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Home My WebLink About1000-59.-7-12 Rental Permit 1377 Owner: Glen Hoffman , Barbara Miller Occupied as: Single Family Dwelling Located at: 1855 Kenneys Rd Southold 59.-7-12 Maximum Permitted Occupancy: 4 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- ual in ection. Issued: 09/24/2025 Expiration: 09/24/2027 c de n , t OfficialThis Notice must be posted by the main entran a all times S * 3Ob N C� 4S 1 Oq b TOWN OF SOUTHOLD—BUILDING DEPARTMENT d -w Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone(631) 765-1802 Fax(631) 765-9502 hV:Hw S0 Ut o1dtq n ITgLy RENTAL PERMIT APPLICATION Rental Permit Fee $300(Application must be renewed every tw eo . 2 E l5 Section A. Property Information: Building Department Town of Southold Rental Property Address: 1855 Kenneys RoadJt)Li Tax Map Number: 1000 SECTION 59 -BLOCK 7 -LOT 12 SECTION B. OWNER INFORMATION: Property Owner Name: Glen Hoffman and Barbara Miller Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 205 3rd Avenue#8H 205 3rd Avenue#8H New York, NY New York NY 10003 10003 Telephone Number(s): Daytime 917-750-5577 Evening917-750-5577 Emergency 917-750-8944 Property Owner Email Address: glenhoffmanC&me.com/bamiller2l2ggmail.com Page 1 of 4 SECTION F. PROPERTY DESCRIPTION: 1 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." >010 Rental Dwelling Unit Identifier: 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 Dwelling Unit: Master Bed Kitchen Bath 2(Laundry) 2nd Bed Living Room Den Bath 1 (Tub) 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. 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 Cl�,-IV f_f_-,1UW\) 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, M agin Agent, or Site Manager. Property Owner's Name: Property Owner's Signature: - -� — /� CAROLINE M MACARTHUR Sworn to before'me this J day of �rn�iC_ , 202� Notary Public-State of New York NO.01MA6384635 Qualified in Suffolk County MY commission Expires Dec 17,2026 Official Notary Public Signature and Original Notary Stamp 1p — Page 4 of 4 /g�� mmAN P\�- svAz(6--- b , TOWN OF SOUTHOLD BUILDING DEPT. , n 631-765-1802 INSPECTION ' [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ FI AL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL R ARIAS: DATE INSPECTOR TOWN O Y O _ a STREET VILLAGE DISTRICT SUB. LOT _ N - -- j E ACREAGE - - s S W ' TYPE OF BUILDING R S ! IND CB .n _ •�. VL. � FARM � f � � :;��.f�� MlSC LAND I . .01ADATE _ ....° _.s.- 3 ' BUIL I G, 'ONDITION , 6 g NEW NORMAL BELOW ABOVE: Form Acre Value Per Acre Va ue Tillable 1 _ -- Tillable 2 ' clod, h )v r T Elleble J Ilk l _ j> Wood.ond Swampland Brushland House Plat M 1-7 F# e € 1 l € i -- i � i-- I t t f i __� ._ ..� t 1 .t z F I � _ - I t �4 , - .tea....=^ _tom ..m 59.-7-12 3/6/2023 59-7-12 10/03 -# , , M. Bldg, Foundation Bath Extension BasementE Floors Extension _ Ext. Walls Interior Finish Extension �� - � Fire Place Heat 3 - - Porch Attic fie'' $A� PctC! Rooms Ist Floor } E_€� Breezeway Patio Rooms O-nd Roo, Garage Driveway O. B. I i TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, NEW YORK CERTIFICATE OF OCCUPANCY NONCONFORMING PREMISES THIS IS TO CERTIFY that the / ( Land Pre C.O. #- Z15339 /_/ Building(s) Date- March 11 1987 / / Use(s) located at 1855 Kenny's Road Southold Street Hamlet shown on County tax map as District 1000, Section 059 Block 07 , Lot 12 doesknot�conform to the present Building Zone Code of the Town of Southold for the following reasons: Insufficient total area. On the basis of information presented to the Building Inspector's Office, it has been determined that the above nonconforming /jy/Land /_/Building(s) / /Use(s) existed on the effective date the present Building Zone Code of the Town of Southold, and may be continued pursuant to and subject to the appli- cable provisions of said Code. IT IS FURTHER CERTIFIED that, based upon information presented to the Building Inspector's Office, the occupancy and use for which this Certifi- cate is issued is as follows: Property contains a one story, one family, wood framed dwelling, with attached