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Home My WebLink About1000-33.-3-13 TOWN OF SOUTHOLD v ,t Rental Permit Its 0886 Owner Nicholas Sourbis & Karen Lucia Occupied as Single Family Dwelling Located at 200 Green Hill Lane Greenport 33.-3-13 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. 4/28/2023 Code for t fficial This Notice must be posted by the main entrance at all times r: � „ ft (. -* i2tb `i Telephone(631)765-1812 Town Nall Annex - 54375 Main Road i e Fax(631)765-9502 V P.O.Box 1179 Southold,NY 11971-0959 P C UILDING DEPARTMENT � Ii OWN OF s+ �'H�rLDll� )` cilkAL PERMIT APPLICATION Rental Permit Fee $200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION -Bi OCKD �.-LOTCL 00 Low t Se SECTION B. OWNER INFORMATION: C Property Owner Name: N `C-hod.US Joy�b� C" Property Owner legal Address: Property Owner Mailing Address: Telephone Number (s): Daytime t��1-4V-t � F. ning� 1' �Emergency Property Owner Email Address: ► w Page 1 of S Town Hall Annex �� ", Telephone(631)765-1802 54375 Main Road < Baa (631)765-9502 rr P.U.Box 1 179 Southold,NY 11971-09-59 w '� cou "� «r BUILDING DEPARTMENT TOWN OF SO HOLD 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." Rental Dwelling Unit Identifier: , - e- Requested Maximum number of persons allowed to occupy Dwelling U t: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: X10Z� x 11) 6 •l Page 3 of 5 I J,Cz � QF s Town Hall Annex" 'telephone(631)765-1802 54375 Main(toad Fax(631)765-9502 P.O.Box I l79 Southold,NY 11971-0959 um BUILDING DEPARTMENT TOWN OF SOUTHOLD SECTION G. INSPECTION: Pursuant to the Town Code of the Town of Southold Chapter 2177 (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. ! 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) I �CA-� ��" ,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 "W' ' of s � Telephone(631)765-1802 Town Hall Annex �a 54375 Main Road Fax(631)765-4502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOMN 4F S4 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. l 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. l 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: wor to before rAe t isA day of _ _ 202.3 Official Notary Public Sig a ure and Original Notary Stamp DEBORAH A.WOJCIK Notary Public State of Nm,`fr�� No�4991)159 Qualified in Suttolk County Commission Expires Dec.SCS„2 0_ S Page 5 of 5 � 4f SOIJ Town Hall Annex Telephone(631)765-1802 54375 Main(toad � � Fax(63 i)765-9502 P.O.Box (179 Southold,NY 11971-0959 CO01,y ..a BUILDING DEPARTMENT TOWN OF SIOUTHOLD 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. 'lam requesting a fire safety inspection to be performer) 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 NEIN YORK) ) COUNTY OF SUFFOLK) I 1�3 Q c` ,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 "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 soul. `*.. Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179w Southold,NY 11971-0959 COATI 4'j BUILDING DEPARTMENT TOWN OF SCS 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 information regarding Authorized Agent, Managing Agent, or Site Manager. Property owner's Name: '► L7,z—jProperty Owner's Signature: �,�,� ---� 4 �� " wo to before e t s dakatre of � ._ 20 icial Notary Public SigndOriginal Notary Stamp DEBORAH A.WOJCIK Notary Public,State of New Yo„c No.4990159 Qualified in Suffolk County r)5 Commission Expires Dec.30,20— Page 5 of 5 (orwo4� �ik� �V\ I (0111= TOWN OF' SOUTHOLD BUILDING 631 -765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAI [ ] FRAMING / STRAPPING NAL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY IN! [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL E T ICAL (F [ ] CODE VIOLATION [ ] PR / [ REMiARKS: (641 &"oOo�. e DATE tf[)A]70)A_;P_ INSPECTO SKETCH ADDENDUM FVeM 062aa133-- Borrower/Client NICHOLAS SOURBIS/KAREN LUCIA Properly Address 206 Green Hi11 l n........... w www wwww.....www�_ _..._...._.w............_..� ..... 