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Home My WebLink About1000-106.-5-30 Rental Permit 1254 Owner: Steven Kalogeras , Dionysia Kalogeras Occupied as: Single Family Dwelling Located at: 800 Ruth Rd Mattituck 106.-5-30 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. Issued: 02/03/2025 Expiration: 02/03/2027 fc-rcement official This Notice must be posted by the main en nc atalltimes 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 1it1li,�f/ w .sot l�dtowng M rg RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed eve two ye rs A �w v Section A. � � ' Property Information: lJ�, ('d �30o neLt�lay 181 Rental Prop�r Address Addre w T Tax Map Number: 1000 SECTION 106 -BLOCK -LOT .30 SECTION B. OWNER INFORMATION: Property Owner Name: 5MVW IAL A—S Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) Af e`�]�P �.�//.�/� gym, Maw Z d r 1 1 • � I { 9 I• —i�� RENTVAEN Y t i '357— 1�57 Telephone Number (s): Daytime ng Emergency &tg q `7q I,� Y ` Property Owner Email Address: flokAto 510e H4AlLo &V 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: b 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 Un,t: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: Lt V 1 N 6rkXM K-t TCHCN 27x 15 1D1N1 6:- Xc � -FV " ��X�� u>� 3 � IOxIL 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. S( I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold 0 1 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 STr- �` ��PrEf �_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: �'oGv�rt S Property Owner's Signature: Sworn to before me this /S day of DrWA//✓,*XZ 204S '01- Official Notary Public Si nature and Original Notary Stamp VIVIAN KALI KALOGERAS Notary Public-State of New York NO.0 1 KA6404 3 81 Qualified In SO**County Page 4 of 4 My Commisriom Expires Feb'eb 18,2028 g Town Hall Annex Telephone (631)765-1802 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959 s � BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Town Hall Annex ��; Telephone (631)765-1802 54375 Main Road --J Fax(631)765-9502 P. O. Box 1179 to a„ps 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 Home Inspector must provide copy of valid current certification Rental Property SCTM Number: Rental Property Address: Owner/Name: Rental Dwelling Unit Identifier: Number& Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom #1 — 100 sgft., Bedroom #2—90 sgft., etc.) Property Description (Include all improvements indicated on survey) 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. Print Name and Title Original Signature Please place Professional Seal: TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 INSPECTION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] NAL [ ] FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTAN/(FAL) RATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL CODE VIOLATION [ ] PRE C/O [ TAL FIE77KS: (1) �Mofl-e, Vol4(x pp� - www DATE INISPECTORA WAX(— 1 -3 / J R TRIM 3 � x 3 s 1 � y i S i 106-5-30 2/04 91- tx M F L Bldg (�o E Extension f � I Extension 3 g M � Extension i = 3Foundation ;Both 1 Dinette / Porch r ?3 y So «, Basement �l Floors ( / jf� K. Porch r Ext. Walls 'Interior Finish £LR. �/ 3 Breezeway ' Fire Place �eS !Heat 0%l�9 ;DR. [Typearage J f % +�� Roof �spG,�(� Rooms 1st Floor BR. Z _ Patio z2 (/ ! ;Recreation Room ' ,Rooms 2nd Floor 'FIN. B I O. B. Driveway f i Z ; xr � _ x Total t j ell GilC. r e TOWN OF SOUTHOLD PROPERTY RECORD CARD 17 ........ STREET I-vrLLAGE DIST_ SUB- LOT 4-v ,,FORMER CywNER/,-, E i ACR. L C) rLk' w TYPE OF BUILDING RES. Mkt. Value SEAS. I VL, FARM comm. CB- mics. M LAND IMP. TOTAL DATE REMARKS �7- CIO v XP, 4-2! L HI -44 I fy 7 --al t 0 IZ4 i Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD rrMeodcywlcm DEPTH House Plot BULKHEAD Total FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29514 Date: 06 12 03 THIS CERTIFIES that the building NEW DWELLING Location of Property: 800 RUTH RD MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 47889 Section 106 Block 5 Lot 30 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DULY 5 2002 pursuant to which Building Permit No. 28665-ZZ dated _AUGUST 1 .x....,.002 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 COVERED FRONT PORCH AND ATTACHED TWO CAR GARAGE AS APPLIED FOR. The certificate is issued to ROSEMARY CHIRCO (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-02-0061 05/28 03 ELECTRICAL CERTIFICATE NO. 3502 05 2 03 PLUMBERS CERTIFICATION DATED 6 1.1 03 PATRIOT PLUMBING A hor ed Si ature Rev_ 1/81 1 - I �} let 'I 3 ; € Fa 6.e�{ue ea d ��, (?✓ Fi[ m41 '.H p: -fia .n -H k� if :_-f -•d 'E € g Iq L'L"' 74 � 144 k �r i 66 1lIYY� 3 .€:s I:f-ems. 41 - 71 —� I >10 Jt ldtl'I33tb1S A'4 3U4U 4NI4ilUB 3AN �`L�a^��+vN.� f E t:id N UJN(Id3N " i t"........... ZL'Itlb UI SV dtl J'S3 A I D ➢3 oG+'! Y,! S.... _..... �z aN; ,d,draa ,uN anmaeerr133esv�`w°— { }(V b [yrfI"^dVl7tl'i NtlI1tl41NlitlJ :kllNiYll ++o- vb zA W yJ , i C va �fli 71n i11MMv-". 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