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Home My WebLink About1000-78.-1-38 TOWN OF SOUTHOLD E Rental Permit 1197 Owner Jonathan Gilbert & Courtney Occupied as Single Family Dwelling Located at 275 Sleepy Hollow Ln Southold 78-1-38 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. 9/13/2024 Code tnf went ff I This Notice must be posted by the main entrance at all times 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 htVs://www,gQutLigLd!gAnU.gov RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: 2 7 S I've Cry 1 Ja u,0W z tJ 5 Q1AT O'J i 0 �/`� `7 I Tax Map Number: 1000 SECTION r -BLOCK -LOT SECTION B. OWNER INFORMATION: Property Owner Name: J UOJA-T11 r�'") Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) GLIB,, CT Telephone Number (s): Daytime 1114v " r 01venng / Emer enc Property Owner Email Address: t<, 4-124'(L 'PG4 i L. Gym C' 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: Address of Authorized Agent (no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening 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, 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: Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: `( 6 CO 116 1" ( 0 (OpK1 Use and Dimensions of each room in Rental Dwelling Unit: S C C t-\ VA�►�� 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 I am submitting a completed Town of Southold certification form from a licensed architect or a licensed professional engineer. Page 3 of 4 SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW 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 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: G�J A T � AIJ 4 C 1I Ek- l Property Owner's Signature: ll Sworn to fore me this �� da of �l/I LY 20 2`� CAROLINEMMACARTHUR y + Notary Public-State of New York NO.OIMA6384635 M Comumisseon n Suffolk County y Expires Dec 17,2026 Official Notary Public Signature and Original Notary Stamp Page 4 of 4 TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 3e INSPECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. - [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [MENTAL REMARKS: O� � jows 00 000 a aA G OATE INSPECTOR 1 Town Hall Annex �� Telephone(631)765-1802 �� ®r 54375 Main!toad � rr�� j Fax(631)765-9502 P.O.Box 1179 Southold,NY 1 1971AW59 �j f,� �� r�ar" 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 rpreq � C r m " a t rrcllteti � ol � *rc �� wl m b glid curren rti itrl is Rental Property SCTNI Number: _..., _ . . , _� .......�_ ra...... ......__. .... ....... ..._,......._... .- . Rental Property Address: owner Name: �� . A 14 AvJ Rental Dwelling Unit Identifier: ,_ ._. --__..___ . .. _ . �..... .µ.... ... ... -. Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1-100 sq., Bedroom#2-90 sq., etc.) 114 S Property Description iPt�ion (include all improvements r1 tvemen2ts indicated - on survey y G L 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 "fork State. ' Ile Print Name and Title �� C g w*u 4,.w '��G $, / � ��z� J . Please place professional seal, 4 � 7 TOWN OF SOUTHOLD POOPERTY RECORD OWNER E f RE FT VILLAGE � Ms"r, rUIBL LOT "FOR ER O"a T41EIR w a ,k .; E _ d p °- w T PE OF 01..4PED0t Fes. - SEAS, FARM U:,T,M.K CB. PMCS. ,M Value LAND HAP, TC')TAI.. DATE REMARKS e ,a F r p, d 0 Tillable •FF&E46A.�. >- AZER i Woodland FRONTAGE ON ROAD 1 Meadowland DEPTH House Plot f Total t I "" iiN lip uld,i �I� I r� OIOR TRIM _..._..._ .,,...,� , 1 h 1 .__ __...t .. 78:I-38 12/07 ._.,.pr., + ..y.w_,q duo- ..—,M r, y ad*... 1 q hA BMA L Extension _- k Extension ... _._ .... ado Dinette Foundationsement ... .,.. __,_.......�FI . Ba Bo rs K. _._.... ...M_._ __m......M _ . .. _}..._. Fire Place _ Heat Ext WaIIs Interior Finish LR Breezeway 1 R _,w m',,,,,,... .._ ...__ _ _ .Is Garage ... Type Rooms lst Floor BR ......._..... --- Recreation Room R..... .... _._ ... _ -.. ....._ Rooms 2nd Floor FIN B P - �_Dormer Driveway k �W !! 4 "�"�gt^al"" ;'�� ,a . ....... r FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-32125 Date: 11/29/06 THIS CERTIFIES that the building NEW DWELLING _ Location of Property: 275 SLEEPY HOLLOW LA SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 78 Block 1 Lot 38 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 30, 2006 pursuant to which Building Permit No. 31835-Z dated MARCH 9, 2006 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 THREE CAR GARAGE, µCOVERED FRONT PORCH & REAR DECK AS APPLIED FOR. The certificate is issued to JOSEPH G. NESPOLI (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-04-0187 01/09/07 ELECTRICAL CERTIFICATE NO. 06-8054 12 19 06 PLUM9ERS CERTIFICATION DATED 11/29/06 WILLIAM DOOLEY / - tho ized=o4ignature Rev. 1/81 rFFCIt, .a Town of Southold 7/7/2024 ell P.O.Box 1179 53095 Main Rd Southold,New York 11971 .. ,f CERTIFICATE OF OCCUPANCY No: 45333 Date: 7/7/2024 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 275 Sleepy Hollow Ln., Southold SCTM#: 473889 Sec/Block/Lot: 78.-1-38 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated p g 789 dated 5/6/2022 4/5/2022 pursuant to which Building Permit No. 47 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: in.ground, %lrt ing oo[,,fenced_to codes vapplied for, The certificate is issued to Gilbert,Jonathan&Courtney of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 47789 8/l/2022 PLUMBERS CERTIFICATION DATED _........... .. .... .._.*1ze ........ .....At,ti.. atUr f 04" ip, . Town of Southold 4/1712021 erd P.O.Box 1179 53095 Main-Rd Southold,New York 11971 ----------------------- ------- CERTIFICATE OF OCCUPANCY No: 41957 Date: 4/17/2021 THIS CERTIFIES that the building ADDITION/ALTERATION ............... .....Location of Property: 275 Sleepy Hollow Ln., Southold SCTM#: 473889 See/Block/Lot: 78.4-38 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 7/8/2019 pursuant to which Building Permit No. 43983 dated 7/18/2019 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: enclosed vorch addition and replacement of. eck gfkirs to an existing single f jjgj le dwell a1 lie d for. _ ___ The certificate is issued to Gilbert,Jonathan&Courtney of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF-HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43983 3/2/2021 PLUMBERS CERTIFICATION DATED ........... h :rig d ignature 7 7 12. R m fod ILA Is Ir"I 3 4 2.3 S►l 9 7 7 -3 �� _ -0 yi-:ppoptr 4-3 t1a 0 Pao o r I z•3 Al NzEl"'f" 21 V\M,,,11 1 Al� -11,,