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Home My WebLink About1000-40.-3-4 of TOWN OF SOUTHOLD Rental Permit 1300 Owner: 60095 Roxbury LLC Occupied as: Single Family Dwelling Located at: 64380 CR 48 Greenport 40.-3-4 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: 05/02/2025 "VALt Expiration: 05/02/2027 Cod En f rce j t official This Notice must be posted by the main entrance at I ti es Z� TOWN OF SOUTHOLD—BUILDING DEPARTMENT � Town Hall Annex 54375 Main Road P. O. Box. 'I.179 Southold, N" " 11,971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 h a :H � (,sotttl'iol(ltoNyI'L1IY.,&)Q RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: �U C, Tax Map Number: 1000 SECTION O -BLOCK -LOT SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: (Cannot IIbe the same as Rental Property Address) Telephone Number(s): Daytimd ll--(PIASLI"(lvening Emergency n Property Owner Email Address: me aw\o 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 7/-- 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 /E ,ning_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: N �IN �1 Address of Managing Agent (no P.O. Boxes): 11 Mailing Address of Managinaag Agent: Telephone Number (s): Daytime !IS Evening Emergency w Email Address: 6 A, 0 A, C. 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, 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." I'll, 6 -"*** Rental DwellingUnit Identifier: V Requested Maximum number of persons allowed to occupy Dwelling nit: _ Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: 9,)( Ui I� t -° Oran 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. Zon requesting a fire safety inspection to be performed-by-a Code-En ment O forcefficial — the Town of Southold l 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 .dose On k6Tn 0 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: kog s- t+` PLC. Property Owner's Signature: 7S )1nttoL,me t , s day �f �1ll , 20 fficial Notary I ,u Iic Signature and Original Notary Stamp BF TRIZ E. TALA Notary Public, State of New York No 01 TA6170130 QualiGec,l in Queens County Commission ExlAres July 02, 20 Page 4 of 4 Telephone 631 765-1802 Town Hall Annex �� "� "w�a, P � ) 54375 Main RoadCz P.O. Box 1179 , Southold, NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to ccupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: o'j 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 OF SOUTHOLD BUILDING DEPT. 6 1-765-1802 X0-3- I N S wro' E C T I 00"'k [ ] FOUNDATION 1ST/ 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 [4�/RENTAL I EMANK oil s viz � t Town Hall Annex Town of Southold 54375 Main Road Rental Inspection Report PO Box 1179 Lw Southold, NY 11971-1179 Tel: 631-765-1802 SCTM # „_.... ,_. �. .".. .�,...1.' . _. . ..� ,.. . . ....a . . ..... ... . �. _ .. .,., �m Date.. (_. .. .. ,..... �... Owner .�. ..__ .. .. ..�...w �...� " �.,��..._�. _�.M ..... . ._v _.._,_.... Phone. ,..�..�. .._ �..w_._.... ...... . 9 Address�Hamlet.�.. __.�w... . .w._.._� °` .:�_�. � .Visible �' .... . .. _..._.. ......,__....._. ...... ....._. ._, ....w .. Inspector " ..Floor Level Q.uantities. 0 Sub 1 2 3 Smoke........ .�a � �.. . ... . ......... . .w. _.�..�.. .. .-...._ .. _ ...._�. .�-� .....�� ....,...�... . .. mm. ..�. .. ...�..._.... Detectors(not located in bedrooms).. ... _., ...... �.. .,;,.., ......m.� ..,.w�.. �.�._e . .��......�� Carbon Monoxide Detectors f Fire Extinguishers j Exits Bedrooms..... ........._. ..,._... ... m"... _ 1 2 ._ .1.._ ..�. 3 ,_. . _ _a.4._w ,.. .._ ..5..._._ 6 _. Smoke Detectors � Egress Occupant Count a- Building Systems Maintained &Operational Condition of Property . w. .... .... .., _... ._.. .Heating Building interior........w,,. . .. _......... ..�... ..._ . _. �....___ �� .m__� Hot water i Building exterior Electrical Property clean, maintained &safe V Mechanical Handrails &guards installed &secure Pool Safety i Pool on Site Surface water alarm..... . .. ........ __ . ,. . _..µ Date of CO issuance . . ...... ...... .. ...._.w.w.. ..w. ._.µ ...._.. _.. Pool sed " /latching gates ... Pool fence clode requirements u Self closinement" .. Door alarms g/ gg q s CO's for all items present Prior Rental } 'Comments TOWN OF SOUTHOLD PROPERTY RECORD - CARD avVNER ST ,4, ; V-LLAGE DISC SIJBa LOB' _ _ of ate_ �a�-�—' :A.