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Home My WebLink About1000-60.-2-4 Rental Permit 1353 Owner: Anek Holdings LLC Occupied as: 2nd Floor Apartment Located at: 1235 Youngs Ave Southold 60.-2-4 Maximum Permitted Occupancy: 4 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 arrang` for the bi-annual inspection. Issued: 07/21/2025 Expiration: 07/21/2027 a c� m nt official This Notice must be posted by the main entranOat I times TOWN OF SOU OLD—BUILDING DEPART CENT Town Hall Annex 54375 Main Road P. O_Box 1179 Southold,NY 11971-0959 Telephone(631)765-1802 Fax(631)765-9502`:: RENTAL PERMIT APPLICATION Rental Permit Fee$300(Application must be renewed every A y P JUG � Section A. Property Information: Of s Rental Property Address: 1235 Youngs Avenue, 2nd Floor, Southold, NY 11971 Tax Map Number: 1000 SECTION 1000 -BLOCK 60 -LOT 2 _ 4 SECTION B. OWNER INFORMATION: Property Owner Name: ANEK Holdings LLC Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 7345 Soundview Ave 7345 Soundview Ave Southold NY 11971 Southold NY 11971 Telephone Number(s): Daytime 31-804-3 9 Evening LI±04-��Emergency_±31-807-9387 Property Owner Email Address: anekholdingsllc@gmaii.com Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Anna Kozlowska Address of Authorized Agent(no P.O. Boxes): 7345 Soundview Ave, Southold, NY 11971 Mailing Address of Authorized Agent:, 7345 SoundyiewAye, Southold, NY 11971 Telephone Number(s): Daytime 8, 1-807-9387 Evening1- 7�8887 Emergency 631-807-9387 Email Address:.althealarts@optonline.net Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: N/A 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: N/A 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: 1 Floor 2 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: 1 (Floor 2) Requested Maximum number of persons allowed to occupy Dwelling Unit: 6 Number of rooms in Rental Dwelling Unit: 5 Use and Dimensions of each room in Rental Dwelling Unit: Room 1: Kitchen (Dining Nook: 7'x 47; Kitchen: 13' x 87"), Room 2: Den (13'x 11'5"), Room 3: Living room (17'6"x 20'8"), Room 4: Bedroom 2 (13'7"x 16'), Room 5: Bedroom 1 (111A x 13'8") 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. ❑ lam requesting afire 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 Anna Kozlowska 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: 000 Property Owner's Signature: Sworn to before me thil64ty of ZTAZ i4 20 A. Official Notary Public Signature and Original Notary Stamp CONNIE D.BUNCH Notary Public,State of New York No.01 BU6185050 (qualified in Suffolk County Commission Expires April 14, 2,0� � Page 4 of 4 Town Hall Annex Telephone(631)765-1802 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier. 1 (Floor 2) Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: 5 Use and Dimension of each room: Room 1: kitchen Qning Nook: 7' x AV; Kitchen: 13'x 87" Room 2: Den 13' x 11'5 „ Room 3: Living room 17'6"x 20'3" „ Room 4: Bedroom 2 (13'r x 16'), Room 5:. Bedroom 1 (11'1s x 13'8") Rental Dwelling Unit Identifier. NIA Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension c f each room: Rental Dwelling Unit Identifier. NIA 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 O SOUTHOLD BUILDING DEPT. CCU 631-765-1802 I N foik Po hE T 10 N [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANJ(FAL) TRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL CODE VIOLATION [ ] PRE C/O [ NTAL h m4lR =1"IAR . .ww Q�. DATE ) INSPECTOR Town Hall Annex ; Telephone (631)765-1802 54375 Main Road Fax(631)765-9502 P.O. Box 1179 Southold, NY 11971-0959 � zr w 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 Dome Inspector must provide copy of valid current certification Rental Property SCTM Number: 1000 - u.1, Rental Property Address: I Z3 " " 0 w. 1A4T Owner/Name: p+ °e r a " 1-t. Rental Dwelling Unit Identifier: Number& Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 - 100 sqft., Bedroom#2-90 sgft., etc.) - 17 Is Property Description (Include all improvements indicated on survey) A - o cc "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 Code of New York State,the Fuel Gas Code of New York State,the Fire Code of New Yor Maintenance Code of New York State and the Energy Conservation Construc' e te. N� Print Name and Title "� Igin tore Please place Professional Seal: f TOWN OF SOUTHOLD PROPERTY RECO 5 JC) ,�2S OWNER STREET VILLAGE DIST.f 5urs. LOT FORMER OWNER I N E ACR. v S W-/ TYPE OF BUILDING f J RES, SEAS, VL. IFARM jC0 '-' OB MISC. Mlct. Value LAND IMP, TOTAL DATE REMARKS 7 3 0 hL I DE3( - a . AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE �� ; Y L)r CL� 1 FARM Acre Value Per Value i `1US-- L1300 � Occ./e-7 -' Acre Tillable 1 Tillable 2 , ,Tillable 3 Woodland Swampland FRONTAGE ON WATER Brushland FRONTAGE ON ROAD E _ I House Plot DEPTH BULKHEAD I Total ! I DOCK G i 3 I OLO 4 R i I z TRIM e I E . I I a 4 ; E E i *h ! S I E ' e r_ M. Bldg. �.. •� cj y _ y v g v is .3 � o nda E n �� a u��s pr'i�n D� t'o C Both Dinette I Extension `� Z �' asernertt 1 J Floors 1 T� L L` K. Et. Walls i :, E Interior Finish r.._ s LR. Extension Extension _ IFire Place ;Heat DR. Rooms 1st Floor I ,BR. Type Rooff _ i Porch i Recreation Room ;Rooms 2nd Floors IFIN. B. . Porch y ;Dormer I E I _ � BreezewayI Driveway I - ' Garage i Patio O B. I , Total 1 , �� } rem X06 4 TOWN OF SO O BU11DING DEPARTUMT To"Cows S old, N. Y. Certificate Of Occupancy No. .; . . . . . Date . . . . . . . . . x . , . Joy. . . .Ilk. . . . .. 197.7 . THIS CERTIFIES that the building located at X/.S.XQ=90: A". . ! ) . Street Map No. Mt . . . . . . . . . Block No. . . . ? . . . .Lot No. ` M. . A tTp. . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . x . . . . J%r. . 2719.'14. pursuant to which Building Permit No. .72 dated . . . . x a . . . . . .E,&y.. .6. . . ., 19*r4 ., was issued, and conforms to all of the require. ments of the applicable provisions of the law.The occuplincy for which this certificate is issued is . . Mixed. zcc cy: . .Stores. &.dxalling.unit. . . . . . . . .. . . . . . . . . . . . . . The certificate is issued to .Xr...KrA .8tV.VA*.A=Uk . . . . "9. . . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval `qNM A ASUMAC . 7$ . . . . . . . . . . . . UNDERWRITERS CERTIFICATE No. .g 3607,, . . . . .Oct . . i$ . .1 977 . . . .. . . . . . . . . HOUSE NUMBER . . .1235. . . . . . Street . . . ."l 0=9a.Lva . . . . .Southold. . . . . . . . . . .. a rt a . x . .. > . . ♦ . • . • . ♦ • ♦ .... .. .. . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . .. . . . . . . . . . . . .. . . . . Building Inspector Smoke&CO Detector Room 5 Room 1 M;;tCJ Nd31'. . ' Closet Closet Room 2 Bathroom Closet Bathroom Walk in Closet Room 3 Room 4