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Home My WebLink About1000-77.-2-29 TOWN OF SOUTHOLD Rental Permit 1425 Owner: Klopfleisch Family Trust Occupied as: Single Family Dwelling Located at: 205 Pine Ave Southold 77.-2-29 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: 03/08/2026 Expiration: 03/07/2028 Code Enforc cat Official This Notice must be posted by the main entrance at all times re TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone(631)765-1802 Fax(631)765-9502 h a -_// 'w `.s autlwoldtorvnri' . )'o � _-:�0o40 RENTAL PERMIT APPLICATION V(e C- I too 20 Rental Permit Fee $300 (Application must be renewed every two years) a Section A. ' 202 Property Information: Rental Property Address: . .gym 205 PINE AVENUE, SOUTHOLD,NY 11971 Tax Map Number: 1000 SECTION 07700 -BLOCK 0200 -LOT 029000 _ SECTION B. OWNER INFORMATION: Property Owner Name: KLOPFLEISCH FAMILY TRUST Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) RANDY AND STEPHANIE KLOPFLEISCH RANDY AND STEPHANIE KLOPFLEISCH 2288 ALCYONA DRIVE 2288 ALCYONA DRIVE Telephone Number (s): Daytime 21.3-61,0-5695 Evening 32 -465-0498 Emergency 917-224-3960 Property Owner Email Address:rklopfleisch@icloud.com jennklo@yahoo.com Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: JENNIFER K. THELIAN Address of Authorized Agent (no P.O. Boxes): 115 STEVENS AVENUE,HEMPSTEAD,NY 11550 Mailing Address of Authorized Agent: SEE ABOVE Telephone Number (s): Daytime 917-224-39 0 Evening 917-224-396 Emergency 917-554-3892 Email Address: jennklo@yahoo.com Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: Barbara.Poliwoda Address of Authorized Agent (no P.O. Boxes): 124 Front St,Green. ort,NY 11944 Mailing Address of Authorized Agent: 124 Front St, Greenport,NY 11944 Telephone Number (s): Daytime 631-335-1878 Evening631-335-1878 Emergency Email Address: barbara.poliwoda@elliman.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: 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 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: Unit 1 Requested Maximum number of persons allowed to occupy Dwelling Unit: 8 Number of rooms in Rental Dwelling Unit: 10 Use and Dimensions of each room in Rental Dwelling Unit: LMng Room 18'3"x 23'2.Dining Room 127"x 1010',Kitchen 14'10"x 11'1,Sunroom 8'8"x 11'2" Wet Bar 177"x 9'3.Laundry Room 14'10"x 29'8,Bedroom 1 11'10"x 12'0,Bedroom 2 9'6"x 12'0, Bedroom 3 14'10"x 12'1,Bedroom 4 21'3"x 16'0" 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 ❑ 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 RANDY KLOPFLEISCH 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: RANDY KLOPFLEISCH Property Owner's Signature: 14J L V Sworn to before me this_day of 20_ 5re AintArlp W Pi C I Official Notary Public Signature and Original Notary Stamp Page 4 of 4 CALIFORNIA JURAT GOVERNMENT CODE § 8202 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to whichthis certificate is attached,and not the truthfulness,accuracy,µor validity of that document. State of California Co u my of Subscribed and sworn to (or affirmed) before me on this ..._day of 20_ ! -._ by Date Month Year (1) _..._4Ar-J goo c-California (and(2)._w� .. .___ ... ..ww_.. w . ....._ ._. ............_ w.), Notary Public-C 0m, Los Angeles County Names)of Signer(s) Commission#2390584 Comm,Expires Feb 9,2026 proved to me on the basis of satisfactory evidence to be the person(s)who appeared before me. Signature, ._ w.._ _mw ............ Place Notary Seal and/or Stamp Above S"?jnature of Notary Public OPTIONAL .. _............... .... _. _..., Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: .............�_....._..__.._._.w_�w_.._ w_. _...ww..._._.