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Home My WebLink About1000-31.-14-13 fat a TOWN OF SOUTHOLD a Rental Permit cos 1054 Owner Country House By The Bay LLC Occupied as Single Family Dwelling Located at 12680 Route 25 East Marion 31.-14-13 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. 1/24/2024 cid fc ce t Official This Notice must be posted by the main entrance at all times 1112,q �_T>4a �3wn TOWN OF SOUTHOLD—BUILDING DEPARTMENT ' Town Hall Annex 54375 Main Road P. O. Box 1179 Sout old,NY 1197 - 9 9 Telephone (631) 765-1802 Fax(631) 765-9502 lis://ww'w.soq l 6�wm c ti t ;y RENTAL PERMIT APPLICATION ,N, Rental Permit Fee $300(Application must be renewed every two years) Section A. Property Information: Rental Property Address: 12680 MAIN ROAD-EAST MARION,NY 11939 Tax Map Number: 1000 SECTION 31 -BLOCK i4 -LOT 13 -0 SECTION B. OWNER INFORMATION: Property Owner Name: country House By The Bay LLC Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 12500 MAIN ROAD-EAST MARION,NY 11939 PO BOX 413-EAST MARION,NY 11939 Telephone Number(s): Daytime 646.201.3560 Evening 646.201,3560 EmergenCy646.201.3560 Property Owner Email Address: acetweety@aol.com Page 1 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: 1 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: House 1 Requested Maximum number of persons allowed to occupy Dwelling (A t: 8 Number of rooms in Rental Dwelling Unit: 11 Rooms (3 Bedrooms) Use and Dimensions of each room in Rental Dwelling Unit � t 311 x 17'-1") Bedroom 1 (19'-0" x 13'-7), Mast Bath (7'-2" x 13'-8"), Powder (4'-9" x 4'-9") Laundry(6-1"x 5'-3"), Living Room (21'-0"x 18'-3"), Dining (11'-5 x T-9"), Den (17'-1"x 20'-2"), Kitchen (11'-4" x 21'-5"), Bedroom 2 (10'-11" x 14'-3"), Bedroom 3 (9'-9" x 18'-2"), 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. ❑ 1 am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold A I am submitting a completed Town of Southold certification form from a licensed architect or a licensed professional engineer. Page 3 of 4 FF Town Hall Annex "" ' Tblephone(631)765-1802 ^, 765-9502 54375 Main Road � W Fax(631) P. O. Box 1179 Southold, NY 11971-0959 ` BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a licensed architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Professional seal re aired for Architect or Engineer, Licensed Home- Inspector must provide copy of valid current certification Rental Property SCTM Number: 1000-31-14-13 Rental Property Addre s: 12680 MAIN ROAD-EAST MARION,NY 11939 Owner/Name: Country" Se By The Bay LLc Rental Dwelling Unit Identifier: HOUSE 1 Number& Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 — 100 sqft., Bedroom#2—90 sqft., etc.) BEDROOM 1:19'-0"x 13'-7" - BEDROOM 2:10'-11"x 14'-3" BEDROOM 3:9'-9"x 18'-2"wwwww . Property Description (Include all improvements indicated on survey) +-.5 ACRE LOT WITH tTWO STORY-SINGLE FAMILY RESIDENCE-POOL IN REAR YARD-POOL HOUSE IN REAR YARD 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, the Fire Code of New York State, the Property Maintenance Code of New York State and the Energy Conservation Construction Code of New York State. ZACKERY E.NICHIOLSON,RA Print Name and Title Original Signature Please place Professional Seal: SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFOLK) I SOFIA ANTON IADIS 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 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 s to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager. Property owner's Name: SOFIA ANTONIADIS Property Owner's