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Home My WebLink About1000-78.-2-30 o �frQ�� TOWN OF SOUTHOLD co im Rental Permit 0488 Owner John Lei Lorena Bloom Occupied as Single Family Dwelling Located at 1240 Glenn Road Southold 78-2-30 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. 6/29/2021 Code Enf ent Official This Notice must be posted by the main entrance at all times Town Hall Annex �y► y SOUTHOLD TOWN 54375 Main Road o - PO Box 1179 Southold, y a Rental Inspection % F" NY 11971-1179 ®,t, • �� Tel: 631-765-1802 Fax 631-765-9502 SCTM # .—a - c7 Date Owner NO rr, Iooln Phone Address 0-y0 6le-An l Zip IJ ct-7 Hamlet Inspector Q Address visible from street? LEVELS SUB 1 2 3 Smoke Detectors (#- bedroom detectors excluded) Carbon Monoxide Detectors (#) Fire Extinguishers (#) Exits(#) BEDROOMS 1 2 3 4 75 . Smoke Detector Alarms (#) V Carbon Monoxide Alarms (#) Egress (windows) (YIN) BUILDING SYSTEMS CONDITION OF PROPERTY /N Heating system maintained/operational Building Interior is clean/maintained Hot water system maintained/operational Building Exterior is clean/maintained Electrical system maintained/operational Property is clean/safe/maintained Mechanical system maintained/operational Handrails&guards present POOLS Yo POOL BARRIERS Y Pool present Pool is completely enclosed' Pool surface alarm and/or door alarm Barrier is a min. 48" high resent POOL GATES Y All openings in barrier less than 4" Self-closing, self-latching Max. 2"clearance @ bottom of barrier Latch on pool side of gate, meets height Barrier capable of being locked &child- requirements proof when unattended COMMENTS: -to L5Sv e - Town Hall Annex Telephone(631)765-1802 54375 Main Road AAFax(631)765-9502 P.O.Box 1179 , Southold,NY 11971-0959 ' rr BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200 (Application must be renewed every two years) (C E�_" Section A. MAY 1 9 2021 Property Information: N Rental Property Address: 1,0,..._, '_ ; "` `T- f r l 2-,4 0 &1 aA .� s�0+40 Ltd._ ,.ki ' 11111 Tax Map Number: 1000 SECTION C�7 d®- -BLQ'CI< Ota ®_ -LOT 0 - 000 SECTION B. OWNER INFORMATION: Property Owner Name: -J0hr _. _OkM%d (.00eACA, LV0VV1 Property Owner Legal Address: Property Owner Mailing Address: 5-03 Suje,�+ I-I 000u) std SID 3 5' 4- - ko I iv-)J_ - A4.e'UUo t 1f__, W.y 117L/'7 - A4e by;I l,,J y 11.7q7 Telephone Number (s): Daytime '7011 Evening ?397�-)S3 emergency. 1-11 IVY Property Owner Email Address: e o h V► a �l oow► l ��-ti�1C �rartt�.�,f.zv�. a�hPrl�scx�elll•Ce�t'� Page 1 of S so Town Hall Annex Telephone(631)765-1802 54375 Main Road _ Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 �� ou BUILDING DEPARTMENT TOWN OF SOUTHOLD 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):; Page 2 of 5 7is;4t'��i• b1J . TowHall Annex r� :M _3i y�} ; 54375 Main Road Telephone(631)765-1802 I'.O ..: _ Box 1179 s�, :.;, ,sF �� i Fax(631)765-9502 Southold,NY 11971-0959 i BUILDING DEPARTMENT Ij , �-� i `�1 'SOWN OF SOUTH' OLD `I �' r t JUN 2 4 2021 Mailing Address of Managing Agent: Telephone.Number(s)': Daytime. # ` ~ ` ' � • - Evening Emergency_ Email Address: SECTION Fa PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: For each Rental Dwelling Unit set forth the Rentai-D:welling Unit i.denfifier(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 occupv Dwelling Unit: Number of rooms in Rental Dwelling Unit:—- ..... Use ��and Dimensions of each room in Rental Dwelling Unit:�ecl!'� 9.:Z,c:%'n tPA i` i 9 I def i Lo a it a�; ZZ- S/2 cmo Page 3 of 5 ko 16 nag* - �F SiVIVlVL ., �` y y' Ml4SET`. arta �� ,•2ND FtOt7R PLM Town Hall Annex 's Telephone(631)765-1802 54375 Main RoadFax(631)76.5-9502 P.O.Box 1179 Southold,NY 11971-0959 VU : � � BUILDING DEPARTMENT TOWN OF SOUTHOLD 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 ❑ 1 am submitting a completed Town of Southold certification form from a licensed architect or a licensed professional engineer. SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFOLK) n p 1WA a. J� &w '1 under Fl , 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 Page 4 of 5 t `�� {.