�..._... ___ Document Date: _W _......._._w_.... ....._ _,.Number of Pages:. w...._.._ w_......M. ,w Signer(s) Other Than Named Above: 02019 National Notary Association Ni so rr�M TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 IN S P E C T 10 m1mm [ ] 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 (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [�ENTAL t2- " Age,— DATE INSPECTOR Town Hall Annex Town of Southold 54375 Main Road Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 SCTM# Date Owner ZO Phone AddressAV4 Visible Hamlet Inspector Floor Level Quantities Sub 1 2 3 Smoke Detectors(not located in bedrooms) Carbon Monoxide Detectors Fire Extinguishers Exits Bedrooms 1 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 O Door alarms Pool completely enclosed Self closing/latching gates Pool fence to code requirements CO's for all items present Prior Rental Comments. TOWN OF SOUTH OLD PkOPERTY RECORD OWNER, ;. �'�� t t a_ s STREET VILLAGE DISTRICT SUB. LOT z x = a a F: ti FO ER C}WNER '" r _ Nop _ E ACREAGE 1 f ,� — ,, W TY { PE OF BUILDING _ T,-� S f e RES. ! SEAS. FARM COMM. IND, CB. MISC. Est. Mkt. Value ,. LAND IMP. I TOTAL DATE REMARKS �� t/o 'Z' ! F _ I -� ,`s jr i -NEW NO L BELO� , ABOVE FRONTAGE ON LATER _- - - - FRONTAGE ON ROAD _ Tillable: L iw �Ib(��l I D BULKHEA � Tillable _� � - Z 97 � s DOCK I Tillable 3 Woodland Swampland Brushland House Plot Total SCTM # El ck��' TOWN OF SOUTHOLD PROPERI 1 aC� kRD OWNER STREET Z b 5 VILLAGE DIST. SUB. LOT 1 �� 1A ve wv. 1� 1� �ool: �a = ACR. a REMARKS TYPE OF BLD. zcej zS - L1330`1 P8(o v drs. TO Kl pvIeI5c-kTr+. PROP CLASS ` O - 05 � Foy. LAND IMP, TOTAL DATE 800 i 5 o0 (0000 ►oll O I 1 9 FRONTAGE ON WATER HOUSE/LOT BULKHEAD TOTAL " f T t L E 77:2-29 10/10/2019 M. Rld 1 ram?' �(p�J, Foundation Bath Dinette �_ Extension i 1 "; Basement ca""L Floors y ,;\1� Kit. "D a SLAB V Interior Finish Ext. Walls �(� L_R Extension Extension Fire Place ®� Heat �a F r{ 0 D.R. Patio 09s P' 5 Woodstove Porch- = 2°' (ec� Dormer Deck 3o = 2 1p t2 Attic Rooms 1st Floor = 4- ra a Driveway ICE{ _ mil Cl F' 74 `1 ri Cc Pool , C4 a z _ --- ° A k - - o I SIN gk o; -�\ e _ M. Bldg, _ Foundation Both Extension �J_ t _ Basement ' Floors Extension a= 3 ! G Ext. Walls (�1 Interior Finish Extension Fire Place i . Heat ®v� 1 ��f � '; �" >/ Root Ty Porch pe _ — �\ Porch. - Rooms 1st Floor Breezeway \� Patio , Rooms 2nd Floor Garage ( 77 Driveway ��1� �' ; Dormer O. B. 5 Pc>r =c) r FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town [fall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z18679 Date DEC. 291 1989 THIS CERTIFIES that the building ONE FAMILY DWELLING R W SOUTHOLD_ Location of Property INI 11,11N "IL House No. Street Hamlet County Tax Map No. 1000 Section 77 111c6*, 02 1,40t 29 MAP OF 63 to 70 Subdivision GO0,13E BAY Filed Map No. 1176 Lot No. 71 72 Aonforms substantially to requirements for a private one-family dwelling 'Mrsuant to which built prior to AFRIL 9 1957 Certificate of :);1(:EMB%R 28- 1989 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. WIT8 ATTACM The certificate is issued to SONIA H. GRASSO (owner, XXXXXXXXXXXXXXXX) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED..,"", *SEE ATTACURD INSPECTION REPORT. W11-1ilding Inspector Rev. 1/81 ................................ TowN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold® N.Y. CERTIFICATE OF OCCUPANCY 1993 NO Z-22387 Date JUNE 10 THIS CRRTIFrES that the building---,n=T11 TPEA.MT-EiLh 1,ocation of Property.,205 PIKE. AVENUE Sou-mar.)t N.Y. No. Street Hamlet County Tax Map NO. 1000 section_ 77 B I ock 2 Lot, 29 Subdivision Filed Map [o.