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Home My WebLink About1000-103.-12-5 of so TOWN OF SOUTHOLD Rental Permit 1521 Owner: Ivan Guerrero , Amy Brill Occupied as: Single Family Dwelling Located at: 850 Track Ave Cutchogue 103.-12-5 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: 07/17/2026 � S Expiration: 07/16/2028 Code Enforcement official This Notice must be posted by the main entrance at all times P�'Cej 119 lo�O3 �d� 1 1,E TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, u 9 - �E E Telephone (631) 765-1802 Fax (631) 765-9502 h -,//www , ho(dtowt o ,J U L Buildinq nepartment RENTAL PERMIT APPLICATION Town of Southold Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: -0 -re A A.v te"I i�r � l � Tax Map Number: 1000 SECTION D� ,� -BLOCK 2 -LOT - SECTION B. OWNER INFORMATION: Property Owner Name: Z\/,41\J Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) u N 1 H91 Telephone Number (s): Daytime 117-g33-5033 Evening SANI E Emergency g17-6I-YY54 Property Owner Email Address: &k ��') i�• C�r`'i vel-Y�►'�. i Q� YnQ��.GoH Page 1 of 4 Section C. t Authorized Agent Information: t" 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. IT 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: Unit 1 Requested Maximum number of persons allowed to occupy Dwelling Unit: 10 Number of rooms in Rental Dwelling Unit: 10 Use and Dimensions of each room in Rental Dwelling Unit: Bedroom 1 - 13'8"x14'8" Bedroom 2- 13'x10', Bedroom 3 - 10'x16'8", Bedroom 4- 14'11"x10'8", Dining Rm, 12'0"x12'6" Living room - 12'6"x21', Kitchen - 16'x12', Recreation Room - 23'8"x13'0", Basement Study- 94" x127' Basement Recreation Room - 26'0"x 257", Bathroom 1 -7'8"x7'8", Bathroom 2-4'x4', „ , „ 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 :—yA-N (� U 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 this Z day of JUL , 201� icial N ry Public Signature and Original Notary Stamp ROLAND ISSAGHOLIAN Notary Public-State of New York NO.01IS6278060 Qualified in Queens county My commission Expires Mar 18,2029 Page 4 of 4 TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 to3: 12 S INS' of"OkECTION [ ] FOUNDATION 1ST/ REEIAR [ ] ROUGH PLEIG. [ ] 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 [✓]RENTAL REMARKS: DATE _-7 11-I (2-0U INSPECTOR i2 ��r �6• ��ti Town Hall Annex Town Of Southold 54375 Main Road Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 SCTM # 103.-12-5 Date 7/17/2026' Owner Ivan Guerrer&Amy Brill Phone Address 850 Track Ave Visible Hamlet Cutchogue Inspector �tin Floor Level Quantities Sub 1 2 3 Smoke Detectors (not located in bedrooms) Carbon Monoxide Detectors Fire Extinguishers Exits Bedrooms 1 2 3 4 5 6 Smoke Detectors 1 Egress f 1 Occupant Count 'Z rL Z Z a Building Systems Maintained &Operational Condition of Property Heating ,/ Building interior Hot water Building exterior Electrical Property clean, maintained &safe Mechanical lHandrails &guards installed &secure Pool Safety Pool on Site Surface water alarm Date of CO issuance Door alarms Pool completely enclosed Self closing/latching gates ✓ Pool fence to code requirements CO's for all items present Comments: l CO- or, v a 1 4f1 TOWN OF SOUTHOLD PROPERTY IECORD CARD OWNER STREET V12 LAGE DIST, SUB. LOT e —FE ACC — t_ r> a V1 l``l ct / L.� .G{ ° t I W TYPE OF BUILDING t � RES. 'SEAS. YL. FARM COMM. CB, MlCS. Mkt. Value - LANE? IMP. TOTAL DATE REMARKScre - _ 7 G of 5�f�-f i T_1 _ er�,� x - a r4 � m 44 - -_ w 127 eq, .. & R Tillable FR�N�`Af�E�fATEf�" Woodland FRONTAGE ON ROAD MeodowklMd DEPTH , House Plot BULKHEAD Tatol - '�` COLOR Vim; f-� TRIM C,✓ t m f F , t 1 € s j I '§1 € 4-H � S -. - - 1 ip e c € I r I € s S z i M. Bldg. 3 g i Extension Extension 4i Extension Foundation P Bath S Dinette I Porch Basement`r° i K. Floors 1 V 7 d k' porch ;Ext. Walls Interior Finish LR. I / I ;Fire Place Heat ' � DR. 4; / _ roge a / �� / �, ✓ Type Roof Rooms 1st Floor i i BR. 5! Go 2/�u,, Recreation Room 400ms 2nd Floor FIN. B ;:; s /Q l Sao rtU, B. /�' = !7 F .�S � 3 Dormer Scf��Iz�°$ Driveway ��YI f Tgfal Z� 7�0 i FORM Na 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate OF Occupancy No. . Z7212 . . . . Date . . . . . . . . . . . . . . . 