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Home My WebLink About1000-78.-2-22 TOWN OF SOUTHOLD �{. Rental Permit 0803 Owner Jeffrey & Melissa Blum Occupied as Single Family Dwelling Located at 420 Glenn Road Southold 78.-2-22 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. 12/22/2022 L-)t, Code Enforce a Official This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD g Rental Permit 0361 Owner Jeffrey & Melissa Blum Occupied as Single Family Dwelling Located at 420 Glenn Road Southold 78.-2-22 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. 12/22/2022 £ a . Code Enfor-cment official This Notice must be posted by the main entrance at all times 17 w: r � FFOL,i- SOUTHOLD TOWN Town Hall Annex 54375 Main Road Rental Inspection PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 Fax 631-765-9502 r u an ✓/r�� / Ifl J h/ /�� %1 l� f 11 IN, ir.,rri c, 9r1»r''j% % , IN Pr NO lO y LEVELS l n7 ,If 3 l f1„ ,uf ra(I"a! Smoke Detectar ,(#- bedroom°detector's excluded) . Car'bo nMonoxideDetectors (#.) `F:ire,iExtinguishers (#) l=xit ..f ! EEORQO $ Smoke`Detector�glaems (#) ,r Carbon"MonoxidefAlarms (#)` Egress(!wfndav )'';., `r'l );;,„ BUILDING' YST�I�PIS- IONDITtON OF PROPERTY Y He-atlrig'System rnaintairied�n ereti aria) Building Interior is clean'/maintained Hot wafer„syste"m;maintained/operational, Building Exterior,is clean/:maintained', Electrical system mairnaine, operational Probarty is;,dlaa`n;%safel`meintairi et77 ch, rn Intal n /o eratlr nal l anclreils &guards present PiLS P 'OMNRRIER� N Pool present P661 is completely enclosed Pool surface alarm and/or door alarm Barrier is a min.48" high resent”. POOLGATES All.openings in barrier less than 4" Self-closing,"self-latching, - Max. 2"clearance@ bottom of barrier Latoh..on pool,side,of gate, meets height Beerier ca bleof being;locked"&child- - z, , reuirernents . preofwhenatterctd COMMENT$ gHot; TOWN OF SOUTHOLD k Rental Permit Al ik Permit No. 0361 Owner Jeffrey & Melissa Blum Occupied as Single Family Dwelling Located at 420 Glenn Rd Southold 78-2-22 Address S/B/L 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. 11/12/2020 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times . � 76.5-19102 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIO BAULKING [ ] FRAMING /STRAPPING [ ] ANAL J If [ ] FIREPLACE & CHIMNEY [ ] FIRES FETYINSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: - ltb Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 "k Coil BUILDING DEPARTMENT TOWN OF S01UTHOLD RENTAL PERMIT APPLICATION INSTRUCTIONS Rental Permit Fee $200 (Application must be renewed every two yearsl The items listed below are required to be submitted with the completed application. [Floor Plans: Floor plans of each Rental Dwelling Unit, please show location of all smoke &carbon monoxide detectors. ❑ Certificate f Occupancy and Pre-Certificates of Occupancy: Certificates of occupancy or Pre-Certificates of Occupancy for each rental dwelling unit. ❑ Certification of Code Compliance(form enclosed): Must be submitted by a license architect or engineer or license home inspector if an inspection by Town of Southold inspector is declined. ❑ Rental Permit Fee: $200.00 m, /I eJ Town Hall Annex Telephone(631)765-1802 54375 Main Road �:'r Fax(631)765-9502 P.O.Box 1179 e Southold,NY 11971-0959; BUILDING DEPARTMENT D DD TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION UG 2 5 2020 Rental Permit Fee$200(Application must be renewed every two years) 1 LT O'D"F ,, Section A. Property Information: Rental Property Address: l �/ Tax Map Number: 1000 SECTION IrD -BLOCK -LOT SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: s Telephone Number(s): Daytime TJ O - fyening Emergency Property Owner Email Address: • C, 0 P14 Pagel 05 N Telephone(631)765-1802 Town Hall Annex 54375 Main Road W Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 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 a� Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 179 'k 0 I Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime Evening Emergency Email Address: 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: Lk)t' 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 Dwellingrte : ) X�Z• � vvt 1 .. 