11941 H SUFFOLK S NY Zip code .. Ci ,Greenport....,,, t'°"ray',5.... . . m..,.. ......._. ...........................w .....�..,.,.,.. Lender JPMORGAN CHASE 34.51 ;L Zn Bedroom dull �d 0 CL Bath Bedrac�r�t L 9.51 e� L ®0 L 2 CL Open to Below Bedroom 161 Second Floor [700.25 Sq ft] .P,5r^� t)Y-� a�� rprti Sufi 5r.�.mom..��_ AdC'a Co;wA6rloorac!5ranrmrw, WW"Arta Ctk"$"D ..., SemW sm 700.25 Sq ft 15.5 x 9.5 = 109.25 16x if 176 17.19 M 6x 15 = 90 0.5x2 x2= 2 Yobl Wag Arae(Rounded). 76B Sq k SKETCH ADDENDUM F*# 062DO133— Borrower/Client NICHOLAS SOURBISAKAREN LUCIA .......... .......... Property Address 200 Green Hill Ln ty CiGr Comity SUFFOLK State NY Zip Code 11944 .... ..... ... Lender JPMORGAN CHASE 22.05' 14.3' Cla"d Patch z4 Living (258.3 Sq(t) U! Deck NOW— Bath Room Kitchen WIC OSE to bwaremen Master 1/2 r Bedroom Bath Dinfing Foyer 06 Master I� I � Front=..,cmh Bath 6.5' 21' Flint Vicar (1690.6 Sq ft) svvq 0 CL TOTAL A0h wmf*mcdv,jm to tm"Am 0ALAW" FM Floof 16%6 Sq it U-28,25 x Q,I LAI 29.25 x 20.8 587,6 05 "I O'll 000.25xa L 0.5.6.9x7.39 a 25,51 26,36-6.9 IBL86 45 X 14.3 64315 25.75-7.75 I99.56 5.5-8.75 48,12 T*WLkAmAres(Raundd!d)- 1"I Sq rt *W*W"Al I Car Attached I38.25 sp it 20.5-I" - 33&25 Closed Porch 258.3 Sq it 14.3 x 11.25 = 160.86 9.75 x 7.3 71.L0 0.5 x 75 x 7 F 26,25 TOWN OF SOUTHOLD PROPERTY k AVS c�� ARD OWNER ,STREET VILLAGE DIST." SUB_ LOT = . _ FORMER OWNER N E ACR. e S W TYPE OP BUILDING RES, SEAS. VL. FARM COMM. CB, MICS. Mkt. Value 777 Z LAND IMP. TOTAL DATE REMARKS a t r _ AGE BUILD iNG CONDITIO N, a NEW NORMAL BELOW ABOVE FARM Acre 4 Value Per Vclue Acre a _ --- t_ Tillable [ RONTAGE ON-.,WATER 1,7,1 = : Woodland _ a � FRONTAGE ON ROAD — 5��; � -_ Meadowland DEP TH House Plot _ . BULKHEAD Total � � � � DOCK i i COLOR U,_:_' TRIM I — At .. 1 t i t It r M Bldg E a Extension [" Extension E i I Extension `Foundation L, ;BathDinette E E Pores Basement r _ . � i � Floo s K Ext. Walls`" �' Interior Finish LR. ire Place eat R. t � Breezeway ` Fi e 3H D <� ° f; � Type Roof Rooms 1st Floor BR Garage I �= RecreatioiRooms 2nd Floor FIN. B Patio n Room: O B �� I Dormer Driveway Total \ aye \\\ \\\ , A COLOR TRIM _ a = 33-3-13 10/04 g 1st 2nd � 4 # f ' ldg_ Foundation p Fin. B. Bath ,� _ ` Dinette f r Extension x Basement Floors Kit_ -7 , SLAB Extension ' Ext Walls w Interior Finish �L,R_ _ _ l Extension Fire Place � ea - - >_ e Heat � D R Patio t Woodstove BR- Porch Dormer Baths n e I - - si a_ Deck 1 Dock Farn. Rm f r Garage 4 Pool ? ` s FORK NO 4 TOWN OF SO OLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. . Z�186. . . . . Date . .Au u+�t. . . .2 . . . . . . . . . . . . ., 19. .78 THIS CERTIFIES that the building located at . . 200 •Greenhi, 11 •Lane• • • • Street Map No. . .402' . . . . . Block No. . . . . . . . . . .Lot No. . . . . . . . . 147. . . . . . . . . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . .April. . .1g. . . . . . ., 1978 . pursuant to which Building Permit No. . . 9691Z dated . . .April. • .24• . • . • . . . ., 19.78., 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 . . . . , . . . Private •On+e Family -Dwelling- . . . . . . . . The certificate is issued to . . .pantelis Psaltakkie . . . • . • . . . ° . • . . . . (owner of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . .eT50n3$. . . . . . . . . . . . . . • . . . UNDERWRITERS CERTIFICATE No. . . . . . . . . . .Pending. . . . • . . .N»q p?«K5 3. HOUSE NUMBER . . .200. . . . . . . . Street , , . . -oreen .14ill •L•an-e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -Greenport; -New- -York . . I . . . . . . . . . Building Inspector w FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22234 Date 14A Cl'&`S '33. 1.993 THIS CERTIFIES that the building ADDITION Location of Property 200 GREEN'HI'LI, LANE GRI%NPORT N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 33 Block 3 Lot 13 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 3 1991 _pursuant to which Building Permit No. 20134-Z dated SEPTMMER 11 1991. 