HomeMy WebLinkAbout1000-88.-1-1.3 a -
�� }ff' Rental Permit
Permit No. 0120
Owner Leor & Kristen Shapiro
Occupied as Single Family Dwelling
Located at 725 Jacobs Lane Southold
Village
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.
5/19/2021
Code Enforcement Official
This Notice must be posted by the main entrance at all times
SOUTHOLD TOWN Town Hall Annex
54375 Main Road
Rental Inspection
PO Box 1179 Southold
� NY 11971-1179
T
Tel: 631-765-1802
Fax 631-765-9502
SCTM # 8e 1 jo3 Date
Owner SIS✓-�P vz-o Phone
Address `7�S �i�co�s LANE- Zip
Hamlet ���-e`d7�6o(.� Inspector
Address visible from street?
LEVELS SUB 1 2 3
Smoke Detectors (#-bedroom detectors excluded) /
Carbon Monoxide Detectors(#) ( -�2
Fire Extinguishers(#) p O d
Exits
BEDROOMS 2 3 4 0
Smoke Detector Alarms
Carbon Monoxide Alarms
Egress(windows) (Y/N) '
BUILDING SYSTEMS tY/ CONDITION OF PROPERTY Y/N
Heating system maintained/operationalBuilding Interior is clean/maintained
Hot water system maintained/operational Building Exterior is clean/maintained
Electrical system maintained/operational Property is clean/safe/maintained
Mechanical system maintained/operational Handrails&guards present
POOLS Y/N POOL BARRIERS Y/N
Pool present Pool is completely enclosed
PoopresentBi
nd/or door�Nrm AV�I � Barrier is a min.48"high
POOL GATES Y/N All openings in barrier less than 4" }%
Self-closing, self-latching Max. 2"clearance @ bottom of barrier
Latch on pool side of gate, meets height l/ Barrier capable of being locked &child- V
requirements J proof when unattended
COMMENTS:
Town Hall Annex Telephone(631)765-1802
54375 Main Road
1F % Fax(631)765-9502
P.O.Box 1179 ��i� g of
Southold,NY 11971-0959
BUILDING DEPARTMENT
Wi 1 2 2021 TOWN OF SO 'MOLD
RENTAL PERMIT APPLICATION
Rental Permit Fee$200(Application must be renewed every two years)
F,
Section A.
Property Information: ,
Rent'al Property Address:.
.
,., 0
Tax Map Number: 1000 SECTION EY--BLOCK--I--LOT I J
SECTION B.
OWNER INFORMATION:
Property Owner Name: sl',C
�cAP)Y2
Property Owner Legal Address: Property Owner Mailing Address:
rJ4 41
Telephone Number(s): Daytime EveningEmergency
g Y
Property Owner Email Address:
p Y
i���, (Q k I L ® mall , ctv,^
Page 1&S
—Bargain and Sale Deed,with Covenant against O,antoes Acte—Individual or Corporation(Single Sheet)
CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT—THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY.
THIS INDENTURE,made the 15th day of January,in the year 2021
BETWEEN Vito Plaia and Marilyn Plaia,his wife,both residing at 725 Jacobs Lane,Southold,New York 11971
party of the,first part,and Leor Shapiro and Kristen Shapiro,his wife,both residing at 26 Kenworth Road,Port Washington,
New York 11050
party of the second part,
WIT ESSE"I H,that the party of the first part,in consideration of Ten(10.00)dollars
paid by the party of the second part., does hereby grant and release unto the party of the second hart,the heirs or successors
and assigns of the paw"of the second part forever„
t certain lot, piece or parcel of land,with the buildings and improvements thereon erected,bounded
lying d and,being
ALL flea p more
particularly bounded and.described as
in the Town of Southhold, County of Suffolk and State of New York being
follows:
e intersection of the northwesterly side of Jacob Lane with the
EECr
O at a point on the northwesterly side of Jacobs Lane, distant 631.07 nortlaeaster'ly as measured along the
northwesterly side of Jacobs..Lane from the corner fiaiTne y
northeasterly side of Main Bayview Road;
orth 59 degrees 30 minutest
20 seconds west 291,21 fee
RUNNING THENCE from said point of begiruiing n
THENCE north 28 degrees 18 minutes 10 seconds east, 1.50,00 feet;
59 degrees 30 minutes 20 seconds east,291.21 feet to the northwesterly side' weof Jacobs Lane;
st 50,00 feet to the point
THEN south g y degrees 1. minutes 10 seconds
THENCE along the northwesterly side of Jacobs Lane south 2g
or place of 13Ef"xINN
New York 11971
SAID premises being known as 725 Jacobs Lane,Southold!, .dated December 16,2011 recorded December 29,2011 i
Intended to be the same premises described in Deed f Suff+�l ,.
