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Home My WebLink About1000-87.-1-6.4 TOWN OF SOUTHOLD Rental Permit 1460 Owner: Jacqueline Jones Occupied as: Single Family Dwelling Located at: 4525 S Harbor Rd Southold 87.-1-6.4 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: 05/11/2026 Expiration: 05/10/2028 a E orc me t official This Notice must be posted by the main entrance at all "me TOWN OF SOUTHOLD —BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box H 79 Southold, NY 11 71-0959 ' t MY! Telephone (631) 765-1802 Fax(631) 765-9502 his; xv v southol to,, nn x. ` L_ - 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 a n -BLOCK -LOT .2 —�l SECTION B. OWNER INFORMATION: Property Owner Name: )in tel Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 11 �t 1n Telephone Number (s): Daytimes) ZEvening Emergency Property Owner Email Address: 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: Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: 14 ' x 20 , Beal 3 - 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) I 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: Property Owner's Signatu ��-A, I Sworn to before me this JS7 day of �rl , 20ZL Official otary Pb `c ` atu�e and Original Notary Stamp FIGGIANI LJTIHIO�MAS Publ a State of New York NO.01FI0009083 ified in Suffolk countyission Expires Jun 5,2027 Page 4 of 4 F 5 1, �T�T�,✓17� ' "' - '`•"� '[TOWN OF SOUTHOLD BUILDING DEPT. .L 631-765-1802 I N Sik P E T 10 N [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] INAL ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F AL) [ ] CODE VIOLATION [ ] PRE C/O RENTAL REMARKS: ��I� w DATE INSPECTOR 71'OWN OF SOUTHOLD PROPERTY RECORD CARD .......... OWNER STREET VILLAGE DISTRICT SUB. LOT ........... 4[4,� 44 ................................ F0!'d,1At1�,4bW1`DER _v �� ,x""r� , E ACREAGE 0 0j 54 1A /M 0 ;;11/ 11 11-1-1 .............4 e.......... TYPE OF BUILDING ff 16....... j�, ......... RES. SEAS VL 'ARM Comm, IND. CB. misc. LAND IMP. TOTAL DATE REMARKS i.......... . .............. .......... .......... f ..................... 4k� 'r 4,ol,d 21, ........ 4, C IN NEW- _NQ!3,,MA1_ BEL,QW, PVE zzll ", 3 " � /............ .............. v, FaTM Acre A palue. � S�, 4r, TilIGble I 0(� )W 4 Tillable 2 4, 7' Tillable 3 . .... m. Lt,,Y Woodland C. zI/1 Swampland fi A,! . ....... Brushlawjw j J/11 0 ?1//),�1111111 House Plot 1;z ? e#v C............... ........... Total ................ ............ ................. i 41 V jp AO'2 1 e� IW / IM g r s ro .o A1,01,1 l r wiz ,.. f i M Bl Foundation �.. ., Extension ' Basement , Floors 71 Extension E„tw moils ; ,� Interior Finish _.. io Extension es D "yore Place �1�� Heat } Po ,U rch Atticic Porch Rooms Ist Floor 1 Breezeway�i Patio Rooms 2nd Floor" ...,,,,, ........ Garage f 5 ,5 Driveway 9< O B � �.,,.., �,,,a,. .._.. ... .... ............ ..,,.... i Total „ M, �, SO FT r l0 ��;� � u r , 1 # all 87.1-6.4 3/24/202s C f 00" c Il (0 14, PC ce � Foundation OTHERWW Bath Dinette ,...... a ,� C r Extension Basement cwiw� PawTru Floors Kit, Extension Finished B. Interior Finish L.R �.._w_.._n... .._..___ .. __..._..m ._..n.._., .. ma... .......... ,., ..._. ,.,. ..... _. ..............._............_ Extension FP�wss Heat Garage Ext. Walls Color BR. �i. Trim Baths P�d� Dormer i -Fin"BSC?FT _ F am.......m Rm. Pool Solar 1st Fir Foyer f 2nd Flr Laundry i Lib aryl fE � udy ` — �........ .,... ...._,.._ Dock * n7o� __,........,..............,,.,aw. _.�,., _.._....._.