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Home My WebLink About1000-63.1-1-30 1O`WWWN OF SOUTHOLD Eli Rental Permit 0990 Owner Gina T Cerniglia Family Trust Occupied as Single Family Dwelling Located at 2555 Youngs Ave #16E Southold 63.1-1-30 Maximum Permitted Occupancy 3 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. 9/14/2023 This Notice must be posted by the main entrance at all times Code Eo#or ern o Official A&D 6 5337 Fe "�ro Telephone(63'1)765-1 2 Town Hall Annex 54375 Main Roads P.O.Box 1179 Southold,NSC 11971-0959 a� U � All 2 9 2023 BUILDING DEPARTMENT artment TOWN OF SO THO D Brown of Southold RENTAL PERMIT APPLICATION Rental Permit Fee $200(Application must be renewed every two years) Section A. Property Information: Rental PropertyAdfts s: Tax Map Number: 1000 SECTION 3• BLOCK LOT SECTION B. OWNER INFORMATION: Property Owner Name:__Q Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) i&L 4t-A 15 ' sig y8b ��7t' 3l 63d � Telephone Number(s). rI Property Owner Email Address: ` t9N _ 6 Z, A Page 1 of 4 Section C. Authorized Agent Information: o fl �}b4 Name of Authorized Agent of dwelling unit,if any:_&AP,6nt-A Address of Authorized Agent(no P.O. Boxes): Mailing Address of Authorized Agent:_ Telephone Number(s):W_ _ H_.. Email Address: APj f 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): Email Address: -� SECTION E. SITE MANAGER INFORMATION:(required for rental properties containing 8 or more rental units) Name of Ma ing Agent of dwelling unit,if any: Address of Managin Agent(no P.O. Boxes): Mailing Address of Managing ent: Telephone Number(s): Email Address: _. Page 2 of 4 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 bwelling Unit: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: 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 NYS licensed architect,a NYS 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. Page 3 of 4 o I am submitting a completed Town of Southold certification form from a licensed architect, a licensed professional engineer,or a licensed home inspector who has a valid New York State Uniform Fire Prevention Building code Certification, SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) ) COUNTY OF SUFFOLK) <_ � i � , ,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 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 s to any change to the information regarding Authorized Agent,Managing Agent,or Site Manager. Y w INS Property Owner's Name: Property Owner's Signature: _........,_; a Sworn to before me this day of ...._. 20 Official Notary Public Signature and Original Notary Stamp SARAH COSTA-BRAND Notary Public,State of New York Page 4 of 4 No.01 006441644 g Qualified in Suffolk(county Commission Expires September 26,2026 so TOWN OF SOUTHOLD BUILDING 831 -765-1802 INSPEC ION [ ] FOUNDATION 1ST C ] ROUGH PLBG. [ ] FOUNDATION 2ND C ] INSULATION/CAI [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN! [ I FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI [ ] CODE VIOLATION C ] PRE C/O [ a - &�� K�_--- " DATE %•/ '� = - INSPECTOR Town Hall Annex ` Town of Southold 54375 Main Road Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 .Data e SCTM # Owner Phone - . Nisi ....... . _..w " Visible Address _ __ _ ...., _ Inspector Hamlet d .,e _ �_.. ......... .. Floor Level Quantities Sub 1 2 3 Smoke Detectors (not located in bedrooms) Carbon Monoxide Detectors Fire Extinguishers - Exits Bedrooms 1 2 3_ 4 5 6 Smoke Detectors Egress Occupant Count .12 Building Systems Maintained & Operational Condition of Property Heating Building interior Hot water Building exterior Electrical Property clean, maintained &safe Mechanical Handrails &guards installed &secure 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 CO's for all items present Prior Rental Comments: cI PATIO BATH BATH LIVING ROOM i CI 0 0 19-0/12-10 cr i \ BED Room B-ED DOOM tKITCHEN 12-0J15-0 10-4/11-4 1a-0/11 4 .o 0.0 of DINING 0-0/1 1-1 FLOOR PLAN( MODEL A FOUNDERS VILLAGE TOWNHOUSES OUTHO , NEW finJ- 1c� TOWN OF SOUTHOLD PROPERTY RECORD C/ 5 c4(o) as .- OWNER S GREET —M VILLAGE DIS LOT — _ s ACR. REMARKS 3 y,. TYPE OF BLD — PROP. CLASS LAND IMP TOTAL DATE I i FRONTAGE ON WATER HOUSE/LOT i ° BULKHEAD 1 TOTAL TOWN OF SOUTHOLD PROPERTY RECI ��N R _qTR_ET VILLAGE - DIST. COUNTY TAX MAP NO. e t LAND 1MP. TOTAL DATE i REMARKS t� a i f - e v d 1 I .E LAND A y AT C iN F. W r l N z b Q v CJ — C E co r € � E 1 0 0s FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. .214568 . . . . . . . . Date . . . .June ,27. . . . . . . . . . . . . . . . . . . .. 19 86 THIS CERTIFIES that the building . . . . . MULTIPLE DWELLING, , , , , , , , , , , , , , , , , , , , , Location of Property . . . 2555 YOUNGS AVENUE SOUTHOLD House'IVo. . . . . . . . . Sireei . . *H*a* r%at County Tax Map No. 1000 Section . a.6 3 . . . . . . .Block . . . . . . . . . . . . . . .Lot . . . . . . . . . . . . . . . . . Subdivision . . FOUNDERS .VILI:AG . . . „ „ , . , .Filed Map No. . . . . . . . .Lot No. . . . . . . I . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . .S QPt.-. .�7, . . . . . . . .. . , 19 ?A.pursuant to which Building Permit No. 135167 . . . . . . . . . . . . . dated . .Oct.. 2 . , . . . . . . . . , • . . • . . . . 19 . $4,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 . . . . . . . . . Building16 Unit E--Unit in Multiple dwelling: . . . . . .. . . . . . . . . . . The certificate is issued to , , , LIZDA REALTY LTD. (oiw!rer, of the aforesaid building. Suffolk County Department of Health Approval . . . .S-5.4. .> fid. .#.16. 5,/.2 (86 . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . .Pending. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBERS CERTIFICATION 6/4/86 w V`� *Building Inspector— Rev.1/81 11i'f Town of Southold 10/9/2021 P.O.Box 1179 53095 Main Rd Southold,New York 11971 �k CER"T"IFICATE OF OCCUPANCY No: 42421 Date: 10/9/2021 THIS CERTIFIES that the building RAMP ......... Location of Property: 2555 Youngs Ave Unit 16E, SoutholdWWIT..._._m...v.w..�_.._.w.....w_....._....w_._.__. w.w... w_..........._..........-....._� _. SCTM#: 473889 Sec/Block/Lot: 63.1-1-30 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated P g _..........._......,, _. .... ....4/2020 12/10/2020 pursuant to which Building Permit No. 45573 dated 12/14 mm mmMMµym 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: tjgp0 a ran a r rli,ed for. Unit 11 The certificate is issued to McGowan,Lisa of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED A tkt srh ignat '