Being and " streets and roads
g87 in the,Office of the+ lewrk of the county and to any
Liber 12fag0 pageof the party of the first p appurtenances and all fixe estate and
T0013THER with the slap ranted unto the
t title and interest, if any, TO HAVE
AND"fO IlOLD the premises herein g
TOGETHER with all right, reeriiss to Ilia center lines thereof;
abug the above described p pr of the secohd part forever.
coed'f the f"trt p�in and to said p s of the p the said
Of
right' of e p art,the heirs or successors and
assigns where y
p�of the se p arty of the first part has not clone or suffered anything art will
of the fprst part covenants that the p t as aforesaid. covenants that the party of Ilia fust p
AN) the ply an way whatever,earcep funto be applied
beerhe first part, in compliance with Section 13 of the Lien Lave, pim I of the cost of the
premises have oTt encumbered ttt y a, 1 dee seine first to tile'1? ail tae construed as if it
encs and, hold the rightito rep a such consideration as a trust
ANIS the p� roveinent and p
the,cost of tine Iml a for ant,other purpose„Tile word pal
receive the consideration afo�this convey
first for the purpose of p art of the total of the tai es.
so red year
first above written.
improvement before using y p e soured this deed the day and y
red`parties"whenever tine sense of this indenture art has duly
IN WITNESS WHEREOF,the paw"of the first p
IN p OE 1", VITO PLAIA
t.
hqp ,,LYN PLAIA
Town Hall Annex pfM Telephone(631)765-1802
54375 Main Road 9 t 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
Town Hall Annex t, Telephone(631)765-1802
54375 Main Roadl % Fax(631)765-9502
P.O.Box 1 179
;r �
e "
Southold,NY 11971-0959 �, e
�u
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:
Requested Maximum number of persons allowed to occupy Dwelling Unit: (D "
Number of rooms in Rental Dwelling Unit:_�A
Use and Dimensions of each room in Rental Dwelling Unit:
Page 3 of 5
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 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.
W 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
1, , 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
6
Town Hall Annex Telephone( 1)765-1802
543751Vbm Road Fax(631)765-9502
P.O.Box 1179
Souftgd,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
applicable laws and rules. I further acknowledge that 1 will notify the Town of Southold
I
Building Department of any changes of addss within
received3. 1 have read and r 207 of the Code of the Town of Southold and
agreed to abide by the same,
® 1 will notify the Town withinbusiness information
regarding Authorized Agent, ManagingAgent,or Site Manager.
Property Ownees amen ' � ,�
Property Ownees Signature.
�tjl
Sworn to before me is-day of f
Official(Votary Public Signature and Original (Votary Stamp
ALAN IL HOOM
N1111"PWft ftft of"M Fr 7
2 ...
„
e
* TOWN OF' SOUTHOLD BUILDING DEPT.,
765-1802
INSPECTION
[ ] FOUNDATION 1ST ] ROUGH PLBG.