— .... , ut , Town of Southold P.O. Box 1179 awe 53095 Main Rd Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 46553 Date: 10/03/2025 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 4525 S Harbor Rd Southold, NY 11971 Sec/Block/Lot: 87.4-6.4 Conforms substantially to the Application for Building Permit heretofore,filed in this office dated: 11/20/2023 Pursuant to which Building Permit No. 50156 ' and dated: 12/26/2023 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: Single-family dwelling with an unfinished basement, covered front porch, and outdoor shower as applied for per ZBA#7807 dated 8/17/2023. The certificate is issued to: Robert Jones Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: R-23-0619 7/11/2025 ELECTRICAL CERTIFICATE: 50156 4/10/2025 PLUMBERS CERTIFICATION: - Leo-a.Pugh Five Star mb` 10/1025 V4 Autho i tore �ittu, ;tl,riir tt�l dd ' � yuliihal�f, Aeiv �ii�b 1 lir�t yy 1L(�lI{TIONAt 1I1i�1�iIC 1�3 '�f��a 2 1�z 5tt L 5t� in 3 �i stcci l'«?b=?fl P Yiwill� t��.d!!P�1 Shy ti t�113!'�IY3GI5 i.�of tjj, jipplicable provisions o the law. '7c ,. rip.rrr. for +'filch this c rtifteate is tssucd is: Single-family dwelling with an unfinished basement, cover h, and outdoor shower a� applied for per?BA#I7807 dater Sl17120 3 VNONUNION'.A�: —F CAL CERTIFICATE, 50156 411012025 PLC,'IB RS CERTIFICATION: Leon Pu PIV t I011 25 Y c a y \ \\ � \WksMg, \, O\\\\ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ...427............... Date ........................ftmem"r....22........... 1959... THIS CERTIFIES that the building located at...E/°v....South..Harbor..Resod.................... Street Map No. .M. ............... Block Na. .XXX................Lot No.IM........Southo-ldy....N-J.. ........................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................Sopt...U................ 19-59.,pursuant to which Building Permit No. ....Z..U7.............. dated ...........................geptftber....24, 19...59.,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.............. ............. ....,..,......,.........,...............................................................,... This certificate is issued to ..JALmQs..Fat ........(..Mmaz)....---................................. ................... (owner, lessee or tenant) of the aforesaid building. Building Inspector f e Basement RiserSuD 7* 3 7# 8� 8" Bsmt Si New Crawl Space r Su Riser r Crawl t Job#: GGMA24.22 Scale: 1 :85 Performed for: Green Guru,LLC Page 1 Sasso Residence 12Arbutus Court Suite 2 RghtSufte®Universal2023 4525 S.Harbor Rd. Greenlawn,NY 11740 23.0.01 RSU26941 Southold,NY 11971 Phone:631.398.6906 2023Oct 1614:21:17 www.greenguru.org michael@greenguru.org ldSasso14525 S.Harbor Road.rup First Floor 7 78 ofm 78 Irn B1-CI Bed 1 6 CER FP 151 cfrn Stair 1 Riser er 5 Kitchen Grt Rm Bath 1 Riser B3-CI 00 cf a1 1 Bed 3 Bedroom 2 cfm B2-CI CEq III cfM Job#:GGM.124.22 Green Guru,LLC Scale: 1 :85 Performed for: Page 2 Sasso Residence 12Arbutus Court,Suite 2 RbhtSuke®Universa12023 4525 S.Harbor Rd. Greenlawn,NY 11740 23.0.01 RSU26941 Southold,NY 11971 Phone:631.398.6906 2023-0ct 16 14:21:18 wwwgreenguru.org michael@greenguru.org IdSasso14525 S.HarborRoad.rup Fl Second Floor RI 79 dP 6 cfm Loft Chimn Stair 2 SUPRiser S ge 56cft IL cfm Bath 2 Sup Riser 96" �79 can Job#: GGMA 24.22 Green Guru,LLC Scale: 1 : 85 Performed for: Page 3 Sasso Residence 12Arbutus Court,Suite 2 RightSurle@ Universal2023 4525 S.Harbor Rd. Greenlawn,NY 11740 23.0.01 RSU26941 Southold,NY 11971 Phone:631.398.6906 2023-0d-1614:21:1 S L I www.greengurmarg michael@greenguru.org •••IdSassoW525 S.HarborRoad.rup f g-7- -4 SNORE&CARBON WRESE-mawkNaILL UlEARAAU4- Ut" E Mom%= um C�r- S M. Or 9.w T, < ------------ 'KA, - ---------- Wiu--------- ----------- ---------- -------- --- .......... ----------------- ............. ......... ----------- t Dwr Am S PATIO ----------- . .......... ---- ------ I'M UlhO, ................ 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