deck; an accessory shed B.P. 1555Z and C.O. Z1225 and all situated in the A-Residential Agricultural zone with access to Kenny's Road. The Certificate is issued to Dennis and Dorothy Mulligan (owner, )e xwxXwXX%tm x of the aforesaid building. Suffolk County Department of Health Approval A UNDERWRITERS CERTIFICATE NO. N/A NOTICE IS HEREBY GIVEN that the owner of the above premises HAS NOT CONSENTED TO AN INSPECTION of the premises by the Building Inspec- tor to determine if the premises comply with all applicable codes and ordin- ances, other than the Building Zone Code, and therefore, no such inspection has been conducted. This Certificate, therefore, does not, and is not intended to certify that the premises comply with all other applicable codes and regula- tions. ailt,i:r inspector -... V01M NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERICS OFFICE SOUTHOLD, N. Y. x ;44 CERTIFICATE OF OCCUPANCY No. ....... Date ....................J=UaX-Y---23............. 19...62 "!nyls Roa4, SoUthold _......... Street THIS CERTIFIES that the building located at ..............................-............. • Map NcK!tjV!YWqQ.d... Block No. .***.............. Lot No. .................IS.............................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .............6g1#R1tftx..ut......................... 19.61.. pursuant to which Building Permit No-Z--j5&'.%... dated ............... .....1 19...161, was issued, and conforms to all of the requirements of the applicable provisions of the tow. The occupancy for which this certificate is issued is .......... PRIVA" ....OM..!� ........ ................ .........._ ...................................... .............................. ..... � J. Godoundeen, omor Thiscertificate is issued to .... ...... ......... ..I...... .......... ...... ........ (owner, lessee or tenant) of the .aforesaid building. Building Inspector ............ Town of Southold 8/10/2021 P.O.Box 1179 53095 Main Rd Southold,New York 11971 ..........--.......... ......... ............... CERTIFICATE OF OCCUPANCY No: 42223 Date: 8/10/2021 ..........—................ THIS CERTIFIES that the building ADDITION/ALTERATION ............................. Location of Property: 1855 Kenneys Road, Southold . ............... SCTM#: 473889 Sec/Block/Lot: 59.-7-12 ............ ....... ....... Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 10/6/2003 pursuant to which Building Permit No. 34733 dated 6/2/2009 ............ ............... 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: bathroom addition to an existing_ingle f ttiLo&gs,app lie 4fior, The certificate is issued to Hoffinan,Glen&Miller,Barbara of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 34733 7/9/2021 PLUMBERS CERTIFICATION DATED 10/8/2012 M mbing e ting ...... . .... .e Signature �� tifFtlt,f Town of Southold 3/23/2023 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43938 Date: 3/23/2023 THIS CERTIFIES that the building DECK Location of Property: 1855 Kenneys Rd., Southold SCTM#: 473889 Sec/Block/Lot: 59.-7-12 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 7/11/2022 pursuant to which Building Permit No. 48208 dated 8/25/2022 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 single-family dwell.in as a lied for. h The certificate is issued to Hoffman,Glen&Miller,Barbara of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28892 Date: 09 26 02 THIS CERTIFIES that the building DECK ADDITION Location of Property: 1855 KENNYS RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 59 Block 7 Lot 12 Subdivision Filed Map No. Lot No_ conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 26, 2002 pursuant to which Building Permit No. 28122-Z dated FEBRUARY 28, 2002 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 SINGLE FAMILY DWELLING AS APPLIED FOR.m The certificate is issued to GLEN HOFFMAN _.......w _ (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A (W/Y, A Authorized S�.gn� re Rev. 1/81 , C e C _0 dw i F D 00 fo s s na (GI11111t r i ,,1)rrpj "' M1 f r; i "ll" 0// % Oo�Yrrrr rip/ /,ri 41r % / r r r rr�AAi/// +n / / F / r o D