HomeMy WebLinkAbout1000-143.-3-33.3 `SOWN OF SOUTHOL
Rental Permit
1408
Owner: Jeb 1 LLC
Occupied as: Single Family Dwelling
Located at: 10470 Route 25 Mattituck 143.-3-33.3
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: 01/06/2026 1--/ xotll
Expiration: 01/06/2028 co a Ens ment Off1i
This Notice must be posted by the main entrance at all times
6t ury
TOWN OF SOUTHOLD BUILDING DEPT.
co 631-765-1802
ON
[ ] 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 (F AL)
[ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL
REMARKS: .. ��- CJ�
W).'O'
u ,
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone(631) 765-1802 Fax(631) 765-9502 htt L/� r.soutl oldt wiil),y,.
RENTAL PERMIT APPLICATION
Rental Permit Fee$300(Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
0 1 I qS�
Tax Map Number: 1000 SECTION 1 L, -BLOCK -LOT 33-
1-3
SECTION B.
OWNER INFORMATION:
Property Owner Name: ��
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
3
`7 4 °-T 7 k
Telephone Number(s): Daytime A4 Evening Emergency a- =j-Sec)
Property Owner Email Address:
Page 1 of 4
^I µ
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any:
Address of Authorized Agent( &P.O. Boxes):
Mailing Address of Authorized Agent:
Telephone Number(s): Daytime.,.. ``°. Evening Emergency
w�
Email Address:
Section D.
Managing Agent Information:
Name of Authorized Agent of dwelling unit, if any:
Address of Authorized Agent(no P.O. Boxes):
IV
Mailing Address of Authorized Agent:
Telephone Number(s): Daytime Evening Emergency
Email Address:
SECTION E.
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
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: r l
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; 'Ca �(
jZ f
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.
1K 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)
�ci (4�5P (�l-,
1UQL�tid, T
1t: - `erEify un Jer �alty 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:
Property Owner's Signature:
Sworn to before me this�Aday of AA 20
TIFFANY J BEREZNY
Notary Public-State of New York
No.01BE6284112
Official Notary Public Si Lure and Original Notary Stamp Qualified in Suffolk County
rY g ry p My Commission Expires 06/17/2029
Page 4 of 4
Town Hall Annex
Town Of Southold 54375 Main Road
Rental Inspection Report PO Box 1179
Southold, NY 11971-1179
Tel: 631-765-1802
SCTM # — ^ 33-3 Date
Owner Phone
Address Q 7 Visible
Hamlet Inspector
Floor Level Quantities Sub 1 2 3
Smoke Detectors(not located in bedrooms) I
Carbon Monoxide Detectors t
Fire Extinguishers I
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 dean, 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:
1 IX.ENTRY IX,HOSE BIB
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WINDOW ARE
Np 77—r7—o c 2 FLOOR AREA;
8 WIN/FLR ARE)
- 11'-9" VENT AREA; 8
FLOOR AREA:
JINDOW AREA: 14 sq.ft. ® -03 -0� VENT/FLR ARI
LOOR AREA: 81 sq.ft.
/IN/FLR AREA RATIO: 17.3%
ENT AREA: 8.5 sq.ft. INSTALL NEW INSTALL NEW
_OOR AREA: 81 sq.ft. WINDOW ON --- , WINDOW ON '
ENT/FLR AREA RATIO; M5 EXISTING R.O. CL EXISTING R.O. ; CL.
11 11
r1N BEDROOM#2
EX.CHIMNEY �� EXISTING
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205
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WINDOW AREA: 14 sq.ft.
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FORAAER OWNER F N E ACR.
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LAND IMP, TOTAL DATE REMARKS
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143.3-33.3 10/20/2022
M. 6141g, !Foundation _ Bath Dinette
4
Floor
Extension Basement " s Extensic�rt' ' € / `Ext. Walls
v Interior Finish LR
Extension Fire Place Heat Df:.
Type Roof Rooms 1st Floor sBR.
Porch I Recreation Room= Rooms 2nd Floor_ FIN, B l
Porch 'Dormer
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Breezeway _ Drivewoy
l- - - --
Garage
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Patio
O. B.
Total ' ��
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OF SOUTRMD
NUVJM ARC'
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N. T.
No. .. ...». . e ... Date ».....».. .».. » . ..... » .......... 29111.
THIS CERTWM that the building lOmUd at s. ...... fit'
alrxO. ............ Slock N& .. it.. .».,»..s at No. .....0 ..........................................................
substantially to the APPIlestion for Building Pormit hentofore filed in this office
x zoo
dated .,.. . ..».... . . ».. 19M. ptmant to which t No. ........». .-.-
dated ................SOVOWMbWAA., M.P., was issued. and confomm to all of the
menu of the applkaWe provisions of the law. The occupancy for which this cerUfleste is
Issuedis ..., . ... ..... ... ..... ,..._....................................................
This certUlcale is ISSUSd to ............. ._..... ....
