Loading...
HomeMy WebLinkAbout1000-117.-10-20.5 TOWN OF SOUTHOLD a Rental Permit 0518 Owner Ronald Pollio Occupied as Single Family Dwelling Located at 165 Second Street New Suffolk 117.-10-20.5 Maximum Permitted Occupancy 5 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. 10/18/2023 o o e t Official This Notice must be posted by the main entrance at all times �o� �6 �,�Q �j2to✓lC �I • 0 TOWN OF S01lTHOLD BUILDING D 631 -765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCA [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI [ ] CODE VIOLATION [ ] PRE C/O [ REMARKS: � r 2Ar S�_ ACq DATE ---- ------- L0Lqf'Y��'�_ INSPECTOR Ploq no Io umol ;uaw eaq 6ulpllnB ° iFai ire 11, �: Town Hall Annexe 7 1 B . 54375 Main Road �i lry ;�' Fax(631)765 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT 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 Prcrfe ssic r c i seal r.e wired dr rclritect or I:n irr erg:licensed Yq!Ve Ins actor rrrust rnvlde ooLv,alld !Trent r i�cation am., Rental Property SCTM 9-Cl Number: -738 - _I C.) 9-0 " Rental Property Address: ✓� �� �� Owner/Name: ��� Rental Dwelling Unit Identifier: Number &Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 -100 sq., Bedroom 2-90 sq., etc.) u 14J�c 1,A' -� i .�.5� B��' 110',.x• 14 L — 14a s 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 ns ruction d of New York State. An"p- 4A6aw� Print Name ar,oT6te Original Signature Please placd a (,. )� k r, :xZ. TOWN OF SOUTHOLD =� Rental Permit 0518 Owner Ronald Pollio Occupied as Single Family Dwelling Located at 165 Second Street New Suffolk 117.40-20.5 Maximum Permitted Occupancy 5 Is in compliance with all of the provisions of the code of the Town of Southold, the lauds 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. 8/10/2021 U 4 o e forc m nt fficial This Notice must be posted by the main entrance at all times f rr � Sdi�1,� Town Hall Annex ?, Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 X, §� BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION MAY 26 2021 Rental Permit Fee$200 (Application must be renewed every two years) ;Y 7717",.T. Section A. Property Information: Rental Property Address: 1657 sge_or�v> Tax Map Number: 1000 SECTION 17 00 -BLOCK W-00 -LOT ©90 - . 005 SECTION B. OWNER INFORMATION: Property Owner Name: 2©r\*u.-> A' Property Owner Legal Address: Property Owner Mailing Address: 5 5C-CSS D smel=--t` 14(.I Fo;/Ma� o k e Lt-I� SFW 50T—'1F0 LAC tV,� . Telephone Number(s): Daytime Evening Emergency Property Owner Email Address: J-Onc P0Ik I 0 AfY1L3'.1 k"C®VVj Page 1 of 5 so�r,,l�` Town Hall Annex , Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959p��c® ,,a�j}$ 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: Wl k Address of Managing Agent (no P.O. Boxes): Page 2 of 5 Town Hall Annex A�i � Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 CIO P.O.Box 1179 Southold,NY 11971-0959 'Q Y COW, ,fig 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: VN IT 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: 13 1 ® x la .140Sr- ., 3�3 : lox lt' -- Ilos, ; L R Zo`x 13 = Z6Os7 5VN fo664 5')( = 1 Zosr- Page 3 of 5 j 2 V " �l,2 Town Hall Annex Telephone(631) 765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 .3 5 Southold,NY 11971-0959 ' r,. �. ;' r<:rr, `y 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. ❑ 1 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. SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SUFFOLK) I R aNA-ld ?otJ Z- , 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 } gig o If t �. zle, Town Hall Annex Telephone(631)765-1802 54375 Main Road d Fax(631)765-9502 P.O.Box 1179 _ Southold,NY 11971-0959Q, BUILDING DEPARTMENT TOWN OF SOUTHOLD 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: _ R©N�(A� � & k I o Property Owner's Signature: Sworn to before me this i day of � , 20?