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Home My WebLink About1000-55.-6-24 'OWN OF SOUTHOLD Rental Permit 1355 Owner: Lesica D Irry Trt Occupied as: Single Family Dwelling Located at: 275 Maier P1 Southold 55.-6-24 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: 07/21/2025 Expiration: 07/21/2027 Co En 6rcArnentOfficial This Notice must be posted by the main entran 0eatI -h Town Hall Annex ' s Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 NL Southold,NY 11971-095906 � v BUILDING DEPARTMENT TOWN OF SOLFTHOLD RENTAL PERMIT APPLICATION w Rental Permit Fee $200 (Application must be renewed every two'years) Section A. Property Information: Rental Property Address: 275 MAIER PLACE, SOUTHOLD, NY 11971 Tax Map Number: 1000 SECTION 055.00 -BLOCK 06.00 -LOT 024.000 SECTION B. OWNER INFORMATION: Property Owner Name: DIANA LESICA IRREVOCABLE TRUST Property Owner Legal Address: Property Owner Mailing Address: C/O THOMAS LESICA, TRUSTEE C/O THOMAS LESICA, TRUSTEE 210 OLMSTEAD HILL 210 QLMSTEAQ WILTON, CT 06897 WILTON, CT 06897 Telephone Number (s): Daytime 646-416-3155 Evening Emergency Property Owner Email Address: TOM@TOMLESICA.COM zwc) I P OA �`��(a� Page 1 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road H Fax(631)765-9502 P.O.Box 1179 � s Southold,NY 11971-0959 m � u BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: MARTIN D. FINNEGAN, ESQ. Address of Authorized Agent (no P.O. Boxes):13250 MAIN ROAD, MATTITUCK, NY 11952 Mailing Address of Authorized Agent: PO BOX 1452, MATTITUCK, NY 11952 Telephone Number (s): Daytime 631-315-6070 Evening Emergency Email Address: MFINNEGAN@NORTH FORK.LAW Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: THOMAS LESICA Address of Authorized Agent (no P.O. Boxes): 210 OLMSTEAD HILL ROAD, WILTON, CT 06897 Mailing Address of Authorized Agent: 210 OLMSTEAD HILL ROAD, WILTON, CT 06897 Telephone Number(s): Daytime 646-416-3155 Evening Emergency Email Address: TOM@TOMLESICA.COM SECTION E. SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units) Name of Managing Agent of dwelling unit, if any: NIA Address of Managing Agent (no P.O. Boxes): Page 2 of 5 Town Hall Annex 41 1 Telephone(631)765-1802 54375 Main Road Fax (631)765-9502 P.O. Box 1 179 y Southold,NY 1 1 97 1-0959 � BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime Evening Emergency Email Address: SECTION F. PROPERTY DESCRIPTION: 1 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." 00, Rental Dwelling Unit Identifier: Requested Maximum number of persons allowed to occupy Dwelling U it: 6 Number of rooms in Rental Dwelling Unit: 8 Use and Dimensions of each room in Rental Dwelling Unit: LIVING ROOM 20'10"X12' BEDROOM 1 13'2"X12' KITCHEN 10'X14'2" BEDROOM 2 107'X112" BATHROOM 1 5'X7'3" BEDROOM 3 107"X112" BATHROOM 2 4'6"X5' BASEMENT FAMILY ROOM 23'X26'2" BASEMENT UTILITY ROOM 12'X26'2" Page 3 of 5 1' Town Hall Annex Telephone(631)765-1802 54375 Main Road d T Fax(631)765-9502 P.O.Box 1 179 Southold,NY 1 1971-0959 " <? BUILDING DEPARTMENT TOWN OF SOUTHOLD 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. CPr'*"I am requesting a fire 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. SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. CONNECTICUT STATE OF W:W 40W) FAIRFIELD) COUNTY OF*ii«i ) I THOMAS LESICA , 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 Page 4 of 5 r'!q m , Town Hall Annexy Telephone(631)765-1802 54375 Main Road k Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 1W BUILDING DEPARTMENT TOWN OF SOUTHOLD 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. 4<'I am requesting a fire 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. SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. NORTH CAROLINA STATE OF I +001900 COUNTY OF513FF9l I JOHN JOSEPH LESICA 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 Page 4 of 5 Town Ball Annex Y` �' Telephone(631)765-1802 54375 Main Road j� f Fax(631)765-9502 P.O.Box 1179 a , Southold,NY 11971-0959 � °ti;, BUILDING DEPARTMENT TOWN OF SOUTHOLD 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 as to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager. DIANA LESICA IRREVOCABLE TRUST Property Owner's Name: BY: JOHN JOSEPH LESICA, TRUSTEE Property Owners Signature: Sworn to of s day f �, 2022 mNC Official No ry P a e nd )ngl al N tary Stamp Page 5 of 5 Building Department Apiglication AUTHORIZATION (Where the Applicant is not the Owner) w�Wwww.wwE 210 OLMSTEAD HILL ROAD, THOMAS LESICA, AS TRUSTEE OF H I DIAMA LESICA IRREVOCABLE TRUST residing at_.. www. ...._.__......._.