—Lot No._ conforms substantially to the Application for Building Permit heretofore A'iled in this office dated $EPTEMBER 14 1992 _pursuant to which 1111 1-- Building Permit No.—209-5B-Z dated 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 & DECK ADDITIONS AjT,,1PrRAC%11:JS In L1XLsTTt;G O�E FAYILY OWFL11ING AS-AEPLTt.D The certificate is issued to_,_AW (owner) of the aforesaid building. SUFFOLK 'CuUNTY DEPARMNT OF HEALTH A1111R()VA1,W-L-- UNDER WRI"TEIZ C%RTrFICATE PFNDIN(, PLUMBERS Q I rIFICATION DATED JUNF 6 1993 fir CON W MR1 77R�,i tali ng Inspector Rev. 11'81 i rlti t � Town of Southold 615/2019 P.O.Box 1179 53095 Main Rd q c Southold,New fork 11971. Mdlite CERTIFICATE OF OCCUPANCY No: 40433 Date: 6192019 THIS CERTInES that the building IN GROUND POOL Location of Property: 205 Pine Ave,Southold SMI#: 473849 Sec/Black/Lot: 77,21-29 Subdivision: Filed Alap No, Lot No, 4 �m conforms substantially to the Application for Building Permit heretofore fled in this office dated I Of512018 pursuant to which Building Permit No. 43143 dated 10/16018 .vas issucz',and conforms to all of the reguiranents of d:c apphc3ble provisions of the lady. the occupancy for Wch th,: ccrrtificatn is issued is: d(, ;1W1_S ,1M„ I1 1➢ t r„1 t?1I1 11m tMl t t t.b61^'s... " ,r '.�'l..t ,P l t The certificate is issued to Murpl:•y,A`I`inmfiy&ors _... ...�.__._ of the afore&aid buil(Ung. SUFF'OLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43143 4- 018 PLUMBERS CERTIFICATION UATEll ell .w �.....� A tIt t;r' Sid:,Ulture BUILD!*'(; DZP.ART:-=T TO','r,4 OF SOUViOLD, N. Y. H0USI',1G CODE INSPE-ECTIO111 REFORT Location 205 PINK AVE. SOUTPOLD ---Tj*un—jLc�.xpa.L.Lty) knLr. C, Subdivision -- ?-lap Nu.--Lot(s) Name of Oviner'(s) SONIA M. GRASSo__ Occ'upancy R-40 owner e (o-v,,ner-zenarrc) Ad;jitted by: ELLEN NEFF by: '3AHF- Key available folk Co. Tax P;O. 77-02-29-.— Source of request SONIA M- GRA"So Data 12/6/89 Type of construction., HOOD FRAME —e-stories Off! Foundation CEMENT BLOCK Cellar FULL Crawl space Total rooms, lst. F1 6 2nd. F1 —3rd. Bathrooms) ONE BATH Porch, type type 1�y:;� BF74k.99 ARAGE Breeze-way _Gara g-e"Wool) VRAME Utill tkY Type Heat Warm Air xx Fotwazcr , Q111 --- Fireplace(s) ONE No. Exit.:, 2 Domestic hotetater—, ELEC. Other ACCESSORY STRT:CTM75: NONE Gara-e, type const. Storage, type Or Swi=iing pool Guest, type connt.. Other VEOL!4TIG�:S- Housing Code, Chanter 45 N.Y. State uniforn Fire Prevention ............ is nation De criuticn \rt. E Sec. Remarks: Inspected by: Date of insp. , Time start 10:4 5 end. I 1 00 5 erxsa r 3 - BEDROOM 14'17x 12'1' _ CN•xI - 1 - BEDIROOM \p PATIO ]7r4'x -. - --. - 111 21'rx 1s' 21'x21'1' --- `` ' OPEN TO BELOW STORAGE LOFT 29'SD'x 13' CH 6'5 IN i WALK €. CLOSET 1 CLOSEr . 59 x PATIO'6 FLOOR 3 a 3 PATIO '( �= KITCHEN w 14'10'x 11'1' - crrm GARAGE i a lot 21'1'x 22'11' f CROV s SUN ROW DININGAREA 1- f` 3E 1 - BASEMENT LAUNDRY ee iia cit.e' 12T z 1010' __ L -- cH.a -` Lf d 35'CH:6W aF 14'10' cN:as cm LNNG ROOM i UAKAU - t WET BAR 17'T x 9'3' BEDROOM BEDROOM g1;rT 11'10'x 12' 9Tx 12'GM 7,111 OH:8T a - _ _ FLOOR 7 FLOOR 2 f =SMOKE DETECTOR =SMOKEt02 DETECTOR INTERIOR TOTAL:4,443 SQ FT PATIO:2302 SQ FT FLOOR 1:1212 SQ FT SHED:30 SQ FT FLOOR 2:1909 SQ FT STORAGE:102 SQ FT FLOOR 3:2322 SQ FT POOL:646 SQ FT w-+-E EXTERIOR TOTAL:3,080 SQ FT TOTAL:7,523 SQ FT 11 Scale in feet.Indicative only.Dimensions are approuimate.All information contained herein is gathered from sources we believe to be reliable.However,we cannot guarantee its accuracy and interested persons should rely on their own inquiries. 205 Pine Avenue, Southold vouglasE �k-n sue,. a_sh •. ,,-I'i All t 3k vk --------------- At : a d s ?TT i A E � — � t � E i k I �N F LLD L,i'T t. 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