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Home My WebLink About1000-113.-8-11 TOWN OF SOUTHOLD Rental Permit 1289 Owner: Half Acre Wood 215 LLC Occupied as: Single Family Dwelling Located at: 215 Meday Ave Mattituck 111-8-11 Maximum Permitted Occupancy: 8 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 / ito'." Expiration: 04/10/2027 Code Enf4emerkyfficiall This Notice must be posted by the main entrance at all times E C E u V E 200 TOWN OF SOUTHOLD—BUILDING DEPARTIE'S } _ Town Hail Annex 54375 Main Road P. O. Box 1179 Southold,NY 119 044 Departmant Town of Southold Telephone (631) 765-1802 Fax (631) 765-9502 l� to�:3'.111`. XV' s�u�l -1ld(Avlin €V �`�`�G�j,,,r i`,nJ„�GJ� Va RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION /1 -BLOCK 0 9" -LOT SECTION B. OWNER INFORMATION: Property Owner Name: �cc,( tic m- cpo d �. Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 19j)q& dries bdioar Rives Pwolr 4 A�itle 63� ° 46t 2Sff9-�7 Telephone Number(s): Daytime Evening Emergency Property Owner Email Address: k -` C, dJ e Page 1 of 4 Section C. Authorized Agent Infor ation: Name of Authorized, ent 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. Managing Ag/Inoration: Name of Autho of dwelling unit, if any: Address of Autnt(no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening Emergency Email Address: SECTION E. tA 1, SITE MANAGER IN MATION: (required for rental properties containing 8 or more rental units) Name of Mana g Agent of dwelling unit, if any: Address of anaging 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: 2 ELI- For each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier(f&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: Oh 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: 0 ! 16 4 l0 Ft � r g • n 1 LF/� SECTION G. INSPECTION: L— R, 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 N ORK) COUNTY OF SJ1FF151K) T i �� d-'! ( 1 01- n A)c) 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: s' Y Property Owner's Signature; r Sworn to before me this-26 T—Aday of u , 2025 NA E CLARK -- E�,M ic-State of Floridaon#HH 35853bxpires Peo 5,2027ational Notary Assn. Official Notary Public Signature and Original Notary Stamp Page 4 of 4 Town Hall Annex - Telephone(631)765-1802 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959 Sk _" BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: h t� i L a�-►�� h cue Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: T' Use and Dimension of ead room: Rental Dwelling Unit Identifier: u/1 t-t- t Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: S� -Ft kifr-Wr4 '( 13 I' Rental Dwelling Unit Identifier: T Ong= Crnh � Requested maximum number of persons allowed to occupy each dwelling uni : Number of Rooms in Rental Dwelling Unit: U e and Dimension of each roo -41 Ft- �. 1I Ft- f ` ' 4F so TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 //-?;- 8 - // INSPECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINA - [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: �hS�C- horl MOA0X4_ O/il pond 0q2 I A � o'l' 1111. 62- h ed 2va xn . GZ.CC255 7�)e,(A A,,l 0100 ho w o� ha8 s /s An DATE �3-/42-aS— INSPECTOR Town Hall Annex vev � Town of Southold 54375 Main Road t Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 SCTM# Date Owner W Phone Address /2 Visible Hamlet Onspector 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 lHandrails&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: � — wl — 4 � r 16 11 � LOdR!�g low J ," � y✓fF myry / fly ... .,.n... ....... .... �3 h ryry f I, R,7 y OEMffi 1 �i 113:8-11 4109 I M. Bldg. Foundation Bath °� �Y Dinette jr Extension 3 0'3$ Basement Floors K �, ," � _.... _._ Fasten " _ Z� (p� Ext. Walls Interior Finish .G LR. 2 27 5i I — - 2.00 e� Fire Place �itip Heat :: DR. .. _. » f ,-...• Type Roof „ ,� o,d ,,,. Rooms 1st Floor L� BR. Recreation Room Poici' Rooms 2nd Floor FIN. B, I SPoT 7 o Dormer Breezeway Driveway " 'Per Plates�pwo 9 z 2 C7 F 0. B. 09 324 ,p Total 1 r UTHOL PROPERTY�OPERTY` RED r TOWN O� SO .._ O_�._.. WNER STREET VILLAGE DIST. bub. 77 , ,dw�''"w��W ' •FIn,.�� ,�„��7"N�w� ,.,..„ gh, / i��...F � � ��t � �/4 !F �i � f;: �f �� ✓ �� ,0/✓ali /"l� � k� y FORMER OWNER E ACR S W TYPE OF BUILDING _ ._._ SEAS. VL..........W... .FARM._. �.._....w w COMM...._..CB. MISC. ._... Mkt. Va..�. DES f „r lue LAND IMP. TOTAL _—DATE REMARKS G 9p Q -,'a a �E 3(od D BU DING NDITIm o�� R � „ : �/ Gam,.N � �i � �.,� a'�el d 1 'r °�P" i,� `�"c.•kr;,�r �,r "� 1. ...��''' ,.,.�...,s� =r� ,. -�'%., µ NEW r R AL OW B , �� _.! a• _• _ __w_.. FARM Acre Value Per Tillable i � Tillable 2 mm ww_33 36 (k"JAi,.,l(piµ.,'� ' '&',1 Tillable 3 Woodland ' Swampland FRONTAGE ON WATER B rush I....�.M.�.... and FRONTAGE ON ROAD House Plot DEPTH BULKHEAD �_._....w�...._..__. _ _.......... ._.... Total DOCK V a �o hg C fi J ,�: �` �: ��o\�� \\ ��. ��; , �� _�„` Q fi ti �s _- � � - �-_� �_ \��,. �� \ \\ :: �� \��,. `\\ \,, \ \ �, �� o „��„ i� �. p ry �r ti 7