[ ] FOUNDATION 2ND INSULATION
[ ] FRAMING /STRAPPING FINAL `L
� T
[ ] FIREPLACE & CHIMNEY [ FIRE SAFETY I SPC ION
{ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL"(ROUGH) [ ] ELECTRICAL (FINAL)
I -
[ ] CODE VIOLATION [ ] CAULKING
ARKS-
(OVA/ eiv *ik/
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DATE
IbINSPECTOR `
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FORM NO. 4
TOWN OF SOUTHOLD
EUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
NO: Z-30272 Date: 06/"30/04
THIS CERTIFIES that the building D7EW DWELLING
Location of Property_ 725 JACOBS LA SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No_ 473889 Section 88 Bloch 1 Lot 1.3
Subdivision Filed Map No. Lot No.
Y
conforms substantially to the Application for Building Permit heretofore
i
filed in this office dated _ MAY 9, 2003 pursuant to which
u
Building Permit No. 29431-Z dated MAY 28, 2003
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificaze is issued
is ODJE FAMILY DWELLING WITH COVERED WP-;),P AROUND PORCH PS7D ATTACHED TWO CAR
GARAGE AS APPLIED FOR.
... .......... ...... �.
The certificate is issued Lo WILLIAM E & MELISSA DOL_AN III
(OWER)
of the aforesaid building_
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-02-0024 05/25/04
ELECTRICAL CERTIFICATE NO.. 3977 03/24,/04
PLUMBERS CERTIFICATION DATED 02/09/04 WILLIAM SCHVIAUB
A a11rized Signature
r
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-31178 Date: 09 26'/'05
TMS CERTIFIES that the building ADDITION
Location of Property: 725 JACOBS LA SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 88 Block 1 Lot 1.3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 2 2004 pursuant to which
Building Permit No. 30545-Z dated AUGUST 5, 2004
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.
The certificate is issued to MELISSA & WILLIAM E. DONLAN III
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO_ N/A
PLUMBERS CERTIFICATION DATED N/A
"thorized Signature
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-31179 Date: 09/26/05
THIS CERTIFIES that the building ACCESSORY
Location of Property: 725 JACOBS LA SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 88 Block 1 Lot 1.3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 10 2004 pursuant to which
Building Permit No. 30437-Z dated 'rUfl�� :2:1, 2004
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 SWIMMING POOL IN THE REQUIRED REAR YARD WITH FENCE
TO CODE AS APPLIED FOR.
The certificate is issued to MELISSA & WILLIAM E. DONLAN III
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 4453 07/27/04
PLUMBERS CERTIFICATION DATED N/A
Ax h r.
ized Signature
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-33672 Date: 04/27/09
THIS CERTIFIES that the building ALTERATION
Location of Property: 725 JACOBS LA SOUTHOLD
(HOUSE NO.) (STREET) _ mm (HAMLET)
County Tax Map No. 473889 Section 88 Block 1 Lot 1.3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 2,. 2008 pursuant to which
Building Permit No_ 34055-Z dated JULY m11, 2008
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 "AS BUILT" BASEMENT ALTERATION AS APPLIED FOR.
The certificate is issued to WILLIAM E & MELISSA DOLAN
(OWNER) ..�......................�__
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NA
ELECTRICAL CERTIFICATE NO. �� 88781 03/15/09
Y,
PLUMBERS CERTIFICATION DATED
,zKjulorized Signature
Rev. 1/81
- - .,,.
TOWN OF SOUTHOL
I CIO
Rental Permit
a
Permit No. 0120
Owner Vito & Marilyn Plaia
Occupied as Single Family Dwelling
Located at 725 Jacobs Lane Southold 88-1-1.3
Address Village S/13/1-
Maximum
/B/LMaximum 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.
