HomeMy WebLinkAbout1000-59.-5-14.1 � � E TIOW. - N OF SOUTHOLD
Rental Permit
0080
Owner 1205 Lake Drive LLC
Occupied as Single Family Dwelling
Located at 1205 Lake Drive Southold 59.-5-14.1
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.
6/7/2023
official
This Notice must be posted by the main entrance at all times jodefor
x
Town Hall Annex Telephone(631)765-1802
54375 Main RoadFax(631)765-9502
P.O.Box 1179 ' C�?
w�
Southold,NY 1 197 1-0959 s '�
f
BUILDING DEPARTMENT
TOWN OF SOOT OLD MAY 2 6 20P-
RENTAL PROPERTY CERTIFICATION
Form is to be completed by a license architect, licensed engineer or licensed home inspector
Separate form is required for each individual Rental Dwelling Unit
f"ro essional seal rerired + r architect or Fn irleer Licensed dome ins actor mast rovide
coAV ooJ valid current cerci i ation
Rental Property SCTM Number: '_
Rental Property Address: 0�r
Owner/Name: w
I ,
Rental Dwelling Unit Identifier:5 irl cx Ll t:n
Number&Square footage of each bedroom as depicted in the attached floor plan:
(i.e. Bedroom#1 -100 sq., Bedroom#2-90 sq., etc.)
g � h^ cx
Property Description (Include all improvements indicated on survey)
I certify that I have done a physical inspection of the subject rental dwelling unit and find that it
fully complies with all the provisions of the Code of the Town of Southold,the Residential Code
of New York State,the Building Code of New York State,the Plumbing Code of New York State,
the Fuel Gas Code of New York State, and the Energy Conservation Construction Code of New
York State.
Print Name and TitleD Original Signature
` ,
Please place professional seal: -
,h 01 24
OP N
l
4 �F � �a TOWN OF SOUTHOLD
t� Rental Permit
Permit No. 0080
Owner 1205 Lake Drive LLC
Occupied as Single Family Dwelling
Located at 1205 Lake Drive LLC Southold 59-5-14.1
Village
Maximum Permitted Occupancy 6
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.
6/7/2021
de En rte ent tial
This Notice must be posted by the main entrance at all times
Sf S 011
• � �®�'iia �=P 02�2�
Town Hall Annex tt AG./ t Telephone(631)765-1802
54375 Main Road `CA 9 _ Fax(631)765-9502
P.O.Box 1179 (�`
Rte
Southold,NY 11971-0959
` Uf ,<a ',
- 2021
'R)'vl�et J
BUILDING DEPARTMENT JUN 7
TOWN OF SOUTHOLD
RENTAL PROPERTY CERTIFICATION
Form is to be completed by a license architect, licensed engineer or licensed home inspector
Separate form is required for each individual Rental Dwelling Unit
Professional seal required for Architect or Engineer, licensed Home Inspector must provide
copy of valid current certification
Rental Property SCTM Number: L al
Rental Property Address: 1���" ak 11 nr Som , 11 01
Owner/Name:
Rental Dwelling Unit Identifier:
"v �� Gfl �91�-� w►r s� �5 0�- �f�l� j
Number&Square footage of each bedroom as depicted in the attached floor plan:
(i.e. Bedroom#1 -100 sq., Bedroom#2-90 sq., etc.)
V GC rooms GLS0^0a: t
Property Description_(Include all improvements indicated on survey)
I certify that I have done a physical inspection of the subject rental dwelling unit and find that it
fully complies with all the provisions of the Code of the Town of Southold,the Residential Code
of New York State,the Building Code of New York State,the Plumbing Code of New York State,
the Fuel Gas Code of New York State, and the Energy Conservation Construction Code of New
York State.
�rcat�lL G. Ae '(Icipaj5�ARE
Print Name and Title �,G\ I J inal Signature
Q' FRAM(G C�
Please place professional seal: 7A o
® � "24
TOWN OF SOUTHOLD
co ft Rental Permit
Permit No. 0080
Owner Dean & Gladys Glasser
Occupied as Single Family Dwelling
Located at 1205 Lake Drive Southold 59-5-14.1
Address Village S/13/1-
Maximum
/B/LMaximum Permitted Occupancy 6
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.
