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Home My WebLink About1000-70.-9-28 TOWN OF SOUTHOLD Rental Permit g c R 0580 Owner Gregory Safran Occupied as Single Family Dwelling Located at 200 Breidstadt Court Southold 70.-9-28 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 t -annu pec on. 1/25/2022 od_ n mento icia This Notice must be posted by the main entrance at all tim " °i so# Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-950: P.O.Box 1179 Southold,NY 11971-0959 I " p SEP 1 4 2021 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION 0 -BLOCK -LOT 9- SECTION B. OWNER INFORMATION: Property Owner Name: f ` G'AU(& Property Owner Legal Address: Property Owner Mailing Address: GO �Ce-;4 4,,J� 0, d So✓- -L 0.1.1 !V -3,1 Telephone Number (s): Daytime Evening� Emergency Property Owner Email Address: gr e" r Page 1 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box I t79 Southold,NY 1 1971-0959 C BUILDING DEPARTMENT TOWN OF SO J"" 'HOLD Mailing Address of Managing Agent: Telephone Number (s): Daytime Evening Emerg n+cy Email Address: SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: U 1� 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: n d Requested Maximum number of persons allowed to occupy Dwelling U Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: t, K,2 : i2S XdD 1 'L l � ��b� 3 ; �) x °� �� 'f� l2. 5 Page 3 of 5 F Town Hall Annex AL Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 coum 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. la' 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) I 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 *14f so Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOM 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 Name: C r Property Owner's Signature: Sworn to before me this_„day of 20 r Official Notary Public Signature and Original Notary Stamp r< J Page 5 of 5 y o CT- TOWN OF SOUTHOLD BUILDING DEPT. 7651802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAUL IN [ ] FRAMING /STRAPPING [ ] NAI. " [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY IN,S CTI [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O UAX DATE �lN M 1 301 2-1 INSPEC,7TORJ SECOND FLOOR bedroom bathroom bedroom 11.5x9 8.5x9 12.5x10 stairwell } bedroom bedroom bathroom 12.5 x 13 11x9 8x7 Powder rm Kitchen 13 x 11.5 laundry room 7.5 x 10 1 I� living/dining YY 15,5 x 22.5 stairwell office 11.5x13.5 °nj0'm iw�m mulWmm^m�mut we m q m0, m�ummm is i +mmuuwRm w ummnui°tm as , TOWN OF SOUTHOLD PROPERTY RECOR A/I- OWNER STREET VILLAGE DIST- SUB LOT if F e (4 C kElACR. REMARKS,- la TYPE OF BLD. -7 0-704- jt<)-7 1 t-A rwrsd poo f fcr L PROP. CLASS A) 7 hJ 0 9 6 p�:.T- ul rlz-2 re,roac L5 3,12 q 17 LAND IMP TOTAL DATE 3:4-F z5 'o k7-1 7-0 CaLh .-v p6Atls—W lI FRONTAGE ON WATER TILLABLE FRONTAGE ON ROAD WOODLAND DEPTH MEADOWLAND I BULKHEAD HOUSE/LOT TOTAL mc TOWN OF SOUTHOLD PROPERTY RE jOWNER pj) ISTREET VILLAGE DIST.' SUB. LOT L3 t - FORMER OWNER aillt( rf!ale N E ACR, k- pi, lap # wS W TYPE OF BUILDING SEAS. ` VL. FARM COMM, CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS lb r z- �\N AA 7 pe" 9 37-1 1 4 -s' e--.-4"', e"--- 1:3 q 4. c , L flit-; /v AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE q1 �q-Z-j 14-11 /-rc,-v 5�1 0� I Z 3S-2 FARM Acre Value Per 1 Valuet--f- Acre I �� 12�" U-5 J wmf,- j C-) Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH House Plot BULKHEAD Total DOCK DLOR TRIM - F i- r v E _ 1 I I € 1 3 Tiff, - a° , 3 t. E [ I 70.-9-28 zeas - €� , } 4— IL1 I 1 77— IM. Bldg. . 