` 5N Town Hall Annex ,. . t " , ? Telephone(631)765-1802 lzw km ' 54375 Main Road ;F.= ." c b 3 Fax(631)765-9502 P.O.Box 1179 - ':aix � '•:' -� Southold,NY 11971-0959 ' . BUILDING DEPARTMENT TOWN OF SOUTHOLD 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 as to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager. Property Owner's N o n -" IW Property Owner's Signatur 1 Sworn to before me this ( �day of 20 a/ Official Notary Public Sign ure and Original Notary Stamp CL AUMA KAUFMAN Notegy No i01State Of Ai KA6350181 WYo Qualified in Nassau mber 7�20a)1 Commission Expires Page 5 of 5 cf (DEC K) -- . L rr a,rabia / 1y!2. I _ ac6e sl 604 tar !� - I�itn�e-coir+ 13f yah Of I� z � 2,Y tj Or • nx q (GAa�c� . Qy'�'cie �treQ«+ is EtfCiR" LAID r - - - - - - - - --- - -- - - - ¢ K"amwm ® SM KM r - -- - - - - -- -- - - � annwNwanow m omm l! ! !Ima iCI1GEt fIQIIBE ® BJ um f m MON FAN M UN 1 ! A.-o ! CURAGE � I Fax t? EA FtQOR g x l 2 , a 8imL JL � a ROt ® tr ® > 2g ® ream (3 I'7 2w 2w Aw� fllBStifA as t1.QOR AAFAa M SF COAD PATIO ON GRADE PLAN a lbl ay TOWN OF SOUTHOLD PROPERTY RECORD GAKU OWNER;;,, 1 STREET VILLAGE DIST SUB. LOT FORMER OWNER N E ACR. S W TYPE OF BUILDING RES. SEAS. VL. FARM COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS .1- r �/.: �� ,. IP SaV � �uA�c� lt'_On!- �•- �",�� / rt^ ,i r, F"/ ,,� p L ._. .5� �� .ti, i i+*�Ili -'�0 — L��. � Ny'�A C:.,•� <..j-,.. i r •i/ t7 tM V I.d ISIYq P 5 �!�oC 2 Tb DC 41�AIi c q GE. BI LD I NG CONDITION 'Vr"'n 11 NEW NORMAL ELOW AB V .l FARM Acre Value Per Value CCD 3?K0 0 / Acre l I. 1 1ct1,05 v561 aro �nTNCtr,rc n. - �� 50 Tillable 1 Tillable 2 Tillable 3 Woodland Swampland FRONTAGE ON WATER Brushland FRONTAGE ON ROAD House Plot DEPTH BULKHEAD Total DOCK a . '~ SSSS■ .■.■■■■■■■■■■■■ — ■■■■■MM■MEN■■■■■■■■■■M■■ •r _- ■■■.�� ■■■■■■M■■.■■■■■■■■■■ ' — MEN ■■■■■■■■■■■■■■■■■■■■ * ' . ' - � ■■■■.� ■MSEN■■■■■■MEM■MO■MM ■...... . ■■■MM■ ■■EMM.■ MM■■■■®■■■■■■■■■■■■■ ■ _ ■O■ M.■ ■■w SEMS■■■■■■■■■■■■ a . SOME■.■ ■WE E■■Ef1■ ■■■■■ ■■■■■■_ ■. ■■■■I..■11■11■■... ■ME ■■■■�.... andation Basement • Recreation Roon, FIN. BJ i FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27988 Date: 10/05/01 THIS CERTIFIES that the building NEW DWELLING Location of Property: 1240 GLENN RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 78 Block 2 Lot 30 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 29, 1999 pursuant to which Building Permit No. 26451-Z dated APRIL 20, 2000 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 COVERED FRONT ENTRY, REAR DECK AND ATTACHED TWO CAR GARAGE AS APPLIED FOR. The certificate is issued to JOHN DEVEAU (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-99-0011 08/27/0 ELECTRICAL CERTIFICATE NO. N 563673 07/11/01 PLUMBERS CERTIFICATION DATED 10/02/01 CHARLES SANDERS Authorized S' nature Rev. 1/81 Town of Southold 2/18/2015 yJfFO(,t �� pry's, P.O.Box 1179 53095 Main Rd ti Southold,New York 11971 631-765-1981 CERTIFICATE OF OCCUPANCY No: 37440 Date: 2/18/2015 THIS CERTIFIES that the building ALTERATION Location of Property: 1240 Glenn Rd, Southold, SCTM#: 473889 Sec/Block/Lot: 78.-2-30 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/8/2015 pursuant to which Building Permit No. 39500 dated 1/22/2015 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"ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Bissell,George&Burkhardt,Patricia (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 39500 02-18-2015 PLUMBERS CERTIFICATION DATED 10-15-2014 Peter Victoria Aut ed ignat re