6/7/2019 John Jarski
Date of Issue Code Enforcement Officer
This Notice must be posted by the main entrance at all times
1
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 SOUTHOI.D
Y
RENTAL PERMIT APPLICATION
Rental Permit Fee $200(Application must be renewed every two years) J
Section A.
Property Information:
Rental Property Address: 7`
r
Tax Map Number: 1000 SECTION ®56i BLOCK OS LOT_I " i`� �• �� _
SECTION B.
OWNER INF=ORMATION:
Property Owner Name: 'D s
Property Owner Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
H 5 S p (0UX jjl�K' 0I b Cru 4
11-7 T7
Telephone Number(s): 3—(0767 (WD b5 J— 6 en-7,f 9.�C, 6119 71-t.01-7
Property Owner Email Address: 6r!/CAc 2Y ® `�°`"�`i% C®"
G
Page 1 of 4
SECTION F.
PROPERTY'DESCRIPTION:
Number of Rental Dwelling Units on property: JLur �`h��`e—�=� m� I4
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: 45K i,Zp2 pz'7j3s�'''��5
Use and Dimensions of each room in Rental Dwelling Unit:MA(eC, r, ` ,5 57
t31L.a(S� �,`l0 5�r-f� WL3M 1513!4t'V'164,H(0 ISO ,1:4- Ltv%�� izocv._ b'Zo*Fd-;
�•`oo�,,2 5 iZ�5�,l�- �,1 � '` �Jo��f_�- `�a,°d�+y ��-, 5°�r+.;�F�
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 NYS licensed architect, a NYS-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,codeof the
Town of Southold,the laws and sanitary and housing regulations of the County of Suffolk and
bythe laws adopted by the New York State-Fire Prevention and Building Code Council.
❑ lam requesting afire safety'inspection to-be performed by a Code Enforcement Official
from the Town of Southold.
Page 3 of 4
, r
j
Cf I am submitting a completed Town of Southold certification form from a licensed
architect, a licensed professional-engineer,or a licensed home inspector who has a valid
New York State,Uniform Fire Prevention Building,code Certification.
SECTION H.
DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit.
STATE OF NEW YORK)
COUNTY OF-SUFFOLK)
I acy% �, 5 ��er� certify under penalty of perjury,the following:
1. I 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 j5)business days.s to any change to the information
regarding Authorized Agent, Managing Agent, or Site_Manager.
Property Owner's Name:- Lo C.-VI G"C_n-S5
Property Owner's Signature:
Sworn to before me this, day of &24 _,_,_, 20t
BINA T NANAVATI
Official Notary Public Signature and Original Notary Stamp Notary Public-state of New York
NO.OI NA6143453
Qualified in Suffolk county
Page 4 of 4 My Commission Expires Apr 10,2QU
l
o
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
RENTAL PROPERTY CERTIFICATION
Form to be completed by a NYS licensed architect, NYS licensed engineer or licensed home
inspector
Separate form is required for each individual Rental Dwelling Unit
Professional seal required for Architect or Engineer, licensed Home Inspector must provide a
copy of a valid New York State Uniform Fire Prevention Building Code Certification.
Rental Property SCTM Number: 1000 -0trA — (05-- 134 l__(T,
Rental Property Address: V105- ka.t-e Dr SoJ ® ✓'• 114"7!
Owner/Name: Dec,^ 4- Gr-u*;Py-s G'-w+%S
Rental Dwelling Unit Identifier:
Number&Square footage of each bedroom as depicted in the attached floor pian:
(i.e. Bedroom#1-100 sq., Bedroom#2-90 sq., etc.)
Property Description (Include all improvements indicated on survey)
I certify that I have done a physical inspection of the subject rental dwelling unit and find that
the unit 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.
Print Name and Title Original Signature
Fs-- -
C� �pNK G. .y
Please place professional seal: ��' F
to
9�1$1 °>7724 Q�
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O� NEW�
Borrower:DEAN GLASSER �ti�•�••
Property Address:12o5 LAKE DRIVE Case No.: nj
QV:SOUTHOLD State:NY Zip:11971
Lender:CrrIMORTGAGE INC.
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Comments:
-'" AREA CALCULATIONS SU_MMARY_.,--_`- _ LMNG AREA,BREAKDOWN=-:-- :
.Code''_ Descd(ption ___ -_-_ Size To
=.N0ttaIS = Breakdown.
