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Home My WebLink About1000-107.-3-4.1 TOWN OF SOUTHOLD Rental Permit - - 1474 Owner: Brian Noll , Barbara Noll Occupied as: Single Family Dwelling Located at: 450 Maple Ln Mattituck 107.-3-4.1 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: 05/15/2026 1 famL Expiration: 05/14/2028 C4e a em nt Official This Notice must be posted by the main entrantoataltimes #_3oo 0 let C I o-?a�'j % TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. 0, Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 Fax(631) 765-9502 ,litt)s://w,ww,,souti,ioldlokN,��ll,)Y gov F RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: f Lis-o ,4-/-�/ ' TVC- Tax Map Number: 1000 SECTION 10 -7 ,00-BLOCK _O _- LOT 00q - 001 SECTION B. OWNER INFORMATION: V 2 17etJ & /-ba-rk f Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) i&qd �er 11jL1rtj cvry A/ Ps.�'C) --()A i�j_e6 C/ 11S30 GAI Y, 0 Telephone Number (s): Daytime 0-02— Evening P�Z6 2--Emergency 0/o Property Owner Email Address: b0 '0'1 Lq C)R_ �ICAJ /-K.)e— . Ale 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 Unit: Number of rooms in Rental Dwelling Unit: 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. ❑ 1 am requesting a fire safety inspection to be performed by a Code Enforcement Official corn the Town of Southold V am submitting a completed Town of Southold certification form from a licensed architect or a licensed professional engineer. Page 3 of 4 lvl�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. Managing 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 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 H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) ) COUNTY OF SUFFOLK�)/ / I6q,bif�" ,/ o f -------1, 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: o Property Owner's Signature: Sworn to before me this day of-ap __ ,,, .,, 200� cf Official Notary Public Signature and Original Notary Stamp ERICA M.MISOREK Notary Public,State of New York No.02MI6194904 Ouaiitaod do Nassau County My Co ion Src4a OcL t 4,20� Page 4 of 4 AAJJ TOWN OF SOU THOLD BUILDING DEPT. � 631-765-1802 I N PmEmn C T 1O N [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] NAL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI AL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: dv r rOht f f Y DATE INSPECTOR Feb17, 2024 Town Hall Annex Telephone(631)765-1802 )765-9502(631 54375 Main Road `' Fax P.O.Box 1179 Southold,NY 11971-0959 ° U1 � 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 Fro essional seal�°e ulred c+r, rwcllitect or n ineer licensed llorle ins actor mutvil coov of valid current certi ication Rental Property SCTM Number: Rental Property Address: . 45Q I e. tiC 1 Owner/Name: Brian Doll 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 #2 10Qgft 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 1111 CEO Inspector Print Name and Title ceo## 1216-02 3 JiginatlSig*natue Please place professional seal: TOWN OF SOUTHOLD POOPERTY RECORD , OWNER 1 STREET . VILLAGE DISTRICT i SUB. LOT bi )o /A 's FORMER OWNER 1 N E ACREAGE S � = W TYPE OF BUILDING W/�L 1_ Z e' },• (q y C l Y k-1 ' i f RES. g SEAS. i VL. FARM COMM. IND. CB. ? MISC. LAND IMP, TOTAL DATE REMARKS -fAj e- An77 r � _ I - t /d Farm Acre Value Per A clue 2 ID 3 TiIIa t 1 - — ll lZ - 00 g r_ bon � �, .2 � E Titjr t; _ A.- - — m - ll CA Wcadland IQ ZrA f Swampland = f s��ld �_. r ��_ h - g r � _ 3 Srushland a House P11`7't ! lz r Zr Tonal ��r% _ C? fJ ;==Z I�AL O cC� �-. A/Z74 as 3 7. 0 _,fir 0 L C / - t E x 1 a� - 4 _"--•--ice - _," ___ �y"_' �t J� _ V tl t _ 107.-3-4.1 3/17/2021 f � All � 3 E I �5 Foundation �� ' Lt``.� Bath f� ion 1 7 Basement Floors L r _ _ T ! ! E-tWalls j Interior Finishxfensl flu<< iraaa fieas'io `�`xa i � // ,<,t 1 Fire Place Ye Heart CRN Y y ' - �-- rPorch Attic �j { wt Porch Rooms 1 st Floor } i k 'Patio Rooms 2nd Floor iax 5; lF ara e o� �, 3 D A �- y f a Driveway _ 3;LO a _ V�� 3 2- =e 07 <i � >. FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. .......2-1 ...... Date .....................J.8cUUc&X-Y..24........... I9.42, THIS CERTIFIES that the building located at . 