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Home My WebLink About1000-43.-4-22 TOWN OF SOUTHOLD ,- Rental Permit 1025 Owner Meropi Zervos Occupied as Single Family Dwelling Located at 385 Wood Lane Greenport 43.4-22 Maximum Permitted Occupancy 6 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. 11/15/2023 odenf m nt Official This Notice must be posted by the main entrance at all times YC C 0 3q 1 oil v1510 a Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 E E W E BUILDING DEPARTMENT A 2 9 2023 TOWN OF SOUTHOLD Building Department RENTAL PERMIT APPLICATION Town of Southold Rental Permit Fee $200 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: 4 �� too e &�ee" Tax Map Number: 1000 SECTION q,.(-BLOCK 0 qO0 -LOT „�� 0 � SECTION B. OWNER INFORMATION: Property Owner Name: r Property Owner Legal Address: Property Owner Mailing Address: �- _.. 6 Ej / .., / 1 Telephone Number (s): 'Daytime Evening Emergency / 7- 1...f 7Q Property Owner Email Address: . - Page 1 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 40 P.O.Box 1 179 Southold,NY 11971-0959 % BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: [ 0 r1 -0 of Authorized Agent (no P.O. Boxes): / ' en ca4 Mailing Address of Authorized Agent: " f • 8-45 ` ' Telephone Number (s): Daytime 4 Evening Emergen+ . 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 41u'r: . r w Town Hall Annex Telephone(631)765-1802 54375 Main RoadFax (631)765-9502 c P.O.Box 1 179 Southold,NY 11971-0959 0 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: 7 ��e �� l � Telephone Number(s): Daytime�76 �S� Evenin Emergency Email Address: l l 62) 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." 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: y p o v 10W rz x Zo ti�� ( — fz x rr A'x Z — r< .Z Page 3 of 5 f Telephone(631)765-1802 Town Hall Annex 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Ys Southold,NY 11971-0959 1 -C, BUII_.DING 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 a gineer or a home inspector who has a valid New York State Uniform Fire Prevention ilding Code Certification is required stating that the property which is the subject of the ren I permit application is in compliance with all of the provisions of the code of the Town of outhold, the laws and sanitary and housing regulations of the County of Suffolk and by t/hews adopted by the New York State Fire Prevention and Building Code Council. I am requesting a fire safety inspection to be per 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 , certify under penalty of perjury,the following: 1. I am the owner of the property identified in "Section A" of this application. 2. The property owner's legal address set forth in "Sectiop B" of,, Ws appl}cation is my Illegal 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 P_O.Box 1179 =„a � � Southold,NY 11971-0959 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 ipformation regarding Authorized Agent, Managing Agent, or Site Manager. Property Owner's Name Propgrty Owner's Signature: Sworn to before me this 0 day of 2C 2- O lcial NotaPub�Sign�atureand Original Notary Stamp ROLAND ISSAGHOLIAN Notary Public-State of New Wrk. NO.-01102180$9 Oaalifled tn 04e(a County, Comml aiarw IM Pffs Page 5 of 5 • r � , o ,v . � � � �� f4f so Iro vi 4e lftN6 t *' TOWN OF SOUTHOLD R 631 -765-1802 q3t .., (4 waft , INSPEC ION [ ] FOUNDATION 1ST [ ] ROUGH PEBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAI [ ] FRAMING / STRAPPING L ] FINAL [ ] FIREPLACE &. CHIMNEY [ ] FIRE SAFETY IN! [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE L ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F L ] CODE VIOLATION [ ] PRE C/ [\4 REMARKS: t DATE , INSPECTO t TOWN OF SOUTHOLD SOUTHPROPERTY RECD F _ 2 OWNER STREET VILLAGE LOT -FORMER OWNERI � E ACR. u k b is } Sw I TYPE OF BUILDING REQ SEAS. VL. ' FARM I COMM. CB. §MISC. Mkt. Value " _ a TMP. TOTAL DATE REMARKS :, _. LAND l I , w .` .` 2 _ E x 3 r? BULf3�G 00 ON NEVA! NORMAL BELOW ABOVE FARM Acre Value Per I Value Acre Tillable l Tillable 2 i ..Tillable _ 3 Woodland l Swampland FRONTAGE ON WATER Brushland FRONTAGE ON ROAD House Plot DEPTH I t I BULKHEAD Total DOCK 1 i f COLORs € kl Ll 71? w l } — € 3 t l t Foundation Bldg. Bath Dinette F Extension w i _ _ r ;Basement Floors K Extension Ext. Walls 4 Interior Finish I LR, Extension i Fire Place Heat DR. 'Type Roof m ' Rooms 1st Floor BR. Porch Recreation Roan-4 Rooms 2nd Floor' l FIN. B. Pore Dormer l E Breezeway z I Driveway Garage Patio Total _ _ - TOWN OF SO OLD BURDING DEPARTNOM Town Clerk's Office Southold, N Y. Certificate Of Occupancy No. Date . . . . . . . . . . . . . . THIS CERTIFIES that the building located at .W . . . . . . . . . . . . . . . . Street Map No. .=. . . . . . . . . Block No . . . . . . .Lot No. . . q*p X*. . AVTP. . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . . April . .15 19-76 pursuant to which Building Permit No. 8,5W. dated . . . . . . . . . . Apr. . . . ., 19.?6., 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 . .p4rte. . . fa�i1)! d'wet 13r_g. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . w . . . . . The certificate is issued to . 9=15.4_ . . . . . . . . rf. . . . . . .. . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 414Y . .27. . .1970. . -�Y. A±. A4*. . . UNDERWRITERS CERTIFICATE No. 3'!4 g. . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . HOUSE NUMBER . . V5. . . . . . . . Street . . . . w998. . . . . . . . . . . . . . . . . . . . Building Inspector