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TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11 71_ 9 9 - w
Telephone (631) 765-1802 Fax (631) 765-9502 tit .:// w ti.1 oi .�(�L, iiy �N a�
AY - 1 2024
RENTAL PERMIT APPLICATION „ E'11'.tio
Rental Permit Fee $300 (Application must be renewed every two years)
Section A. (�-< a
Property Information:
Rental Property Address:
CrrO e im ct
Tax Map Number: 1000 SECTION 042 -BLOCK -LOT O 10
SECTION B.
OWNER INFORMATION:
Property Owner Name: QA<
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
QyUo�;- "A%N Cz~�
Cv (1
Telephone Number (s): Daytime '� ( Evening Emergency S Cl 155 (�
Property Owner Email Address;
I
Page 1 of 4
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any: `S P ["3
Address of Authorized Agent(no P.O. Boxes): d 0--V G-e-AE SQ'-k,--?k
Mailing Address of Authorized Agent: �� �:4"' `0(L7 k-1u
Telephone Number(s): Daytime Evening Emergency
Email Address: i1 �y H�'��� �i . .. � �
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:
Use and Dimensions of each room in Rental Dwelling Unit:
2 X 12. z � : X z�
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
E 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
,,O�F_SUFFOLK)
1 `1�\ �p �-�`� , 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: VA� Q,°
Property Owner's Signature:
Sworn to before me this_J_day of 2Q2H
Official Notary Public Signatu nd iginal Notary Stamp
FNOTARYPUP.-,,v,
� � ; od P S
,,,«i" ,w,''A:�; OF NEWYORK:'�;eNoo 01A00019644c in Suffolk County Page 4 of 4
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Town Hall Annex Telephone (6 1)765-1802
54375 Main Road
P.O.Box 1179
Southold,NY 1 197 1-0959
0
24
BUILDING DEPARTMENT
TOWN OF SOUMOLD
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
Professional seal required Lor,grchitec or Enaineer licensed dome Itts actor must rovide
Copy ot valid current wcerti ication
Rental Property SCTM Number: 1000-48-1-10
Rental Property Address: 711 Front Street, Greenport NY, 11944
Owner/Name: Mark Breen
Rental Dwelling Unit Identifier:
Number&Square footage of each bedroom as depicted in the attached floor plan:
(i.e. Bedroom#1 -100 sq., Bedroom#2-90 sq., etc.)
Bedroom 1 - 121 Sq. Ft.
Bedroom 2 - 150 Sq. Ft.
Bedroom 3 - 76 Sq. Ft.
Property Description (Include all improvements indicated on survey)
2 Story Frame Residence, Landing & Steps (Front), Frame Deck (Rear), Concrete
Walks, & Concrete Driveway,
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 Conservat Construction Co i f New
York State.
Anthony Portillo, R.A
Print Name and Title �aO � , Ori i ture
u A
Please place professional seal: �a �• �`
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Town of Southold 5/26/2023
53095 Main Rd
Southold,New York 11971
PRE EXISTING
CERTIFICATE CCUI'A CY
No: 44129 Date: 5/26/2023
THIS CERTIFIES that the structure(s)located at: 75700 Route 25,Greenport(aka 711 Front St.)
SCTM#: 473889 Sec/Block/Lot: 48.4-10
Subdivision: Filed Map No. Lot No.
conforms substantially to the requirements for a built prior to
APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 44129
dated 5/26/2023 ' was issued and conforms to all the requriements of the applicable provisions of the law.
The occupancy,for which this certificate is issued is:
wood ftam s�llef mil dwelling with unfni ed ment and enclg e r h *
The certificate is issued to Ray,Annette �w
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
A t4niignature
a
\ BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPE ION REPORT
LOCATION: 75700 Route 25,Greenport(aka 711 Front St.)
SUFF.CO.TAX MAP NO.: 48.-1-10 SUBDIVISION:
NAME OF OWNER(S): Ray,Annette
OCCUPANCY:
ADMITTED BY: Linda McGinness
SOURCE OF REQUEST: Ray,Annette DATE: 5/26/2023
DWELLING:
#STORIES: 2 #EXITS: 2
FOUNDATION: concrete CELLAR full CRAWL SPACE: partial,
BATHROOM(S): 1 TOILET ROOM(S): 1 UTILITY ROOM(S):
PORCH TYPE: enclosed DECK TYPE: PATIO TYPE:
BREEZEWAY: FIREPLACE:. closed GARAGE:
DOMESTIC HOTWATER: oil hotwater TYPE HEATER: ail AIR CONDITIONING:
TYPE HEAT: steam radiator WARM AIR: none HOT WATER:
#BEDROOMS: 6 #KITCHENS: 1 BASEMENT TYPE: unfinished
OTHER:
ACCESSORY STRUCTIT S:
GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST:
SWIMMING POOL: GUEST,TYPE OF CONST:
OTHER:
VIOLATIONS:
W
REMARKS:
INSPECTED BY: _ NANCYD _ DATE OF INSPECTION: 5/26/2023
TIME START: 11:07am END: 11:35am.
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-34702 Date: 11/22 10
THIS CERTIFIES that the building ADDITION
Location of Property: 75700 MAIN RD AKA 711 FRONT SR GREENPORT
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 48 Block 1 Lot 10
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated pursuant to which
Building Permit No. 24368 dated
_�.........._.......................___...
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 AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to ANNETTE E RAY
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N A
ELECTRICAL CERTIFICATE NO_ N A........................ _.�
PLIERS CERTIFICATION DATED N A
71�� ized Signature
Rev. 1/81
Bunch, Connie
From: Bunch, Connie
Sent: Wednesday, May 8, 2024 10:46 AM
To: 247sunny247@gmail.com
Subject: Rental Permit Application for 711 Front Street (aka 75700 Route 25), Greenport
Hello,
Thank you for submitting the rental permit application for 711 Front Street in Greenport.The building inspector has
reviewed your file and has denied the certification because a building permit is required for the HVAC and the upstairs
full bathroom.To apply we need a building permit application,electrical inspection form, HVAC manual or a picture of
the sticker on the outside condenser, and 4 sets of plans from a New York State licensed architect or engineer for the
bathroom. When the building permit is written the building inspector will inspect for the rental as well as the building
permit.
Best Regards,
Connie Bunch
Principal Office Assistant
Southold Town Building Dept.
connieb southoldtownn . ov
631-765-1802
P.O.Box 1179
Southold, New York 11971
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Town of Southold 5/8/2024
m 53095 Main Rd
id Southold,New York 11971
631-765-1802
0" �►��M. .1�PLAIN
To: Ray,Annette Complaint#: 2024-321
711 Front St SCTM#: 48.-1-10
Greenport,NY 11944 Follow-up Inspection Date: 5/21/2024
Location: 75700 Route 25
PLEASE TAKE NOTICE,a complaint has been registered against the location described above,in that the above
named individual(s) did commit or permit to occur the following offense:
When Nancy reviewed the certified rental she found HVAC and an upstairs full bathroom have been added since she did the Pre
CO inspection in 2023.
This condition constitutes a violation of:
`�taxt\" aLk-.e_A.o'�y- 410p rd V'0'j
ele-c4c C_ SkA\i i c.Q C8'0 d
When on 5/7/2024,I did observe the following:
This property will be re-inspected for compliance on: 5/21/2024
Nancy Meyer