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HomeMy WebLinkAbout1000-94.-1-12.2 TOIWAWIN OF SOUTHOLD { Rental Permit 0632 Owner Panayiotis Basios Occupied as Single Family Dwelling Located at 2505 Soundview Ave. Mattituck 94-1-12.2 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. 5/3/2022 r� e t� C��cial This Notice must be posted by the main entrance at all times IF%Iry V� �v V��My Town Hall Annex ° ' Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 �' "4101�P+f� v V BUILDING DEPARTMENT TOWN OF SOUTHOLD I � C' 11,x' 02 EPT RENTAL PERMIT APPLICATION FU All",4..UNG Y ll" l�dli°�A�'�(��'�'�:'i:�'�9�D°"II"WIL..D Rental Permit Fee $200 (Application must be renewed every two years) Section A. Property Information: Rental Pro erty Address: (yj Cc" Tax Map Number: 1000 SECTION BLOCK -LOT 12. SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: Q r7 Telephone Number (s): Daytimesj�' 3 j� Evening _ Emergency �,L���6 Property Owner Email Address: �?� SOS@GM�Pt1C.o Co M �� Page 1 of 5 Town Nall Annexs Telephone(631)765-1802 ' �", 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959t�r BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: * d Address of Authorized Agent (no P.O. Boxes):____­­__­—,.,,„......_._�------ Mailing Address of Authorized Agent: -6 �...._...(� �- Tele hone Number(s): Daytime� Evening_. ._-- Emergency_—. ., Email Address:—1--��� ����65��5��ll�Gtl �'c9 r� Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: „Tvf Address of Authorized Agent (no P.O. Boxes): Mailing Address of Authorized Agent: 0y Telephone Number(s): Daytime - wening Emergencl Email Address: �,)�q 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 a: r. MW d? Town Hall Annex � ; Telephone(631)765-1802 54375 Main Road f Fax (631)765-9502 P.O.Box 1 179 Southold,NY 1 1 971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD 1Mo� " ' .. Mailing Address of Managing Agent: � '° -( ) °� �" i ( 0 3� Telephone Number (s): Daytim ��� L�zivening,` Emergency­,,�,� Email Address: -",4 d" i ��.111k ------ 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." ell Rental Dwelling Unit Identifier: _ ,Un�j ° � Requested Maximum number of persons allowed to occupy Dwelling Unit: M Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: M Ij LM .M .`--...."�� ..........,.... w........�.,.. LC 4 # 23 Page 3 of 5 / P r Town Hall Annex "telephone(631)765-1802 54375 Main Road Fax(631)765-9502 �J . P.O.Box 1179 ry "' Southold,NY 11971-0959 � 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 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) GA-00i 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 �' V �� 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. Property Owner's Name: .,_. ( ()7 ` 3 __ Property Owner's Signature: S Ern t hefo,,Wme this day o , 20Z/ Officia otary Public.Signature and Original N tary Stamp MARCIA Pt,GRANT Notary oublio,State of Now Yoh No.OIGR 114114 iQualified In Queens Countit, m Commission aspires 181091 Page 5 of 5 Town Hall Annex Telephone(631)765-1$02 s 54375 Main Road Fax(631)765-9502 Ck P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOM RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: srr�; TOWN OF SOUTHOLD BUILDING 765-11802 114SPECTION [ ] FOUNDATION 1ST L ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/C UL ING [ ] FRAMING / STRAPPING [ ] FINAL �PivWti� [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMA S-0 vy ", INSPE,CTORAW � ,�� Oct 09, 2021 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 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 Professional seal required for Architect or Fri inset fig e��se�l l Orme lrls actor rr�ust iii coov of valid current certification Rental Property SCTM Number: Rental Property Address: 2505 Soundview Ave. Mattituck NY Owner/Name: Pana iotis & Pana iota 8asios Rental Dwelling Unit Identifier: Number & Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom #1 -100 sq., Bedroom #2-90 sq., etc.) B room #1 140 sqft Bedroom #3 230 sqf Bedroom #2 140 s ft Bedroom #4 130 sqf Property Description (Include all improvements indicated on survey) single family bome 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. Victor Cornelius III CEO Inspector Print Name and Title ceo# 1216-0283 O igi al Signa re Please place professional seal: �1 l TOWN OF SOUTHOLD PROPERTY RECON 3 , OWNER ISTREET " e� m VILLAGE DIST ? SUB, LOT 2 FORM R OWNER N E f F I AOR ' - Jo pi-4 c, M 41 S W TYPE BUILDING E �O�F ' AT � RES. SEAS. } VL. FARM COMM. CB, MICS. Mkt. Value qi LAND IMP. TOTAL DATE REMARKS - v f ' r ' ���7 I - - L � s a s - " ? s 7 / //-r z5 7 9° F . _ r } EF, a ,ry � 1 , i i i i IL Tillable I FRONTAGE ON WATER 5 Woodland I FRONTAGE ON ROAD Meadowland I DEPTH House Plot BULKHEAD i Toto N. CYY� ` iL _. _ I ?LOR wx �� TRIM F it a 0 � a \\ �.. 44.-1-12.2 10/10 � o M. Bldg EXternion �.• / Extension k � E Extension - l c r�7 I l� AY > P ,5 tte Foundation ne C B�fi Di poi k _ k Basement Floors rch x :. -Ext Walls interior Finish LR Breezeway Fire Place Heat = DR. Gor Type Roof Rooms 1 st Floor ;BR. FoY o Recreation Roam Rooms 2nd Floor F k Donner � Total w r FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Wt04 . . . . . . Date . . . . . . . . . . . t. . . .12. . . . . .. 1974. THIS CERTIFIES that the building located at Sova& Yi#W. .AV*. , . . . . . . . . . Street Map No. X= . . . . . . . . Block No. . . . . . .Lot Nom. .Matti . . X.Y.. . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . .J . -20- -, 197,E. . pursuant to which Building Permit No. . �, . . dated . . . . . . . . . . . .;AXY. . 24 ., 1973. ., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Private—cm. family .dW*jj .ng. . . .(appXgV9l, .by. M AplaoeXa.). . . . . . . . The certificate is issued to . .Terry. Ttiadae . . . . . . .Pwner.. . . . . . . . . . . . . . . . . . . . . . . . . .. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .Sept - .%6� . . .1974. .by •R.. Yips . . UNDERWRITERS CERTIFICATE No. .9/11174. . .by.J... Xubacki. . . . . . . . . . . . . . . . . HOUSE NUMBER . . .250.5 . . . . . . Street . . P►ound. .Q3ew .AY* . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . Building'Inspector P S F a e > l < eq 4 , 1 ASS aN, 1. Xv 14a: lto N ` jjlr M ti vWIN j I rre r3' a rt 3 E I f > j n NU AF II 4y v g 010, 1 _e o pow A y NO '1 _AN _ - gym` AM �4 >lily / 4 A 1 w ' won _- ,mash kit �_,� L