-d W-7 Official Notary Public SignatbrVand Original Notary Stamp ROBERT L. DOUG14ERTY NOTARY 6'IIBLEC, State of New York No. 4792110 C? Qualified in Nassau County p Commission Expires irah 30, 1�® Page 5 of 5 of s Town Hall Annex Telephone(631)765-1802 54375 Main Roadc� zc { Fax(631)765-9502 P.O.Box 1 179 E �,� �l Southold,NY l 1971-0959 .� } BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: t4/& Requested maximum number of persons allowed 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 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 dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Town Hall Annex Telephone(631)765-1802 54375 Main Road N Fax(631)765-9502 P.O.Box 1179 G' Southold,NY 11971-0959 Q BUILDING DEPARTMENT 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 SCTNI Number: I #-../ Rental Property Address: IGS r1et,) 50%'=two Lr (\)Y, 11g5G Owner/Name: tZONA-td •7ot Rental Dwelling Unit Identifier: miT Number & Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1 -100 sq., Bedroom #2-90 sq., etc.) , 6 IZ I 14' X 1V = I G'95 F 10' X 1 I 146 5F 0 Q : 1 O' X I `` ! I oS� L-R. : a0' X Svc! ofLcH = lS` ` = IaoSr - ;t eo : 3 ATS : s' X S' = 4o 5 P Property Description (include all improvements indicated on survey) -5-10V-V EAm is kk's t�- , GNC&Q:gi r)6cl< , U I loc'mz 51A0OC-2 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 Cons tion Code New York State. 0 s © ' Print Nam ( - Original Signature Pie se a ro �o��pF SOUIyo� Nem �,V;fMlk, * # TOWN OF SOUTHOLD BUILDING DEPT °�y�nurmN 765-18O2 - : _ INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] FINAL 6 4 pew+ [ ] FIREPLACE &-CHIMNEY [ ]' FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] 'FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: D DATE INSPECTOR 16" Closed Porch 90 06 [128.9.8 Sq ft] rn 16 12' 3 Living I Bedroom 12 ooGo. c. Closets Closets Deck [286 Sq ft] I = 113 a -� � — I4 1 712' 10 3 i 37' First Floor [1036 Sq ft] M0 C-- COa 1)CT�1"aCIS (5 ClOOClP- T BOUT OLD PROPERTY ...... OWNER ..STREET _1`a ----- .. . VILLAGE' ,; ' DIST.' ". SUB.--- LOT V$ _ --!-- 1...#l.,°sTryt✓ 4ri _- �^.,,. i ag'Y..`i }a'yy,,r°,c'.•%`�,g u 3°�, ` ., "+ a;,. r:�,, . FORMER OWNER — N P EACR. / f..� f"}.�•p�, f. _.f> 3,_��?r••,; t' ��` �w.,,'»��.�;:,.. >l ;per� ' S fj W _y pg TYPE OF BUILDING. RES: c.=w SEAS y ' VL. � FARM COA%M CB. MICS.:, Mkt. Value LAND IMP. TOTAL { DATE REIviARKS: w "'l �.�jr alp t T Y' ✓ i Y'�,=' �+ '•� '-i ._� zt r '� J�-4 iA.•, -'w✓:,�r�.,..T,.f', °wg # �., ,M f;« ''.;;+ ?r,, .�t!t a:", F'•`. ."`' - 7-7 71 ... 1... ...._..__-- ( '• ppb°" `_ � „"`,,.::444. ``./t,_— /,,p'L ;"�"S,i�J"' ^++A'r ',,.1"Sz —<Z l LP11-7 �{�7 L°s .''' '? i "3'�. ., i [L? ", if''f ri�.c.' t, a.. � I ,•(:<rc�� ,✓7,,,''"' j'j {, I.. .,>, fs ',s.,,yc 1 6 r i` !IGSrPF a r.. y sa I 6s6J ��� "ted Qg sr Tillable FRONTAGEO,N WATER' Woodland. FRONTAGE ON ROAD Meadowland DEPTH House Plot BULKHEAD Total - .. " " " _:. ........... _, _. .._..................................... .........._._. .... .-:�.:-.- ;- .:.yam�,_ _ - ���. _ �;.• - �; . OWNER;I-t P(-t Its- €� .- -' t�.. STREET ;i, VILLAGE DISTRICT SUB LOT ' ........... . �- ,....._...-.-a..+ . ._f< .. -F�.I• ..._-N� 'FORMER OWNER ..._ r w' q- J E ACREAGE ' a g, • 'w TYPE'OF:BUILD;NGAg rAY' . RES. !I, `SEAS:-- �/L, lAiM' ' ..GONtivt. IND.: `CB Iv1°fsC - „a LAND IMP. TOTAL . 'DATE " `, RElv1ARKS, s , : ; A ......... p r « I —_ .......... 5 ......................... .......A-(> �' 1 �"'B .✓i!f�__ �-Tf t'.� f. "�Q.___- �ar' ., '�1� '���j �` __�,'"""__' waat,.�d"t�'i{_ G.:r'`.� r � �� ✓ 1yF� : y 4 ' 0 !?i Lp�"4 D r 2 �y, 41sk i r` �`.r': ✓ '6 a i�G'C�c }` r'f'`°r" 'O,�``d,9, cJ ,r vy AGE - " 'NEW NORMAL BELOW ABOVE < s. Farm Acre I Value Per Acre Yolue': �` 3 ./ ate::. , �- �°` Tillable 1 `I�i`.l a b l e, 2 I a �Pj "' -..._._..__...._—. - _..__..._.................................._...- - l G� iA 'Ti } r Tillcnie. YJ 11 . , Woodland _ ........_............_._._. __ _......._......._...........__......................... ........