13.►x Iii. 3�� 2 � `�,Sx fin.3 ��R.c�w� v� :�,•�x LU. r I Page 3 of 5 Town Hall Annex "a Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 i Southold,NY 11971-0959 w� OU +, 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. V*'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. SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) ) COUNTY OF SUFFOLK) 1 Jf t,cl✓✓�, certify under penalty of perjury,the following: 1. 1 am the owner of the propertv 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 d � Town Hall Annex Telephone(631)765-1802 54375 Main Road 31 Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 n BUILDING DEPARTMENT OF SOU"fili""[OLD applicable laws and rules. I further acknowledge that 1 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 Name: Property Owner's Signature: Sworn to before me this day of jeaN1QS�- 20 2-0 I F—CHELSEA L. CHALONE Notary Public, State of New York Registration#01CH6287106 Oficial Notary Public Signature and Original Notary Stamp i Qualified In Suffolk County Commission Expires Aug. 5, 20 2Z. Page 5 of 5 BLUM R;E5IDENCE Floor Plan Layout i I 's` v 3 _ I' IT _ p y �Y st= s _ ic _ h �,Et S E s YOOK i5 TOWN OF SOUTHOLD PROPERTY Il o I &41 to MD OWNERS t STREET VILLAGE DIST. SUB. LOT r FORMER OWNER N E ACR. R . S W TYPE OF BUILDING RES SEAS. VL. FARM COMM. CB. MISC. Mkt. Value LAND IMP, TOTAL DATE REMARKS JI a t : l — ;J: . r, �7 is tea_'� 3 JJ ` J � s d/.•�f�a ti� �� / �� ;� e. 1 fi � AGE = - BUILDING CONDITION - ;. ., 01 a Yt Tillable 1tj� Tillable 2 - � Tillable 3 t = . r Woodland Swampland FRONTAGE ON WATER Brushland FRONTAGE ON ROAD House Plot DEPTH BULKHEAD ' 1 Total IDOCK COLOR t TRIM _ FLI, i m. - - ». 4 i z P I lk�4 "lb 78:2-22 1/30J2020 1 I - i d E s l M. Bldg _ ondation Bath Dinette! } Extension !L4k ? c c� � � }Q Basement Floors < . K. -¢ u — - — Extension - 4 = �, Ext. Walls I ; Interior Finish LR. it✓ _ ._ Extension I Fire Place41 : Heat Crf45, DR. ,Type Roof Rooms 1st Floor BR. Poroma §- _- SRecreotion Rooml Rooms 2nd Floor' I FIN. B t Porch F 1 /_ :Dormer I rs v Breezeway 0Driveway E Garage Patio -�. B. — — --—----- Total Total I a SCTM # TOWN OF SOUTHOLD PROPERTY F OWNER STREET VILLAGE DIST SUB. LOT .£r � - �=° ,� -, �-_em`s \_'.1 i,t°�v-�r-� ��7R Je�t�.��•-.fj'�1 �1`, .�<"�`� -- - _ ACR_ REMARKS r, � y TYPE OF BLD. P - ROP CLASS t, LAND IMP, TOTAL DATE (-,Coo I DO FRONTAGE ON WATER HOUSE/LOT BULKHEAD TOTAL FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY Date .......... ...,..Octobe.r. .ll. .., 19. b6 THIS CERTIFIES that the building located at . . . 43/8 . .Glenn-Road••• • •••• Street "NPMp No. .Cre... BatatA. ck No. .Lot No. .6q.. .8oU.tb01dt. l+1«Y-* conforms substantially to the Application for Building Permit heretofore filed in this office dated . -Mardh. . ..2.-., 19 64. purs cant to which Building Permit No. .2299Z- dated .. . ...... ..- Torah• •3• •-, 19.64, 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 . ..Fr&vate•one•faxiiy, 11IMC.. . . . . The certificate is issued to . .3=03t.& .4aT01d•Zai #b r ssee.or-Owner . of the aforesaid building. Suffolk County Department of Health Approval . . .fit.-8j-vW By. R:vina . .... • I u I,ng Inspector . FORM No.