HomeMy WebLinkAbout1000-67.-2-21.1 of so TOWN F S UTHOLD
Rental Permit
1418
Owner: Kathy Stupak and Maryann Herrick
Occupied as: Single Family Dwelling
Located at: 1100 Huntington Blvd Peconic 67.-2-21 .1
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.
1
Issued: 02/06/2026
Expiration: 02/06/2028 � nc� � ntOfficial
This Notice must be posted by the main entranceotaltimes
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TOWN OF SOUTHOLD—BUILDING DEPARTMENT
' 5 Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 htt s,;"/ Nwsggt:llgtdtc)wnny,,&ov
RENTAL PERMIT APPLICATION C
Rental Permit Fee $300 (Application must be renewed every two years)
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Section A.
Property Information: °
Rental Property Address:
kR 58
Tax Map Number: 1000 SECTION -BLOCK � _ -LOT. - 1
tie caY,i G, 1\3 L t �R S
SECTION B.
OWNER INFORMATION:
Property Owner Name: " «
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address) p..�u►GZn
Telephone Number (s): Daytime _ Evening Emergency
Property Owner Email Address: n 1+
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Page 1 of 4
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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.
ly` SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units)
I" Name of Managing Agent of dwelling unit, if any:
Address of Managing Agent (no P.O. Boxes):
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:
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: 9
Number of rooms in Rental Dwelling Unit: 13
Use and Dimensions of each room in Rental Dwelling Unit: —lie",
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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 afire 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 SUFFOLK)
I VcLJkq 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 247 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: k
Property Owner's Signature: -�
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Sworn to before me this 1-0� day of —10 r) L4 0L r 20�(,
A-1( &Vr,a
Official Notary Public Signature and Original Notary Stamp
CONNIE D.BUNCH
Notary Public,State of New York
No.0 1 BU6185050
Qualified In Suffolk County
Commission Expires April 14,2,,,�
Page 4 of 4
` Telephone 631 765-1802
Town Hall Annex � � � �x, P � )
54375 Main Road "
P. O. Box 1179 "
Southold, NY 11971-0959 w+
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RE TAL PERMIT APPLICATION ADDENDUM
Rental Dwelling Unit Id tifier:
Requested maximum nu ber of persons allowed to occupy each dwelling unit:
Number of Rooms in Rent Dwelling Unit:
Use and Dimension of each om:
Rental Dwelling Unit Identifier:
Requested maximum number of persons all ed to occupy each dwelling unit:
Number of Rooms in Rental Dwelling Unit:
Use and Dimension of each room:
Rental Dwelling Unit Identifier:
Requested maximum number of persons allowed to occupy each elling unit:
Number of Rooms in Rental Dwelling Unit:
Use and Dimension of each room:
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TOWN OF SOUTHOLD BUILDING DEPT.
UN 631-765-1802
INSPECTION
[ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTAXPETRATION
ELECTRICAL (ROUGH) [ ] ELECTRICAL)
CODE VIOLATION [ ] PRE C/O NTAL
REMARKS
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OWNER STREW VILLAGE DIST.F SUB. LOT
SORER OAR r ? r N E A
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RES. - �f SEAS. VL. FARM COMM. CB. MISC. Mkt. Value -
LAND IMP. TOTAL DATE REMARKS
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Extension ` ` Basement Floors � ? 4 K' I
Extension - �L` ;Ext. Walls interior Finish ; LR.
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Extension =Fire Place 3 (t% Heat tr UR.
;Type Roof �.l- - l Rooms 1st Floor `Y BR.
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Breezeway 'Driveway
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Farm . Acre Value Per Acre Value ,
Tillable 1
Tillable 2
Tillable 3
Wcodland 1
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House Plot
oarry� Town of Southold
P.O. Box 1179
53095 Main Rd
Southold, New York 11971
PRE-CERTIFICATE OF OCCUPANCY
No: 46843 Date: 02/06/2026
THIS CERTIFIES that the building PRE-CO
Location of Property: I 100 Iju tin&ytop Bly(t Peconic, NY 11958
Sec/Block/Lot: 67w-2-21.1
Conforms substantially to the Application for Building Permit heretofore, filed in this office dated: 01/15/2026
Pursuant to which Building Permit No. 52655 and dated: 02/06/2026
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:
Wood frame single family dwelling with open front/side porch.
Violations:
None
The certificate is issued to: Marilyn Hofinam�
Of the aforesaid building.