_............- —---- _._ - I Swampland _ _—- ........... .:..:.............---- ............. .............. _ ✓rushldt�d - -- - -- -- - ___ .._.. . . ____..._.._.... _.._.._........_._... House Plot _ i i ,......__.......... . ............ .. .... . I T VILLAGE DISTRICT SUB. LOT FORP,IER OWNER N C; ACREAGE ---- Co Af S TYRE OF BUILDfNG= ----- .RES: FARM .. COMM. ,. IND. .CB., . MISC. LAND:- ( . fNIP DOTAL. DATE REMARKS /... .. —__- - - - — -- - ........._..__....__.._...-._...-----— -- - - _ ..._.—..:.. _-.................---- ........................... _:..__...: :........... ..__...._.. ..................................._..._.................................... ..----..................... - AGE i BUILDING CONDITION _..._.._............ ......._....._.___,._._...-- - -__...._-___.....-. —_-_- _ ...... .......... ...__-------..._...._._...-.._.._...__.._._._....._. ..... ...........--_............................. ...__ _-_.-- NEW NORMAL BELOW .ABOVE t ,_......... _ -. - - _ ............. . -- --_.... ._....._.............................................----_..._...__.._._._...---_.-._...._....-...................._ Farre► Acre Value Per Acre I Value I -- __. ........_ ..... _ ..._.... - -- _ _ — .. .... ....... ..... ......... Ti l lab,le 1 Tillable 2 _............. --- -v_._........-........... Tillable, 3 .......... ... _ _..__....._........................._..._.__-_-_.___. _ .. __ Wcodland ' , _.................................... ...----------_--- _ - - - --- - ..........._..._....__....... - --- ........................_ Swampland + ............ Brushl ;_. —_- House Plet j .•- ., j - r Tofq :................................................. .... ........,,..-.. _..-.. ...._..... ..._.... .-..,............ ...._. __.. _•_ _. '��� o`er ......f, eS �`- •�� 'aip,`� - F� '� T � �•y.S moi.{� <;' ice_ " � I � i I , I • t"�e•-, .-. — �k!�.„`� �AM•$ �>a� IL-1 1 I 1 i a,"•.".5;,�ropP•d��,K,+,. tw, r i .� 'd•` I r • • t 4: ^, a, '�Gui..• v .�n•:45.r,.�l';y-�`i��,,; ,i•, en. � ". � -- -y-"—_' �� _v w �+.� .�, � I • ' t.:._:_"'.•^�•.:=> =»"a,-x»:.w.a,,,i,'.�5�" :Y%'".;eri`�`fr�$'r:t`>,�w`??°��c'�;:`%:,ii•';C:s2F'��:}`i,.`'+u``�:5�`.��::.:.,E y � i' I �t � � i .. 117.-10-20.5 4/09 : a i : g , ;, ' a •-:��' Foy ' _.._ L._........._�._....,._ Bath tion Extension 7r g :: Bos l Floors ( pp Extension Ext. WallsInterior Finish 4, _............._....._...... .............. Extension ` ' ' Fire Place `tA Heat j= 3 Porc tic I Porch Rooms 1st Floor . , Breezeway = '' Patio Rooms 2nd Floor ,—t-- Garage :tf ` ` I„ Driveway i.. Ze ' Z �, •.r f ip` ''-w'� ffffff"`.'e("€,. _ ,di _ .^."`� . L tl" l a r g r � � •P yle � � -'tom ��✓'''yt �`� ',°yv t, ��`�: �`�, � I �— ' r J f I M. Bldg. ( " i Foundation Bath __..— Extension Bas - - ement I F'I� oors Extension -_.- -__--- - ---_ 'Ext: Walls_--� � --� anterior finish Extension Fire.Noce Heat ---- _.. -- - - ----- --- - -. . . -. ._.__........... , J {, _ r j — A• `Porch Attic __--- ` Porch { Rooms ]st Floor Breezeway Patio I Rooms,2nd'Floor; Garage Driveway O. B. FORM NO.4 TOWN OF SOUTHOLD BE366DE 'RTMENT Office of..the.Building Inspector. Town Half Southold;N:Y. Certificate .Of. :Occupancy r No.Z.1 Q9.2 7. . . . . : . . Date . ... . . . .... . . . . . . ..M'a "o. o . . . .. . .. 19 A4 . THIS CERTIFIES that the building . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . ... . . . . . . : . Location of Property 165 . . . . . . ... . . . , 8econd .Street;. . . . . ; . New.Suffolk House No. . . Strseet . . . . . . .Hamlet County Tax Map No. 1000 Section . .1.17. . .. . . . .Block . .1..0 . . . .. . . . . .Lot.: 020:P. . . . . : . . . Subdivision X . . . . . . . . . . . . . . . . . . . ... ... . .Filed`Map'No. X . . . . . X&No. .—%. . . . . . . Requirements for- a -private ono-family dielling .built prior to conforms substantially to the AppIkm4on_lor -Perm,t hN_-tef ffl&. -this-affiecdat A Certif :date of Occupancy . :A S P f A .V. . . . . . . . . . . 