(owner, lessee or tenant)
of the aforesaid building,
BUUAftg ......,«.,»...... ..+war....
r t
ina .roa'iwmnMrvak .`"P:uad�eiu*m�,kmbe",mµa'7mpmnurcR^mlw:m.lvmm,^�uMim�!{5rtl'vxam k'"p'^"""Y^Ymm,7r�✓lAWmc'x"'C"'m^vgn"ryCQ""1"",T'„#TCr^t4"Y'Y„'m"lM1' fiM��1�Im�GCll'+Y"lw ,�`�YM'M�4'RkG�tln1'"X%k4'04""�"'wM2�'9'r�F,.4.IYA,.rwwW.W,„"G,lu'�M"'"'Mm.^?b"ttmwummmwubre^. nu�,:mmmmmmmmmnw�irvwwm immmwumuwwn'maw�wwrvw.w... ww.w.w.,w.w...««....,.....,........ ..»....,,......�.....................„.....
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CgWrMC .T Opr OCCtMAJRCY
140. .........+K `M... ......... .. a
a��r•••••l Maw..
THIS CERn=S that-the buUdtag 16ated at
Mai? No. .........: ....... Block . ..... ...................................... ......... `
conforms substan :: .to the � �: ��d� •;'; � � he �' in � oPfiCe
'« pea for : • --
�yA7
.....M a.w.wMMw.Ma................f yy((,]]w.....
dated aurstta t mb .......7
date .......... .... .. j r...... .. :t.7. �.y waq eWp �and .conf r ��,4: 0 all ..-I:datedreqq'�
- . ... p .
es oP- the a lie o�` of the law. The oceuar�cy for which this. .eate
issuedb ........ ........... .......... ...... - ............ ..........
This certificate Is Imied to W 41,k9A.:,wM.w.M .. ..... .......... .... ,
* (ovvx�er,�lessee or tenant)
of the Atotesaid b4ding. ;
...............
Building cta
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a
row M 4
TOWN OF D
SUMDIXG =PARMENT
TOWN CLERMS CWnC5
SCOMOLD, X. Y.
CMRTMCAVE Cr OCCMPANCT
w. No. ... Date ................. .. sex....... 1 wawa..
ltl9 CERMUS that the building located at Vbw.w.w,.w wa. w.awww'd .w.at C& Street
f; Map Rio. .. .... ... Mock No. ........*.* .......Lot Mo. .. -*OM....................................................
cvnforms substantially to the Application for Building Permit Ix fore filed in this office
It doled .................a a .. : ........ 19A9.. psxrsaaxxt to which Building Permit No. .........
.� ,
€ a ................4101MMAA......... 19.... was issued. and conforms to all of the require-
meats of the applicable provisions of the law. The occupancy for which this certificate is
issued is ......................................x....w... .......................................................w.....t,.............w...................
WAM
ThisCertificate is Issued to " .. ,.. .w.,.. .ww....,. fr..w. ................................ ............... ....
(owner, lessee or tenant)
F' of the aforesaid building.
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FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector,
Town Nall
Southold.N.Y.
Certificate Of Occupancy
Z-I5579 April 2, 1987
CEIt°[" 3 bue� ADDITION TO EXISTING ONE FAMILY DWELLING
TMS ............................................. ..
10470 Main Road Mattitoct, New York
Location of Fto y « « ..... .. .....«..«...... ......«.........I......... ..
33.3
County Tax 41r No. 1 Section ,.«i 4 3,.....BI It ...3...........mat ..«.«..«.»..,.. «
Subdivision. .. ............................Filed gap No. ........WNO. ...............
conforms suboantially to the Application for Bultdft Pumit heretofore filed in office dated
March 26, 1985 13794Z
.................... ant to WhM Building Permit No. .....................
da ...Match.. 26, . 19.8 5 ....... was isaued,and confbruis to all of the requirements
of the li provisions of the law.The occupancy for which this cerdficate is Issued is .........
ADDITION TO EXISTING ONE FAMILY DWELLING
................................««....... ........................................
PUMILL
The certificate is issued to .....dODY.... ..... ......., ....
Of the aforesaw humno.
Suffolk County Department of Health Approval ...........A
ERW , ,RS CE TB NO .. ... N.....# .. .. .. . .... .
PLUMBERS CERTIFICATION DATED: NSA
B w hag
t8�v.1/a1
a w r
OO m r
aorr � Town o thold O? now
P.O. Sox 1179
53095 Main Rd
are Southold, New York 11971
CERTIFICATE OF OCCUPANCY
No: 45770 Date: 11/19/2024
THIS CERTIFIES that the building WINDOWS IN DWELLING
Location of Property: 10470 'Route 25 Mattituck NY 11952
See/Block/Lot: 143.-3-33.3
Conforms substantially to the Application for Building Permit heretofore,filed in this office dated: 10/05/2022
Pursuant to which Building Permit No. 48615 and dated: 12/19/2022
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:
"as built" window replacements to existing single-family dwelling as applied for.
The certificate is issued to: Jody Pumillo
Of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL:
ELECTRICAL CERTIFICATE:
PLUMBERS CERTIFICATION:
,t
Aut ie Signature
x