F _ n Tillable I Tillable 2 iI � R v Tillable 3 teii � Woodland i Swampland FRONTAGE ON WATER ) =F i Brushland FRONTAGE ON ROAD i House Plot ' DEPTH - f BULKHEAD - 3 Total � 5 � i ! DOCK 1 i L-n f GGLGR ' — t TRIM 6T 2 j , i 123.-5-27 3/2014 I r s 2 3 3 07M Bldg Y a �!f Foundation Bath Dinette -� 3 q Wiens� �' - '73 Basement /�f f k 1 l Floors K _ <- f ^� ` _ Interior Finish f LR. • Walls xer �on � �� ` � �. � ^ - � s'' Ext Its � � Ftensi �� ^1 k — `" �_�,� i �$ =Fire Place i _ D Heat R I a x of ; 3 o a ! Rooms 1st Floor ;Type Roof BR. s ,< I �If 0 e? 0 _ s x 7 Cs — - Recreation Room, / Rooms 2nd Floor' (FIN B_ / i �a v Dormer I Breezeway Driveway I Garage tat o 1 SPuI 9 E Total ! I 51970 PW FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18319 Date AUGUST 29 1989 THIS CERTIFIES that the building—ALTERATION TO ACCESSORY Location of Property 4135 CAMP M'INEOLA RD. MATT'ITUC1 N.Y. House No. Street Hamlet County Tax Map No_ 1000 Section 123 Block Oar tot 27 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed are this office dated AUGUST 26 1986 _______pursuant to which Building Permit No. 15513-Z dated NO ER 19 1986 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued as ALTERATION TO EXISTING ACCESSORY GARAGE AS APPLIED FOR ZBA APPROVAL #3553. The certificate is issued to EUGENE & GEORGENE BOZZO (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL, N/A UNDERWRITERS CERTIFICATE NO. N-081116 - JULY 18 1989 PLUMBERS CERTIFICATION DATED N A Building Inspector Rev. 1 f 81 s FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18320 Date AUGUST 29 1989 THIS CERTIFIES that the building FOUNDATION Location of Property 4135 CAMP MIOLA RD. MATTITUCK4, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 123 Block 05 Lot 27 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 26t 1986pursuant to which Building Permit No. 15514-Z dated NOVEMBER 20 1986 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 NEW FOUNDATION FOR EXISTING ONE FAMILY DWELLING AS APPLIED FOR - ZBA APPROVAL #3553. The certificate is issued to EUGENE & GEORGENE BOZZO (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED NZA lei Ib Bu .din Ireipector Rev. 1/81 w FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town ball Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18321 Date AUGUST 29 1989 THIS CERTIFIES that the building RELOCATION & ALTERATION Location of Property 4135 CAMP MINEOLA RD. MATTITUCK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 123 Block 05 Lot 27 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated. JANUAR'Y 16 1987 __pursuant to which 1 Building Permit'No. 15640-Z dated JANUARY 27. 1987 was issued, andlconforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is RELOCATION & ALTERATION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR - ZBA APPROVAL #3553. The certificate is issued to EUGENE & GEORGENE BOZZO (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-081117 - JULY 18 1989 PLUMBERS CERTIFICATION DATED JUNE St 1989 - M ,TTITUCK PLUMBING & HEATING .01 B lding 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-31749 Date: 08 oO6 THIS CERTIFIES that the building SECOND STORY ADDITION Location of Property: 4135 CAMP MINEOLA RD _w MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 123 Block 5 Lot 27 Subdivision Filed Map No. Lot No_ conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 6, 2004 pursuant to which Building Permit No. 30392-Z dated JUNE 141._.2004 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 2ND STORY ADDITION WITH DECK, & 1ST FLOOR DECK ADDITION OUTDOOR SHOWER ENCLOSURE TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR & AS PER CONDITIONS OF ZBA #5567 DATED 10 7/04 & ZBA #5668 DATED 5/12 05. The certificate is issued to GEORGENE BOZZO (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2926 455 19 06 PLUMBERS CERTIFICATION DATED 06 30 06 MATTI'TUCK PLUMB.& HEATING Zathorized Signature Rev. 1/81 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, NEW YORK CERTIFICATE OF OCCUPANCY NONCONFORMING PREMISES Date: January 9, 1985 THIS IS TO CERTIFY that the Pre C.O. #Z13084 /X1 Land Building(s) Use(s) located at 4135 Camp Mineola Rd. Mattituck Street Hamlet shown on County tax map as District 1000, Section 123 , Block 05 Lot 027 , does�not)conform to the present Building Zone Code of the Town of Southold for the following reasons: Lot is insufficient in width and area--accessory garage and bath facilities are located in the front yard area--dwelling has insuffic- ient rear and side and set backs. On the basis of in-formation presented to the Building Inspector's Office, it has been determined that the above nonconforming /_X/Land 9-)V Building(s) F/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: One family dwelling w/accessory garage and hntb faCility. Premises is located in an A Residential district with FLivate road access from Kraus Rd. The Certificate is issued to PAUL KELLY & JACQUELIME M. KELLY, HIS WIFE (owner, kag-4�XbXYDERNAtOX of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO. N/A NOTICE IS HEREBY GIVEN that the owner of the above premises IIAS 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 othlerpplicable codes and, regula- tions. 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