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HomeMy WebLinkAbout1000-113.-2-14 F soy TOWN OF SOUTHOLD Rental Permit CO 1508 Owner: Joseph Bruno , Marianna Bruno Occupied as: Single Family Dwelling Located at: 5765 Bergen Ave Mattituck 113.-2-14 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: 07/01/2026 Expiration: 06/30/2028 Cocleinforceotofficial This Notice must be posted by the main entrance at all times �w �- TOWN OF SOUTHOLD—BUILDING DEPARTME 1 5 2025 Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax(631)765-9502 littps://www.southoldtowi2nY ww.southoldtownn .�o uRdIn Oap re nt Tov"In of Southold RENTAL PERMIT APPLICATION Rental Permit Fee $300(Application must be renewed every two years) Section A. Property Information: Rental Property Address: 7 5 Eoeatj A- e i MXI -Tv ct< N'Y I (ash Tax Map Number: 1000 SECTION I�3,00 -BLOCK, DZ,d D -LOT 0 1 -� SECTION B. OWNER INFORMATION: Property Owner Name:, �'04+ Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 369 AS*Y Ab Telephone Number (s): Daytimes JU Eveningl 33 ! mergency i 7-32, 69T 1 Property Owner Email Address: D 21, J_ Cal Page 1 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. Managing Agent Information: Y Name of Authorized Agent of dwelling unit, if any: hA 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 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, 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: VA St, Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: 13 Use and Dimensions of each room in Rental Dwelling Unit- 3 0,DbNJrA K 2 x 12 Kr' a-1,4 %'x a piNtl Rotes 63`r 1 ' 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. I am requesting afire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ 1 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 �, 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: Property Owner's Signature: ` Sworn to before me this m d f 20 � Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.01 BU6186050 Quailf led in Suffolk County Commission Expires April 14, . ""` Page 4 of 4 � OAF SO TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 I N b P E tAm;hT ION [ ] 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 (FIN ) [ ] CODE. VIOLATION [ ] PRE C/O [ RENTAL (REMARKS: DATE INSPECTOR U Sgtlr� TOWN OF SOUTHOLD BUILDING DEPT. M� 631-765-1802 IN " P ' A"T1 O N [ ] 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 (FIN L) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL 4 REMARKS: , �� � 5wta �. rZ r � �►✓i.i� a� 6l� DATE F INSPECTOR F OilTown Hall Annex � Town Of Southold 54375 Main Road Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 SCTM# — Date • Owner Phone Address Visible Hamlet , Inspector az 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 All Surface water alarm Date of CO issuance Door alarms Pool completely enclosed !Self closing latching gates Pool fence to code requirements uirements /r '0 �� � � /alil`��i�'+Y� �ri�i y , CO's for all items present f '� f//,,,,/1 Comments: FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30886 Date: 04/28/05 THIS CERTIFIES that the building NEW DWELLING Location of Property: 5765 BERGEN AVE MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 47889 Section 113 Block 2 Lot 14 Subdivision Filed Map No_ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 8, 2004 pursuant to which Building Permit No. 30415-Z dated JUNE 224 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 SINGLE FAMILY DWELLING WITH ATTACHED GARAGE,COVERED FRONT PORCH & REAR WOOD DECK AS APPLIED FOR. The certificate is issued to HARBORVIEW HOMES, INC. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-04-0062 12/21/04 ELECTRICAL CERTIFICATE NO. 92327C 11/23/04 PLUMBERS CERTIFICATION DATED 04/20/05 BERTSAND PLUMB.&HEATING �- - Authorized Signature Rev. 1/81 ... ...... .......... ....... . ...... ......._._._ ..--_.. ti Town of Southold 8/20/2018 P.O.Box 1179 53095 Main Rd 41, ' 0 Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39851 Date: 8/20/2018 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 5765 Bergen Ave,Mattituck SCTM#: 473889 Sec/Block/Lot: 113.-2-14 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/16/2017 pursuant to which Building Permit No. 41445 dated 3/21/2017 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"IN-GROUND SWIMMIN�POOL lZjCE0jO CODES AS AJ IPLT, FOR, The certificate is issued to Dylan Levy of the aforesaid building. S,UFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 41445 06-27-2017 PLUMBERS CERTIFICATION DATED tb lgmtu�re oI Fat 4, Town Hall Annex Town Of Southold 54375 Main Road Rental Inspection Report PO Box 1179 aCAJ Southold, NY 11971-1179 a Tel: 631-765-1802 SCTM# I Date"111111111 -o? Owner iQU/Z.0 Phone Address Visible Hamlet_ Inspector. Floor`Le�el Quantities, Sub 1 2 3 Smoke Detectors(not located in bedrodms),. Carbon Mbnoxitle Detectors Fire Extinguishers Exits Bedrooms;,;. 3 4 5 6 Smoke Detectors Egress Occup ant Count a, 04ilding,5ystems Maintained &Operational Condition o Property Heating "; Building intetiow Hot water Building exterior ElectricaC, ;' ; " Pr erty n�maintained &safe ap lei Mec'anica,, Handrails'& ra ids m'stallecC Pool Safety:` Pool on Site SurfacenraXer„ala m Date of C0 issuance; r li i „„ ITl et Self closing/iatchirig gates Pool<fence#onode requirements O's for all`tems-present Prior',Rentaal Comments: 49 `tOJ/3NUW5 (4 ST/ZZ) (4£T/ZZ) N3dO/39VMS wooy Aipunel pue ImpepaW ...................,. ]uawaseq.1100p J0011 IST 1N3N135tlg (4 OT/oT) (14 OIM) £woo�pag 1san9 Z wowpag Isan0 (481/61)woapag 1a3seW 3NCJV!VS :WOWS FempH/Su!puel_.............. ZOJ/DONS DAMS 14 OC/OT) 3NOW5 T woojpag 1san9 43ee IIn3 43eB aalseW 3aso10 u!4IeM N0014 ON033S ,OOp J-1 aaua3 B Put WI04S DOM -..... 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