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Home My WebLink About1000-104.-1-5 Rental Permit CO 1397 Owner: Greg Deligiannis Occupied as: Single Family Dwelling Located at: 795 Pine Tree Rd Cutchogue 104.-1-5 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 arranging for the bi-annual inspection. Issued: 11/13/2025 Expiration: 11/13/2027 CdeEnf mend This Notice must be posted by the main entrance at all times ) I - 12 --2-S C s e—n n 6,b TOWN OF SOUTHOLD—BUILDING DEPARTMENT re 4 7 V"oTown Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 1 300°—z Telephone(631) 765-1802 Fax(631) 765-9502)att /WWW'S0Ud101d'toW1'11a r.�' 0" ' l:_ jV C, ,1 I ! 2025 RENTAL PERMIT APPLICATION '"'" Rental Permit Fee 00(Application mist be renewed every two yearn, yV""' Section A. Property Information: Rental Property Address: 795 Pine Tree Road, Cutchogue, NY 11935 Tax Map Number: 1000 SECTION 104 -BLOCK 1 -LOT 5 - SECTION B. OWNER INFORMATION: Property Owner Name: Greg Deligiannis Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 23 Woodland Road, Roslyn, NY 11576 23 Woodland Road, Roslyn, NY 11576 Telephone Number(s): Daytime(917)415-7110 Evening Emergency Property Owner Email Address: greg.deligiannis@gmail.com Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: None 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: None 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: None 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 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: Unit 1 Requested Maximum number of persons allowed to occupy Dwelling Unit: 4 Number of rooms in Rental Dwelling Unit: 8 Use and Dimensions of each room in Rental Dwelling Unit: Bedroom#1 (16-2 1/2"X 11'-10"), Bedroom#2 (1 1'-3"X 1 Y-9"), Bathroom (7'-4"X 7'-1"), Kitchen (14'-8"X 10'-9"), Living Room (17'-4" X 12'-2"), Garage (12'X 19'-4"), Patio (12' X 7'-7"), Family Room (16 4"X 29'-6") 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. ❑ 1 am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold X 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 1, 1' ` 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: �� ." _. r / Property Owner's Signature: ` - . I w rn to before me t is day o , 20?� . �„„ r.11rr1MW..M1w FRANCO V CICCO Offic Lary Public Signature and Original Notary Stamp Notary Public-State of New York NO.01CI6181297 Qualified in Queens County My Commission Expires Jan 28,2028 Page 4 of 4 so TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 INSPECTION . [ ] 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 (FINA ) [ ] CODE VIOLATION [ ] PRE C/O ( RENTAL REMARKS: K,S: ell DATE 11-Ao?45� .._.......... 11IMSPECTOR Town Hall Annex � � �� Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P. O. Box 1179 Southold, NY 11971-0959 w M 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 En ineer. Licensed Home Ins actor roust provide copy of valid current certification Rental Property SCTM Number: 1000-104-1-5 Rental Property Address: 795 Pine Tree Road,Cutchogue, NY 11935 Owner/Name: Greg Deligiannis Rental Dwelling Unit Identifier: Unit 1 Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 —100 sqft., Bedroom#2—90 sgft., etc.) Bedroom#1 - 180 sgft., Bedroom#2- 121 sgft. Property Description (Include all improvements indicated on survey) Private One Family Dwelling 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 w York State and the Energy Conservation Construction Code of New York State. � �D �a � w ✓�I��'— IZAN ry " Print Name and Title Original Si re t*° Please place Professional Seal: ,30794 �a }_ TOWN OF SMTHOLD PROPERTY RECORD" CARD _ OWNER STREET VILLAGE DISTJ SUB. LOT _ /0f a t FORMER OWNER �N _ im I tN _TYPE OF BUILDING m R€S :J,,� SEAS, VL. FARM COMM. CB, MISC. _ Mkt. Value LANC? IMP_ TOTAL DATE REMARKSji AO } vo, 3 7 1c '1rf +ri t � rr o s _ e 1 _ n� G� AGE BUILDING CONDITION f2t A t c ._ . _ t F NEW NORMAL - BELOW ABOVE �� FARMAcre Value Per Value _ e � m = Acre Tillable 1 �'f t x v� � ,� { m Tillable 2 E F Tillable 3 Woodland 5wampl nd I !FRONTAGE ON WATER g Brush[ond FRONTAGE ON ROAD 0 f DEPTH House Plot BULKHEAD Total !DOCK e r COLOR -- _ s yCIF dam_ TRIM e Y a = , d _ UU,A-- - ._ . . 3— w }} : -1.- a _ t 3 1M:1-5 11/6/2024 e M. Bldg.+ u-cin Bath !Dinette 3 Extension � t Floors1 _ x .. Walls Interior Finish 'LP Extension 1 fire Place Heat DR. +3 t Roof - Rcarns 1st Floor'rvpe � i re-ati� Doom -0 2nd Floor FIN_ B i, ParchDormer � I Breezeway Garage i 0.platio B. Total 0001. Town of Southold P.O. Box 1179 53095 Main Rd Southold,'New York 11971 CERTIFICATE OF OCCUPANCY No: 46356 Date: 07/30/2025 THIS CERTIFIES that the building ADDITION Location of Property-, 795 Pine Tree Rd Cutchoggg,NY 11935 Sec/Block/Lot 104,1,5 Conforms substantially to the Application for Building Permit heretofore, filed in this office dated: Pursuant:to which Building Permit No. 9677 and dated, 04113/1979 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; addition to existing single-family dwelling as applied for The certificate is issued to: -Eric Wahl Of the aforesaid building. SUFFOLK.COUNTY DEPARTMENT OF HEALTH APPROVAL: ELECTRICAL CERTfFICATE-. 9677 07118/2025: PLUMBERS CERTIFICATION: Auth i; kattar FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. .7,22.94............ Date ...........................Npo' amber..2 ..., 19..65 THIS CERTIFIES that the building located at ..................... Street Map No. ....X=............ Block No. ......VXX........ Lot No. ZYX.......QU 11a4.....xl xa............... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............................� g}#....•.••..10 ,.••••••, 19.6.5.. pursuant to which Building Permit No. .2340.1 dated .............................. 19-6 ., 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 ........ FFrivate. •om. ..............................---..........----.....r......---...........,...,.. The certificate is issued to ........................OWner.0.................... (owner, lessee or tenant) of the aforesaid building. H.D. Approval Oct 29 1965 by H. Villa ,. . . .��......'....... . ........ Building inspector LEGEND COMBINATION SMOKE AND CARBON MONOXIDE DETECTOR LOFT NON-HABITABLE NOTES: NON-HABITABLE BASEMENT& ATTIC FAMILY ROOM SMOKE/CO AT BOTTOM OF 15'-4'X 29-6' STAIRS TO BASEMENT&TOP OF STAIRS TO ATTIC Xr PATIO 12'-0"X T-7' BEDROOM#2 _3"X 1 0,_g, 11 KITCHEN I of 14-8"X 10'-9" CL CL CL CIL F + CL LIVING ROOM 17'-4"X 12'-2" GARAGE BEDROOM#1 12'-0`X 194" 1 T-2 1/2'X 1 V-1 0' CL -4 o LL, PROJECT DRAWING SCALE 1/8"= 1'-10" 795 PINE TREE ROAD EXISTING FIRST FLOOR PLAN DATE 11.06.25 ro