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Home My WebLink About1000-63.-3-21.3 of so TOWN OF SOUTHOLD a Rental Permit Ulf 1545 Owner: Tom Vasilis , Jillian Vasilis Occupied as: Single Family Dwelling Located at: 57455 Route 25 Southold 63.-3-21.3 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: 09/17/2026 Expiration: 09/16/2028 code " en °ffid This Notice must be posted by the main entrance at all times Lf TOWN OF SO OBI)—BUI O 1►E PART NT Town Hall Annex 54375 Main Road P. 0.Box 1179 Southold,NY 11971-09 Telephone(631) 765-1802 Fax(631) 765-9502 htt s://www.southoldtow nllva iyov �d � RENTAL PERMIT APPLICATION APR 1 5 2026 ' Rental Permit Fee$300(Application must be renewed every two " r 'ems; Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION 3 -BLOCS -LOT?- SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 5L45,57Vjket- p- I Telephone Number(s): Daytime Evening Emergency Property Owner Email Address: ' A 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, C);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: C7 Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: k 3 12 2- CrX 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. D' 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 1-4 A- 5 LLH'�Io 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: S77 to before me this eday of 'L>rI 20 2�o Official Nota ublic Signature n Original Notary Stamp TRACE TRACEY L.DWYER PUNX,STATE OF NEW Y'OAK NO.01OW63MM WIED INSUPFOLK COUNTy Page 4 of 4 TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 INSPECTIC3N [ ] FOUNDATION 1ST/ 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 [A'-R' ENTAL REMARKS. '`�CA ° (o DATE INSPECTOR Town Hall Annex Town Of Southold 54375 Main Road ` Rental Inspection Report PO Box 1179 at Southold, NY 11971-1179 Tel: 631-765-1802 SUM # Date •a Owner • Phone Address JC r /l/lic it,, Visible Hamlet Oj Inspector Floor Level Quantities Sub 1 2 3 Smoke Detectors(not located in bedrooms) Il 1 Carbon Monoxide Detectors 1 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 Handrails&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 //%%' poi/ CO s for all items present Comments: SCTM # �- CTM _ P �kl , TOWN OF SOUTHOLD PROPERTY RECO �0 OWNER STREET - �j VILLAGE DIST, SUB. LOT ACR. REMARKS TYPE OF BLD. PROP. CLASS _ \ 0 / v 7G, l�r f $3`J :- .vim:m �=1 NAvis l� r) LAND IMP. TOTAL DATE E � F a FRONTAGE ON WATER HOUSE/LOT BULKHEAD TOTAL .-JOWN 'OF SOUTHOLD PROPERTY RECOI STREET VILLAGE DISTRICT SUB. LOT --�vd req 6a FORMER ORM1R OWNER` E ACREAGE vK6 Cj ' ,:;t f,4 f W TYPE OF BUILDING RES. SEAS. VL. FARM comm. IND. CB. j misc. 1 Est. Mkt. Value LAND imp, TOTAL DATE REMARKS 1 i A Cy .............. AGE BUILDING CONDI-fl&"�� FRONTAGE ON WATER Form Acre Value Per Acre Value FRONTAGE ON ROAD Tillable 1 BULKHEAD Tillable DOCK Tillable 3 Woodland c? L 49 t5, 23 - Swampland Brushland J J Ll House Plot ?6 IV Total IA V4 (, v, 1-ar C- E . 011 63.-3-21.3 09/22/201742 z Z. M. Bldg. o - ca Foundation Bath y, Extension z s . Basement Floors Extension _ e Ext. Walls � � � � Interior Finish Extension 41 y V Fire Place ` Heat N/ z Z- A-iZ o G Porch Roof Type YP Porch Rooms 1st Floor L 3�iv x 72 y_� ptio Rooms 2nd Floor Garage _ � p V7- Drive ay Dormer 4 0 — C r , ► - __ 4-- i FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 25571 Date: 03/05/98 THIS CERTIFIES that the building DWELLING Location of Property 57455 MAIN RD SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 063 Block 0003 Lot 021.003 Subdivision Filed Map No. Lot No. conforms substantially to the Requirements for a ONE FAMILY DWELLING built prior to APRIL 9 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 25571 dated MARCH 5 1998 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 