The URL can be used to link to this page

Home My WebLink About1000-126.-6-3.1 � of so�� SOWN OF SOUTHOL Rental Permit 1407 Owner: Louis Zameryka , Cindy Ahlers-Zameryka Occupied as: Single Family Dwelling Located at: 2815 Sigsbee Rd Laurel 126.-6-3.1 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: 12/29/2025 Expiration: 12/29/2027 cad nt�rcement V clef This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD—BUILDING DLP I M T Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, Ny i'l97lk-'60.5§" Telephone (631) 765-1802 Fax (631) 765-9502 littt)s://www.southoldtowjiny.9ro ,,, ,P,,,w, RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION _ � � .--BLOCK -LOT 0 G 00 SECTION B. OWNER INFORMATION: Property Owner Name: 1' A G + c Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) Telephone Number(s): Daytime'S`17S30 W961Evening EmergencyS16- yS-ls66! Property Owner Email Address: r•V�4oq�, M ,.c Page 1 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, 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: U 1 Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: f Use and Dimensions of each room in Rental Dwelling Unit: 10- :� 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. 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. 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 (,i:!� ka _ 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: 0" ✓! c Property Owner's Signate5f=:;;�� Sworn to before me this 2 day of , c+o e 202 5 �- 4110'e0li 62-e Zmaj, Official Not Public Signature z no Original Notary Stamp L'.,; S i �� `TVV YORK COPAN :FOLK 001 iy Page 4 of 4 t1�SOUpy�� TOWN OF SOUTHOLD BUILDING DEPT. 11-765-1802 ' E TION Q R [ ] ROUGH PLBG. [ ] INSULATION/CAULKING Ole, [ ] FINAL [ ] FIRE SAFETY INSPECTION "ION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (FINAL) [ ] PRE C/O [ RENTAL REMARKS: 112SA_// 1��e,le c DATE - INSPECTOR T O Town Hall Annex Town of Southold54375 Main Road Rental Inspection Report PO Box 1179 w° Southold, NY 11971-1179 Te1: 631-765-1802 SCTM # /02 G- - 31ZDate C22 1-17 Owner Phone Address •s fj Visible Hamlet inspector Floor Level Quantities Sub 1 2 3 Smoke Detectors (not located in bedrooms) 1 Carbon Monoxide Detectors Fire Extinguishers Exits Bedrooms 1 2 3 4 5 6 Smoke Detectors Egress Occupant Count Building Systems Maintained &Operational Condition of Property Heating Building interior Hot water Building exterior Electrical Property clean, maintained &safe Mechanical Handrails&guards installed&secure Pool Safety Pool on Site Surface water alarm Date of CO issuance Door alarms Pool completely enclosed Self closing/latching gates Pool fence to code requirements CO's for all items present Prior Rental Comments: Ev 20.E ILI• i E �0 P� W-100 bE 9-A t i t� � 'N tK -T` � SCTM # TOWN OF SOUTHOLD PROPERTY RECORD OWNER STREET ac- = VILLAGE DIST SUB. LOT �E Ss�0,r-c- d ACR_ REMARKS TYPE OF BLD PROP. CLASS LAND IMP, TOTAL DATE FRONTAGE ON WATER HOUSE/LOT BULKHEAD TOTAL sw, qg G 1 k� vim' co � " c r � v m O w a , Ul ui ag ry V Ln 113 �, •. Q us LU U y ' w w ❑ LU - Q a O O U OLU ^� cr w O LL w7j ref, _ rw " o<k r � w w \h" w v ZY y, 166 F - �M"a _....�, w N � V) > ..._ _. ..... _.... _._... _. _w _.w e W J `.1 -- Z _......._..�m _...... _ _ . _.. ._ _ ------ _...� _. ) ,. �," w --i Z c` w � • Q� �'° g o � 1 � a � o m o a °. 