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. . .G12390, . Date . . . . March 28. . . . I .. . . . ., 19 84 THIS CERTIFIES that the building .77.deck.addition • . . , , • • • , . , .. , ,, , , ,, , , ,, , , , , of Property Glyn, f?o d southold Location 1? Y , 8 . . . . . . . . . . . . . . . Street:. . . . , . . . . . • " let Home No. County Tax Map No. 1000 Section fl. . . • . —Block :. .�2. • . . . . .. . •Lo# • ;022 . • • . �,r West Creek Estates .Filed Mag No. Subdivision . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated March 26 1988, pursuant to which Building Perrctit No. 12943 Z: , •. ,. , -dated March 27 . . . . . 19 .8`1,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 . . ..., a. deck addition to existing dwelling, • . „• • ♦ . • r • • . r • r . • • • • . . • . . • • • • • . . • . . . • r • • • . • • • e . • . The certificate is issued to RONALD & LUCILI., BACKHAUs , , , • , , , , ,:, . . . . . . . "(r�iaer„,« ' °teziztrrdd� of the aforesaid building. Suffolk County Department of Health Approval . . . . N��. , . . . . . .• • UNDERWRITERS CERTIFICATE NO. . . . . , • , . . N/A« » » « » « « . . „ • « „ „ ° « Building Inspector r+oy.i/si FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY I No Z-20283 Date OCTOBER 16 1991. THIS CERTIFIES that the building. ADDITION Location of P`d t ' 40 GLENN ROAD SOU TOL N.Y. House No. Street Hamlet County Tax Map No. 1000 Sct: BU� BM•+ +" Lot 22 Subdivision Filed Hap No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 10 1991 __pursuant to which Building Permit No. 0090.•Z datoA. SLY 29 1991 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 ENLARGE EXISTING DECK ADDITION TO ONE FAMILY DWELLING The certificate is issued to PAUL & RITA ,HOLOBIGIAN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO- PLUMBERS CERTIFICATION DATED N/A I-X�"tz", - r Building Inspector Rev. 1/81 �'grkttl �¢ Town of Southold 9/24/2020 P.O.Box 1179 53095 Main Rd ` Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41466 Date: 9/24/2020 THIS CERTIFIES that the building ADDITION/A :1"13 AI"ION Location of Property: 420 Glenn Rd, Southold SCTM#: 473889 See/Block/Lot: 78.-2-22 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/21/2019 pursuant to which Building Permit No. 43809 dated 5/30/2019 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: alt rat ons s a € it o l c covor !t a It e t ipa r wn&pool with depkjjurround and outdoor show x._ r p e i titi one family ll gas applied for. The certificate is issued to Blum,Jeffrey&Melissa of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL F.T.ECTRTCA1— CERTMCATE NO. n2Qnn 0/1 c TJ V Vl 11 1J/LVtV PLUMBERS CERTIFICATION DATED 11/13/2019 rad Piecuc t ` igtature TOWN OF SOUTHOLD r BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICTIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 43809 ..__ _.._�...�.....�..._�.�......�.... Date: 513012019....�....��..�,�.., ....�.. .,.._� Permission is hereby granted to: Bluml�efr� 60 Water St A t 311 _._. .....M ..... .... __. ...... Brook! n NY 11201 _....._. .. ..... ___....... w ._w�.. ...... ......__.._M.. .. .. .... . .. ._.w.......... .. . .... ....., To: make additions and alterations to an existing dwelling as applied for. At premises located at: 420 Glenn Rd, Southold ..._.... .. ._..._ SCTM # 473889... .. _._..._......_ .........._ .... _. .. - .......... . w...... .. w...._ Sec/Block/Lot#78.-2-22 ....... . ._w_ ........ .... ._.. ....... _,..... w Pursuant to 211,201 dated application �5/ 1 � and approved by the Building Inspector... p To expire on 1112812020. Fees. _�.�.�.�.�. SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $1,174.40 CO -ADDITION TO DWELLING $50.00 $1,224.40 Building Inspector