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HomeMy WebLinkAbout1000-106.-6-3 Aof so 0110"WN OF SOUTH OLD Rental Permit 1363 Owner: North Fork Project LLC Occupied as: Apartment (2nd Fl) Located at: 5775 Mill Rd Mattituck 106.-6-3 Maximum Permitted Occupancy: 6 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: 08/08/2025 ` Expiration: 08/08/2027 c� E meet official This Notice must be posted by the main entra a all times ElVE TOWN OF SOUTHOLD—BUILDING DEPARTME JUL2025 Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone(631) 765-1802 Fax(631)765-95021t :/fN r.,sotittioldtoNyMO Town D,r-;rm-nt d -7 12191V5 Fa,;c) �3pp t- Y•mc- C' l i a to 10 RENTAL PERMIT APPLICATION Rental Permit Fee$300(Application must be renewed every two years) Section A. Property Information: Rental Property Address: ln]c.�5r M a-1, 6'� ✓V11 T�Q��C-�- /v l ►�I S� Tax Map Number: 1000 SECTION 106- ©o :BLOCK 06 - 0 0 -LOT %?°3 _ !2()0 SECTION B. OWNER INFORMATION; Property Owner Name: ✓` 4 TL'V- ?ek5 ZT Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) Iyoz-o oL o s0,61—rn A-✓V- a3 z-0 v"V TTC rz1c,v-- I,Vi -T-U6V- ► c jT fa-- Telephone Number (s): Daytime I-" Evening -k- Emergency Property Owner Email Address: IK d-;NJ67q & L ��- 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: Requested Maximum number of persons allowed to occupy Dwelling Un t: i ��)/ D Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: gep R 00VV-7 3 r yv s &L F-J K -—4u-f S-Z) s r-r- 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. ❑ 1 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) I ag,! � 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: i Property Owner's Signature: tk Sworn to before me this 11 day of ��1 2025 Z26a�afy ; Official Notary Public Signature and Original Notary Stamp ANNALISE OUELLETTE NOTARY PUSLIC-STATE OF NEW YORK No.01 OU6409457 Page 4 of 4 Ouslifiod in Suffolk County My Commission Expires 09-28-2028 Pat T V ICI OF SOUA OLD BUILDIN DEFT. 631-765-1802 INSPECTION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT' PE TRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL ( NAL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL r REMARKS: I _ ...._ DATE INSPE C"TO . .__.._ Town Hall Annexe Telephone(631)765-1802 54375 Main Road " Fax(631)765-9502 P.O. Box 1179 ae Southold, NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a licensed architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Pro ssio + l e u ed Arc to r Licensede I s c r t r ide gogy of yalld ggrrent certification Rental Property SCTM Number: 1000-106.00-06.00-003.000 Rental Property Address: 5775 West Mill Road Mattituck NY, 11952 Owner/Name: NORTH F RK PR Rental Dwelling Unit Identifier: Number& Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 —100 sqft., Bedroom#2—90 sgft., etc.) Bedroom #1 - 124 sf Bedroom #2 - 1 f Property Description (Include all improvements indicated on survey) Existina 22 seat ± I Q bar seat m1taucant with kitchen: QuldgQc dgrk; Second F1!QQr 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, Fuel Gas Code of New York State, the Fire Code of New York State, the Property Maintenance Code New York State and the Energy Conservation Construction Code of New York State. John Mahler, AIA Print Name and Titleo Ac Original Signature Please place Professional Seal: 9i 9A " 01f Nt TOWN OF SOUTHOLDPROPERTY RECORD CAR STREET VILLAGE DIST.i SUB. LOT CR° �R OVER �r►u N E ACR. ./� S W TYPE OF BUILDING t RES. SEAS. ; VL. FARM COMM CB. MICS. Mkt. Value r LAND IMP. TOTAL DATE REMARKS E 41 ' 1. � �_- / - e Ll 0 _ AGE BUILDING CONDITIONS 1 r NEW NORMAL BELOW ABOVE _ FARM Acre Value Per Value r Acre ? t �� O� x.. r��G '. �. , y�, 1��'r r}, o Tillable ` FRONTAGE ON WATER ' Woodland FRONTAGE ON ROAD Meadowl•and DEPTH BULKHEAD House Plot 1 , 3 - Total '°�'; i DOCK L; i LOR E D TRIM j _ _ s I � 11-A I R _ \\ I I � i 106 6-3 4/09 i — -Z : 3 I : : 1 