HomeMy WebLinkAbout1000-42.-2-10.5 (Unit 5) TOWN OF SOUTHOLD
Rental Permit
1465
Owner: Greenport Group LLC
Occupied as: Apartment - Unit #5
Located at: 920 Chapel Ln Greenport 45.-2-10.5
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: 05/12/2026
Expiration: 05/11/2028 c �' � � _ �
This Notice must be posted by the main entranOattime
6 Val
Tole hone(63f)10-18G2
`'own F. Annex w P
Pax(6'3.1)765=9501:
1',o2 Bax 117
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AUG - 2 2099 :._.
TowN Or SOUTHOLD
RkN AL P IT P LI
Rental POFM!t Fee$20.0(Application MuSt bt rOr gwEd Overt'twO year)
Section A.
Propert+� rr+ orant ;
Re-Atal Property Address:
� Of
Tax Map Number: 10W SEC71ON
SECTION B.
OWNER WFORMATION:
Property Qwner N§ncc L U
Property Owner Legal Address. Property Owner Mailing Address:
Telephone Nt�rn' ers :iiaytirl ��," .4 t 3 iver�iri Emergency-__--.
Praporxy. Owner Errvall Add.r®st.'
(2,-tC
Pare Iof5
r
Town k4pl!Annex Telephone(63 i)765-1802
5 Mani€tt €l Fax(631)745-9502
outh117t
Or
BUILDING I)SPARTMIP.NT
TOWN OF SotmHOLD
section
Authorized Agent.information:
Name of Authorized Agent of dwelling unit,if an
Address of Authorized Agent(no. P.O. Box
Mailing Address of Authorized Agen .
Telephone Number (s): eayti �., _ Evening Emergen y ....�.
Email Address:
Section D.
Managing Agent;information;
Marne of Authorized.Agent of dwefling unit,if any
Address of Autfiori�ed Agent(no P 0. Boxes):_
Mailing Address of Authoriied Agent- �
"
Tele0hone,Number(.$),Day tme i, 4 4��4` v+enirr g' Emergency_
Emall-Address:t krA
.".
SECTION E.
SITE MANAGER INFORMATION:(require fo ntal properties containing 8 or more rental units)
Warne of Managing Agent of dweill utnit, if any:
Andress of Managing Agent o P:0.80xes):_—
Page I of 5
ski rye( 3 i) 5-1
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TOWN .'iT H OLD
M.61ling Address of Mginaging,Agents
&: ahe Nu Y. v(4)F l ytlrrie, ,]N'e 3"*i�'t'. �uMtl.YfS +dN'... b Ern ergent G u UY+Mp'P1mJap'tuYV,�
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SECTION F.
PROPERTY DESCRIPTION::
Number of Rental Dwelling,Vnits on property: �
For a rh Rerftal'DwOlingtrilt set forth tht Rental Dwe11r11' Unit Identifier foruample
Unit 1, Unit 2, Uri-It 3 or Apt; ;0,0;the use pf'e00 roorh in tare'Rental Dwelling Unk
(for example, Kitchen,Bedroom 1, bedroom 2, Living Room) and the Aitmensions of each
room..
i or properties with multiple Rental Dwelling Units use""Rental:Permit Application
Ail ... !'
7Rentiel Dwelling Unit tdentifidt � . ..
Requested Maximum rtvmber of persons a llor e�to occupy Dwelling Urilt:
Number of rob-ms Ph Aot1tal DWellln J1ntt€..
s Dimensions, # afa l i°tM w
�o c �
k
own 13 n x a` Telephone( f)765-l*8
5 75 groin Road
Fax t63 ra 7 - �
a-x,.° t k rRryry P.O. x79
S �hold,NY 107110959
bUILDING-DEPARTMENT
TOWN OFSOUTHOLD
SECTION G.