GLA1 First FIoor 2175.81 2175.81 First Floor
GLA2 Second Floor 1632.00 1632.00 18.0 x 54.0 972.00
GAR Garage 640.00 640.00 20_0 x 32.0 640.00
10.0 x 46.0 460.00
8.0 x 9_0 72.00
14.1 8 180.0° 31.81
Second Floor
4_0 x 72.0 288.00
16.0 x 24.0 384.00
24.0 x 40.0 960.00
TOTAL LIVABLE (rounded) 3808 8 Calculations Total(rounded) 3808
PH:516-729-8942 FM 24G-206-1386
Ex7z469
�d
OF SOUTyo�
TOWN OF SOUTHOLD BUILDING DEPT.
�ycourm, ' 765-1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] INAL iwr-
[ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
11pt� lJWY���
DATE INSPECTOR
i
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OWNER STREET ? ^"x , VILLAGE; DIST. SUB LOT —
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TOTAL DATE REMARKS
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`�o�oguFFc Town of Southold 5/14/2019
53095 Main Rd
Southold,New York 11971
PRE EXISTING
CERTIFICATE OF' OCCUPANCY
No: 40380 Date: 5/14/2019
THIS CERTIFIES that the structure(s)located at: 1205 Lake Dr, Southold
SCTM#: 473889 Sec/Block/Lot: 59.-5-14.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the requirements for a built prior to
APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 40380
dated 5/14/2019 was�issued and conforms to all the requriements of the applicable provisions of the law.
The occupancy for which this certificate is issued is:
wood frame one family dwelling.*
Notes: BP 5379 &5754 addition&deck COZ-6404;BP 13894 addition&alteration COZ-22560•BP 15337 deck
additions COZ-22562;BP 15189 in ground swimming pool COZ-22561.
The certificate is issued to Glasser,Dean&Gladys
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
ZVL7-
u o ' ed Signature
BUILDING DtPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 1205 Lake Dr,Southold
SUFF.CO.TAX MAP NO.: 59.-5-14.1 SUBDIVISION:
NAME OF OWNER(S): Glasser,Dean&Gladys
OCCUPANCY:
ADMITTED BY:
SOURCE OF REQUEST: Glasser,Dean DATE: 5/14/2019
DWELLING:
#STORIES: 1 #EXITS: 1
FOUNDATION: cement block CELLAR: CRAWL SPACE: x
BATHROOM(S): 1 TOILET ROOM(S): UTILITY ROOM(S):
PORCH TYPE: DECK TYPE: PATIO TYPE:
BREEZEWAY: FIREPLACE: 1 GARAGE:
DOMESTIC HOTWATER: x TYPE HEATER: oil AIR CONDITIONING:
TYPE HEAT: oil WARM AIR: HOT WATER: baseboard
#,BEDROOMS: 2 #KITCHENS: 1 BASEMENT TYPE:
OTHER:
ACCESSORY STRUCTURES:
GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST:
SWIMMING POOL: GUEST,TYPE OF CONST:
OTHER:
VIOLATIONS:
REMARKS:
INSPECTED BY: JOHNJ DATE OF INSPECTION: 5/13/2019
TIME START: 9:33am END: 10:00am
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
NO. Z64-.01t. . . . . . Date . . . . . . . . . . . .April . . 1,5 . . . . 19.75.
THIS CERTIFIES that the building located at 14ket .0riVe.. . . . . . . . . . . . . . Street
Map No. . XX. . . . . . . . Block No. . . XX. . . . .Lot No, . .xx . . .Sr uthold. . N.J 0. . . . . . . .
conforms substantially to the Application for Building Permit heretofore filled in this office
5 97 53792
dated . . . . . .. • 2 .20-1 .97219. . . . pursuant to which Building Permit No. . 54Z.
dated 6,26/7.9. .&. 3/.21/72. ., 19. . . ., 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 4)(WAn9, x h .additignz . . . . . . . . . . . . . . . . . . . . .
The certificate is issued to .;oroma. .UlharstAln. . . . . . .Omar. . . . . . . . . . . . . . . . . . . .
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . NaR.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
UNDERWRITERS CERTIFICATE No. x. 319892 . . . . No. 1.6 . . 197.1 . . . . . . . . . . . . . . .