3 > _ i Extension C) E Extension ' i j 3 F A Extension C ,•::.. �# E Foundation ��-t' �S? 1130th ;Dinette I ; Reams _ ;Basement I .Y. _ Floors IK i n �_ _ y Parch' x� Ext. Walls, _ ,>w = J1L Interior Finish SLR, _Breezeway Fire Place Heat ; µ 'DR. i Garage Type Roof Rooms lst Floor I 6R, Patio I ;Recreation Room € Rooms 2nd Floor FIN. B O. B. S i is Dormer ;Driveway Total ; � � i - FO$M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Date . . . . . . . . . . . . . . :; , ", . �', 19.7f. THIS CERTIFIES that the building located at . ftj*tSW!t ,G .-Btre Map No.SuM !U .Mock No. . . . . . . . . . .Lot No. 15 . . . . AfRO !. . A.1.. . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . 00t . . . & . . . . . .. 19,70. pursuant to which Building Permit No. 4"X. . dated . . . . . . . . . Det. . . .8. . . . .. 1970. ,, 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 .PtAT00. . . XOWLAY.0013U9. - - . . . . . . . . . . . . . . The certificate is issued to . .Fer .Mlrp 3r. . . . .Owaor . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Mar. . .24. .49?1. . .by, R .Yi Building Inspe FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. . . 536 . . . . Date . . . . . . . . . ..&WM4. . . . . . . .. 19 73 . THIS CERTIFIES that the building located at ArIOAUdt. .G4lrt . . . . . . . . Street Map N $44. Block No. .=. . . . . .Lot No. 15. . . . . . . . . AQV%hQj'40. AVT.*. . . . Park conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . . .ApTU .30.9., 19.73. pursuant to which Building Permit No. .652= . dated . . . . . . . . . . .APrJA .30* ., 19.73., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issuedis . . . &t0 .M44. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . .. . . . . . The certificate is issued to . .ft .wok.Wober. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . .. . . . . . . . . . . . . . . , UNDERWRITERS CERTIFICATE No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .. . . . . . . HOUSE NUMBER . .200. . . . . . . . . Street . Briotatadt. gourt . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Southold.$. N.X., . . . 11971 . . . . . . . . . . Building Inspector " Town of Southold Annex 6/24/2013 P.O.Box 1179 54375 Main Road Southold,New York 11971 "o CERTIFICATE OF OCCUPANCY No: 36307 Date: 6/24/2013 THIS CERTIFIES that the building fN GROUND POOL Location of Property: 200 BREITSTADT COURT, SOUTHOLD, SCTM#: 473889 See/Block/Lot: 70.-9-28 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 7/6/2009 pursuant to which Building Permit No. 36888 dated 12/27/2011 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: It cssor iia around srrrzaza poo!with flee to code as aatlilar. The certificate is issued to MERYL GREENBAUM ..__ .. ....._. ..... ..,.. _..._ _.(ow..__......... �._...._._ . _� w. .... .... N ER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ... .... . ........ 36888 _ _ .... . ELECTRICAL CERTIFICATE NO. 6/12/13 PLUMBERS CERTIFICATION DATED —... ..:. Aut....... Pure h z ign 1 f Town of Southold 2/6/2023 P.O.Box 1179 53095 Main Rd Southold,New York 11971 ,m. CERTIFICATE F OCCUPANCY No: 43 821 __ 23 Date: .�...._ 2/6/20.................._...___.. ..W._._. THIS CERTIFIES that the building HVAC Location of Property: 200 Breitstadt Ct., Southold SCTM#: 473889 Sec/Block/Lot: 70.-9-28 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/10/2022 pursuant to which Building Permit No. 47375 dated 1/24/2022 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: IV knilt" EIT1 sa P p lied,1(al. The certificate is issued to Safran, Gregory&Laura of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 4.7375 - 2/4/2022 PLUMBERS CERTIFICATION DATED t orij Signa.. ..... ture