Pursuant to the Town Code of the Town of Southold Chapter t 7(Perital PrcPertieO,a safety
inspection by Code Enforcement Official is required, if the owner c oo.ses not to have said
inspection performed by the Town, a certification from a licensed architect,a licensed
professior..val engineer or a home inspector who has a valid New York State uniform Fire
Preventidh,guil=dift Code Certification is required stating that the property which is the subject
of the rental p.erm.it applicdtion is in compliance with all of the provisions of the code of the
Town,of Southold,the laws and sanitary and hor�si ng,re�gulations off the.Ecru of Suffolk and
by the laws,dooted by the New York State Fire'Pre ent(dn and Building Code Council.
I am requesting a fire safety Inspectlon to he performed by a Code enforcement afticlat
from the Town of Southold
1 am submitting a completed Torn of Southold.. certification form from a licensed
architect.or a l cerised professional engineer,
SECTION M.
DECLARATION: signature gust be notarised and MUSTbe the other of the dwelling unit...
STATE OF NEW YORK)
l
COUNTY OF SUFFOLK):
I Y certify under,penaity+oaf perjury,the fallowing.
1, lain the owner of the property identifier In "Section:fig"of this application.
The property owner's legal address set forth in `Section V of this application is my legal
address and i understand the Town will'use the address for service pursuant to all
Page 4 of
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W
Ttiephone(b3.1)1t55-Lt1
Town Hall AAnmex � � ��'
V$7t(684)1 16 -9s4I2
t .-
BUILDING DEPARTMENT
rj�WN 0F.SOUTHOLID
appheable laws anal rubs; i further acknowledge that i wilt notify the Towwn of Stwtb old
Building Department of any changes of address w thia five'(5)days of any changos
thereto.
3. 1 have reed arid.receiver) a:copy of Chapter 207 of the Code of the ToWn of Southold and
agreed to abide by the sarne,
4: l.W11 notify the Town withtp five is)b:uslness gays i wo arty Change to the information
regarding Authorizidd Agent,Managing Agent �r Site M nager.
Pr�o.perty Owwner's tlar�te: ,
Property Owner's Signature,
Sworn to fore e:this ,day llf ,1 ---------e 4
Official rotary Public Signatureand Original Notery.Stgmp
DIEGO F VARELA
Notary Public-State of New York
No.01VA,6392915
Quawied in Suffolk County
My Commission Expires Jun 3, 2023
Page 5 of 5
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TOWN OF SOUTHOLD► BUIL-D►1 O DEPTH,
631-765-1802
I N soft
r E
TIUN
[ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN ULATION/CAULKING
[ ] FRAMING / STRAPPING [ ] INAL
[ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE TRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL NAL)
[ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL
REMARKS: ��
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DATE INSPECTOR
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CERTIFICATE OCCUPANCY FOR COTTAGES
TOWN OF SOUMOLD
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VHS CERTIFIESthgtM 1 il 1)i
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APPROVED AS NOTED
151
CD DATEI��Al- B.P.#
J 10 By
NOTIFY BUILDING DEPARTMENT AT
631-765-1802 8AM TO 4PM FOR THE 1
F—T-1 T--T-F----11 FOLLOWING G INSPECTIONS:
FOUNDATION-MIO REQUIRED
FOR POURED CONCRETE
3 ROUGH-FRAMING&PLUMBING 1
i
INSULATION
0 <D CJ
L FINAL-CONSTRUCTION MUST
W
-L (D
L91 s BE COMPLETE FOR C.O.
T
ALL CONSTRUCTION SHALL MEET THE
CODES OF NEW ;
EMENTSOFTHE
-y-"R JSTAFE. R
NOT RESPONSIBLE FO
DESI' OR
CONSTRUCTION ERRORS i
L 1 Additional
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wa sh/drY
Certification
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y May Be Required.
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T MPLY WITH ALL CODE,
NE NYORK STATE&TOWN C061
-AS--REQUIRED AND CONDITIOJNSI•
Lr SOU THOLD TOINN ZBA
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INSPECTION REQUIRED
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