HOUSE NUMBER . . . . . .120.5 . . . Street . .Lake. •Driva . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Building pector
FORM NO. ?,
TOWN OF SOUTHOLD
BUILDING DEPARTMENT,
TOWN CLERIC'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL. FULL
COMPLETION OF THE WORK AUTHORIZED)
5379 Z Daae ........................... e....... .... .. 19....67
Permission is hereby granted to:
........... .amuold......................I.......................
..................................... ...................... .f. ...............
to ...........
s
atpremises located at ............ -Pr&VO.. ...................... ... .......................................................
................................1.......................9 thv ....... .NA.............................................................
.................................................................................................................................I..............................
pursuarpt to application dated ....................................jkwe..... ...., 19.71..., and approved by the
Building Inspector.
Fee $.... x.00..........
. ........ ..i:`..�:...........s....... .. .............
Building Inspector
FORM NO.z
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N95754 Z Date ............................ ....� :.... 19...`
Permission is hereby granted to:
......Lerl..itlll:ZsL....
b
...............Scuthold.............................................
to .... . ........................................................
..........................................................................................................................................I.....................
! great POW .l
at premises located at ..........,aeiJu....7L., ,i.�'a............................. ......... ..........................................
....................................................�.yv.�a'�.D.l1.L.....tA.T A.i. ..................... .,....................................................
................................................................................................................................................................
pursuant to application dated ...........................;rzWvh....24........... 19..72.., and approved by the
Building Inspector.
Fee $....... .�:CD®'....
, .r�.. t,: t� ' ...........
Building Inspector
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22560 Date AUGUST 30, 1993
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property 1205 LAKE DRIVE SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 59 Block 5 Lot 14.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 22, 1985 pursuant to which
Building Permit No. 13894-Z dated APRIL 29, 1985
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 ADDITION & ALTERATION TO EXISTING ONE FAMILY DWELLING
AS APPLIED FOR.
The certificate is issued to JEROME D. & VIVIAN SILBERSTEIN
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-777467 - NOVEMBER 4, 1986
PLUMBERS CERTIFICATION DATED OCT. 27, 1986 - SHORE MECHANICAL CORP.
2. IL
/Xilding Inspector
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-22561 Date AUGUST 30, 1993
THIS CERTIFIES that the building SWIMMING POOL & FENCE
Location of Property 1205 FAKE DRIVE SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 59 Block 5 Lot 14.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 14, 1986 pursuant to which
Building Permit No. 15189-Z dated AUGUST 19, 1986
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued 1s INGROUND SWIMMING POOL WITH FENCE AS APPLIED FOR.
The certificate is .issued to JEROME D. & VIVIAN SILBERSTEIN
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-808704 - MAY 11, 1987
PLUMBERS CERTIFICATION DATED N/A
u.ilding Inspector
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-22562 Date AUGUST 30, 1993
THIS CERTIFIES that the building ADDITION
Location of Property, 1205 LAKE DRIVE SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 59 Block 5 Lot 14.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 27, 1986 pursuant to which
Building Permit No. 15337-Z dated SEPTEMBER 27, 1986
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 ADDITIONS TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to JEROME D. & VIVIAN SILBERSTEIN
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
/Building Inspector
Rev. 1/81
r
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JEROME SILBERSTE/N 61 V/V/AN SILBERSTE/N
AT SOUTHOLD
TOWN OF SOUTHOLD
SUFFOLK COUN� 77,Nw.
TAX MAP NQ W00-059-05-19&/4
SCALE, )rr=40' /
APRIL /9, 1985
,1. JUNE 27,1986
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S.LICRNO!496/8 OR 1.6289 ACRES' �`� f%C /��e ,th,L.I.A. &and a�� �aZ
S/6)72T—7//B .� �o by The New York Stme Land
:396 ROANOKE AVE.
'/VERNEAD,N.Y. //90/
81•/69
Town of Southold 5/14/2019
53095 Main Rd
c Southold,New York 11971
01 0
ONz
y ® 58F.
Cpl� ,03
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: 40380 Date: 5/14/2019
TIIIS CERTIFIES that the structure(s)located at: 1205 Lake Dr, Southold
SCTM#: 473889 See/Block/Lot: 59.-5-14.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the requirements for a built prior to
APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 40380
dated 5/14/2019 was issued and conforms to all the requriements of the applicable provisions of the law.