0 t N o a a o o �, a O ,S w ,..,1 w Z tL � I— I— Un m 2 W LL LL u- cv ; U — L N N "-4 ......... _w.. O � O p N 4- ' o _ °o ° a°r E `P cl� (' 1� LQ puma. r r e "� „"m, N O O 'in .n m "`—' N .. � ' ° � p O m a _mow +�- O p O W W w n m CI a O f- f y a 1 r �1 O in } a v .. w Q 0. � u. LLI Z Z �w O O 'c� m w w C] �l w u Ya' Q Q uQ] Q 2 2 Z Z o LU LL LU U_cl� p p (31 w LLJ .` Z O v m v LO Z N J Z > Q '. J w 3 Q JL _....._ w....,.. J \� C Q Q w LnLLI _......... ,w f �. 'r w N M o 8 a 4 a w z z O s o Ow — W V LL 0 o v v ° En3 o 0 In _ F- g .. C: Z 0 s o i LL u- 4- - u. c o Ln V) L p w .;� o o o _...... n N 0O All l eo., X j ask .,�� ;• '�"� _ �__.. .�., �.. l; /. �.• C C 0 va o 0 0 3 a: c s o ° 0 co *� *' x o o CD �' o o F�- _............... ._._-------- w w w a rL m C7 CL O FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. a PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 29638 Date: 08/13/03 THIS CERTIFIES that the building DWELLING Location of Property 2815 SIGSBEE RD __- LAUREL ST _ (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 126 Block 0006 Lot 003 .001 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- 29638 dated AUGUST _13, 2003 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 TWO CAR GARAGE* The certificate is issued to ELEANOR PEDERSEN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NA _ ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED /A *PLEASE SEE ATTACHED INSPECTION REPORT. :h .ized J,signature Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOL➢ HOUSING CODE INSP CTION REPORT ...... _....,................. ...__... LOCATION: 2815 SIGSBEE RD LAUREL SUBDIVISION: MAP NO.. LOT (S) NAME OF OWNER (S): ELEANOR PEDERSEN OCCUPANCY: SINGLE FAMILY ELEANOR PEDERSEN ADMITTED BY: ELEANOR PEDERSEN ACCOMPANIED BY: SAME KEY AVAILABLE: SUFF. CO. TAX MAP NO.: 126.-6-3.1 ATTY 8 7 03 DATE: 08 13 03 SOURCE OF REQUEST: OI�SFN f OLSEN µ �m ,. ...w.wwwwwww�w... _� DWELLING: TYPE OF CONSTRUCTION: WOOD FRAME STORIES: 1.0 # EXITS: 4 FOUNDATION: CEMENT CELLAR: CRAWL SPACE: TOTAL ROOMS: 1ST FLR.: 6 2ND FLR.: 0 3RD FLR.. 0 BATHROOM(S) 2.0 TOILSP ROOK(S) 0.0 UTILITY ROOM(S): YES PORCH TYPE: DECK TYPE: WOOD PATIO TYPE: BREE2JKWAY: FIREPLACE: ONE GARAGE: DOMESTIC HOTWATER: YES TYPE BEATER: GAS AIRCONDITIONING: TYPE HEAT: GAS WARM AIR: XX HOTWATER: OTHER: ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST.: 2 CAR WOOD FRAME STORAGE, TYPE CONST.. SWIJUING POOL: GUEST, TYPE CONST.: OTHER: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION I l I C j I V 9 1 � G U q � p p REMARKS: BP #17527-Z-COZ-17868 (ADD) INSPECTED BY: DATE ON INSPECTION: 08/13 03 GARY J. FI TIME START: 10:00 AM END: 10:2S AM .......................... ........... FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-30703 Date: 01/21/05 THIS CERTIFIES that the building ADDITINS/ALTERATIONS Location of Property: 2815 SIGSBEE RD LAUREL (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889, Section 126 Block 6 Lot 3.1 Subdivision Filed Map No. Lot NO. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 26, 2004, pursuant to which Building Permit No. 30041-Z dated —JANUARY 27, 2004 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 —ADDITIONS & ALTERATIONS TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to NANCY RODILOSSO (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 1189439 11/22/04 PLUP93ERS CERTIFICATION DATED O111c3/05 MATTITUCK PLUMB.&HEATING /Aut yorized Signature Rev. 1/81