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Home My WebLink About1000-47.-2-2 TOWN OF SOUTHOLD Rental Permit 0986 Owner Irma Lekkas Occupied as Single Family Dwelling Located at 120 (aka 13)Silver Ln Greenport 47.-2-2 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. 9/12/2023 de E rc t (ficial This Notice must be posted by the main entrance at all times 00 o . .,,, —124, ,i Telephone( 1)765-1802 Town Hall Annex // V, 54375 Main Road ;,,, %,��i�� Fax(631)765-9502 r P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD t RENTAL PERMIT APPI-ICATION r Rental Permit Fee$200(Application must be renewed every two years) I Section A. Property Information: Rental ddress: y w Prc ert A �ZI `' f� fL U��Z ,(,QNB 4Gr� Tax Map Number: 1000 SECTION °- -BLOCK -LOT--� SECTION B. OWNER INFORMATION: Property Owner Name: -I-e" Property Owner Legal Address: Property Owner Mailing Address: Telephone Number(s): Daytime'Z - � :Itvening Emergency_._,_,_... Property Owner Email Address: � F � 1i µ Page 1 of 5 z Oyu ;- Town Hall AnnexTelephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY If 971-0959 m 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.O. Boxes): "- C Mailing Address of Authorized Agent: ✓ � � � Telephone Number(s): Daytimes " „ peening Emergency Email Address: 6dr� 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 r°� Southold,NY 11971-0959 '� IAll �, 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." * ww Rental Dwelling Unit Identifier: Requested Maximum number of persons allowed to occupy Dwelling i : Number of rooms in Rental Dwelling Unit:-, Use and Dimensions of each room in Rental Dwelling Unit: ;, Lb M V l +'V Page 3 of 5 Town Hall Annex S5 Telephone(631)765-1802 54375 Main Road f Fax(631)765-9502 P.O.Box 1 179 aa � " Southold,NY 11971-0959 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. t� I am requesting afire 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) 1 ,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 AnnexTelephone(631)765-1802 54375 Main Road �� Fax(631)765-9502 P.O.Box 1179 �& � Southold,NY 11971-095940�� p I, . 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: " Property Owner's Signature: Sworn to before me this—day of 20_ r Official Public-Sigh ure and Original Notary Stamp SEE ATTACHED NOTARY CERTIFICATE Page 5 of 5 CALIFORNIA JURAT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document,to which this certificate is attached,and not the truthfulness, accuracy, or validity of that document. STATE OF CALIFORNIA } COUNTY OF Contra Costa Subscribed and sworn to (or affirmed) before me on this day of 2023 Datenth Year by �_� Name of Signers proved to me on the basis of satisfactory evidence to be the person(s)who appeared before me. TONY DEPOLO Notary Public•California ZContra Costa County Commission N 2439657 90my Comm.Expires Feb 28,2027 Signature: Seal Signat e of Notary Public Place Notary Seal Above --------------------------------------------------- OPTIONAL --------------------------------------------------- Though this section is optional, completing this information can deter alteration of the document or frau ulent attachment of this form to an unintended document. Description of Attached Document Title or Type of Document; Document Date. Number of Pages„ Signers Other Tan Naiad Above: Ivim--JW �,. 6rAov+ TOWN OF SOUTHOLD BUILDING DI 631 -765-1802 INSPEC luAahkN [ ] FOUNDATION 1ST [ ] ROUGH PTBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAl [ ] FRAMING / TR PPI G [ ] AL [ ] FIREPLACE & CHIMNEYFIREPLACE [ FI E SAFETY IN! [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL {T [ ] CODE VIOLATION [ ] PRT C " [ I RE RKS11 DATE 114SPECTOR c y e � v _ e � i TOWN OF SOUTHOLD PROPERTY W// /? OWNER STREET _ VILLAGE DIST - SUB. LOT - r K FORM R OWNER N f E_ ACR. _.V- � _. S W TYPE OF BUILDING s RES,f; ° SEAS. VL. FARM COMM. CB. MISC. Mkt. Value f LAND IMP= TOTAL t DATE I REMARKS - i s d f s — .• € _ - _ r AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value I Acre Tillable 1 I Tillable 2 Tillable 3 Woodland l Swampland z ' FRONTAGE ON WATER Brushland ' I FRONTAGE ON ROAD House Plot DEPTHa � i ;BULKHEAD Total DOCK - - �, COLOR y_ ;- I I = s 3 _ .. � TRIM 1 i y , a z a , ` a i Faundatian Bath Dinette M Bldg_ e _ Extension 'f K. ;Basement I Floors i `7-1 Ext. Walls Interior Finish LRa � Extension i = i Extension Fire Place ear DR_ Type Roof Rooms 1st Floo BR - Recreation Raom! Rooms 2nd Floor F 1N. B ' Porch ecTom— Porch Doemer s Breezeway 1 ;Driveway - t I Ga rage ._ t Patio E Total