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Home My WebLink About1000-128.-1-18 TOWNOF SOUTHOLD Rental Permit 0885 aux Owner Emanuel & Maria Tsoukaris Occupied as Single Family Dwelling Located at 4795 Gt Pec Bay Blvd Laurel 128.-1-18 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. 4/27/2023 tode � c e �Official This Notice must be posted by the main entrance at all times Y Pif so 01 Town Hall Annex ww Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959Dili ff! n" L ��° a BUILDING DEPARTMENT 8 2023 TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200 (Application must be renewed every two years) Section A. Property Information: Rental Property Address. 7 A�0'�z Tax Map Number: 1000 SECTION " 7J -BLOCS 2j-LOT-.. _Z -,----j SECTION B. OWNER INFORMATION: Property Owner Name: 6AA'/11v6'Z— Property Owner Legal Address: Property Owner Mailing Address: / 7 - Telephone 7Telephone Number (s): Iaytille Evening�. Wm��mergency = " Property Owner Email Address: (ZeC /03? 3 Page 1 of 5 A 1y� S 004 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax (631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 10 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." rR ental 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: fl � . � �.� �' �' C1f ° 5 - 0V\ D Page 3 of 5 S Town Hall Annex Telephone(631)765-1902 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 A 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. 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) � /,Eertify 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 P.O.Box 1179 Southold,NY 11971-0959 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: div �^ � � Property Owner's Signature: Sworn to before me this I day of re,,15 JAIME RODRIGUEZ Notary Public-State of New York No.01 R06332316 Qualified in Suffolk County C) ficial�1 ary Public lgnat re riginal Notary Stamp 111Iy Commission Expires IVov.02,2023 Page 5 of 5 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, NEL' YORK CERTIFICATE OF OCCUPANCY NONCONFORMING PREMISES THIS IS TO CERTIFY that the / XJ Land Pre C.O. #- Z14916 Building(s) Date- Septep:ber 1986 / J Use(s) located at 4795 Peconic B a,L Blvd. Laurel, N.Y. Street Hamlet shown on County tax map as District 1000, Section 128 , Block 1 Lot 18 , does�'not)conform to the present Building Zone Code of the Town of Southold for the following reasons: Insufficient total area; side yard set-back. On the basis of information presented to the Building Inspector's Office, it has been determined that the above nonconforming /.--/Land /_J Building(s) J_/Use(s) existed on the effective date the present Building Zone Code of the Town of Southold, and may be continued pursuant to and subject to the appli- cable provisions of said Code. IT IS FURTHER CERTIFIED that, based upon information presented to the Building Inspector's Office, the occupancy and use for which this Certifi- cate is issued is as follows: Property contains a one story, one family wood framed dwelling with access to Peconic Bay Blvd. a Town maintained road. The Certificate is issued to Lillian E. Huth (owner, hegsiee)ax °fir of the aforesaid building. Suffolk County Department of Health Approval NIA UNDERIATRITERS CERTIFICATE NO. N/A NOTICE IS HEREBY GIVEN that the owner of the above premises HAS NOT CONSENTED TO AN INSPECTION of the premises by the Building Inspec- tor to determine if the premises comply with all applicable codes and ordin- ances, other than the Building Zone Code, and therefore, no such inspection has been conducted. This Certificate, therefore, does not, and is not intended to certify that the premises comply with all other applicable codes and regula- tions. - ,uii,d,i.n, nspector TOWN OF SOUTHOLD BUILDING DI 631 -765-11802 INSPECTION ] FOUNDATION 1ST [ ] ROUGH PLRG. ] FOUNDATION 2ND [ ] INSULATION/CAl [ FRAMING / T ING [ ] FiNAL ] FIREPLACE & CHIMNEY [ FIRE SAFETY IN! [ ] FIRE RESISTANT CONSTRUCTION [ FIRE RESISTANT PT [ ] ELECTRICAL (ROUGH) [ ' ELECTRICAL (Fir CODE VIOLATION PRE C/O [ c ] c ] REMARKS: w V 04 0 DATE INSPECTORj - 'r L I I7 l � 1ST-' FL s 4 1v_ 1r, wry ► ' • 0 L .=I, - g3 QJ r A&- /2J s - � ice. )4 , 7 Xl� VL Y-,C( IF L /i� . A TOWN OF SOUTHOLD PROPERTY RECORD OWNER STREET VILLAGE DISTRICT �tfB LOT . ......... .......... -—--------- I� FORMER OWNER N E * EAGE S W TYPE OF BUILDING iL-Z,t i-� FE -- -- ----------- IND. CB misc. st. Mkt.Value RES, SEAS. VL. FARM comm. LAND IMP, TOTAL DATE REMARKS z 6 /z AGE BUILDING CONDITION - .. .. ......... NEW NORMAL BELOW ABOVE FRONTAGE ON WATER Form Acre Value Per Acre Value FRONTAGE ON ROAD Tillable I— BULKHEAD Tillable 2 DOCK Tillable 3 Woodland Swampland Brushlond House Plot Toto I IE, i � a i I w. Ah ..._.�_�........,.,.......,_...�.,.. _.. .�.. _.._..._.... ..�._. ..w,...., .� ..........� ...µ�.,� �..,..........._ . M. Bldg. ✓ ot.i�ienatu�:ri; Bath Extension Basement Floors Extension Ext. Malls { q Interior Finish Extension Fire Place Florc a Root Type F,Orch` Rooms lst Floor Patio i Rooms 2nd Floor I Driveway Dormer 1 _.. . B, ��.o