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Home My WebLink About1000-51.-6-19 TOWN OF SOUTHOLD Rental Permit Permit No. 0369 Owner Joshua & Elizabeth Criscillo Occupied as Single Family Dwelling Located at 430 Grove Road Southold 51-6-19 Village S/B/L Maximum Permitted Occupancy 6 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. 12/11/2020 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times > � 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 RENTAL PERMIT APPLICATION D L! j Rental Permit Fee $200 (Application must be renewed every t��'years Af Y 2 7 2020 Section A. ,y n Property Information: Rental Property_Address: 3 0 ®re,--**,r 1 s GU /V,1//Y. Tax Map Number: 1000 SECTION �. -BLOCK -LOT - SECTION B. OWNER INFORMATION: Property Owner Name: /� D/V'v) G2 iSc Property Owner Legal Address: Property Owner Mailing Address: SS A/Qft fr f /161,1151— sr v,�� r S,11-7 "'I/tr/y�'� C `/`�/�/ _PQ GG/i L`9 A-/ Az 2- Telephone Number(s): Daytime ��7Even ng Emergency Property Owner Email Address: A)Aj-1- C l c LG e2 e/—IA/e. - Cr/1-1- '�'ub ec.elC'aI-\.g3 Ib a D_c .t Page 1 of 5 �oF`so . Town Nall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 G�O Southold,NY 11971-0959 ! , OU 5� BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent (no P.Q. 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: 63/— 506 - 6sy3 Telephone Number (s): Daytime Evening Emergency Email Address: 1-^I A 7 22l P 0J 6*1 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): Page 2 of 5 �k pf SDUTgQ Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959Q ® �O VU �'-�zzrrU:a BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime Evening Emergency Email Address: 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: 15 j Use and Dimensions of each room in Rental Dwelling Unit: S , Page 3 of 5 0s 0 . Town Hall Annex , Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 G m Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLID 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. 41, 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. SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) ) COUNTY OF SUFFOLK) f •10/1 C Q If,--/,---c G , 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 Page 4 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 G iz 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, Property Owner's Name: C2 4 Property Owner's Signature: Sworn to fore me thiy�-' ay o 20;� BOGUMILN T. ROSEBURG NOTARY PUBLIC-STATE OF NEW YORK N0.Official Nogry Public Signat and Original Notary Stamp QUALIFIED IN QUEENS COUNTY r .Q COMMISSION EXPIRES JANUARY 13,20--) Page 5 of 5 �aoe Soup, _q mve., Xw& # # TOWN OF SOUTHOLD BUILDING DEPT. °`ycourm N�' 765.1802 - : INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] ' FOUNDATION-2ND ; . [ ]. INSULATIOWCAULKING [ ] FRAMING /STRAPPING [ INA r [ ] FIREPLACE'&-CHIMNEY [ FIRES FE' INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL-(FINAL) [ ] CODE VIOLATION [ ] PRE C/O- REMA � 1 KS: iw da o A e,,r (9 - �V It vo p w 41AL Inv DATE A 3 w INSPECTOR �__ 5/19/2020 floor plan.png l r�tiraca�� ®tillcllft®Sketch ffm atCA� $14 14Y to C40 k°rra# a3t�caro E L t h I r 1/2 Bedroom Oath Kitchen Both Parch' a Sitting Room m Bedroom { UvIng Room 1c. / ww°wwwPne ' a Bedroom 21.5 111 Cawna � q levet 1 16° Q AIMte4eabftfts,w.a.nw urteaay�e sort#sae ss.�ts.sa°_e /e1�91M iAaea{Ne�n/s1)i _ l4tl ls7 tl cast., twSam 't4•io'. eu Tacencd ArW N75+p�t ?t<ft - rte (cm SU.g DW='TOW kviL U so!wa by 8 W mWe.1x•14WAL UDDE https:Hmail.google.com/mail/u/0/#inbox/QgrcJHsBschwRvGvVhVkvPXNZXxgRnPwCmQ?projector--1 1/1 TOWN OF SOUTHOLD PROPERTY WNER STREETVILLAGE DIST. SUB. LOT p in FORMER OWNER I ,w'5C ket N E ACR. rez "c%o r P a w i2w -P�. S W TYPE OF BUILDING f f >r+ gyp�r f=r�1�a`i + �; P�r��s7•�?cw U k RES. �'�� SEAS. VL. FARM COMM. CB. MISC. Mkt. Value 1- LAND IMP. TOTAL DATE REMARKS ! ' �• o� 4� S��`I ftp s—_ z� ?