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Home My WebLink About1000-139.-3-29 � SO& TOWN OF SOUTHOLD Rental Permit 1528 Owner: Guo JY 2021 Revoc Trust Occupied as: Single Family Dwelling Located at: 465 Farmers Rd Mattituck 139.-3-29 Maximum Permitted Occupancy: 4 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: 07/23/2026 Expiration: 07/22/2028 Co Enfo ent ci This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD— BUILDING DEPARTMENT r. `... Town Hall Annex 54375 Maim Road P. O. Box 1179 Southold, NY 11971-0959 p ( ) (631) 765-9502 Itti� Telephone 631 765-1802 Fax .. RENTAL. PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two yeV -� Iao1a6 'A'-6W R_c,4 a Section A. Property Information: Rental Property Address: 465 Farmer Road, PO Box#1088 Mattituck, NY 11952 Tax Map Number: 1000 SECTION �139 —.-----BLOCK— 03 -LOT. 29 SECTION B. OWNER INFORMATION: Property Owner Name: Jiun Yi Guo Revocable Trust Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 415 Central Park West, 713 415 Central Park West, 76 New York NY 10025 New York, NY 10025 Telephone Number (s): Daytime 917-921-6591 Even ing917-921-6591 Emergency 917 596 1530 Property Owner Email Address: lostein.guo@g mail.corn Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if 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___, µ Evening__ Emergency____ Email Address: Page 2 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units or 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: Unit 1 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: _. GROUND FLOOR: Foyer-77 SF, Living Room-378 SF, Kitchen/Dining-251 SF, Restroom#1- 36 SF, Mud Room- 101 SF UPPER FLOOR: Bedroom #1- 272 SF, Bedroom #2- 219 SF, Restroom #2- 40 SF 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. 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 Jiun Yi Guo 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: Ji Yi Guo Revocable Trust m � Property Owner's Signature: Sworn to before t e pis clay of ® 20_A Official NoOarvy Public Signature and Original Notary Stamp NAHIAN HABIB Notary Public-State of New York NO. 0 1 HAD023845 Qualified in Queens County My Commission Expires Apr 23,2028 Page 4 of 4 ;ac'a^nxey , TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 I N ZS' P E C T 10 N [ ] 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"L) [ ] CODE VIOLATION [ ] PRE C/O [RENTAL REMARKS: Ok el2sa/� �cGv DATE '�a�� _ INSPECTOR k Town Hall Annex Town of Southold 54375 Main Road ^. j Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 ` Tel: 631-765-1802 '` * » " SUM # �39- —, �' Date Owner (9vp Phone Address 65 a M-e2S 96 . Visible Hamlet /VI Inspector 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 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 #: oc upon s: Comments: I� TOWN OF : O THOLD PROPERTY RECOI �Z (o VyNER STREET VILLAGE DIST. SUB. LOT "c' FORMER OWNER I N E ACR.. p A S W TYPE OF BUILDING v _ _ RES = SEAS, -VL. FARM COMM. CB. MISC. MId. Value LAND IMP, TOTAL DATE REMARKS s r , Jf r r _ _ .' s ° GIB BUILDING DIT t)I �, BUILDI - l ( 4 t NEW j �( ,3 ` v F 7 4 I _ ' 4r u FARM l V / t t = �_ 3 - Tillable 1 lr LY _ �t it f � � s; i Tillable 2 1 Tillable 3 _ 1, =. • �.. f Woodland Swampland FRONTAGE ON WATER 4 Brushland I FRONTAGE ON ROAD House Plot DEPTH BULKHEAD Total DOCK �� . - 7/Q3/ 3 TOWN OF SOUTHOLD PROPERTY RECORD C ►RDyi%' - ! OWNER STREET VILLAGE DIST i SUB. LOT � . FORMER OWNER N E ACR. W TYPE OF BUILDING RES. 3 �3 SEAS. VL. + FARM COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL i DATE I REMARKS � 3A"1 Ere AGE 1 BUILDING CONDITION NEW- NORMAL BELOW ABOVE FARM Acre Value Per Value Acre Tillable 1 Tillable 2 Tillable 3 Woodland Swampland FRONTAGE ON WATER Brushland FRONTAGE ON ROAD House Plot DEPTH BULKHEAD Total I 1 DOCK I j } OLOR s f I 'RIM / I ,s - { 139.-3-29 03/09/2018 I Bldg 'Foundation X f�= Z G %� 7�� `Foundation Both I Dinette 5`o r f �00 -may ` Base ent - �� i �'� K. �ctension - �S- l Floors / l� . - y 35Q Extension 'Ext. Walls�� _, Interior Finish /lay•(' i LR. Extension ( .Fire Placej Heat DR. l p � : Type Roof i f• Rooms 1 st Floor BR. orcfs �' '`` 3.�06Recreation Room jRooms 2nd Floor FIN. B- -` g 7 'Dorm e r S;GOT :2,00 1 Driveway Garage Patio_ 9 0 'a3 O. B.-). 