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Home My WebLink About1000-83.-1-27 � TOWN OF S UTH LD Rental Permit - 1257 Owner: Michael Gagliano , Denise Gagliano Occupied as: Single Family Dwelling Located at: 535 Birch Ln Cutchogue 83.-1-27 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: 02/05/2025 Expiration: 02/05/2027 fti ode oc mentOfficial This Notice must be posted by the main entranc at �ro 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 htt s://w ww. outholdto RENTAL PERMIT APPLICATION e� � old ld SOO Rental Permit Fee$300(Application must be renewed every two years)*t 18-;L5 Pd ��v w, ► 0C1100 Section A. "k i_(09 Property Information: Rental Property Address: 5 5 BIRCH LANE CUTCHOGUE, NY 11935 Tax Map Number: 1000 SECTION 083.00 -BLOCK 01.00 -LOT027.00 SECTION B. OWNER INFORMATION: Property Owner Name: DENISE AND MICHAEL GAGLIANO Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 22 Argyle Place 22 Argyle Place Rockville Centre, NY 11570 Rockville Centre, NY 11570 Denise cell- Michael cell- Telephone Number(s): Daytime(310)339-1706 Evenin 917g� )459-4216Emergency Property Owner Email Address: denlse.gagllano47@gma1l.corn; michael.gagliano2O@gmall.com Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: No agent,just owners 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: No agent,just owners 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: No agent,just owners 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: One 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 Requested Maximum number of persons allowed to occupy Dwelling�n( Number of rooms in Rental Dwelling Unit: 7 Use and Dimensions of each room in Rental Dwelling Unit: Living Room-345.83 sq.ft Kitchen/Den- 391.67 sq.ft; Bathroom 1-43.75 sq ft ; Bedroom 1- 188.91 sq ft Bathroom 2-36.25 sq ft; Bedroom 2- 138.67 sq ft; Bathroom 3-60 sq ft Bedroom 3 +Walk-in closet- 365.57 sq ft 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. r7 lam requesting afire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ 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) 1 Denise Gagliano 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: Denise Gagliano Property Owner's Signature Sworn to before me this(' day of fin. 20 KAMERON JAMES Notary Public,state of New York Offici ), otary Public Signatur � d Original Notary Stamp Reg.No.01JAOo3a3o2 Qualified in Nassau County ornmission Empires October 29,29-a � Page 4 of 4 *` TOWN OF SO T U� � HOL.D LLD G DEPT. 631-765-1802 INSPECTION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND VFIRE ULATION/CAULKING ] FRAMING /STRAPPING AL ] FIREPLACE & CHIMNEY SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F AL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: v >ro ` lCe/ DATE INSPECTOR [:TORX