7/23/2019 John Jarski
Date of Issue Code Enforcement Officer
This Notice must be posted by the main entrance at all times
SO,&
1
Town-Hall Annex Telephow(631.)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
outltol YtI 71-0959
4
BUILDINGDEPARTMENT
"4OWN OF
RENTAL PERMIT APPLICATION
W' ? '
Rental IIP irrvik Fee$200(Application inusf be renewed evvy two years)
Section
Property Information:
Rental Property, ddress;, :
EV
Tax Map Number• 1000 SEC -LOT "
SECTION B.
a
r
Property Owner Name:
Property O' rhee'L ; al Address :Property Owner,�Mai,lingAddress:
Address,
- o
D
Telephone Number (s): Daytimes GErering Emergency , ly�
Property Owner Email Address: ✓ �� I
Page 1 of 5
S01AJ k"
Town Hall Annex Telephone(631)-765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1 179
Southold,NY 11971-0959
Cou
BUILDING DEPARTMENT
TOWN OF SOUTHOID-
Section C.
Authorized Agent Information:
Name of Auth S '� Ll� �
riz dwellingunit, i any:
JJ
B
Address of Authorized Agent (no P.O. Boxes): 1;! Ncam I�OA �
Mailing Address of Authorized Agent:
1p
Telephone Number(s): Daytime � �; ^ Hing :::�m:.�:g..r�y
Email Address:.. _ 0"FO, ..(
Section D.
Managing Agent Information:
Name of Authorized Agent of dwelling unit, if any:
Address of authorized;A ent 1(qq P.O Boxes):.
Mailing Address of Authorized Agent:„
Telephone Number(s): Daytiar e; i veer ing Emergent
Email Address:,—.
p_
SECTION_E.
INFORMATION:(r 'ulre for rental properties containing 8 or,more rental units)
Name of Managing Agent of dwelling unit, if a
Address of Managing Agent (no P.O. Boxes):
Page 2 of 5
$0 '
Town Hall Annex Telephone(631)76:5-1802
54375 Main Road tn. Fax 1(631)765-9502
P.O.Box 1 179
Southold,NY 11971-0959
eou
BUILDING DEPARTMENT
TOWW OF SOUTHOLD
ladling Address of Managing Agent:
Telephone >r , : ber(s): Daytime Evening Emergency
ti
F.ini Address:
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on propertyi
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 ip,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'Per'r7nit'Application
Addendum."
Rental Dwelling Unit Identifier:
Requested-Maximum hum ber-of persons allowed to occupy Dwelling U111
Number of rooms in Rental Dwelling Unit:
Use and Dimensions of each room in Rental Dwelling Unit:
Page 3 of 5
Town Hall-Annex Telephone(63:1)765-1802
'54375 Main•Road Fax(631-)765-9502
Y.O.Box 1 179
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SGUTHOIM
SECTION .
INSPE l
Pursuant to.the Imown Co e,of the 7Q n.of Southold Chapter 207" (Rental tP;roper ips),,a safety
inspection y 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
Preventlon,.I3uildirr --Code O I-t;if 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: gffolk.and
_. n
y the laws adopted by the New York State Fire Prevention and Building Code Council.
^" C ..16 � bra ."M�. a ✓L:. :. : .' ti! ".�• ;. r..':' :' .:' ' i i':'�,r' ' �d" '
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 To `of;Southold certification form,from a Iicensed,,
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 I r 0 certify lander penalty of perjury; the following:
1. I am the owner of the property identified in 'Section A`g ofthi "acppj)� i. ;r��•.e.
2. The property owner's legal address set forth in "Section B" o ::thgs-a ,pwllca c"'j JO y legal
address and I understand the Town will use the address for service pursuant to all
Page 4�of 5
Town-Halt Annex Telephone(631).7.65-1802
54375"Main Road Fax(631)765,9502
coo
P.O.Box 1179
Southold,
179Southold,NY 11971-0959
BUIL ING` EP.A T ENT; :
applicable laws and rules. I further acknowledge that I will notifythe Town of Southold
lii iiiidbin ,bel arty c�i ` wf anyllmiul °f Ve ( ) day of ahy
wr ,.
