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Home My WebLink About1000-30.-2-6 of SO& TOWN OF SOUTHOLD Rental Permit 1529 Owner: John Siderakis , Margaret Siderakis Occupied as: Single Family Dwelling Located at: 405 The Short Ln East Marion 30.-2-6 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 ins ection. Issued: 07/27/2026 1 mf,'. Expiration: 07/26/2028 Co En name t cial This Notice must be posted by the main entranOattimes TOWN OF SOUTHOLD—BUILDING DEPARTMENT a Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 lit SQUIhOOd«1w JAN 1 RENTAL PERMIT APPLICATION !3,W.1d,gn0 P.)epartment Rental Permit Fee $300 (Application must be renewed every two y a r ti ti?f�F:cihtfr ld rc CIS It Section A. 3DOO47 Property Information: Rental Property Address465- THE .T Zjw6 M a4 Tax Map Number: 1000 SECTION 30. -BLOCK Z -LOT C - SECTION B. OWNER INFORMATION: Property Owner Name: o �/ DE "I s Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 44461- l 46� 036 & �--r NY lto3o Telephone Number (s): Daytime2tA2G?,, evening Emergency Property Owner Email Address: S'IOEQAPCI.5' J_ y-4ffo0• Co 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): �f I 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): Ufa* 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: ZWE C -d 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: rc"� , Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: . L Use and Dimensions of each room in Rental Dwelling Unit: Cl X Is') 1p JI N C I lye 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 SUFFFFOLK) rV"YORK I �° J/�� , 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 day ofJ Nu me , 202� r Offici Mary Public Signat and 6riginal Notary Stamp ,ALL piJOSftPH NOTARY PUBLIC STATE OF NEW YORK UC.#0113I461 \ COMM.EXP.1W1.246 A"h Page 4 of 4 COMMISSIONED IN NEW YORK COUNTY TOWN OF SOUTHOLD 13UILD1 G DEPT. 631-765-1802 �, Z W% ww look IN .mormt;TION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING / STRAPPING [ ] ANAL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT P NETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL INAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARI DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 3v,d-( limtiPECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FIN. L) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: r � DATE INSPECTOR q So TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 jD-,:g—ep I N S E T 10 N [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] 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: '_�� ' Q- t 4to�r �� w f2e55 .1�a,�Lu Syt SATE INSPECTOR W . Town Hall Annex . Town Of Southold 54375 Main Road u Rental Inspection Report PO Box 1179 -� Southold, NY 11971-1179 Tel: 631-765-1802 SCTM # 30-a- (o Date Owner 51d -PA.,k-.t-*S Phone Address ?„ ° 06 Visible Hamlet �Lxj- Inspector Floor Level Quantities Sub 1 2 3 Smoke Detectors (not located in bedrooms) E Carbon Monoxide Detectors I Fire Extinguishers Exits Bedrooms 1 2 3 4 5 6 Smoke Detectors Egress Occupant Count 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 Prior Rental Comments: m TOWN OF SOUTHOLD PROPERTY RECOIf Ig? STREET t� VILLAGE DIST. SUB. LOT dv- il T14 e -Nb -t 1-46k4 FORMER OWNER '� M.L-C-Ulk-irtl E A-CR. are V'� eV IS S W TYPE OF BUILDING /4 ' -, 1 RES. SEAS. VL. FARM COMM. CB. MICS. Mkt. Value 04e LAND imp. TOTAL DATE REMARKS L Koo " 4 WO el" Ll L v oncl -70J t c c k f - iL2 -7 7 I Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH House Plot BULKHEAD Total ---1— 1 — L - i a< COLOR _ TRIM g F I s 1 f -� - i , r � k I • Extension 1 1 Extension _ Extension ' i Foundation 1 Both �� 1 Dinette Porch _ [-,�+1 ,: {� <j 5 Basement Floors K. ✓ Porch k. �: - r e r Ext. Walls Interior Finish i LR. s ✓ ; Fire Place ; Heat , ? ! DR. Garage X z a 1,.Z i 1 Type Roof jRcoms 1st Floor i 1BR. Patio Recreation Room j Rooms 2nd Floor 2$?o - 2-0 X3b 72-o r Z ,Dormer Driveway Total I s 07-9�'j S.C. �r. ?(20 � ��a q lar9 t� Fat& Town of Southold 5/13/2015 " P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OIL OCCUPANCY No: 37555 Date: 5/13/2015 THIS CERTIFIES that the building IN GROUND POOL .................... _ _ ......._........._..__._�.............. _.._ Location of Property: 405 The Short Ln,East Marion SCTM#: 473889 Sec/Block/Lot: 30.-2-6 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 10/9/2013 pursuant to which Building Permit No. 38577 dated 12/17/2013 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for i which this certificate is issued is: ACCESSORY IN-GROUND SWEMMING POOL AS APPLIED l . The certificate is issued to Siderakis,Margeret and John of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 38577 04-02-2015 PLUMBERS CERTIFICATION DATED A, iatta _w FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y_ CERTIFICATE OF OCCUPANCY No: Z-30357 Date: 08/13/04 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 405 THE SHORT LA EAST MARION (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 30 Bloch 2 Lot 6 Subdivision Filed Map No_ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 24 2004 pursuant to which Building Permit No. 30353-Z dated MAY 25, 2004 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" DECK ADDITION AND BASEMENT ALTERATION AS APPLIED FOR. CONSTRUCTION CERTIFIED BY IRA H]7SPEL ARCHITECT. The certificate is issued to JOHN F & MARY LOU CULKIN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMWI OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2009350 06 2 /04 PLUNDERS CERTIFICATION DATED 06/24/04 ERIK ENDEN AL h izEK signa re Rev_ 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24715 Date OCTOBER 290, 1996> THIS CERTIFIES that the building NEW DWELLING Location of Property 405 THE SHORT LANE EAST MARION N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 30 Block 2 Lot 6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 7 1995 pursuant to which Building Permit No. 22907-Z dated JULY 27, 1995 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 FAMILY DWELLING WITH ATTACHED GARAGE & OPEN PORCH AS APPLIED FOR. The certificate is issued to JOHN F. CULKIN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-95-0065 . 7 1996 UNDERWRITERS CERTIFICATE NO. H-051954 - SEPT. 24v 1996 PLUMBERS CERTIFICATION DATED FEB. 2, 1996 - RICHARD BRUNO Building Ins ctor Rev. 1/81 4o5- -Toe S`t - 44viF,, WT 4 fc ,-I y /1?3 NVA(Eo WAt EIL Torh^)St 941,"4 tSS Q n ,4�xr m4 E cftM �NS�onIS I Id J ` Of 4 ol 4', 7 r$ot4 15� 7 /6� l3�ft�� MC-o wAIE 1+,V Yl PC—JZ.4 a-1 COO)v - L ' ' '-J�►r-I N Gj OooAl ,4p &x l m,4TG VIM E41910AJs' F J f 4-rH: S -S O-/C smog c C- ` , lios -77tE S�f9-T 44,4,G, F�sT Mf�d oit1, 1✓f/ f�Cpg)O A J r > APPPDXtMRTr 1/tM6USIONs _H a 4 jq `H 7 &J 'Bep1?.Oo M L