�.. _. ..3.. -ten -,�_- DER V-N -R vi` ACk a, P.E OF BUILDING �..,_ LAIN D OTAL DAB REMARKS Lt- ti - - 4 _ = - e em_ a �- s £. BUILDING I T[O _- NEVI NORWL BELOW ABOVE FAIWA Value Per Vclue e, m Amy —illoble FRONTAGECTER Wo FRONTAGE ON RaAD Meodowdmid DEPTH plot BULKHEAD C — t � F.w z df Fes. #, TRIM , . . e t y� ± r S e L 40.-3-4 01/2016 € s x a t 1 M. Bldg - < t ± Extension ± Extension } < - f Extension �__ - Foundation Bath Dinette Porch F i r asement r (oars K i Porch � - - - Ext. Walls 1 _. Interior Finish LR. Breezeway Fire Place Heat - — et4 - 4 Garage i ` ype Roof Rooms 1st Floor �Y � tBR. i Patio Recreation Roorn E Roans 2nd Floor " F:IN. B 0. B. :Dormer _Driveway i Total �. FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 28105 Date: 12/07 01 THIS CERTIFIES that the building DWELLING Location of Property 64380 CR 48 GREENPORT (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 040 Block 0003 Lot 004 Subdivision Filed Map No. Lot No. conforms substantially to the Requirements for a ONE FAMILY DWELLING built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 28105 dated DECEMBER 7 2001 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 ACCESSORY THREE CAR GARAGE The certificate is issued to VIRGINIA SLEDJESKI (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. NfA PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTIO ,,,R PORT" � E Authorized igha re aU Rev. 1/81 g LOCATION: SUBDIVISION MAP NO, LOT (s) NAME OF OWNER (s) OCCUPANCY �" P� Ora��r-t�r�sDt a ADMITTED BY: � ACCOMPANIED BY: KEY AVAILABLE SUFF. CO. TAX MAP NO. SOURCE OF REQUEST: DATE: d DWELLING: TYPE OF CONSTRUCTION " # STORIES_ EXITS FOUNDATION CELLAR t CRAWL SPACE TOTAL ROOMS: TST FLR. _ 2ND FLR. 3RD FtR. BATHROOM (s) TOILET ROOM {s} C3�-� UTILITY ROOMev PORCH TYPE + DECK, TYPE PATIO, TYPE BREEZEWAY FIREPLACE GARAGE DOMESTIC HOTWATER' TYPE HEATER 0/9�� AIRONDITIONING _. TYPE REAT WARM AIR HOTWATER OTHER: ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST. 461a STORAGE, TYPE CONST. SWIMMING POOL GUEST, TYPE CONST. OTHER: ------------------ ---------------- VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION 3 BUILDING CODEMM �� LOCATION Sc PTION ART. SEC. REMARKS: INSPECTED BY: r DATE ON INSPECTION z3v TIME START -- Town of Southold 9/21/2023 P.O.Box 1179 c 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44557 Date: 9/,21/2023 THIS CERTIFIES that the building ADD1TlON/ ,"rFRA 1ON tl.._....... Location of Property: 64380 CR 48,Greenport SCTM#: 473889 See/Block/Lot: 40.-3-4 Subdivision: Filed Map No. � Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/13/2017 pursuant to which Building Permit No. 49676 dated 9/13/2023 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: frgnt entrance la orm with handican rare: as dition to exi ti g single-family dwellin as apilic,l for. The The certificate is issued to HNF Resorts LI LLC of the aforesaid building. r SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED _�_.. u..._wri d gn tore w_.M vymoovvAy \ . Al F ��\�� y ti \\ �. � � e �, a — � �_ 7 st �,� � ,� ._� - a. �� , � r �_ g �� - I _�� , � �. =' W=to-Y s-t+Y, 20-aY, '-al3ts Unfinished Basements Unfinished Storage Basement Room I Screened Porch Foundation Y 0 L Unfinished a .E Basement = Utility Room CIAMPA 1 oil RESIDENCE Unfinished Tank NORTH ROAD(CR 48) Basement GREEW RT,NVllW SCTW 1000<0 343 it - EXISTING FOUNDATION PLAN 24'-i�' E'-9�• EX. FOUNDATION PLAN Scale: I I I I I I I I I 1 I I I A101 0 5 10 20 30 40 50 2 2Q'- Bye ti�B DBLOl:AMIATES,ac 2830 286 Tam_Glass 2844 c W D G]a o Launder m Bath Room � �. � Bedroom ..«� ® ® 74.54 SgFt i 4040 4040 ci 4 28 Screen Screen 3Q � 668 2868 — 0 a m ® N N N Kitchen ..iceN Screened Porch ti ' ICI tom_ -43C C( -s ' Living RoomN Dining Room a ! 4040 4040 CIAMPA F Screen Screen RESIDENCE -N NORTH ROAD(CR 43) GREENPORT,NY 1 44 M#00 SCT 10-3-0-94 Wa. Foyer 30fi8 TA. 2844 2844 2044 4244 2044 EXISTING - FIRST FLOOR PLAN j' Y-� 3 � 1-tlt(S• EX. FIRST FLOOR PLAN A102 Scale: � � � � � � � C � � � ° �6. ��"�� 0 5 10 20 30 40 50 30'-1 t„,.. ..>aa.h.s T2838 28M 838 2£3�8 668 a e Bath —11§ t I 1 V4 . LLi {tqp I l 2658. - - 7 - ;< haw , N Bath 2` Bedroom - 132.35 SgFt Bedroom 113.85 SgFt CIAMPA RESIDENCE ' NORTH ROAD(CR 48) GREENPZT,NY 11S44 iv SCTM#1000d0-0S-04 2838 2838 EXISTING SECOND FLOOR PLAN �•-16}$• t xa nrr-mz+ EX. SECOND FLOOR a�os Scale. a.�.;.��4�� W ��4 . 0 5 10 20 30 40 50 �m�=��.��, o� +aN once esa ma noi..ea5 m