3. I h c �" :`'p y of h ytf� y07'of time Cod `i4 fli ri ll!'Of S0U' iw"ply' yd
vc rri �m�I r � iii��..�i a �
u� dao"` l'l l:)y the Suiym
4o i will notify the Town within five (5) business days as to any change to the information
regarding Authorized Agent, Managing Agent, or Site Manage'r.
; Iw .
, it ..
Property w�. i .r-s' anL :, '
Property Owner's Signature
Sworn to before me this ` day of� , 01
ficial Not Public Signature d Oripinal.,.NotarySta��p I �
TRACEY L. DWYER
NOTARY PUBLIC,STATE OF NEW YORK
NO 01OW63 69010
QUA JFIEC'IN`SUFFOLKCOUNTY
COMMISSION EXPIRES JUNE 30,2
Page-5 of,
TOWN OF SOUTHOLD BUILDING
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] FINAL &hd `
[ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION
{ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
I
[ ] ELECTRICAL;'(ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y_
CERTIFICATE OF OCCUPANCY
NO: Z-30272 Date= 06/30/04
THIS CERTIFIES that the building __......NEW DWELLING
Location of Property_ 725 JACOBS LA SOUTHOLD_
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 88 Block 1 Lot 1.3
Subdivision _ Filed Map No. Lot No.
i
conforms substantiallV to the Application for Building Permit heretofore
r filed in this office dated _ MAY 99, 2003 pursuant to which
Building Perrtrit No. 29431-Z dated MAY 28, 2003
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this cerzificate is issued
is ONE FAMILY DWELLING WITH COVERED WRAP AROUND PORCH AND ATTACHED TTQO CAR
GARAGE AS APPLIED FOR.
The certificate is issued Lo WILLIAM E MELISSA DOL_AN III
(OWNER) �-
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL, R10-02-0024
ELECTRICAL CERTIFICATE NO. 3.977 03,/2 /0„4
PLUMBERS CERTIFICATION DATED 02/09/04 WILLIAM SCHViAUB _
P'. 11ized Signature
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-31178 Date: 12216/05
THIS CERTIFIES that the building ADDITION
Location of Property: 725_ JACOBS LA SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 88 Block 1 Lot 1.3
Subdivision Filed Map No. Lot No_
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 2, 2004 pursuant to which
Building Permit No. 30545-Z dated AUGUST 5, 2004
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.
The certificate is issued to MELISSA & WILLIAM E. DONLAN III
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO_ N/A
PLUM3ERS CERTIFICATION DATED N/A
�uthried Signatu re
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-31179 Date: 09Z26ZO
THIS CERTIFIES that the building ACCESSORY
Location of Property: 725 JACOBS LA SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 88 Block 1 Lot 1.3
Subdivision „m_ mm Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 10 2004 pursuant to which
Building Permit No. 30437-Z dated JUNE 23, 2004
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 SWIMMING POOL IN THE REQUIRED REAR YARD WITH FENCE
TO CODE AS APPLIED FOR.
The certificate is issued to MELISSA & WILLIAM E. DONLAN III
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL, N/A
ELECTRICAL CERTIFICATE NO. 4453 07/27/04
PLUMBERS CERTIFICATION DATED N/A
1
A horized Signature
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-33672 Date: 04/27/09
THIS CERTIFIES that the building ALTERATION
Location of Property: 725mm JACOBS LA SOUTHOLD
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No- 473889 Section 88 Block Lot 13 1 mmmm ..,...m
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
............... ........
filed in this office dated JULY 2, 200808 Pursuant to which
Building Permit No. 34055-Z dated JULY 11, 2008
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 "AS BUILT" BASEMENT ALTERATION AS APPLIED FOR.
The certificate is issued to WILLIAM E & MELISSA DOLAN
--- (OWNER............�_......_....................
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NWA
ELECTRICAL CERTIFICATE NO. Dnp 8781 03/15/09
r
PLUMBERS CERTIFICATION DATED
..A. .._._
zed Signature
Rev. 1/81