M. Bldg. i _ 3 . _ 1 Extension Extension I � i z 3 Extension I Foundation �o ra Both Porcl Z520 as Floors Dinette !Basement i K. i Porch I Ext. Walls I Interior Finish LR. -_ UJJ U,G r:fs Breezeway ? Fire Place C Heat i AY DR. Garage IType Roof Rooms 1 st Floor - i }Recreation Room Rooms 2nd Floor {FIN. B 0 B. z SQL ;Dormer Driveway I Total I i i s SCTM # j E TOIIVIIN OF SOUTHOLD PROPERTY RECORD CARD � _- OWNER STREET t� _ VILLAGE DIST SUB LOT J a _ - ACR REMARKS` R - TYPE OF BLD_ - PROP CLAAWg j - ' LAND IMP TOTAL DATE oQ d t t i g FRONTAGE ON WATER HOUSE/LOT BULKHEAD TOTAL COLOR e TRIM - 17 r a 106.-6-3 12/'4 j2024 LF SO, FT. Fin"B" 1st Floor £nd FP ar fa !'� [� TOTAL ► A4.81d - e` Pc cs v 9 Foundation t r 5 OTHER Bath l � Dinette N COMM T j t Basement is Floors Kit. IN Extension firtisheti$ Interior Finish L.R. Extension FP J WB s Heat �! s D.R. - _m Garage Ext Walls 3e BR� - _ _ Dormer a _ - Porc aths Roof Dew" F, Fam. Am, Pool Solar a . - Foyer. ,;.. A.C.IG" Laundry - p_g Library/ _ Study Dock . - -- t FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33300 Date: 29/26/08 THIS CERTIFIES that the building ALTERATION/REPAIRS Location of Property: _. 5775 MILL RD _ __. MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 106 Block 6 Lot 3 Subdivision Filed Map No. Lot No_ conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 22, 2008 pursuant to which Building � -„Z dated SEPTEMBER 22, 2008 Buil Permit No. 3417�_ .,.. 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 ALTERATIONS AND REPAIRS TO AN EXISTING RESTAURANT. The certificate is issued to GLEBE ASSOCIAITES LLC (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLU#MJM CERTIFICATION DATED N/A t �uthorgnature���� Rev. 1/81 s' FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20729 Date MAY 14, 1992 THIS CERTIFIES that the building ALTERATION Location of Property 5775 HILL ROAD MATTIfiUCR N.Y. House No. Street Hamlet County Tax Map No. 1000 Section, 106 Block: Lot 3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated. FEBRUARY 7, 1992 -______pursuant to which Building Permit No. 20444-Z dated FEBRUARY 24 1992 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 ALTERATION TO EXISTING RESTAURANT AS. APPLIED EOR. The certificate is issued to BRUCE AIR & WALTER ST TON (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL VA UNDERWRITERS CERTIFICATE NO. N-230962 - APRIL T 1992 PLUMBERS CERTIFICATION DATED N A Building Inspector Rev. 1/81 fllt Town of Southold 8/22/2024 P.O.Box 1179 53095 Main Rd *y Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45487 Date: 8/22/2024 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 5775 Mill Rd,Mattituck SCTM#: 473889 Sec/Block/Lot: 106.-6-3 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/9/2022 pursuant to which Building Permit No. 49034 dated 3/17/2023 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: additions and a.lteratio to an existing res rant with ae nd f1 or apartment and 3rd floor attic storage only aonlied for ner ZBA 7573 dated 12/16 2021 and 1,11Ae Minimus apprpyal dated 8/l/2023. (The Old Mill In The certificate is issued to North Fork Project LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL C-21-0373 3/20/2024 ELECTRICAL CERTIFICATE NO. 49034 7/26/2024 PLUMBERS CERTIFICATION DATED 6/3/2024 F edSignatur ng Ae Q� Town of Southold 3/9/2018 P.O.Bog 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39552 Date: 3/9/2018 THIS CERTIFIES that the building COMMERCIAL REPAIRS Location of Property: 5775 Mill Rd.,Mattituck SCTM#: 473889 Sec/Block/Lot: 106.-6-3 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/26/2016 pursuant to which Building Permit No. 40673 dated _ 5/6/2016 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: structural revairs,Ao a itl ► liedr The certificate is issued to Glebe Associates LLC of the aforesaid building. 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