HomeMy WebLinkAbout1000-15.-4-5 of so TOWN OF SOUTHOLD
Rental Permit
1458
Owner: Konstantine Lolos , Angela Lolos
Occupied as: Single Family Dwelling
Located at: 1095 Ryder Farm Ln Orient 15.4-5
Maximum Permitted Occupancy: 8
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: 05/08/2026
Expiration: 05/08/2028 ement
This Notice must be posted by the main entrance at all times
a
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 lItLtp,_://w,ww,sotit�holdtowtigy.gov
�� �.m., � RENTAL PERMIT APPLICATION
Rental Permit Fee $300(Application must be renewed every two years) "'
SOU rtt.0 l l�
Section A.
Property Information:
Rental Property Address:
Tax Map Number: 1000 SECTION -BLOCK �S -LOT -
SECTION B.
OWNER INFORMATION:
Property Owner Name: �onl5� �7��/� '�C' U S
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
541"15-
/6 U
Telephone Number(s): Daytime Even ingso"4Z Emergency S'40-7 ;
Property Owner Email Address: /<4040
Page 1 of 4
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit, if any: l�G/`� i "s1✓"' % �° G� G S
Address of Authorized Agent (no P.O. Boxes): "
Mailing Address of Authorized Agent:
Telephone Number(s): Daytime Evening 54-l"I Emergency
Email Address:
Section D.
Managing Agent Information:
Name of Authorized Agent of dwelling unit, if any: '� / �" •
Address of Authorized Agent (no P.O. Boxes):1��5
Mailing Address of Authorized Agent: }
Telephone Number(s): Daytime Evening Emergency S �
Email Address:
SECTION E.
SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units)
Name of Managing Agent of dwelling unit, if any:
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:
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: G
Use and Dimensions of each room in Rental Dwelling Unit: �i7C Cif— 13
b1*1,�l,,- -- /S"i )( /3 G ,,�;�ii < ,t?w, - /'r'-ia X 13 13exl2x,�11 -
Pei-oARZ - /<'6 b3 rllp- x, Y"-/� .
' " 1
-------------
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.
1 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)
K riJS'�w�iN� /--4 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 Signature
Sworn to before me thi6 day bf I , 20 ,
Official Notary Public Signature and Original Notary Stamp
CONNIE D.BUNCH
Notary Public,State of New York
No.01 BU61$5050
Qualified in Suffolk County,„ Page 4 of 4
Commission Explr0s April 14, ��� 2
Town of Southold— Rental Permit Application
TOWN OF SOUTHOLD-BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P.0.Box 1179 Southold,NY 11971-0959
Telephone(631) 765-1802 Fax(631) 765-9502 https://www.southoldtownny.gov
RENTAL PERMIT APPLICATION
Rental Permit Fee$300 (Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
1095 Ryder Farm Lane;Orient Point,NY,11957
Tax Map Number: 1000 SECTION_-BLOCK-1 5--LOT--4 -—5—
SECTION B.
OWNER INFORMATION:
Property Owner Name:—Konstantine Lolos—
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
108 Executive Drive_ —SAME_
New Hyde Park,NY_
11040
Telephone Number(s):Daytime-516-639-1483 Evening-516-639-1483
Emergency-516-639-1483—
Property Owner Email Address:—10010s@verizon.net—_
Section C.
Authorized Agent Information:
Name of Authorized Agent of dwelling unit,if any:_Konstantine Lolos_
Address of Authorized Agent(no P.O.Boxes):
Mailing Address of Authorized Agent:_108 Executive Drive; New Hyde Park,NY 11040_
Telephone Number (s):Daytime_516-639-1483_Evening_516-639-1483_
Emergency_516-639-1483_
Email Address:_Klolos@verizon.net_
Section D.
Managing Agent Information:
Name of Aut horized Agent of dwelling unit,if any:_Konstantine Lolos_
Address of Authorized Agent(no P.O.Boxes):
Mailing Address of Authorized Agent:_108 Executive Drive; New Hyde Park,NY 11040_
Telephone Number(s):Daytime_516-639-1483 Evening_516-639-1483_Emergency 516-
639-1483
Email Address:
SECTION E.
SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental
units)
Name of Managing Agent of dwelling unit,if any:_Konstantine Lolos
Address of Managing Agent(no P.O.Boxes):
Mailing Address of Managing Agent:_108 Executive Drive; New Hyde Park,NY 11040_
Telephone Number(s):Daytime_516-639-1483_Evening_516-639-
1483_Emergency_516-639-1483_
Email Address:__klolos@verizon.net
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:_ 1
Requested Maximum number of persons allowed to occupy Dwelling Unit:_2
Number of rooms in Rental Dwelling Unit:_1,0
Use and Dimensions of each room in Rental Dwelling Unit:
First Floor Second Floor
1,Kitchen- 13'-3'x 13-0 1.Bedroom two- 12'-6"x
2.Dining Room- 15'-9"x 13-0' 2.Bedroom three- 13'-5"x 13'-0"
3.Living Room-15'-10"x 13-0" 3.Bedroom four- 10'-3"x 13'-0"
4.Bathroom-7'-9"x 2'-11" 4.Bathroom- 8'-1"x 5'-1"
5.Primary Bedroom-15'-6"x 13"
6.Primary Bathroom-10'-6"x 4'-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
❑I am submitting a completed Town of Southold certification form from a licensed architect
or a licensed professional engineer.