ACCESSORY GARAGE The certificate is issued to ELIZABETH H BARNETT (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. r sukfdingins ctor 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-25569 Date: 03/05/98 THIS CERTIFIES that the building ADDITION Location of Property: 57455 MAIN RD SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 63 Block 3 Lot 21.3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 12 1997 pursuant to which Building Permit No. 4433-Z dated OCTOBER 27 1997 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ELIZABETH H BARNETT (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Bui ing inskeetor Rev. 1/81 Of SE1Ct� Town of Southold P.O. Box 1179 53095 Main Rd ° N". Southold, New York 11971 CERTIFICA"T"E OF OCCUPANCY No: 46008 Date: 02/28/2025 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 57455 Route 25 Southold, NY 111971 Sec/Block/Lot: 61-3-21.3 Conforms substantially to the Application for Building Permit heretofore, filed in this office dated: 07/01/2016 Pursuant to which Building Permit No. 40835 and dated: 07/15/2016 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: Additions and alterations, including trellis and second floor balcony, to existing single family dwelling as applied for. The certificate is issued to: Tom Vasilis Jillian Vasilis �...._._...._mm__- ................... ........................._ ...__.... . ,..........—.,. .w......._.._............_._._._._._._._._._...._w_ Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: ELECTRICAL CERTIFICATE: PLUMBERS CERTIFICATION: tho ize Si tat ►re } TOPOS a DESIGNS, CONCRETE FATIO --- - COVERED 1MTN INC. NEW TFELL15 61.04 37TH AVENUE WOODSIDE,NY 11377 PHONE:(718)478-6786 e � FAX:(718)478-6786 E-MAIL•TOPOSNY®GMAILCOM a DRAWING,SPECIFICATDNIS AND OTHER ----. ----. DWLUAIENRPREP WY CMTECf ARE ( i Wj.TRIktwfmIM��TMTHEMCH�C�V— VKE WNKH THEYAREMDMBISCDNSTRD DR yC NOT.THEARCHDECISDRAWINDS EU15 DNANY DTHE PERDIECf MRADD€NDNS $—b NEW BALCONY a- TD TH15 PMECFANt—COWLMONOF UNEXCAVATED AN LIVING RM ABOVE THSPRDIECTWYDTIEAS,ExCEPTWYADREEMEHr I S INWRMI MDWITHAPPRDPRIATE - + �� CDMPENSATIDNTDTHEARCHna STAIR5 n 3 NUMBER OF '- --. I P15ER5 TO BE 5 V.I. ° � € SONO T 5 I KITCHEN (3'4°X33° --. ---. - I G ISLAND v € 1 ARvrmx IN VASSILIS RESIDENCE a DINING FM 57455 MAIN ROAD,SOUTHOLD �—g N. UNEXCAVATED m b I RENOVATION #: tD CELLAR @ FIRST FLOOR PLANS zn AFf 2'-10°) ---- - (2'-19X3'-10°(2'-10'X3 10' gr AFF 3'-M AFF 3 0') N� - OCELLAR FLOOR PLANFIRST FLOOR PLAN SCALE: 1/8"=1'-0° SCALE: 1/8°=1'-0" A-002.00 TOPOS DESIGNS, INC. 61.09 37TH AVENUE WOODSIDE,NY 11377 PHONE:(718)478-6786 FAX:(718)478-6786 E-MAIL:TOPOSNYOGMAIL.COM DRawwp,sPECIFIunoNSANE—T pp[LME PREPARED RETHE/JIUOTECT ARE 3 THEINRTRLLNENIS OF1HEANCRTYGF SERVICE AMC 51WL.WH TNEPRW TMOFTHE ARCHIfER.WHEIMNDE NOTTHE P UCTED FO0. WNICHn1EYARE INRENDED P COISEpOCIFD o0. NOT.1HE ARCHRECES pRAWocu f SP USED NS ANDORNERDO[UMFRADDMNOT RE USED ON ANY OTHER P0.OJECTS iORADD1110N5 TO PR JECTOTAND/DR FOR PTBYAG OF s INW MGMRYOTHERS,OMATRY ADRFFA'ENT ROOF BELOW C WREI MON WEMAPPROPRNTE v ---. COMPENSAnON Ib TMEARCHIIER. (3'-10'X 2'-10° (3'-10'%2'-10'(3'-10'X LAFF 2'-81 AFF 2'-87 AFF I - I ' O' NEW BALCONY [€ O ; (3'-4'X 3'-4' it § AFF 5-4") I I a b - m m W.I.CL , x VASSILIS RESIDENCE b� 11 fI � 't 57455 MAIN ROAD,SOUTHOLD I I f RENOVATION ° I SECOND s I I t ,® 4:mf:?,) STUDY E - 4 OR @ ATT_ 'd STICKER (2 6'X 3'-3'(2'-G'X 3-3'( '-6'X 3'-3'AFP 2'-39 AFF 2'-37AF '-" [ N7. - I � (2'-10'%3'-I0' (2'10'X!1 10'(2'10'X3'-I0' tat AFF3'-2') AT3-27 AFF3 2') TIC oSECOND FLOOR PLAN AT FLOOR PLAN 0 jr SCALE:1/8'=1'-0" SCALE: 1/6'=1'-0" A-003.00 w � : IIII II poii � il� i M Y � n 1 Wr�MW,g� t � �o / 1 %� rGhJ�f�Y�' r�1rGP�rRrrcK�YrArll4Prr�r�w,��✓Rral�o ai.m�,�a„n � � �� III i,� i Ij /