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HomeMy WebLinkAbout1000-15.-5-33 TOWN OF SOUTHOLD Rental Permit 1489 Owner: Nicolas Alissandratos Occupied as: Single Family Dwelling Located at: 2590 Plum Island Ln Orient 15.-5-33 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: 06/03/2026 Expiration: 06/02/2028 official 9 This Notice must be posted by the main entraacet all ti s 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 L;as,//�M�"LwArsoutholdtowntiy.gov RENTAL PERMIT APPLICATION <�NVIIXRental Permit Fee $300 (Application must be renewed every two years) low 94L# Ivie Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION . --BLOCK _-LOTjV SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) Telephone Number (s): Daytime ?7ry e�i n 9 Emergency Property Owner Email Address: ko6lfazl. ct.)w Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent (no P.O. Boxes): Mailing Address of Authorized Agent:. Telephone Number (s): Daytime Evening 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): Mailing Address of Authorized Agent: Telephone Number (s): Daytime Evening Emergency 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: Use and Dimensions of each room in Rental Dwelling Unit: er 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. 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) 1 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 e: SW o bef r hr day of_ May y , 20�% Officialotary a lic Signature andd' , Stamp 9041wr ,' -7la3f )M TOWN OF SOUTHO .D P_"O ERTY R�wRv � ►KD �=� OWNER It�C� �� — -- STREET m VILLAGE DISTRICT SUB. LOT a FORMER OWNER N � E� L ACREAGE S W TYPE OF BUILDING YI/r' 7'-Q V/ —oli- . l RES. f p ' SEAS. I VL. FARM E COMM. I IND, CB. MISC. _ i ptvEst. Mkt. Value tv LAND IMP. TOTAL DATE REMARKS yv��a `°'� TUY Ae - _ - i 2 6 0-y j 32- 0-� I, ILDI ICq C0yDITION OivIAL BELO ABOVE FRONTAGE ON WATER � x �v Farm cre f Value Per A e Value FRONTAGE ON ROAD f, Tillable 1 i BULKHEAD Tillable 2 _ ` DOCK Tillable 3 Woodland Swampland Brushland House Plot I I Tota � i fc 15.-5-33 6/11 = IN 31 M. Bldg. /5 7 b . Foundation _ Bat Extension Basement f Floors Extension Ext. Walls Interior Finish k Extension �� �ra.rt't, .�.._� 6w � QFire PlaceHeat ` PorchRoof Type Porch Rooms 1st Floor Breezeway i Patio Rooms 2nd Floor Garage ' z 2 3f t Driveway Dormer Q. B. 4 -71 a�f )0) 3 TOWN OF SOUTHOkD PROPERTY RECORD CARD OWNER I STREET VILLAGE DIST, COUNTY TAX MAP NO. tlT LAND IMP, TOTAL DATE REMARKS: t �w 5-700 l z- 1 kar4s - n. • gy# Y 2 I s , I r. a s I 3 ! TOWN OF SOUTHOL D BUILDING DEPT. 631-765-1802 I N P E T IC ............ [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING / STRAPPING [ ] INAL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE TRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL ( AL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL - I DATE __ INSPECTOR FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. . -Zt/042.6 . . . . . . . . Date . . . "arch- •24.. . . . . . . . . . . . . . . . . .. 19 .R1 THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . .. . . . . . . . . . • . . . . . . . . . . . .. . . . .. Location of Property Str%et +. . .J59p F1. . . us. Inland .Lava X . . . . . Now o. •Har►!et Co y Tax Map No. 1000 Section .o 15. . . . .. . .Block . . . . DA . . . . . . . .Lot . . .414 . . . . . . . .. . Su v •ision- Grient• BY -The •San• Soc,,ZFiled Map N03444. . . . .Lot No. 1A1 .. . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated .p. Aun+r. 13 , 197.3 pursuant to which Building Permit No. . KOO• Z• • . •. . • • . • •• B :ted • • •-htae• 1.3 i . .• . • • • • . . ° • • • • 1973 . ,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 . . . . . . .. . . . . .. . . . . . .Private• One- amiig •Dwe•1.ling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . The certificate is issued to . . . . . .Geeree-stavro . . . . . . • . . . . . . . . . . . . . . of the aforesaid building. Suffolk County Department of Health Approval . . . . . .9TS0,-59. 3ZR4/$.1. .3-/?4/•$1, RoaPrt A. Villa UNDERWRITERS CERTIFICATE NO. . . . . . M5 t 175.3 . . . . . . . . . . . . . . . . . . . . . . .. . . . .. . . .. . . . . . . . ... ... .. . . . Building Inspector Rw.1/91 € It -10 LP 04 € ,' �� - I - a a R t f a - A6, e-r' - _4- - 2tS '3'."'_ _ - ( IDS F ' = £F _ 3 - 't`M { [ It`9 f1 ✓a.f/F ,t t ll € f - t t - I t "e � t-"�-- F 1� �g 3 Y� s 1= f UN. 19 F - 3tr , : S � f I Oi F _ E a � 31 — — — -- — --— — —-- a t. � L- 4 I m i op f i _ FaE.G1G„ � t a �- * yr _. 1 —' m � I n iT YtEF T4�1q c4 aauac - •.•.- �"' _ -:.. �,*.t+c � eta*. s � ,: a t�s©• 5D `1 � Go� Mora i�t'o! +erg r-L(JM 1 S(..d.4Jt> t_tSiJE. i� rover rid t%t 1 t-009 MAXI VW �1f 'tx�WtJ