SECTION H.
DECL ARATION:Signature must be notarized and MUST be the owner of the dwelling unit.
STATE OF NEW YORK)
(COUNTY OF SUFFOLK)
I_Konstantine Lolos_,certify under penalty of perjury,the following:
1.I am the owner of the property identified in "Se ction 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 t hat I will notify the Town of Southold
Building Department of any changes of address within five(5) days of any changes thereto.
3.I 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.I will n otify 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:_Konstantine Lolos
Property Owner's Signature:
Sworn to before me this—day of 20_
Official Notary Public Signature and Original Notary Stamp
of Sd?Uj �
TOWN OF SOUTHOLD BUILDING DEPT.
631-765-1802 �� S
I N P E C T I qJojwbk N
[ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ FINAL r&o�!
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ q-ltiE NTAL
REMARKS: ' ' .. .. . c �1 vw,� [-e--
DATE a INSPECTOR
^'l J rvi,
Town Hall Annex
Town of Southold 54375 Main Road
mow(
Rental Inspection Report PO Box 1179
� Southold, NY 11971-1179
Tel: 631-765-1802
SUM# Date
Owner Phone
Address /0 Visible
Hamlet Inspector �A
Floor Level Quantities Suv A 1 2 3
Smoke Detectors(not located in bedrooms)
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 I Handrails&guards installed &secure
Pool Safety Pool on Site
Surface water alarm Date of CO issuance Q G►Li
Door alarms Pool completely enclosed
Self closing/latching gates I Pool fence to code requirements
/i i//��/iai /J����!� �%i/�%�9%
CO s for all items present Pr
Comments:
TOWN OF SOUTHO .D PROPERTY / CARD
OWNER STREET fr;`? `;°: VILLAGE DISTRIC I" SUB. I LOT "
i jq
FORMER OWNER N `4c I E a ACREAGE
S W ' TYPE OF BUILDING P L
RES. �U SEAS. VL. FARM COMM. IND. CB. MISC. Est. Mkt. Value
- 0 o
LAND I IMP. TOTAL DATE REMARKS d Q_ � i 4I Zr I e,
I - i
i
per 01
AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE FRONTAGE ON WATER`
Farm I Acre Value Per Acre Value I FRONTAGE ON ROAD
Tillable 1 BULKHEAD
Tillable 2 I DOCK
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Tillable 3
Woodland
Swampland
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Brushland
House Plot
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0_ B.
Town of Southold 5/21/2024
P.O.Box 1179
53095 Main Rd
Iry
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 45190 Date: 5/21/2024
THIS CERTIFIES that the building SINGLE FAMILY DWELLING
Location of Property: 1095 Ryder Farm Ln, Orient Orient
SCTM#: 473889 Sec/Block/Lot: 15.4-5
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
2/21/2023 pursuant to which Building Permit No. 49261 dated 5/16/2023
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:
one faini1v dwelling modular with a covered fi"on c °ch .-ea,r deck attached ara e and unfinished basement as
applied for
The certificate is issued to Lolos,Konstantine&Angela
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-20-1200 04/26/2024
ELECTRICAL CERTIFICATE NO. 49261 02/15/2024
PLUMBERS CERTIFICATION DATED 2/14/2024 P 1 Purt~ Sella
Autho z Sigure
Town Hall Annex `o f elephone(631)765-1802
54375 Main Road
P.O.Box 1 179
Southold,NY 1 1 97 1-0959 e` m �� sean.deviin tOw n,BOtdth lldur� .�I�
140
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Konstantine Lolos
Address: 1095 Ryder Farm Ln City:Orient st: Ny zip: 11957
Building Permit#: 49261 Section: 15 Block: 4 Lot: 5
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
rCo-ntract7or Electrician: Double Pole Electric License No: 3913ME
SITE DETAILS
Office Use Only
Residential X Indoor X Basement X Service X
Commerical Outdoor X 1st Floor X Pool
New X Renovation 2nd Floor Hot Tub
Addition Survey X Attic Garage X
INVENTORY
Service 1 ph X Heat Duplec Recpt 4 Ceiling Fixtures Bath Exhaust Fan
Service 3 ph Hot Water Gas GFCI Recpt 2 Wall Fixtures Smoke Detectors 4
Main Panel 200A A/C Condenser 2 Single Recpt Recessed Fixtures 4 CO2 Detectors
Sub Panel A/C Blower 2 Range Recpt Gas Ceiling Fan 1 Combo Smoke/CO 3
Transfer Switch UC Lights Dryer Recpt 34A Emergency Strobe Heat Detectors 1
Disconnect 2 Switches 7 4'LED Exit Fixtures 11 Sump Pump
Other Equipment: Fridge, Oven, DW, Hood, W/D, 200A Panel 40 Circuit/39 Used
Notes: Modular Basement Wiring, Service, Garage & Roofed Over Porch
Inspector Signature: ° )"2, Date: February 15, 2024
S.Devlin-Cert Electrical Compliance Form
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APPROVED BY A REGISTERED ARCHITECT OR ENGINEER IN THE STATE OF HOUSE
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2)THE BUIUOER/PURCRASER SHALL BE RESPONSIBLE FOR DESIGN,CONSTRUCTION
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LROTED TO)STRUCTURAL PUINIBING,ELECTRICAL,HEATING,ENERGY
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