06 D`' 5 0 ?5/ vA1 Total lob ' i � ,3' -7 5 r �— /3 j 8 3s6y � ; e u - FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY s No: Z- 30753 Date: 02/08/05 THIS CERTIFIES that the building DWELLING Location of Property 465 FARMERS RD MATTITUCK (HOUSE NO.) (STREET} (HAMLET) County Tax Map No. 473889 Section 139 Block 0003 Lot 029 Subdivision Filed Map No, Lot No. conforms substantially to the Requirements for a ONE FAMILY DWELLING built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 30753 dated FEBRUARY 8, 2005 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 FAMILY DWELLING WITH ATTACHED ONE CAR GARAGE The certificate is issued to JAMES & BLANCHE DUGGAN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO_ N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. A thcrized Signature Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION- 465 FARMERS RD MAlTI UCK SUBDIVISION: _. ...__ NAP NO.: LOT (S) NAME OF OWNER (S): TAMES..,.& BLANCHE DUGGAN...._ ..,..- ......M...„ OCCUPANCY: SINGLE FAMILY DWELLING JAMES & BLANCHE DUGGAN ADMITTED BY: JAMES DUGGAN .... ACCOMPANIED BY: SAME KEY AVAILABLE: SUFF. CO. TAX NAP NO.: 139-.-3-29 SOURCE OF REQUEST: JAMES DUGGAN 01„L9 OS DATE: 22 08 05 DWELLING: TYPE OF CONSTRUCTION: WOOL)_FRAME 1 STORIES: 2.0 N EXITS: 2 FOUNDATION: CONCRETE CELLAR: PART. CRAWL SPACE: PART. TOTAL ROOMS: IST FLR.: 5 2ND FLR.: 2 3RD PLR.: 0 BATI' ' (S): 2.0 TOILET ROOM(S): 0.0 UTILITY ROON(S): ONE PORCH TYPE- ROOFED DECK TYPE: WOOD PATIO TYPE: BREEZEWAY: .. FIREPLACR: _..,. wvw_ GARAGE: ONE CAR DOMESTIC HOTWATER: YES TYPE HRATHR: HOT WATER* AIRCONDITION31MG: TYPE HEAT: OIL WARN AIR: m 90TWATER. �.._.................. OTHE2: *BASEBOARD ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST.: STORAGE, TYPE CONST.: SWIMMING POOL: .. ......... GUEST, TYPE CONST.: �._ ............... OTHER: .......... .............. VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION _.....�.... AR"T„ � SEC. II N P Q h 0 V REMARKS: BP#30922-Z-COZ-30751(ACCY SHED)BP#30943Z-COZ-30752 (NEW BOILER) _._.._ ......... INSPECTED BY: „✓ DATE ON INSPECTION: Ol 07 OS GEORGE GILLEN TIME START: 9:45 AM END: 10:15 AM FORM NO. 4 TOWN OF SOUTHOLD p BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY i NO: Z-30751 Date: 02 0, 8/0a THIS CERTIFIES that the building ACCESSORY Location of Property: 465 FARMERS RD MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 47889 Section 139 Block 3 hot 29 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 25 2005 pursuant to which Building Permit No. 30922-Z dated JANUARY 27 2005 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 STORAGE SHED IN THE REQUIRED REAR YARD AS APPLIED FOR "AS BUILT" . The certificate is issued to JAMES & BLANCHE DUGGAN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL n A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A �hor�izedSignature 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-30752 Date: 02 08/05 THIS CERTIFIES that the building HEATING SYSTEM Location of Property: 465 FARMERS RD MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 139 Block 3 Lot 29 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 7, 2005 pursuant to which Building Permit No. 30943-Z dated FEBRUARY 8 2005 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 INSTALLATION OF NEW BOILER IN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JAMES & BLANCHE DUGGAN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2040509 O1 27/05 PLUMBERS CERTIFICATION DATED N/A uthorized Signature Rev. 1/81 Town of Southold 6/27/2017 P.O.Box 1179 53095 Main Rd , Southold,New York 11971 CERTIFICATE OF OCCUPANCY ANCY No: 39032 Date: 6/27/2017 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 465 Farmers Rd, Mattituck SCTM#: 473889 Sec/Block/Lot: 139.-3-29 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/8/2017 pursuant to winch Building Permit No. 41640 dated 5 16 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: It `.1)WEI lJN(1 ASm ''1_l [ _QR The certificate is issued to Guo,Jiun of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED r a .. t honk... 3'g ..... ...,_. w..._ ._..,. i nature CLOSET Oro CLOSET BEDROOM#2 219 SF 15'-7 112. S, P BEDROOM#1 9°01�14s Na" 2725E cM (r y.'..,. HALLWAY a �J 2'."4 1 f 2" .. '�RHSl-Ri-b£1wV2 CL05ET 40 SF CLOSET '., iarc 'j UPPER FLOOR PLAN 1�� OFOK , . : FF UP N 9 & aC L. _l 12'-7" ......... .._...............__..........,_.."...,..., M... ......,�,,.,,.,.. � SO 6Np ,� LIVING ROOM i'Y,T, 12A 2p 979 SF rn A 8 � RES 1111 ROOM fiF'0 GARAGE MUD ROOM b KITCHEN Ro'ip,v0 194 SF 101 SF 129 SF ....... ... 1N.,::.' .................................. DN _4------- FOYER n 77 SF ENTRY GROUND FLOOR PLAN 465 Farmers Road Mattituck, NY 11952 FLOOR PLAN