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Home My WebLink About1000-53.-4-44.7 TOWN OF SOUTHOLD Rental Permit 1382 Owner: Glazer L Trust , Glazer J Trust Occupied as: Single Family Dwelling Located at: 2180 Kerwin Blvd Greenport 53.4-44.7 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. Issued: 10/07/2025 Expiration: 10/07/2027 +E ement offi4 l This Notice must be posted by the main entrance at all times i � eec TOWN OF SOUTHOLD—BUILDING DEPART IVCE T � ry � °��' �* '�' Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 1 I ' 9CE VE Telephone(631)765-1802 Fax(631) 765-9502 lattaµ��rnaatkcleto��!x�a , 1 202 RENTAI.PERMIT APPLICATION BulfrIlng r)"p-,irU,nort Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: / Tax Map Number: 1000 SECTION�C3 -BLOCK �__�LOT . --_ -- SECTION B. OWNER INFORMATION: Property Owner Name: r Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) e0 YL � QZ e - Telephone Number(s): Daytimemq' — (�I�iening_�Emergency Property Owner Email Address: Page 1 of 4 Section C. Authorized Agent Information:Name of Authorized Agent of dwelling unit, if any: Um W11 i Kd 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 prop containing 8 or more renttrits) Name of Managing Agent of�dwelling unit, if any: Address of Managing Agent (no P.O. Boxes): Mailing Addres `of Managing Agent: Telephone Niumber(s): Daytime Evening mergency 7 Email Address: � r 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: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: 146— ) g�k1S 8 OR—L3 ItyII gat Lit ISY \ Q?revLk 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 a fire 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) -� IaZ�p I (,�1�1, �f�;,,, ,�....._.....,,..._...!�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, Managing Agent, or Site Manager. Property Owner's Name: Property Owner's Signature: Sworn to before me this ay of 20_a5 Official Notary Pu c Signature and Or g rual Notary Stamp P ACHY L. DW'YM NOTARY PUBLIC,STATE Of NEW YORK O, t o n�J,!.LIFIED IN SUPFOLKCOUNTY CO ION E, PI EE JUNE 30,ZaVA Page 4 of 4 TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 lN ,5pp =t;Tlo` N [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FIN L) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL DATE /0' 5 INSP''ECTOR. tot Town Hall Annex Town Of Southold 54375 Main Road 1*13 CZ> Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Tel: 631-765-1802 SCTM # 53- Date , 49, 1 Owner Phone Address C240 'e W/01 VV4 Visible Hamlet e 0 Pnspector Floor Level Quantities Sub 1 2 3 Smoke Detectors(not located in bedrooms) Carbon Monoxide Detectors Fire Extinguishers Exits Bedrooms 1 z 2 3 4 5 6 Smoke Detectors Egress Occupant Count Building Systems Maintained&Operational Condition of Property Heating Building interior Hot water Building exterior Electrical Property clean, maintained &safe Mechanical !Handrails&guards installed &secure Pool Safety Pool on Site Surface water alarm Date of CO issuance 4 Door alarms Pool completely enclosed Self closing/latching gates Pool fence to code requirements CO's for all items present Prior Rental Comments: FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24402 Date JUNE 6 1996 THIS CERTIFIES that the building NEW DWELLING 120 SAGS SPUR & Location of Property 2180 KERWIN BOULEVARD GREENPORT NY House No. Street Hamlet County Tax Map No. 1000 Section 53 Block 4 Lot 44.7 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 2 1992 pursuant to which Building Permit No. 21081-Z dated NOVEMBER 13 1992 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 ONE FAMILY DWELLING WITH ATTACHED GARAGE AND TWO OPEN PORCHES AS APPLIED FOR. The certificate is issued to POSILLICO CONSTRUCTION CO. INC. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 92-SO-93 MAY 23r 1996 UNDERWRITERS CERTIFICATE NO. N281898 JULY 6 1993 PLUMBERS CERTIFICATION DATED JUKE 23 1993 ROBERT VAN ETTEN PLUMB & HEAT Building Inspect Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-25228 Date SEPTEtBER 3, 1997 THIS CERTIFIES that the building ACCES.SORY & ADDITION Location of Property 2180 KERWIN BLVD.&120 SAGE SPUR GREENPORT N.Y._ House No. Street Hamlet County Tax Map No. 1000 Section 53 Block 4 —Lot 44.7 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 17, 1996 pursuant to which Building Permit No. 23793-Z dated. OCTOBER 31 1996 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 ACCESSORY INGROUND S'WI' ING POOL & DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to LOUIS S. & DEBRA RUPNICK (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE DATED DEC. 4 1996 - FILE #14265 PLUMBERS CERTIFICATION DATED N/A ui ing I Spector Rev. 1/81 o ow g Q BREAKFAST ale S m .Vs i 2.6dRAiE PtAOR 8•9&.0M'FIIQ9£a Ft.aQR OF FOtJ3EIF GAAJ To o X "AT WrL 1 � 1 _`A, LIVING R3W - G+r 83 670, . . [ .. wa AMC � T � I�a.A'=V PLUMBING _ I capper my is u4ed ff r s g for water dleuuwtiny rptwm piping shall be SOLDER AT ER C?IN t Of hroes K or 4 an SUppLY SYSTEM 'NOT % 9 a �� s��`� EXCEED if 1 LEAS, � '1 ± 1 NEW YOW MATE�ti s .t OF � �� T F'!5m�ww t'.,�cr;t T HOW W.G AxV fX M A" �S'dr4:xM - `. FOR A - i IA �t C P.a�Ptn'4;v ' HAVEE+ HOMES. INC. Jrel r 4T ES € � ss�s s T h S Fly fli CREEK PA e ` F?v `►J �;_..a 9�: � i --_�y- WIN CousTmicno" a € T o as cs cs�4�� t� _ p�L� c�.l is �5g pr`7 FCyp `>R� - 8fi�AAl'("(1V Yid ��lnr.er U CONTIe YCINY{ �L��1�� v A r � CAPE - -. A FIRST FLOOR PLAN s [ 9(37,1 o� tlob WAX s t ? a L Ji it 1 i . 4 i : - f f ; X &° 3 fat � _. - � _ ?- . kE 0.0F2 H 6T•_ _o y' &� Wes' e .ro 4 .c r> f K ASD,,� y OCT 27ft r FOR A'W _ - HAVEN HOMES. IN PA 4 _ BEECH CRMC. PA - a as re 706 r •. -FLOOR PLAN