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 DECK ADDITION WITH FIBER GLASS ROOF TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to PANTELIS & BESSIEE PSALTAKIS (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N 'A. PLUMBERS CERTIFICATION DATED NLA ding Inspector Rev. 1/81 Town of Southold Amex 9/21/2013 P.O. Box 1179 54375 Main Road Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 36522 Date: 9/21/2013 THIS CERTIFIES that the building GENERATOR Location of Property' 200 Green Hill Ln, Greenport, SCTM 473889 Sec/Block/Lot: 31-3-13 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 5/15/2013 pursuant to which Building Permit No. 38054 dated 5/28/2013 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: jj�-4pelt o for. The certificate is issued to Psaltakis. Bessie (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICALCERTIFICATE NO. 38054 9/16/23 PLUMBERS CERTIFICATION DATED uthorized Signature FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-30608 Date: 12/08/04 THIS CERTIFIES that the building 8ER111ON & ALTERATIONS Location of Property: 200 GREEN HILL LA GREENPORT (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No- .473889 Section 33 Block 3 Lot 13 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......AUGUST 5, 2003 pursuant to which Building Permit No. 29670-Z dated AUGUST 25, 2003 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 ADDITIONS & ALTERATIONS TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to PANTELIS & BESSIE PSALTAKIS (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO- 1202442 2-8-109/04 PLUMBERS CERTIFICATION DATED 10/25/04 KEVIN REMPE PLUMB.&HEAT. l the zed Signature' Rev. 1/81 +, rot ns Town of Southold 7/14/2022 P.O.Bog 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43256 Date: 7/14/2022 THIS CERTIFIES that the building DECK Location of Property: 200 Green Hill Ln,Greenport SCTM#: 473889 Sec/Block/Lot: 33.-3-13 Subdivision: Filed Map No. Lot No. conforms substantially to the Application.for Building Permit heretofore filed in this office dated 3/18/2021 pursuant to which Building Permit No. 46054 dated 4/8/2021 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: deliition to egitin sin le fan.il drrli applied for. The certificate is issued to Sourbis,Nicholas&Lucia,Karen �.w _....... ww of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED _. ..._ �w_.._...........__. ......... .. .................M,,.._. t ori signature 11Qt�C� Town of Southold 8/24/2022 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43366, Date: _ ^8/24/2022 ww . THIS CERTIFIES that the building IN GROUND POOL Location of Property: 200 Green Hill Ln.,Greenport SCTM#: 473889 Sec/Block/Lot: - 33.-3-13 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 10/23/2020 pursuant to which Building Permit No. 45415 dated 11/9/2020--- was 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: oe so in- r u wimmin .ool fenced.to code a4 a 1�,.-feart The certificate is issued to Sourbis,Nicholas&Lucia,Karen of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45415 3/7/2022 PLUMBERS CERTIFICATION DATED __. �tho ' e gnatue .��_....�._ t, llgfACp Town of Southold 5/10/2023 P.O.Box 1179 53095 Main Rd », Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44081 Date: 5/10/2023 THIS CERTIFIES that the building POOL HOUSE/CABANA Location of Property: 200 Green Hill Ln,Greenport SCTM#: 473889 Sec/Block/Lot: 33.-3-13 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/18/2021 pursuant to which Building Permit No. 46053 dated 4/8/2021 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: acesr lhclas rytl 1tcC straed ,rld, iltdoor showerAs goted�fbr a�Z1A-i7754 dated-4/ 0/2023. The certificate is issued to Sourbis,Nicholas&Lucia,Karen of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 46053 3/7/2022 PLUMBERS CERTIFICATION DATED 4/15/2022 -lardlumbin w___.....m.......__..w.. ...................... _ a. t1a rl a cl �nat