1t91,14..AVOLo... MapNo.,p**......»......... Block No. ........**.*....... Lot No. ..................***...........,............................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..............44.1y..16..................................... I9AQ. pursuant to which Building permit No. VA.,1141. dated ...OU;Ly-1-13................................. 19....G() 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 .......... PR:E JAT-R..ONEw PAXILLY >E 1NG o-...................,.........................,,......................,...„...... This certificate is issued to ........................<.........W4tox..:.A'R AK'1 ....... ................w...,, (owner, lessee or tenant) of the a-foresaid building. ...........- ...... ............. . Building Inspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATZ OF OCCUPANCY Nommw Z-23951 Date OCTOBER 16, 1995 THIS CERTIFIES that the building ACCESSORY Location of Property 450 MAPLE AVENUE MATTITUCR N.Y. House No. Street Hamlet County Tax Map No. 1000 Section— 107 Block 3 Lot 4 Subdivision Filed Map No. Lot No. � conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 24, 1975 pursuant to which Building Permit No. 8015-Z dated JUNE 24 1975 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 ACCESSORY INGROUND SWIMMING POOL & CE ENCLOSURE. The certificate is ,issued to EDWARD & STELLA MCLAUGHLIN (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. H-045789 - JUNE 8, 1995 PLUMBERS CERTIFICATION DATED N/A uilding 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-27442 Date: 12/01/00 THIS CERTIFIES that the building ADDITION Location of Property: 450 MAPLE AVE MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 107 Block 3 Lot 4 Subdivision Filed Map No- Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 4, 1999 pursuant to which Building Permit No. 26043-Z dated OCTOBER 20, 1999 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 FAMILY ROOM ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to EDWARD H & STELLA B. MCLAUGLIN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A SI13CTRICAL CERTIFICATE NO. N-542958 11 20 00 PLUMBERS CERTIFICATION DATED N/A f Aut' rized Signature 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-28523 Date: 06 17/02 THIS CERTIFIES that the building ADDITION Location of Property: 450 MAPLE AVE MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 107 Block 3 Lot 4.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 11, 2000 pursuant to which Building Permit No. 27275-Z dated APRIL 30 2001 .. 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 ONE CAR GARAGE ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to EDWARD H MCLAUGHLIN ___............................ (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A _wwwwwwwww. A hor" ed . gnature __..... Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.X. CERTIFICATE OF OCCUPANCY No Z-23950 Date OCTOBER 16, 1995 THIS CERTIFIES that the building ACCESSOR't Location of Property 450 MAPLE AVENUE MATTITUCK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 107 Block 3 Lot 4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated _wNOVEMBER 9 19�, 72 __pursuant to which Building Permit No. 6234-2 dated NOVEMSER 9 1972 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 GARAGE ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to EDIARD H. a StZLLA B. McLAUGHLIN (owners) of the aforesaid. building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. H-047042 - SEPTEMBER 20p 1995 PLUMBERS CERTIFICATION DATED N/A 8uiding Inspector Rev. 1/81 ;TMc,1c 13'41 IS uS'_ I1�'Y i V LX € - riac� F�Gari iU L'"OUT 6 NO, Far!Y R 3�Rcl;rni lP4rQ RC--A fit k-I , Dining Area i2'0" .6'6. Laundry F aa�. Garage 29'6'x 20'0" Garage 29'0'xITT