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Home My WebLink About1000-59.-11-9 TOWN OF SOUTHOLD Rental Permit 0914 Owner Basilio Esposito Occupied as Single Family Dwelling Located at 100 Terry Court Southold 59.-11-9 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. 5/25/2023 e c e Official This Notice must be posted by the main entrance at all times Town Hall Annex Telephone(631)765-1802 54375 Main Road 7 Fax(631)765-9502 P.O.Box 1179 ,E Southold,NY 11971-0959 ' � rl � BUILDING DEPARTMENT OC F 2922 TOWN OF SOUTHOL�D �nmw :j RENTAL PERMIT APPLICATION "` Rental Permit Fee $200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION BLOCK 001 -LOT 5q SECTION B. OWNER INFORMATION: Property Owner Name: ° �q Property Owner Legal Address: Property Owner Mailing Address: Rlow o eA 7.0 G7 Telephone Number (s): Daytime 1',41b— Evening Emergency Property Owner Email Address: ° ' 'G0 Page 1 of 5 r ilTti Town Hall Annexe Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 fly �� Southold,NY 11971-0959 � �� "` , Cowl BUILDING DEPARTMENT TOWN OF SO HOLD J 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 Emergenr 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): Page 2 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax (631)765-9502 P.O. Box 1 179 r Southold,NY If 971-0959 + � BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number (s): Daytime - �`vening Emergency -/"- 3 Email Address: SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: J. 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: Page 3 of 5 t„ , V;; Town Hall Annexe Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 rA. e0um Z 1971-0959 . ,, 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. �l,/ I 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) I � .. � ��. ertify 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 a� Town Hall Annexa Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 it BUILDING DEPARTMENT TOWN OF SO HOLD 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: f9 5f Z S t' S w Property Owner's Signature: � �� Sworn to before me this,day of ) , 20 ZZ CA Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,Stale or New York No.01BU6185050 Qualified in Suffolk County,,,,, Commission Expires April 14,21-,.,-; Page 5 of 5 aFq "' D BUILDINGDEPT. Cow 631-765-1802 �—' INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. ] FOUNDATION 2ND INSULATIOWCAULKING [ ] FRAMING / STRAPPING [ ] FINAL CHIMNEYFIREPLACE & [ ] I INSPECTION FIRE RESISTANT CONSTRUCTION [ FIRE RESISTANTPENETRATION ELECTRICAL (ROUGH) ] LOT I L {FL) VIOLATIONCODE [ ] PRE C/O [ RENTAL is okf44 �ja ,'roV DATE " 4 50U TOWN OF 631-765-1802 pe x [ ] FOUNDATION 1ST [ ] ROUGH PLBG. DATION 2ND [ ] INSULATION/CAULKING [ ] FOUN FINAL [ ] FRAMING / STRAPPING [ ] FIRE SAFETY INSPECTION [ ] FIREPLACE & CHIMNEY [ ] FIDE RESISTANT PENETRATION [ ] FIRE RESISTANT CONSTRUCTION [ ] ELECTRICAL (FINAL) CTRIC L ( H) [ ] [ ] [ ] PRE C/O [ ] RENTAL [ CODE VIOLATION � � INSPECTORM o� TOWN OF SOUTHOLD 13UILDING DEPT. - � INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ l FOUNDATION 2ND [ ] INSULATIOWCAULKING [ l FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ 4"'RENTAL 4��0�1 o 5� DATE1� �a . — INSPECTOR Gv� Q p ®UTHOL® TOWN Town Hall Annex 54375 Main Road b ,t PO Box 1179 Southold, RentalIns a t®�1 NY 11971-1179 � Tel: 631-765-1802 a Fax 631-765-9502 to SCTM # Date a -�- Owner Phone Address Zip City Inspector LEVELS SUB 2 3 Smoke Detectors (#- bedroom detectors excluded) I J 1 Carbon Monoxide Detectors (#) Fire Extinguishers (#) Exits (#) co l 1 BEDROOMS 2 3 4 5 Smoke Detector Alarms (#) ✓ Carbon Monoxide Alarms (#) Egress (windows) (Y/N) BUILDING SYSTEMS Y/N CONDITION OF PROPERTY Y/N Heating s stem maintained/o erational V Building Interior is clean /maintained Hot waters stem maintained/operational Building Exterior is clean/maintained Electrical s stent maintained/o erational ;714—Property is clean (safe/maintained Mechanical system maintained/operational erational Handrai{s &guards present COMMENTS: OL d Ff4 Rental Inspection Form 4/712027 "a H�✓N" p �u. F f 17 P f hyo l tr � r ; 34 r , l� / fir", 1 1'II f JJi J (,� �/ . �Vm ��illi�s IL.................................................... 888888888888888888�I u" ' ii �� , u, I SCTM # _ (coo- 1 - t TOWN OF SOUTHOLD PROPERTY RECORD CAS kz-a, OWNER STREET `00 VILLAGE DIST_ SUB LOT ACR. REMARKS TYPE OF BLD_ g PROP CLASS LAND IMP TOTAL DATE C)C-) fid - 0 0 FRONTAGE ON WATER HOUSE/LOT I BULKHEAD TOTAL TOWN OF SOUTHOLD PROPERTY R RD OWNE STREET VILLAGE DISTJ SUB. LOT cl P E FORMER ONSN ACR. W TYPE OF BUILDING RES.s SEAS. VL, FARM COM: CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS AL —cs 0 LZL t 0 A c2cj 7 q h Z-- AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre i Value Per Value Acre Tillable FRONTAGE ON WATER Woodland I FRONTAGE ON ROAD Q Meadowldnd I DEPTH House Plot BULKHEAD Total DOCK COLON . s ----------- r _ —Y e r c E u — _ 'Y t s s M. Bldg — F - Extension i € v Extension F I res, Extension 'Foundation !Both Dinette nette Porch i 'Basement Floors K. Porch Ext. Walls ;interior Finish LR. Breezeway iFire Place ;Heat j DR. Garage ` - Type Root Raoms Ist Floor ER. Patio Recreation Room 'Roof ns 2nd Floor - FIN, I O. B. Dormer 'Driveway Tato I / 0u `� / lo /7