Signature: X11 Sworn t efore me this da even &-e__, 20 a 70ffal No ary Public Sign re an Original Notary Stamp Sophia Angelakis otary Public„ State of New York Reg, No, 01 AN0015858 Qualified in Nassau County Commission Expires 11/08/c?7 Page 4 of 4 * , TOWN OF SOUTHOLD BUILDING D 631 -765-1802 ��t r INSPEC MION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION TND [ ] INSULATIOWCAI [ ] FRAMING ST"R PPINGle[7I] IRE INAL [ ] FIREPLACE & CHI NEY [ SAFETY IN; [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAT (F [ ] CODE VIOLATION [ ] PRE C/O [ ] LEGEN4 cavcrecra, _.. o aoa ZEN DESIGN 1256 EVERGREEN DRIVE CUTCH UF NY 11435 PHONE 631513.6589 iB �uam�n a�•,•"wao�o.�iworuo., �e+xeR mmo�t�mTM,v � t NO. ISSUE DATE O1 RENTAL PERMIT 1227.23 3 ® }ate al `- 12680 MAIN RD ,, EAST MARION,N•11939 i SCTM:1000-31-SC-13 - _ SCALE 111r.1'-0' - _ DATE 32.2723 DRAWN 6T: ZE.K FLOOR PLANS 1 Town Hall Annex 4 �k � Telephone(631)765-1802 54375 Main Road �� 't� 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 licensed architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Professional seal required for Architect or Engineer, Licensed Horne Inspector rnoust provide copy of valid current certification Rental Property SCTM Number: 1000-31-14-13 Rental Property Address: 12680 MAIN ROAD-EAST MARION,NY 11939 Owner/Name: Country House By The Bay LLC Rental Dwelling Unit Identifier: HOUSE 1 Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 — 100 sqft., Bedroom#2—90 sgft., etc.) BEDROOM 1:19'-0"x 13'-7" BEDROOM 2:10'-11"x 14'-3" BEDROOM 3:9'-9"x 18'-2" Property Description (Include all improvements indicated on survey) +-5 ACRE LOT WITH tTWO STORY-SINGLE FAMILY RESIDENCE-POOL IN REAR YARD-POOL HOUSE IN REAR YARD 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, the Fire Code of New York State,the Property Maintenance Code of New York State and the Energy Conservation Construction Code of New York State. — � `" ZACKERY E.NICHIOLSON,RA 1MM � , �,„Y,r� 70 q. Print Name and Title Original Signature `1a N #. Please place Professional Seal: ()44423 O O� NSt SCTM # _ TOWN OF SOUTHOLD PROPERTY RECOR Z/(q ( a OWNER STREETVILLAGE DIST_ 5uts LOT i IfACR. REMARKS TYPE OF BLD. _ r PROP. CLASS _ LAND IMP- TOTALgE _ DATE �- 4 �� g _ = _ # 3 If Z l f'147i� _x m 1 0 lo t / I -o r � ; FRONTAGE ON WATER HOUSE/LOT BULKHEAD TOTAL LOR _ TRIM 7=71I I � I � 3 DO s � i � I 3 , G I rte- z � z � _ _ €—t _ 4 i 31.-14-13 12/74/2022 _ , I I i ?� front 03/05/2017 , M Bldg s Extension I i I xte Insion ,. .. ' ! t E ' a Extension , c Q ; Foundation I Ba#h Dinette j . Porch F � ,� '�. F K I � � A, Basement >_ _ Floors Ext. Walls Finish Porch ' , , Interior ' Fire Place ! Heat (y DR Breway �>e, P Type Roof Rooms 1 st Floor ;13R.Garage Y I Patio Recreation Room Rooms 2nd Floor 1 FIN. B - � ?-r-�` Dormer i Driveway O. B. . �. Total i R o q � i00 I s - , � Q S TOWN OF S UTHOLD PROPERTir KM.WIts) CARD OWNER 1 STREET VILLAGE DIST, SUB. LOT FORMER OWNER N E� ACR. - m- 7 S W TYPE OF BUILDING i Y` RES. /0_ SEAS. i VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP, TOTAL I DATE REMARKS P. i g x _ 'c' s 1 P - I i . I Tillable 1 FRONTAGE ON WATER 1 Woodland s FRONTAGE ON ROAD Meadowland ( DEPTH "t House Plot BULKHEAD TOO1 A A U Z A M. Bldg. Foundation Both Extension i Basement Floors Extension Ext. Walls Inierior Finish EX en—cz 1 oz-- Fire Place Heat ----------- Porch Attic Porch Rooms I st Floor Patio Rooms 2nd Floor Garage Driveway Q. B. 47 J V 1:4 Afth FORM NO. 4 A TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. r PRN FISTING