--------------------.._. _._._ (Print property owner's name) (Mailing Address) WILTON, CT 06897 do hereby authorize MARTIN D. FINNEGAN, ESQ. (Agent) .. .....w.._ ...... to apply on my behalf to the Southold Building Department. /2022 w� - (Owner's Signature) (Date) DIANA LESICA IRREVOCABLE TRUST BY: THOMAS LESICA, TRUSTEE (Print Owners Name) Building Department Ayglication AUTHORIZATION (Where the Applicant is not the Owner) JOHN JOSEPH LESICA,AS TRUSTEE OF I THE DIANA LESICA IRREVOCABLE TRUST residing at 2910 SWIFT CREEK LANE, (Print property owner's name) (Mailing Address) FAYETTEVILLE, NC 28303 do hereby authorize MARTIN D. FINNEGAN, ESQ. (Agent) to apply on my behalf to the Southold Building Department. i2022 �_.......... 'Own is Sig, re) 'a (Date) DIANA LESICA IRREVOCABLE TRUST BY: JOHN JOSEPH LESICA, TRUSTEE p W(Print Owner's Name) mm lrq4f so TOWN OF SOLMT OLD BUILDING DEPT. Al 631.765.1802 INSPECTION ( ] FOUNDATION 1ST ( ] ROUGH PL13G. ( ] FOUNDATION 2ND ( j INSULATION/CAULKING ( ] FRAMING / STRAPPING [ j F AL ( ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION ] FIRE RESISTANT CONSTRUCTION ( ] FIRE RESISTANT PENETRATION ] ELECTRICAL (ROUGH) [ j ELECTRICAL (FI L) ( ] CODE VIOLATION ] PRE C/O RENTAL REMARKS: k 1) 02 vk' 4o& �4 V . �. �)'f b�� ®tom Vol DATE � � � INSPECTOR 1 l TOWN OF SOUTHOLD PRO Ri RD 4 OWNER. STREET ? = ` VILLAGE DIST _ SUB. LOT _ •ram,-;�{ m}� � _ �=-- � ? E 3 � FORMER OWNER N E -x ACR. - LAI t S W TYPE OF BUILDING RES. 7 � SEAS. 'VL. FARM !COMM. CB. MISC. Mkt. Value I LAND IMP. TOTAL DATE REMARKS l 5 s s. �a F d BVLp�ING 2 F� NEW NORMAL BELOW ABOVE x{ FARM Acre Value Per Value I Acre ;i L . i Tillable l Tillable 2 Tillable 3 Woodland Swampland FRONTAGE ON WATER FRONTAGE ON ROAD Brushland ° House Plot DEPTH - - i �gULKHEAD g DOCK Total COLOR ; s t i TRIMs � s t . f A 3 --.->�6 E , t i Bldg Vundc tior a �. Bath Dinette M. I Extension n � Floors K. - � osrnent . iFloo � iK Extension Fxt, Walls anterior Finish -- `LR- Extension Fire Place `Heat :, �DR. Type Roof Rooms 1st Floor IBR. Porch rt recreation Room Rooms 2nd Floor! FIN. f3 Porch bormer Breezeway', £Driveway Garage Patio O. B. Toto f s w FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22543 Date AUGUST 23 1993 THIS CERTIFIES that the building ALTERATION Location of Property 275 MAIER PLACE SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 55 Block 6 Lot 24 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated F'EBRUARY 4 1993 ursuant to which Building Permit No. 21218-Z dated FEBRUARY 1I 1993 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 CLOSE IN EXISTING ROOFED OVER PATIO PORCH ADDITION TO DWELLING AS APPLIED FOR. The certificate is issued to JOHN DIANE LESICA {owner} of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N A UNDERWRITERS CERTIFICATE NO. H-036417 . AUGUST 13 1993 PLUMBERS CERTIFICATION DATED N/A XA/�, Building dspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22105 Date JANUARY 14 1993 THIS CERTIFIES that the building ADDITION Location of Property 275 MAIER PLACE SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 55 Bloch S Lot 24 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER b 1992 ________pursuant to which Building Permit No. 21019-Z dated OCTOBER 14 1992 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 GARAGE & ROOFED OVER OPEN PORCH ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JOHN & DIANA LESICA (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ___NZA UNDERWRITERS CERTIFICATE NO. PENDING - JANUARY 12, 1993 PLUMBERS CERTIFICATION DATED N/A //"wilding Inspector Rev. 1/81 FORM No. 4 14"N� !S TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No .......... Date .............-........... ......August 30 . ................ 19 65 .... THIS CERTIFIES that the building located at -1/6-xvT.. .F, -APM Map No Block No .....?=. ........ Lot No ......= . DQ;L� 'R -A!W%et . ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated � --1 — .......... .............-W.tt Ab or.....23, 19-- 6� pursuant to which Building Permit No. dated . -.....................00.!toi`...... 19. .65, 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 ........ Private„ T I ......... ............................ ..................... ............. The certificate is issued to .....Gjaorge &Jfux .8,001AIgh (owner, lessee or tenant) of the aforesaid building H.D.Approva:L MY 3 t 1965 by R. Villa Building : ..Inspector lnsp-ector.........A.............. Kitchen Bedroom Bedroom 3 10'x 14' 2" 10' 7" x 11' 2" 10' 7" x 11' 2" Smoke Smoke O O Smoke O CO Bathroom 5' xT3" Smoke O Basement Stairwell Living Room Bedroom 1 20' 10" x 12' 13'2" x 12' Wet Bar Area Basement Bathroom 4' 6" x5' Smoke 0 Smoke 0 Basement Family Room CO 23' x 26' 2" Basement Utilities, Washer/ Dryer, Hot Water Workbench Basement 12' x 26' 2" Stairwell