HomeMy WebLinkAbout1000-40.-3-10.6 TOWN WN F S UTH LD
Rental Permit
5 0277
Owner George & Demetra Tsirinikas
Occupied as Single Family Dwelling
Located at 65400 CR 48 Greenport 40.-3-10.6
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.
2/1/2024 f s
Code i<tfc�r e gent Off c
This Notice must be posted by the main entrance at all times
w
S
� ro 631 765 1802
INSPEC ION
[ ] FOUNDATION 1ST j ] ROUGH PL13G.
[ ] FOUNDATION 2ND [ ] INSULATIOWCA
[ ] FRAMING I STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY 1N
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PI
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (Fl
j ] CODE VIOLATION [ ] PRE CIO [
i E ot7 �c/ 5
DATE '� �. ,' - INSPECTOR
Town Hall Annex
Town of Southold 54375 Main Road
Rental Inspection Report PO Box 1179
8
; Southold, NY 11971-1179
" Tel: 631-765-1802
"o.
SCTM # — Date.—.1,y Z
_... .....,.,. _ ....._..
Owner Phone
Address 6,eVisible
Hamletwyµµµµ Tractor
Floor Level Quantities Sub 1 2 3
Smoke Detectors(not located in bedrooms) .. T
Carbon Monoxide Detectors { /
i
m p w. a u..a� ....... ........,w, �.
Fire Extinguishers
Exits
Bedrooms 1 2 3 4 5 6
Smoke Detectors /
Egress
Occupant Count
c...,_. ...... � ..... ,._ _��. � ��... ........_... ......_... ....
Building Systems Maintained &Operational Condition of Property
eating Building interior
.. ,a.... ....,., . .........
Hot water Building exterior
�
Electrical _... _... f mRM . .....a WWW ....
_
Property clean p y maintained &safe
Mechanical Handrails&guards installed &secure
._ ..,...� .w..,.,� . .., ...... _ _ .. . m... .. ... ....
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
C �
C _.._
.......�,,_.. pre Rental
� J
O s for all items resent Prior
.. ................... ........_w _.,.. _.. ..
Comments:
. ....... .. ...... ...... . ..... .......w_ . „ ......... ... _...,.�...... .. . ..._... . ....._ ,..... _... ... . ...
� ........w . ...... .... ..........
.. ... ... .. .....
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TOWN OF SOUTHOLD
AF
M& Rental Permit
0277
Owner George & Demetra Tsirnikas
Occupied as Single Family Dwelling
Located at 65400 CR 48 Greenport 40-3-10.6
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.
2/9/2022
Code Enfp4nnent Official
This Notice must be posted by the main entrance at all times
app
7
Town Hall Annex �I IUl cru Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
i
BUILDING DEPARTMENT
TOWN OF SOUTHOLD � m
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
iPro essional seal re uireld or Architect or En sneer, licensed Monte Inspector nest provide
co o valid current cerci ication
Rental Property SCTIVI Number:
Rental Property Address: ���. � ) MI
Owner/Name:
Rental Dwelling Unit Identifier: 10 — .0 —
.0 —
Number&Square footage of each bedroom as depicted in the attached floor plan:
(' q•, q )
i.e.
Bedroom #1 �00 s Bedrvo 7xb '��0�� e OX )
eel i oz)
Lr .4 &C,
Property Descri tic n (I clude 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.
6S 6W yl
Print Na �e and Title Ox,ginaISI atu a ,��
� wy
I
Please place professional seal: U
��
�� �������� TOWN Town Hall Annex
��y � F 54375 Main Road
RentalWInspection
� � i PO Box 1179 Southold,
MIT NY 11971-1179
Tel: 631-765-1802
Fax 631-765-9502
SCTM# Date Z
uvner : Phone ( -z- (W 0�
AddressZip
�" a C
Hamlet eefl o ° Inspector
Address uisibie fr'o'm street? tZ
LEVELS SUB 3
Smoke Detectors (#- bedroom detectors excluded)
Carbon Monoxide Detectors (#)
Fire Extinguishers(#)
Exits (#)
BEDROOMS 2 437; ' 4 5
Smoke Detector Alarms (#) -
Carbon Monoxide Alarms
Egress(windows (YIN)
DIN SYSTEMS CONDITION OF PROPERTY
BUILDING S S
Heating system maintained/operational Building Interior is clean/maintained
Hot water system maintained/operational Building Exterior is clean/maintained
Electrical system maintained/operational Property is clean/safe/maintained
Mechanical system maintained/operational Handrails&guards present
POOLS 0 POOL BARRIERS Y/N
Pool present Pool is completely enclosed
Pool surface alarm and/or door alarm Barrier is a min. 48" high
resent
POOL GATES Y/N All openings in barrier less than 4"
Self-closing, self-latching Max. 2" clearance @ bottom of barrier
Latch on pool side of gate, meets height Barrier capable of being locked &child
requirements proof when unattended
COMMENTS:
n
11191(KI
T 'WN OF SOUTHOLDUJPr-1
Rental Permit
� ££ 0277
Owner George & Demetra Tsirnikas
Occupied as Single Family Dwelling
Located at 65400 CR 48 Greenport 40-3-10.6
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.
1/17/2020 John Jarski
Code Enforcement Official
This Notice must be posted by the main entrance at all times
rj� so
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 �Q
Southold,NY 11971-0959
UNC,.