19 5.7, pursuant to which ftNo. VArtq h. 9.9 . . . . . . . . . . . . . . 19$?, 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 . •. . . . . . . . . The certificate is issued to . .F14r PAgg. (owner,lesimertb +tJ of the aforesaid building. Suffolk County Department of Health Approval . . . . p/r , , , . , , , , , , , , , , , , , , , , , , , , UNDERWRITERS CERTIFICATE NO:. . . . . . . . . . . . .n/r . . . . . . .. . . . . . : .:. . . :. :: . . . .ate. 44. iii' 'L�•2? . . . . Building Inspector- Rev.1/a1 r .. FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. . .Z'I'179'I . . . . . . . . Date . . . . . . July 19 THIS CERTIFIES that the building . . . .decl .";�a.cli,tiPA . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property . . 1.65. . . . . . . . . .Beomd .49t;eget. . . . . . . NQw. Suffolk House No. Street Hamlet County Tax Map No. 1000 Section . . . 1..1.7 . . . . .Block . . . . . AQ . . . . . . .Lot . . .W .5. . . . . . _ . Subdivision . . . . . . . . . . . X . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . .Lot No. . . . X. . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . .JI DIY .6 . . . . . . . . . . . 19 .82pursuant to which Building Permit No. . . 1:I.N04. . . _ . . . . . . . dated . . . . . .July. .14. . . . . . . . . . . . . . 19 a2,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 . . . . . . . . . . . . . . .desk.addition .on. .exist.iing. d.redlixtg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . . . . . . . . . PAUL. & .BARBABA. 12A$X (owner,Te ee-e 4ermi�} of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . . N/.A. . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . N/.A. . . . . . . . . . . . . . . . . . . . . . . . . . . Building Inspector Rev.1/81 �^ r FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 217208 Date AUGUST 18, 1988 THIS CERTIFIES that the building ALTERATION Location of Property, 165 2nd STREET NEW SUFFOLK House No. Street Hamlet County Tax Map No. 1000 Section 117 Block 10 Lot 20.5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 31, 1988 pursuant to which Building Permit No. 16889Z dated APRIL 13, 1988 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 ALTER ADDITION TO EXISTING ONE FAMILY DWELLING. The certificate is issued to PAUL LEARY (owner, ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED_ N/A YL ` Building Inspectigr 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-34672 Date: 11/10/10 THIS CERTIFIES that the building DECK & OUTDOOR SHOWER Location of Property: 165 SECOND ST NEW SUFFOLK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 117 Block 10 Lot 20.5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 7, 2008 pursuant to which Building Permit No. 34321-Z dated NOVEMBER 25, 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 DECK ADDITION AND OUTDOOR SHOWER AS APPLIED FOR PER ZBA # 6205, DATED 10/16/08 AND ZBA # 6410, DATED 10/7/10. The certificate is issued to RONALD A POLLIO (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO_ N/A PLUMBERS CERTIFICATION DATED N/A uth ized ignature Rev. 1/81 Ronald A. Pollio 1461 Franklin Avenue Garden City, New York 11530 516-742-3494 VIA FEDEX May 24, 2021 Town of Southold Building Department Town Hall Annex Building 54375 Main Road Southold,New York, 11971 Re: Application for Rental Application Property: 165 Second Street, New Suffolk,NY 11956 Owner: Ronald A. Pollio Dear Ladies and Gentlemen: I have enclosed a Rental Permit Application and other required documents, as follows for your consideration: 1. Rental Permit Application 2. Rental Property Certification(by Licensed Architect) 3. Floor Plans 4. Certificates of Occupancy 5. Survey of Premises 6. Check for $200.00 I If all is in order, please issue a Rental Permit Application. If you have any questions, please call me. Thank you. { Sincerel yprs, 1 Ronald . Pollio i *Permits for Deck and OD Shower not enclosed but were issued. I I i