The occupancy for which this certificate is issued is:
wood frame one fay dwelling.mil
Notes: BP 5379 &5754 addition&deck COZ-6404;BP 13894 addition&alteration COZ-22560;BP 15337 deck
additions COZ-22562;BP 15189 in ground swimming pool COZ-22561.
The certificate is issued to Glasser,Dean&Gladys
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
P `
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
U
Mo
ed Signature
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
ROUSING CODE INSPECTION REPORT
LOCATION: 1205 Lake Dr,Southold
SUFF.CO.TAX MAP NO.: 59.-5-14.1 SUBDIVISION:
NAME OF OWNER(S): Glasser,Dean&Gladys
OCCUPANCY:
ADMITTED BY:
SOURCE OF REQUEST: Glasser,Dean DATE: 5/14/2019
DWELLING:
#STORIES: 1 #EXITS: 1
FOUNDATION: cement block CELLAR: CRAWL SPACE: x
BATHROOM(S): 1 TOILET ROOM(S): UTILITY ROOM(S):
PORCH TYPE: DECK TYPE: PATIO TYPE:
BREEZEWAY: FIREPLACE: 1 GARAGE:
DOMESTIC HOTWATER: x TYPE HE, oil AIR CONDITIONING:
TYPE HEAT: oil WARM AIR: HOT WATER: baseboard
#BEDROOMS: 2 #KITCHENS: 1 BASEMENT TYPE:
OTHER:
ACCESSORY STRUCTURES:
GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST:
SWIMMING POOL: GUEST,TYPE OF CONST:
OTHER:
VIOLATIONS:
REMARKS:
INSPECTED BY: JOHNJ DATE OF INSPECTION: 5/13/2019
TIME START: 9:33am END: 10:00am
�� Academy �~ IMPLANT, COSMETIC JCQJ SpecialCare
of General Dentistry DSE N T I S T R Y
&
GENERAL DENTISTRY
OF LONG ISLAND
Dean E. Glasser,B.S,D.D.S.
ASSISTANT
CLINICAL 6/1/21
PROFESSOR
COLUMBIA
UNIVERSITY
DENTALSCHOOL
DIPLOMATE,
INTERNATIONAL
CONGRESS OF ORAL
IMPLANTOLOGISTS
FELLOW,
ACADEMY OF Attention: Southhold Building Dept.
GENERAL DENTISTRY
FELLOW,
AMERICAN ASSOCIATION
OF HOSPITAL DENTISTRY
FELLOW, Dear Susan,
MISCH IMPLANT
INSTITUTE As per our conversation we certify there have been no structural modifications to the
INTERNATIONAL house since our last rental permit issuance.
CONGRESS OF ORAL
IMPLANTOLOGY
Enclosed please find a check for$200.00 as well as our application for rental permit
renewal.
Sincerely, ✓�� //
Dr. Dean Glasser
458 Old Country Road•Melville,New York 11727•Tel:631-423-6767•Fax: 631-425-7090
www.DrDeanGlasser.com
Academy IMPLANT, COSMETICSpecialCam
Aof General Dentistry JCQ)j D E N T I S T R Y
ASS 0 C I A T 1 O N
GENERAL DENTISTRY
OF LONG ISLAND
Dean E. Glasser,B.s,D.D.S. G G O r
ASSISTANT
CLINICAL
PROFESSOR
COLUMBIA
UNIVERSITY
DENTAL SCHOOL
DIPLOMATS,
INTERNATIONAL +
CONGRESS OF ORAL
IMPLANTOLOGISTS Y
FELLOW,
ACADEMYOF
GENERAL DENTISTRYFELLO ,
AMERICAN ASSOCIATION �/ De
n � �C
OF HOSPITAL DENTISTRY C4
FELLOW,
MISCH IMPLANT
INSTITUTE //
,
FELLOW,
INTERNATIONALCONGRESS OF ORAL
n
IMPLANTOLOGY J //� / l l
v14
41
I,
6-716 7
I_
I 1'h I k ,Ji r
APR 2 7 2021
458 Old Country Road•Melville,New York 11727•Tel:631-423-6767•Fax:631-425-7090
www.DrDeanGlasser.com