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Home My WebLink About1000-106.-5-26 1 Q TOWN OF S UTHOLD Rental Permit 1423 Owner: Jon Johnnidis , Jonathan Klein Occupied as: Single Family Dwelling Located at: 1150 Ruth Rd Mattituck 106.-5-26 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: 03/03/2026 IV IN Expiration: 03/03/2028 Enf ant official U 0 This Notice must be posted by the main entrance at all times ECETVE TOWN OF SOUTHOLD—BUILDING DEPARTMENT ' Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 1.1971- u afing Department Telephone(631) 765-1802 Fax(631)765-9502 iitt s://Ww ,sootho ldtownn . ov Town of Southold RENTAL PERMIT APPLICATION Rental Permit Fee$300(Application must be renewed every two years) Section A. Property Information: Rental Property Address: 1150 Ruth Road, Mattituck, NY 11952 Tax Map Number: 1000 SECTION 106 -BLOCKS -LOT26 SECTION B. OWNER INFORMATION: Property Owner Name: Jon Johnnidis Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 140 Zena Road, Mattituck, NY 11952 140 Zena Road, Mattituck, NY 11952 Telephone Number(s): Daytime 9175185133 Evening Emergency. Property Owner Email Address: ion@axiosproductions.ty Page 1 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: Main House Requested Maximum number of persons allowed to occupy Dwelling ni 5 Number of rooms in Rental Dwelling Unit: 6 Use and Dimensions of each room in Rental Dwelling Unit: Master Bedroom 12'x14', Kitchen/Livi ng room 25'x19', Guest BR 1 12'x9', Guest BR 2, 13'x12', Master Bath 10'x5' Guest Bath 8'x5'9" 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. V I am 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 Jon Johnnidis 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: Jon Johnnidis Property Owner's Signature: V el Sworn to before me this May of August 2025 Official Notary Public Signature and Original Notary Stamp Page 4 of 4 TO N �OAFSOUTHOILD BUILDING DEPT. 631-765-1802 job �� lp INSPECTION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND ZFIRE"' SAFETY INLATION/CAULKING FRAMING /STRAPPING AL FIREPLACE & CHIMNEY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE TRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL ( NAL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REM R S: w VW •G•- „ --------...... DATES INSPECTOR .. _� FORM NO. 4 TOWN OF SOUTH OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No,. . +R.. k1..«......... Date ....„............... A'1t" 3 ab ];"..... ........ 19.65... THIS CERTIFIES that the building located atN/S.....Buth..Road.......................I.............. Street Map No. ......... Black No. ......Z=........ Lot No. ZxXX.......matutucko.....RIX.............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................................August.......9........ Ig65.... pursuant to which Building Permit No. 283.7.1 dated ..„.................„.....„...AU9.uj t..-9...., 1965,..., 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 ....„... ......Px'1.V.4tQ...0>'ae'.xaM11y...ftox1.:i ng....................................................................................,..... The certificate is issued ,to ...................... a,`...............,..„.„...,... (owner, lessee or tenant) of the aforesaid building. H.D.Approval Nov. 109 1965 by R. Villa Building Inspector 3D Floor Plans 1150 Ruth Road Ruth to Scale I Houzz Pro 8/19/24,9:25 AM o �eoe, *am MAG fe 44'8 9/16' - ----------- ............... blob:https://pro.houzz.com/95512adb-3cff-4159-a5f8-1c731a582772 Page 1 of 1