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Home My WebLink About1000-51.-3-3.17 Pr� TOWN OF SOUTHOLD � $z Rental Permit 0899 Owner Nicholas Melis Occupied as Single Family Dwelling Located at 310 Chablis Path Southold 51.-3-3.17 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. 5/10/2023 ode E t Official This Notice must be posted by the main entrance at all times r p Town[fall Annex �� Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Sox 11795 �` Southold,NY 11971-0959 w BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL 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 --BLOCK SECTION B. OWNER INFORMATION: Property Owner Name: .__ _.. Property Owner Legal Address: Property Owner Mailing Address: Telephone Number (s): Daytime." ning ,_ Emerge ncyH___-..—._.- Property Owner Email Address: yx � �- Z')Oa 12(-C-/039�'a P4 3 -a3 Page 1 of 5 � n 0 we z i x � RaP wt�;ffxutr 611`764 1r4d2 o ar&: wtw N �" V, Fax(0. )'765-`j50'2 ""aw s i v xa'%rridRw r,a"0s��w w��"f iii m N""k' &{ a 7 r d b :�rtk drylpp��wipp� 'i'T.wl/fbri?� BUILDING DEF'At2"i"i1nENT TOWN OF SOUTHOLD Mailing Address ofManaging Agent �,�....._..._.,.,�.._. .. ... ....�.��_._..�_�. 1 Teir=yahone Number(s);Daytime,_ .._.�.......... ..M.....Evenrn '_.._..._._,..__ Emergen ;"/-... ., Email address; _..._...._ . ....._ � _��o� ........� ._...� �� ....,------- SECTION ---- .S "I N F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: For each Rental Dwelling Unit set forth the Rental Lbw 'ling Unit identifier(for example, Unit 1 Unit 2,Unit 3 or Apt A, i3,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 Duelling Unit identifier: Requested rvlaximum number of persons allowed to occupy Dwelling Unit:_Lo_ bfrooms in Rental Dwelling I Dwelling. Unit: We and Dinen os of each room m Renta . ._ `; .. s",�.gxdb w � �"�w'x """"`a& �'Q 6 "m'.✓" '�'"a* '0w..,..x R' m`��".:...,,,,'.�.w...w... ..,,�..,.,«,re.,w.M.,� Page 3 of 5 i Town hall Annex Telephone(631)765-1802 54375 Main]toad �� 14 Fax(631)765-9502 P.O.Box 1 179 Southold.NY 11971-0959NTI o BUILDING DEPARTMENT TOWN OF SOU THOLD 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, Lel 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. DECLARATI ON: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEIN YORK) ) COUNTY OF SUFFOLK) 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 d `wJV �gym✓ Town Hall Annex d �. Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 w ,P 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: Owner's Signature: - •_-• Property i g _�....�. _ ,_....�... __ Sworn to before me this Lrday ofµ mm�, 20 23 Official Notary Publi%S' nature and Original Notary Stamp EMILY TOTH,NOTARY PUBLIC STATEOFNEW YORK,COUNTY OF SUFFOLK REGISTRATION No.I11T(16357154 EXPIRES 04/1W20 „ Page 5 of 5 v 041 , TOWN OF SOUTHOLD BUILDING DI 631.765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAI [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN: [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI [ ] CODE VIOLATION [ ] PRE C/O [ F REMARKS: h O ff- �'o v� ReelvtAc\ , 100 ................ DATE INSPECTOR z a. k o - 3 g - s r m 71,7 V. t� ` u t t = ° a T g r � F J, E 4 T z p a gIRM 4 _ i >' as � s a r z a u imP ff .. � �.., vwrjr #rA'jj S g V3 ¢, i � a 00 go 3 _ F 4 a € ¢ � -! ED f x R � a x e i 3M TOWN OF SOUTHOLD PROPERTY REQ OWNER< STREET , VILLAGE_ DIST SUB. LOT i ACR. REMARKS krx QC'` - e TYPE OF BLD. ; £ PROP CLASS,,: LAND IMP_ TOTAL DATE 5� t _ l f z ! c,+7i ' t . f � , kk I tf s q� s i FRONTAGE ON WATER TILLABLE FRONTAGE ON ROAD WOODLAND DEPTH I MEADOWLAND ' BULKHEAD HOUSE/LOT TOTAL VON- COLOR�� , -- I i I TRIM s � I t s M_ . 131d F _ Foundation Bath Dinette 9 i >�° _ FML Basements Floors Kit. Extension � � .=K ,F_ SLAB Extension Ext. Walls t Interior Finish F Extension Fire Place >y Heat _ D.R, Patio Woodstove PorchDormer > Deck _T Attic Breezeway ,, ; Rooms 1st Floor I Garage Driveway Rooms 2nd Floor Pool I t t w i� FORK! NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23450 Date JANUARY 15 1995 THIS CERTIFIES that the building NEW DWELLING Location of Property 110 BURGANDX COURT SOUTHOLD N.Y. House No. Street Hamlet 'County Tax Map No. 1000 Section 51 Block 3 Lot 3.17 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated. AUGUST 16 1994 pursuant to which Building Permit No. 22302-Z dated SEPTEMBER 7 . 1994 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 ONE FAMILY DWELLING WITH ATTACHED GARAGE & OPEN PORCH AS APPLIED FOR. The certificate is issued to NEIL REGO (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-94- 063-J . 12 1995 UNDERWRITERS CERTIFICATE NO. PENDING - JANUARY 12 1995 PLUMBERS CERTIFICATION DATED JAN. 12 1995-BERTSAND PLUMB. & HEATING 0 -XV k9-r�4 Building Anspector Rev. 1/81 ri FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-27171 Date JUNE 29, 2000 THIS CERTIFIES that the building ADDITION Location of Property 110 BURGUNDY COURT SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 51 Block 3 Lot 3.17 Subdivision Filed Map No. Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 11, 1995 pursuant to which Building Permit No. 22913-Z dated JULY 26 1995 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 TO EXISTING ONE FAMILY DWELLING AS "PLIED R. The certificate is issued to STEPHEN K. & PATRICIA M. SP GEL (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. 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