CXRTXrlChTS OF OCCUPANCY No 8-24042 Daae NOVEMBER 22 1995 THIS CERTIFIES that the building ONE FAMILY' DWELLING Location of Property 8335 MAIN ROAD EAST MARION N.X. .' I House No. Street Hamlet County Tax Map No. 1000 Section 31 Block 2 Lot 32.1 Subdivision Filed Map No. Lot No. conforms substantially to the'Requirements for a One Family Dwelling built Prior tot APRIL 9 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER E-24042 dated N0VE21BER 21 1995 M 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 2 ORR rAKELT DMLINGS The certificate is issued to DONNA INGLESIAS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *PLXA8X SJM ATTKOW IESPNCTION RNPORT. s Build ng Inspector Rev. 1/81 BUILDING DEPARTHLUT I'OWN OF SOUTIIOLU DOUSING CODE INSPECTION IICPORT LUCA'I'ION: 8335 Main Road East Marion, N.Y. i1�nnNl(,r I str.._q ,•....,_. SUBDIVISION _ MAI' NO, NAME OF OUNI;II (s)W WmYm DONNA XIGLESIAS W OCCUPANCY SINGLE FAMILY.... ype uwnc"r-tenanC _.. ...W_..... ADDII'l"1'Ii11 fly: DONNA IGLESIAS ACCOMIANlE100 DSAA714..1E "'TAX MAP NO.K{Y AVAILAPS[) ,,. `' 11RC01� DonnaIglesias healer .1 Oct-28. 1995_ ,...,,_,.._ .. � I sTORlcs 2 1 E%II-s 3 7'YI'li UI' CONS'1'ItIICTIOt(.....w......W00D..F.. ......._,._.,._..w...,. ..._..._..... ._.. .,,... .,.,, _LAII .�.,,..05�FO��Y_ ...,,,,._....µ•., �, ...� CELLAR wPART. _ ...,�..._ CRANL SP ACI rOTAR(U�S: 1.IC. 5 2ND Fi,R. 2 31tD NAT1IROOH (s) TOILET ROOM UrLl1Y ROOH 1101tCII lYIL FRO NCOVDDETRELLIS ._....._.._r,...._,...•.w.,._,.n...,.., G VAT10 .-..... ..�_,. ..._...„,.„_m.�. .,..,.,._,.._ DECK, TYPE .__.,, ,...._....-,...�, IIItEE'LIiNAY F[REl'I.ACE 3 _.w . ,... _._._ AItACE TYPE' IIEA'I'lilt _. _„- AiItCUNIIl'rlWµW'n^^„- DOrIFs'r I c IIO'ruA7LILC0 GAS Li oN l Nc CENTRAL ... TYPE, lILA'r WARM Alit II(1•nJALI'It” _... ._ ... 0'I'I l li It: _.........w,_....,....w_........._.,,...�..........,m,.w,...,., _, ._ . . .. LESSOItY S'1'RIIC'I'Uns: (,AltA(lL, TYPE. OF CON,....A, • S'r^ S'1'UItn(-,E, 'TYPE CONST, GA /SPA SWINHING 11001. _,_.._... ....w ._..v__ GUEST, 'I'Yl'li f,ONS'l'. o'nwit: _....ww_.._..- �_._..�.,_..w._..,....,.._�.__...._�.._......_ .,...n....._.............. __�_.....�.�_,._....�._ : VIOLATIONS (:IfAI''rElt 45 N.Y. STATE UNIFORM.M.k,_.. ~-..,...,. . ..,.^�.. "-OLA'r...,. s. FIRE PREVENTION 6 Itl)[I.1]INC CODE 1 O('Al lON (1r 4 R1l'T lUN -_ _.._. AIU SLC_ ._.........,,� .___._.,...,_...,�..,_. Vit,.....,...,.-... ......� #15442Z-CO Z-17505 - Acc Gazebo -_.,.P.#155662 COIT"""".,,. ,.,..�...- B 216443 Addition 6 �.._ ._„ I(IiMAItYS. BP y Cerat.ion. DATE of INS1'1.(.TI()N NOV. 21, 1995 Olen M. Boufis rlMli S'T'ART 9:45.....�_....,._....•-LND 1,0....1. „ 8111 LU I NC uLa'AICI'MEN'1' TOWN OF SOU'f11OLD IIOIJS1NC CODE 1DS1'EG'1'ION REPORT LOCATION: 8335 MAIN RD. EAST MARION, N.Y. k4aM� lwer 6 stn:e( («rW�a)WIC11)altLy��„ Still 01Vi510N lIAI' No I.ur NAFIIi OF l)NNI It (s) DONNA INGLESIAS OCCIII'ANCY ONE FAMILY DWELLING W —6y,110 �ouncr— ADMIT-1'1sD IIY DONNA INGLESIAS rASAME KIKI--.YAVAIIaAI(11 f.'ifV(°�.fO. 7'AXHAI' Nl)EI1100 — ,.,. . 7m .. .. 50111(C; OF Rlit♦IIIiS'f: DONNA INGLESIAS HEELER OCT. 28 DA77.: ,.1 .9995 TYPE OF CONS"FROCT10N WOOD FRAME w. 1 STORIES 1 / FX 17'5 2 FODNDATION POURED CONCRETE _ CRANI, SPACE 2ND FI.R„ 3111, .........w..,...... _•, '1'O'I'A1. ROOMS: IST Fl.lt. ( I AR _.,..,M.._.. 1111,.....,.,..._.�..m.._.............. _ U PLIC, _ 11'1' ......„ lA'1'111tOOM s) OPE TOILET ROOM (s) 1 L I'[ H Y ROOM PANTRY FRONT 1_11_1.8 D—REAR ENCLOSED n,.... _... .. 1111_..„_ 1'URCII 7'YI'E FRONT COVERED—REAR m µX „ SCK, 'TYPE _ PATIO _..GAR..