Please see attached Housing Inspection Report.
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A -ized I nature
Housing Inspection Report
Property Info
S TM # 67.-2-21.1 mm µn m_Property Class: 210 ONE FAMILY RESIDENCE
Address: 1100 Huntington Blvd Hamlet: Peconic
Owners: Marilyn Hofmann Condition of Property:.
Structure
Type of Construction: Wood frame Number of Stories: 1
ww .. _..._._ . ...._......w_ .._ ...w.. ._._......_ ...__ ...... ... ,,.... .,_,.w.w w..
........._...._w.,....., .._.._.....M.... __.__w. __m......�...... ......vw_._....,.._w_-�_� umber of Exits: ....,
Foundation Construction:
ctionw.._. Cellar... ..........._........._
Number._....._.__.. s.__...,.ww2-1 __.......,. __._..�.._............W .,.. w
Finished Base ............Garage: _w_._..... .................._._ __...... e
g _..�._ Breezeway: ............... ....._..._,,,,,,,.�.�.�.�...m�w�_ ...........,,,�__Deck.,�y.�. _._......
............._...,.. _....._. .....
Porch T Open
Patio Type: Mudroom:
Building Systems
type of Heater: „Electric .. ww_._._._.__.... ..Fuel Ty : Oil -forced hot air. mqw wµ _ww_ _ww.W. ......vw_.
Hot Water: Yes Electric Panel:
n.� ____.__..........w. _.....�.�.............�..... ..._.._v_.__.... .... _. ...w .� w_.......
Air Conditio,,....nw�.�.�.._.......-w_.....................�
Fireplace:.
Dwelling Components
Sub 1 2 3 Additional Items:
-,,._....Rooms f Floor Levels ............. ,...w - �.....__,... .._....._ . .. �_.. �... � �. � .......... w _�._..__._....., .....-�www�._._..�_...._.w�_,�........ ..�.. _. ww.w .._...
Kitchen i _. w_...._..
Living Rooms _.._....
Dining Room _._.__.w.... ..,_.._
z-Bedrooms �..-..� .w... .....,.w�._...._._........�.�.__._.�........ ...._�.�. ... _w.........................w�.�....._w.w.._........,.,.,....
Bathrooms,.. z _...................._........._m..,w.__............._... ._............................. .......
Toilet Rooms .....,....-...-........ .. .....__
Utility Rooms ..........
..............
-....... _._�.�.�.�..................._..ww...�..
Entry Areas
Other
Accessory Structures:
Garage: Construction
: Foundation:
... _. .._ .... ...__ _........_._..
Barn Construction: ndation
........._.._.w................._....,,,,,,. .......__..,,.....,,.........,,._�w_._._..,,,,,,,,,,,,,,,..................Constructio.n�..,....................,__.,�... ... _... .__....
Shed: Foundation,.:.,w�-....._...........................w_._..,,,,..,...._._�......._......__,,,,....
Sleep Quarters: Kitchen Facilities: Plumbing
S _-_ _..__ �_.
wimmin Pool: _._..,.w. ..._ _ ___...w...........
Other:
Comments:
Violations:
None
Inspected By: John J.Jarski
In e Inspection Date: 02 04 2026
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold,N.Y.
Certificate Of Occupancy
No Z 15117 Date . .November 21.. . .. . 1 19 g 6.
THIS CERTIFIES that the building .F091. . . . .. . , . . ,
Location of Property 3,5, ,$eeond Avenue , „Pe«conic
House No. Street .Hamlet
County Tax Map No. 1000 Section Block 2 . . . . .Lot . . 19 . . . . . . . . . . .
Subdivision . . . . . . . . . . . . . . - Filed Map No . . . . . . .Lot No. . . . . . . .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
Aug . . . . , 1,98r pursuant to which Budding Permit No. . 1517 7 Z .
dated 19 8 6,was issued,and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate 3s issued is . .
. . pQol. . en4�. and_ deck, . . . . . . . . . . . . . . . . . . . . .
The certificate is issued to . . MARILYN Q. HOF_MANN . . , .
(owner, s. It
of the aforesaid building.
Suffolk County Department of Health Approval N/A. :. . . . . . . . . . . . . . . . . . . . . . . . . .
UNDERWRITERS CERTIFICATE NO . . . .N775023 . . . . . . . . µ . . . . . . . .
Budding Inspector
Rev.1181