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Home My WebLink About1000-38.-7-10.6 a� Qk� TOWN OF SOUTHOLD 07 Rental Permit 1041 Owner George Koutsos Occupied as Single Family Dwelling Located at 130 Summit Lane East Marion 38.-7-10.6 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. 12/18/2023 od n ent Official This Notice must be posted by the main entrance at all times (T I C,te14i4-1 .. TOWN OF SOUTHOLD—BUILDING DEPARTMENT � Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 lett :"� y sr�uthoIdto��un ,. _,w. RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION -BLOCK -- �-LOT 10 SECTION B. OWNER INFORMATION: Property Owner Name. (;CO12Cr 6 L6 Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) f�n � Telephone Number (s): Daytime qt Evening Emergency Property Owner Email Address: fob rte C- bL -/9 Page 1 of 4 Section C. Authorized 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 D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: VA-C,!kfA- Address of Authorized Agent (no P.O. Boxes): Mailing Address of Authorized Agent: a Telephone Number (s): DaytimeX03.45Evening_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): Mailing Address of Managing Agent: Telephone Number (s): Daytime Evening Emergency 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 Dwelling Unit: Number of rooms in Rental Dwelling Unit: YAW Use and Dimensions of each room in Rental Dwelling Unit: 1 13 Z SECTION G. bad. 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 lar adopted by the New York State Fire Prevention and Building Code Council. M/X1am requesting a fire safety inspection to be performed by a Code Enforcement Official the Town of Southold submitting a completed Town of Southold certification form from a licensed architect or a licensed professional engineer. Page 3 of 4 ' SO / V 5 VM-j� L4�, CW"Myl 0' Ll TOWN OF SOUTHOLD BUILDING DI 15 631 -765-1802 love EL 0 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. j ] FOUNDATION 2ND [ ] INSULATIOWCAL [ ] FRAMING I STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INS [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI [ ] CODE VIOLATION [ ] PRE C/O [vf I REMARKS: , June 17, 2023 4u"G Town Hall Annex "' u're 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 Pro essiorlal seal re aired or architect orn ineer licensed Home ins ector myA -to co of valid current cerci ication Rental Property SCTM Number: Rental Property Address: 130 Summit Ln., East Marion NY 11 930 Owner/Name: George Koutsos 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 mom 01 140 scift to b. sly Bedroom #2 120 saft Bedroom #4 140 sqft 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 InspectorAk 7 Print Name and Title ceo# 1216-0283 Original Signatur Please place professional seal: TOWN OF SOUTHOLD PROPERTY RECO 10 (O I OWNER STREET s_e- `VILLAGE DIST SUB. LOT 2 lKu- 4-D s L�rn m I L�l t:: Of 1 I - 7 ACR. REMARKS _ )F TYPE OF BLD. co tt Irl '(i 4 ;� PROP. SS to a� - L I Z C' Arn l CLASS � LAND IMP_ TOTAL DATE ; 7 � T E .. x �w rM, 1CJ,OCA A A4 f _ _ s I FRONTAGE ON WATER TILLABLE FRONTAGE ON ROAD WOODLAND DEPTH MEADOWLAND BULKHEAD HOUSE/LOT i i _m TOTAL r"0 a _ . O ii r Z I - I (_ E 38.-7-10.6 11/04 Foundation Pc Bath / Dinette , xter cion 1 -e Basement C Floors I ��.<< Kit SLAG �-. . Extension "1 `� '2 t�vto Wit' VX, (� ,/{{ Ext. Walls �vLC Interior Finish L,R. 2�, Fire Place e -- Heat D.R, Extension le 4 Woodstove BR. Patio s � R 1Z1i �Q �p Fin. B. Porch Dormer r Deck w\1f 2A �- Z�` ` Attic 1f-•, ,° Breezeway a - Rooms 1st Floor 12 Z ' 'a`1� Driveway Rooms 2nd Floor E Garage 5 ,2 S Y I n e O.B. Pool 8 I FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30659 Date: 12 29 04 THIS CERTIFIES that the building NEW DWELLING Location of Property: 130 SUMMIT LANE _ ,.� EAST MARION (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 38 Block 7 Lot 10.6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 12, 2003 pursuant to which Building Permit No. 29550-Z dated _....JULY 3., 2O 0 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 SINGLE FAMILY DWELLING WITH ATTACHED TWO CAR GARAGE, COVERED WRAP AROUND PORCH AND REAR DECK AS APPLIED FOR, The certificate is issued to BRAVO CONTRACTING CORP. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-02-0145 12 07 04 ELECTRICAL CERTIFICATE NO. 2348H 12f08 04 PLUMBERS CERTIFICATION DATED 12/3,0/04 BRIAN BLOTT ....._._._. Aix oried Signature Rev. 1/81 4" 5, i - I t d 0. kIi ✓# is vi I Q 1 -w- G I'Ll antic -t wz - A T ti R S� '12 l� -5 TH-1 OT 14 S 22 N - - 01 A 1 1 4 41 Z"ZIZ 71%-Z", i'F I 1�SvIl-Izcl-_l-All 7--z t S""Ic.s DEVE ,Ic2 So 4-5 6:tZ Qft9 71 I I qu h kS _-- sV 3u�ffi Sf- \ s Le _ €t F ae to t7 f arc- i.I� I a —s nz-1_z .. � s¢aD.e€w.SPIc#rar� a € sootsr �€ s _ k s� A t 'Tt�r fiRE Lj -MMM PQ -IL I - �.,I L- __ pt§'rr:-' !- -- LI, - �._ tom+ 20— Ai I s aa„icd Y>a L. +rete. a-^`. Y•.4" I � _ c 3, Top c2 CSY.m_.'hzSwhe set i-trz' ' ��.as�:crec, a...,.zs. {` �C✓rv'�t, Gh'�L6X E -'O tir..rcrt4 �'$2S 2 =5slf'# ce:Fn 4K�g+.t AA'FxYtC m'f` cni..vt-<',S.,W,,=.•D�u_rv_.t:var: — =36-,0 F cne um 57LIT.R ' n ' ilk j