„..„k_, .....w. .,. .. FfRlil'1.AC6 ACI: ,.w....._.M._m,.,_..—._..._..w....w.n...,.,...... 1 UiFZI�NAY,.... _„_,.....�..,—,.._,._..._,...m._....w..,w.._,. LILCO GAS AlltCONDl•f... -,. 11'YPF5111 Af110'1'NA'1'Flt YES TYPE III'A'1'I:R L17C0 GAS _w.. — IONINC _ ' .................�.w...,.....w,._.m..____..._..,......., WARM Alit . .. •••. .. Ilfl'l'NA'I'EIC �_.... ._.�........ __... ..�_._...w_�,...�__... ,.. 0"1'I I E.It _... .._._w _....w•... _ ,, ACCESSORY S'1'Itll(:'1'URI .S: GARAGE, TYPIi OF CONST. STORAGE, 'TYPE CONST. HOOD BARN SN 1 MM 1 NG 1'001.. .__„..w_„_„•... CUL'S'f, '1'Yl'E CONST'.. _.._.__, 0'1"Illi It: .... .w.....,._..,..„.,._ 1_11,1.. .a..�,._. .,. „ VIOLATIONS: CIIAI'TEIt 45 N.Y. STATE UNIFORM FIRE PREVENTION 6 IIIII1.DING CODE 1 OCA 1 I Olt _.. _.. _111,1.. ._—.,_.. _......... t DI SCRI1"l i0N .,_1111.. .._..,.•w..„M...._.,,,�_1111.. .....�,.w,,_w_ ,......... ... _................ ..„.. _.�.._,_.., ,,,.....m... ItEMARF.S: ..,, .._._.._,....,....•..._,_. ...�,.,. ,..IIAI'Ii...01 7NSI'F(:1'ION�. NOVEMBER 21�,..�, ... ._ ,..� 1111 1111 11,11,_ _ _ lu..Pf CTED RY �_.. _. 19995 M. BOUFIS _ _..._ ------ START __,_.. '1'IMIi START 10:15 AN IiNO 10:45 AN FORM NO. .4 • ToNN or somot.D DULLDING DEPARTMENT office of the Building Insp4ctor Town Hall Southold, N.Y. CERTIFICATE of OCCUPANCY 1 No 217505 Date ER 0 1' SE3 TRIS CERTIFIES that the "dim Ity Location of Property 8 lb3 tiAINMST M010N House No. street hamlet County Tax Map No. 1000 Suction0�81ock__2jLot 14 Subdivisi' ` Filed No. Lot No.� conforms substantially to the Application for Building Permit heretofore f led in this office dated„ OCT 24. X966 pursuant to which Building Permit No. 154423dated 3O 9II was issued, and conforms to all of the reTiirem&nte of the applicable •" provisions of the law. The occupancy for which this certificate is issued is "f 98M AS �R. The certificate is issued to O E (owner, ) of the aforesaid building. SUFFOLK coUNTY bEPARTMENT O! HEALTH AP$ROVAT. N A UNDERWRITERS CERTIFICATE NO. " N0434 II'. 2 PLUMBERS CERTIFICATION DATED N ]1 Building Inspector a M31VI V0.4 'TOWN OF SOu7HOLD BUILDING DEPARTMENT Office of the Building thspector Town Hail Southold,N.Y. Certificate Of Occupancy No. , ,Z- 164434 Date November a27,M« 1rt987« P . THIS CERTIFIES that the building . .AdditioAlteration. to existing . . . . . LocationofProperty 513;5. Vf Main Road East Marion , New.York House ft: . . eet . .. . . . . . ..Hamlet. County Tax Map No. 1000 Section 03 I .,,Block . . 21 . . . . . . . . . .Lot .. . .I.4 Subdivision . . . . . . . . . . . . . . . . . . . » . . . . . . . . .Filed Map No. . . .. . . . .Lot No. . . . « . , « . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated December 4 , S 5 5 6 6Z 6 ^ * pursuant to which Building Permit No. . F w µ . . . .. . . « « . dated , « MD e c c m b e r I 1 , 41986« « . 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 . . . . . . . . . ADDITION 6 ALTERATION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR . . . « . . . . . . . . . . . . . .. . . . . . . . . . « . . . . « . . . . . . . . . . . . . . . . . . . .. . . . . , . . . . . . GERTRUDE IGLtSSIAS The certificate is issued to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . « . . . . e of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . , .N . . . . . . . . . . . . . . . : . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO N82. 3 78I . .. . . .. . . . .. . . . . . . . . . . . PLUMBERS CHRTIFICATION DATED: September 17 ,' 1987 M . . . . . « .. . . . . .. . . . .. . . . . . . Building Inspector