2 . ., 19. 7A THIS CERTIFIES that the building located at . - 2raek .Ave. . . . . . . . . . . . . . . Street Map No.Pequ&Sk. AS Block No. . . . . . . . . . .Lot No. 5. . . . .Catchogue. . R,Y.. . . . . . . . . conforms substantially to the Application.for Building Permit heretofore filed in this office dated . . . . . . . . . . . ..44 . .13., 191 k pursuant to which Building Permit No.76 . . "?9Z dated July . . . �3 . . . . . . . . . . . . . . . . . , 19. . . ., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Accesgory. (¢creed house btitildi g . . . . . . . The certificate is issued to . .J s .& AlloA. .83 tor. . . - Avuers . . . . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval A.4... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE No. X o A.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSE NUMBER . . . . . . 850. . . . Street . . Track.Ave. . . . . . . . . . . . . . . . . . . . . . . . . . . . . r,. c '�; Building Ins 1NOXX No. S TOWN OF SO OLD BUnDING DEPARTMENT Town Cleark*s Office Southold, N. Y. Certificate Of Occupancy No. Z. Date . . . . . . . . . . . . . .Autust. . .7. . . ., 19. .75 THIS CERTIFIES that the building located at .Truck .l1T . . . . . . . . . . . . . . . . Street Map No. . 5694. . . . . . Block No. . . . zz. . . .Lot No. .5. . . . .Cutcho . . . . X,,T p. . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . .So-pt. . 17 ., 1974. . pursuant to which Building Permit No. .75.51Z. dated . . . . . . . . . . . . Sept. . 23., 19!74 ., was issued, and conforms to all of the require. ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . P-rivate .ons .family. dwelling . .(Iiausing .Bd- aXception. 4a.vindaws) The certificate is issued to .Jame a• X. .slater. . . . . . owner. . . , . .. . • . . . . . • . . • . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . . . .July. . .31. . . . . . 1975. . By.R. .Villa UNDERWRITERS CERTIFICATE No. . RgW9 . . .June,4. . 1975 . . . . . . . . . . . . . . . . HOUSE NUMBER . . . . 59. . . . . . Street . . .Track .eve.! . . . . . . . . . . . . . . . . . . . . . . . . . . . « « . . . .. .. . . . . .. ... . . . . . . . . ... .. . a . . . . ... . . . . . . . . .. . . . .. . . . . . . . . .« . . . . . . . . .. . . . . .. . . . . . Building for ervya Town of Southold P.O. Box 1179 53095 Main Rd r.� Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 46808 Date: 01/22/2026 THIS CERTIFIES that the building AS BUILT ALTERATION Location of Property: 850 Track Ave Cutchogue, NY 11935 Sec/Block/Lot: 101-12-5 Conforms substantially to the Application for Building Permit heretofore,filed in this office dated: 03/31/2025 Pursuant to which Building Permit No. 52448 and dated: 11/12/2025 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: "As built" finished basement with one (1) bedroom and bathroom to an existing single- family dwelling as applied for per NYS variance petition #2025-0795 dated 10/28/2025. The certificate is issued to: Ivan Guerrero Amy Brill Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: ELECTRICAL CERTIFICATE: 115252 12/23/2025 PLUMBERS CERTIFICATION: Amy Brill 1/10/2026 �uthoud1 Si t FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z19768 Date MARCH 4 1991 THIS CERTIFIES that the building INGROUND POOL Location of Property 850 TRACK AVE. CUTCHOGUE House No. Street Hamlet. County Tax Map No. 1000 Section 103 Block 12 Lot 05 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APR'IL 4e 1990. _______pursuant to which Building Permit No. 18937Z dated APRIL 6 1990 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 INGROUND POOL FENCE AND DECK. The certificate is issued to DOROTHY MARA (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N A UNDERWRITERS CERTIFICATE NO. N129317 MAY 17 1990 PLUMBERS CERTIFICATION DATED N/A Building nspector Rev. 1/81 A i bitOQvY SCHEDULE rt. �r u ..., s� €� g. TOWN OF f Fu — TH=.NE,YORK _. g o _ . _ �_, � sa •4 NOTE:DRAWING BE PRIYTED AT ED _ : +e NO E F._'. k, v _ ,ate,€ �..,..neer+ `cn�,V"TE -=. _. � -� L I =_ As— �a LECALUE EW,IING FINISHED BASEMENT BASEMENT FLOOR P-AK - t F 5 i �r q i _ s k� 'I � I ' — - or t � � s -F - - -f s � e A j It ro ltOMC a r - e