. f
BUILDING DEPARTMENT
TOWN OF SOUTHOLD t' 3 -
RENTAL PERMIT APPLICATION
U '- OCT 2 9 2019
Rental Permit Fee$200(Application must be renewed every two years)
Section A.
Property Information:-
Rental Property ress:
tell
Tax Map Number: 1000 SECTION -BLOCK -LOT J D -
SECTION B.
OWNER INFORMATION:
Property Owner Name:
Property Owner Legal Address: Property Owner Mailing Address:
70
fV
V/ � J r �7J Emer encCql;�)qq,- I
Telephone Number(s): Daytime Evening
Property Owner Email Address:. rO
�r
Page 1 of 5 �
A
,> LL\oF So"01
Town Hall Annex Telephone(631)765-1802
54375 Main RoadFax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 �® ���
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
.V
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any: ►'�'� r -
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: 6pjk)e—.r—
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: IV
g g g g
Address of Managing Agent (no P.O. Boxes):
Page 2 of 5
ti
Town Hall Annex A Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 ,
Southold,NY 11971-0959 --
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent: `1700 17V 7� IiV43S-9
Telephone Number(s): Daytime - Evening Em gency
Email Address: , X6(2 , C-,--C-21Z
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on property: �Me
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:
Requested Maximum number of persons allowed to occupLDwellring � ���,Number of rooms in Rental Dwelling Unit: _Use and Dimensions of each room in Rental Dwelling Unit:- fv
Page 3 of 5
Town Hall Annex s , .� Telephone(631)765-1802
54375 Main Road y;� y^. x-.'a Fax(631)765-9502
P.O.Box 1179 "
Southold,NY 11971-0959 ®�®
1�r®� v , ,
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
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 a fire 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.
SECTION H.
DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit.
STATE OF NEW YORK)
COUNTY OF SUFFOLK)
I r4 ��ri �J �2certiiy 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
Page 4 of 5
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
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 as to any change to the information
regarding Authorized Agent, Managing Agent, or Site Manager. 77
�
Property Owners Name
Property Owners Signature:
efore me thiIs�[� `da of � 20
Sworn to b ` y
Cin
Official Notary Public Signature and Original Notary Stamp
CONNIE D.®UNCH
Notary PublicNo.01 BU61856State of 50w Y®rk
®ualifled in Suffolk County
Oommission Expires April 14.20
Page 5 of 5
01/ qOD
�arjl So
# # TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
z
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[
] ' FOUNDATION 2ND [ ] INSULATION/CAU KING
[ ] FRAMING /STRAPPING [ YFINAL/aj,�
[" ] -FIREPLACE & CHIMNEY [ ] FIRE'SAFETY"INSPECTION"
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) ' [ ] ELECTRICALS(FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:fA?4-4z -/
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TOWN OF SOUTHOLD PROPERTY RECt,nu uAKli
OWNER STREET VILLAGE DIST. SUB LOT
ACR. 1. 53 REMARKS
TYPE OF BLD.
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PROP. CLASS.
zllo
LAND IMP. TOTAL DATE
lACj
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FRONTAGE ON WATER TILLABLE
FRONTAGE ON ROAD WOODLAND
DEPTH / MEADOWLAND
BULKHEAD HOUSE/LOT
TOTAL
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TOWN OF SOUTHOLD PROPERTY I� 1 �g
OWNER j _t.�p, _� - I O.L. STREET u VILLAGE DIST- SUB. LOT -'
i n
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RES. �j,TD SEAS. VL. FARM COMM. CB. MISC. Mkt. Value ' 3
LAND- - IMP. TOTAL DATE REti'.ARKS *
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House Plot ( ter' DEPTH �R
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Total r;; =- DOCK
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li NEON 0 NNOMMENEM I No
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
UPDATED
CERTIFICATE OF OCCUPANCY
No Z-23328 Date NOVEMBER 4, 1994
THIS CERTIFIES that the building MODULAR DWELLING
Location of Property 65400 COUNTY ROAD #48 GREENPORM, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 40 Block 3 Lot 10.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated 1/10/86 & 9/11/87 pursuant to which
14498-Z &
Building Permit No. 16456-Z dated 1/10/86 & 9/11/87
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certif
issued is ONE FAMILY MODULAR DWELLING WITH -�►rvun un�ry
The certificate is issued to ESTATE OF DANIEL G. CONKLIN
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-001922 - JANUARY 7, 1988
PLUMBERS CERTIFICATION DATED N/A
*THIS UPDATES CO Z-16603 DATED 1/21/1988 & CO Z-17730 DATED 1/31/89
Bu ing Inspector
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspect
Town Hall
uthold, N.Y_
CERTIFICATE OCCUPANCY
0oroperty
Dat JANUARY 31 1989
/H-1She building ADDITION
Z-1
00 NORTH ROAD GREENPORT, NEWYORK
ouse No. Street Hamlet
County Tax Map No. 1000 Section 040 Block 03 Lot 10
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 9, 1986 pursuant to which
Building Permit No. 14498-Z dated JANUARY 10, 1986
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 HANDI-CAPPED RAMP TO EXISTING ONE FAMILY DWELLING
The certificate is issued to DANIEL G_ CONKLIN
(owner)
of the aforesaid building_
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81