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Home My WebLink About1000-106.-3-19 a T 4 04"WAVIN OF SOUTHOLD A. Y, � Rental Permit t 0640 Owner Central Drive LLC Occupied as Single Family Dwelling Located at 205 Central Drive Mattituck 106.-3-19 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. 5/12/2022 o rc � ficial This Notice must be posted by the main entrance at all times Town Hall Annex Telephone(631)765-1802 54375 Main Road Pax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 "ato BUILDING DEPARTMENT TOWN OF SOUTHOLD I MAR `V 5 "�'un i �j J" L-l" RENTAL PERMIT APPLICATION ��"��ha^1 S , ��sf3UjL'0jj\g"4 rHjr~ Rental Permit Fee$200 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: L Tax Map Number: 1000 SECTION /1200 -BLOCK -LOT 1d, 1000 - 10& - 3 - 19 SECTION B. OWNER INFORMATION: Property Owner Name: 44L M Y Property Owner Legal Address: Property Owner Mailing Address: jj - y Telephone Number(s): Daytime Evening Emergency_L 6 S.3,V9 Property Owner Email Address: Page 1 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 w Southold,NY 11971-0959 sr BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: 4 Address of Authorized Agent(no P.O. Boxes):, Mailing Address of Authorized Agent: ,_,_ Telephone Number(s): Daytime *N*e—LtVvening 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): Page 2 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 1 1 971-0959 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, 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 occupy Dwelling U t: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: Page 3 of 5 Town Hall Annexe; low" ' Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 m 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) 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 kc P.O.Box 1179 Southold,NY 11971-0959 rw�n 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, orSiteManager. Property Owner's Name: Property Owner's Signature: Sworn to before me his of a 20 Official Notary P lic Signature and Original Notary Stamp PMLIS 1_,CALDWELL Notary Public, State Of NeW Ybrk No, 4613 1 C' Qualified In Nassau County Commission Expires May 27,20�� ,i Page 5 of 5 TOWN OF SOUTHOLD BUILDING DEPT. icy INSPECTION , I FOUNDATION 1ST ROUGH PLEIG. FOUNDATION 2ND INSULATIOWCAULKING FRAMING /STRAPPING FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION CONSTRUCTIONFIRE RESISTANT I ELECTRICAL (ROUGH) ELECTRICAL CT I I CODE VIOLATION PRE C/O RENTAL REMARKS.- :?V: DATE __ " �.: April 10, 2022 Town Hall Annex Telephone(631)765-1802 54375 Main Road ';" F'px',(63l)765-9502 P.O.Box 1179 'b � PCZ Southold,NY 11971-0959 ye , UK 10� . °��9 " APR 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 re uired Lor Architect or Engineer, licensed Horne Inspector myg rovide copy of valid current cerci ication Rental Property SCTM Number: Rental Property Address: 205 Central lir. Mattituck NY. 11052 Owner/Name: Nick Moshouris 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.) Be room #1 11 qrlft Bedroom #3 150 scift Bedroom #2 1 Q5 saft Bedroom #4 170 saft Property Description (Include 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. Victor Cornelius III CEO Inspector Print Name and Title ceo# 1216-0283 Original Signature Please place professional seal: TOWN OF SOUTHOLD PROPERTY I OWNER ; STREET VILLAGE � DISTRICT SUB. LOT r �- _ ,r(-RR %ER OWNER e - -- — 1�E - � ACREAGE i a= S V TYPE OF BUILDING PSS. a` SEAS. VL. FARM COMM. IND. CB_ MiSC, L°SND iMP� TOTAL DATE j REMARKS E -c AGE BUILDING GOXD,TION L BLO' _ ABOVE _ s s _ e Tillable TSI �l-,,„Le e _ >. s 4 Swomplond— 510 7 'Brushland House Plot � -- e } P -21 106.-3-19 3/22/2021 — t a a � 3 l _ i ' r f 1 .A Foundation Bath Bldg, _ Extes;on Basement Floors �- Ext. Walls vi h'xtensit - Interior Finish =on Fire Place Heat Porch } Porch 1 Roams 1st Floor 8; Patio Rooms 2nd Floor l ' f F� z, Garage l D 0a'' > j FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT No N s TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. 2 278 Date JUXV 22 , 19 b@1 THIS CERTIFIES that the building located at #/$ trait DVIU* Street Map No. rapt lock No. . . _ . . Lot No. 10 1014tteltU t X*Xo. . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated IMI It . . 10 , 19 67 pursuant to which Building Permit No. .3401 .2 dated ftr$h 2.6 19 6p, 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 one- fenily •4weLling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to An"CAy %GU,ant:,g. . . . . . . . .. . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval JVm 27; 1967 by R*. : ill& Building Inspector FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No . 2,- 16873 „ Date .May 16 , .1988 THIS CERTIFIES that the building ACCESSORY SHED . . . . Location of Property 250 Central. Drive_ Mattituck, N.Yri. Nouse No Street Hamlet County Tax Map No. 1000 Section !d6 . . . . . .Block 03, Subdivision Filed Alap No Lot No. conforms substantially to the Application for Biiilding Permit heretofore filed in this office dated September 9 , 1986 pursuant to which Building Permit No 15292 Z dated S e p t e mb&r 20 , 1986. was issued, and conforms to all of the requirements of the applicable provisions of the law Tlie occupancy for whicli<this certificate is issued is ACCESSORY SHED IN REAR YARD .AS APPLIED FOR Tlie certificate is issued to MICHAEL MOSHOURIS . (owner,la6im X of the aforesaid building Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO . . . NIA . . . . . . . . . . . . PLUMBERS CERTIFICATION DATED : NSA U) Ycl Building Inspector Rev 1181 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31802 Date: 279 13 °06 THIS CERTIFIES that the building ADDITION Location of Property: 205 CENTRAL DR MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 4°73889 Section 106 Block 3 Lot 19 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 29 2006 pursuant to which Building Permit No. 32168-Z dated JUNE 29 2006 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 DECK ADDITIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to IRENE MOSHOURIS (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 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