/ 3 G Lj -Z70 - w /D •G 4O - .fEf'fS,la - [y .l V 19/e, CD , L r 310 d'/ q-, - C l�oufd P�fa�� Sao '3(o9 4-f Uo / 7 P 5I o, a _%e - F.T�iP g— l�a,n-4 G AGE BUILDING CONDITION // tt _Z 9AA/ER, L Ic l�Q (] trs t i�r -=fie �=1Y^4 in x-=_,10 NEW NORMAL BELOW ABOVE I FARM Acre ValuePerer Value (�, �� S 98S,-Oft) Tillable 1 i ! Tillable 2 Ian - Tillable 3 Woodland, Swampland FRONTAGE ON WATER Brushland FRONTAGE ON ROAD House Plot f DEPTH- r 4 BULKHEAD Total DOCK (9, COLOR — I I I �■ _ TRIM i I M. Bldg. _. Foundation 8 Bath I Dinette Extension j ? - Bcpement ,A7 Floors 1 K. _ Extension _ Ext. Walls s ' Interior Finish - LR. I Extension i I Fire Place /V Heat / DR. ,Type Roof Rooms 1st Floor BR. Porch Recreation Room Rooms 2nd Floor! FIN. B. Porch i i✓G /A - eQ i a , ormer Breezeway Driveway Garage l O X Z b = Z. Patio O. B. _. b J ' Total I FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT `� S TOWN CLERK'S OFFICE �v SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ....Z..2361........... Date ............................Pp-b.*........;a....... THIS CERTIFIES that the building located at .W/8.....Gro,vt,•.r%omd Street Map No. ..... . ......... Block No. ....y,X.. .......... Lot No. X=. . ....... ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....................................slap ,.........8........, 19-6.5. pursuant to which Building Permit No. .....28.58-z dated119...............................Sept..... ........ 19...5.5, 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 ........ �.u��t .•�xse... am�1, ...dxr � ix��......................................................................:..................... The certificate is issued to .....yj {1'��31" .' o22' 901' zrll.......................................................... owner, lessee or tenant} of the aforesaid building. H.D.Approval Feb. 237 1966 by H4 Villa . .... . .............. to Building Inspecr FORM NO.4 TOWN OF SOUTHOLD No BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y Certificate Of Occupancy No. 214860 . Date . . . Sept.. 986 .. . . . . . . . . . . . . . . 19 THIS CERTIFIES that the building . 4teration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property 430 Grove Road . . Southold . , . . . . , . . House No Street Hamlet County Tax Map No 1000 Section 1 Block 6 . . . . . . .Lot .19 . . Subdivision Filed Map No . . . .Lot No . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated , , , .Augu.qt 1q . , , . , 19 86 pursuant to which Building Permit No. 1;5.1872 . . . . . . . . . . . . . . . dated . . ..August 18 . 19 86. ,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 . . . . . . . . . Alteration--enclose porch. . . . . . .. . . . . . . . . . . . The certificate is issued to . .Marian T; &/or.Francis J. Dirscherl . . .. . . . . . . . . . (owner��WZHM of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �. . . . . . . . . . . . . . . . . . . Building Inspector R®v 1/81 FORM NO 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. .Z14861 . . . . . . . Date . Sept: .g . . . . . . . . . . . . . ' 19 86. THIS CERTIFIES that the building . . , , , ,Accessory building . Location of Property 430,Grove Road Southold .. . . House/Vo Street Hamlet County Tax Map No 1000 Section 51. . .Block . . . . . .6. . . . . . Lot . . . ..9. . . . . . . Subdivision . . . . . . . . . . . . . .Filed Map No. . . . . . .Lot No . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated ,August,l8, _ . . , . . . 19 . .81pursuant to which Building Permit No . 151872 . 18 dated . , , . .August . . 19 86 ,was issued,and conforms to all of the requirements of the applicable provisions of the law.The occupancy for which tlus certificate is issued-is . . . . . . . Accessory shed in rear. yard. The certificate is issued to MPLXj.an T. &jor Francis J. DirscherJ of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. PSA. . . . . . . . . . . . . . . . . . . . . . . . .*iBuzding n pector 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. . ,Z16304Date October 19 , 1987 . . . . . . . . . . . . . . . . . . . . . . . . THIS CERTIFIES that the building . . ,Q c c e s s o r,y, Location of Property 430 Grove Road Southold House No. Street *Ham/et County Tax Map No. 1000 Section .05.1. . . . . . . .Block . .9.6. . . . . . . . . . .Lot . . . . ,1.9. . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated PA.y Y. 2 9 , 19.8.7. pursuant to which Building Permit No. , . ,16 2 9 7 Z dated . L!1 y. 3 1., .1.9.8.7 . . . . , , . 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 building. The certificate is issued to , SAVAS & TOULA ARAP (owner Vis&xoxYVAJ-DOXXXXXX 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