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HomeMy WebLinkAbout1000-15.-1-25 TOWN OF SOUTHOLD Rental Permit mit 1226 ---------------- Owner Dimitrios & Irene Antoniadis Occupied as Single Family Dwelling Located at 1275 Greenway West Orient 15.-1-25 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. 11/12/2024 Co for a official This Notice must be posted by the main entrance at all times " TOWN OF SOUTHOLD—BUILDING DEPARItownh ..� r :7-1 0 Town Hall Annex 54375 Main Road P. O. Box 1179 Southo �� Telephone (631) 765-1802 Fax(631) 765-9502 htV,,,//www.southolLIN 2 � ���]0 =:. RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: 17 Tax Map Number: 1000 SECTION / -BLOCK d , _,.._..,_,_--LOT ZS -� SECTION B. OWNER INFORMATION: pQ� Property Owner Name: N i 1 P�"q i i 't 0S /T V1 i O N'i.PrAts ► S Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) d i Emergency ' Telephone Number (s): Daytime9i7 Evening --__- Property Owner Email Address: �' t r Page 1 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: A, Use and Dimensions of each room in Rental Dwelling Unit: ' _ 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 ❑ 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) I Isi "i r % AN- i C 5 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: �at�;iT t411iPAb°is Property Owner's Signature: n Z iL Sworn to before me thiQ�Jay of �_ .� 20� ibrl IN-0 W41 Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.01BU6185050 Qualified in Suffolk County Commission Expires April 14,2LL�l,, Page 4 of 4 qf so * ' TOWN OF SOS OLD BUILDING DEPT. 'co 631-765-1802 Awft INtopmuTION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] F AL [, ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI L) [ ] CODE VIOLATION [ ] PRE C/O ( RENTAL RED i.S DATE: �_ IINSPE CF"T`OR 'C WN OF SOUTHOLD PROM RD CARD OWNER ISTREET VILLAGE 1IST. SUB. LOT ! FORMER OWNER CU V t t b ' N E ACR. ry ��sue, "1 zip S W TYPE OF BUILDING RES. �.1 (� SEAS. ?VL. FARM ;COMM. CB. MISC. Mkt. Value LAND( IMP. TOTAL DATE REMARKS 1 t a c j [ d 11 r t . j« 3 ao 7 I 5 (060 1 CoSt? � ; tz }2,/Z IG = F ZiGy, AGE BUILDING CONDITION L � . NEW NORMAL BELOW ABOVE FARM Acre I Value Per Value Acre Tillable 1 Tillable 2 s Tillable 3 � Woodland s Swampland ! FRONTAGE ON WATER a Brushland FRONTAGE ON ROAD I 3 House Plot = DEPTH BULKHEAD s Total t DOCK r - ; s 4 • r (a � hoot — iS � 9J = 4. Aft e� COLOR fl _ TRIMka x V4t —. s e N� � � a A _ 3 1S.-1-25 1/4/"202 _ — M- 61d — n BathDinette — x �t Floors IC, Extension -- �S-4� 4 Basement Interior Finish LR. Extension :19423 4 C Q v Ext. Walls - - -- Extension 1,10A �� �`4 yt }.(p= w y ° Q Fire Place t ( Heat DR 9 of 4 fs 0yP e Roof — Rooms 1st Floor !BR k p_ _ _ Porch ° creation Roam; Rooms 2nd Floor FiN- B _ - Porch 5 � 1 � ti r Breezeway Driveway _ _ _ F Patio E t Total e cA.� t � xiwmle.T�,w,� ixt ,;- tsrcx ewr. fz}±3'x sp s2 _ _ 36i 5e£t Lr— gg A. MASTM ms=s _ V-tY tz3+ ru e,_t8. �31 8 F78LL ( p 1 I � -s sneaco �eomro ooeoco � ,� 1 � ( 4 w .7"{2}t(n 841Ly ( ( 7W Sit ( t Smg=y RESIDENCE RATHRRG st _ T I I — z I CORNER OF 1 - uA mffm% I ___ r 'e"'.ea 1 1 °p" NORTH SEA DRIVE "c - 236_SsiEi " ! 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