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Home My WebLink About1000-103.-11-10 TOWN OF SOUTHOLD y Rental Permit Permit No. 0166 Owner Thomas & Gekee Wickham Occupied as Single Family Dwelling Located at 1250 Pequash Ave Cutchogue 103-11-10 Address Village S/13/1- Maximum /B/LMaximum 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. 8/26/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times Town Hall Annex r�� 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 PERMIT APPLICATION Rental Permit Fee $200 (Application must be renewed e tri ears) �gg g ., 8 2019 Section A. Property Information: jzc"T) I"-"I " 'o`7"" �1r , Rental Property Address: 1250 PEQUASH AVE, CUTCHOGUE, NY 11935 Tax Map Number: 1000 SECTION 103.-11-10 BLOCK LOT SECTION B. OWNER INFORMATION: Property Owner Name: Gekee Wickham Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 28700 Main Rd, Cutchogue, NY 11935 PO Box 928, Cutchogue, NY 11935 Telephone Number (s): 631-255-6667 Property Owner Email Address: gek2@yahoo.com 1 Page 1 of 4 l Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: N/A Address of Authorized Agent (no P.O. Boxes):..____,_ Mailing Address of Authorized Agent:.. _www Telephone Number (s): Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: N/A Address of Authorized Agent(no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number(s): 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: N/A Address of Managing Agent (no P.O. Boxes);,_„ ..,._.....ww..M, Mailing Address of Managing Agent: Telephone Number (s): Email Address: Page 2 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: ONE 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: e ' Requested Maximum number of persons allowed to occupy Dwelling Un , Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: 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 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. Page 3 of 4 ❑ 1 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) v 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: .- - J V- Property Owner's Signature: Sworn to before me this'day of 20 ..._,. _� Official Notary Public Signature and Original Notary Stamp l,4atary Public,Bie'ie of New YOrk Page 4 of No,OiBU 18505 QualnlAed arra SUffOlk County /- f,)mrfiisaion Ey.E,)jree, mil 14,2.��`U 1 So �r>r.,zr Jim * ,TOWN OF SOUTHOLD BUILDING . 765-1802- INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING Sm a DATE INSPECTOR I Yll TI�e r1 �,. 5, 6 T n COO 7k Z i vo (n iY I aww• .. Win. _. yyg w r r o C o D mtn (D Fin "ww o rn N rill p 1 r � U m A r '-T j < _ O Z .... . E rn `° r c cn Z �I m s ♦ ��V j 1 .M. 9 ry -n � r.. 11 b O R O m µ� — < ~ V m µ a n E O0 ,� m n �` 00 I v O Q O 7C Z m B Jl X = . � k m�i � r Ln O O n W m oil CD M u� N i I r 9 o —n t ❑A, Ca C Cil �` G � z , f �i i� tc^ I , 0 0 m r / l 1 ,r N� ive lz V N I ter 4 L 68 jr UJ p vl ! Al 70 , C >v " 4 ' I _ m �_ .. _. O D Q j �, fnD to .t O 70 p "mow... P � _.,,,,. �....., ...... ... .....� _.._ ,e .... _ TI co O O �r p •r $� m 3 3 0 �. ZP N � _ a o a s 0 0 _ _....__ .. _ tin = i :.,.. w, N m OL rt CD wa I f r FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No Z-24058 Date DECEMBER 51 _1995 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 1250 PEQIIASH AVENUE CUTCHOGUE N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 103 Block 11 Lot 10 Subdivision Filed Map No. Lot No. conforms substantially to the Requirements for a One Family Dwelling built Prior to: APRIL 9,, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z-24058 dated DECEMBER 5 1995 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 ONE FAMILY DWELLING WITH ATTACHED GARAGE The certificate is issued to H. BECK & ANO. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-371134 - NO RR 22, 1995 PLUMBERS CERTIFICATION DATED N/A *PLEASE SHE ATTACHED INSPECTION REPORT. w uilding Inspector Rev. 1/81 1 nuiLUnu: nl�:rnu'rlll,li'r 'I'01411 OF SOU 171101.1) 11011SING Com, 1Nsrr(rriotl PrFOitT CTfCHOGUE, N.Y. LocnTl°r1250 P DASH AVE __. ..,...� ._......_ ..�..._... .....,.�_ ,_._ ,�......_.—. ..........,...-_ lilt]n L C L pal t r y munbcr 6 slrcc �) S111IDIVISIOD rlAl' NO I.o'r(w) IIANIt OP OWNI"At M. Beck 6 Ano OCCUPANCYA- es / r-Lennnl .,,,._.. __...._..., Joho Beck AC-01WAIIIEO IIY: SAYE nur11'r'leu Isv C ...._�,.�....._,Pr KE.Y AVAII.AIILI': 111 d'.(t). 'I'A% IIAP NU _ _— SOl11tC1: OF 1t1;y111 S l.� mmm JOHN BECK, JR. OA 1 L NOV. 29 1995¶ IYtI: 01 C(^ OWI I l l N( 0 2 --_- FRAME I ST01H LS I EXITS )NS°I'llll(,'[°ION _ _—_—_ FOUNDATION CEMENT BLOCK FULL CRAWI. TOTAL HOOIIS: ISf 1-11.1t. 4 2ND 17.11. Jlti) PLK„ 11ATIWOON (s) — ONE rOIC1It01rUI'1 L.1lY Il OOH —.—CEME..WN. T POICII IYir STN PORCH 1113-ICK, TYPE PATIO __..—. IIILI?f:ZCWAYO.. __ ....._., NE GA1tA(;F, 1'f RII l A(.I: .,NIL..CO GAS A111CONUITIONIN TYI'I, IILAI'I:It C 110TNA 1'I?R S __. v....-._-_.� .... LILCO GAS WAIN Alit xxIIO'iWA'1'I R ACCLSS01(Y S'IIUICTUItrS: NONE ( AILALF., IY1'I; OF CONS—r,s'I'OIlAGE, 'L'YF'r COIIS'r. SWINIIINC 1'OOi, TY1'1: CONST VIOLATIONS: CIIAI"rlSll 45 N.Y. SUATI? IINIFOIIM PIAL' 1'RI:VI'sN'I'1011 & 111111.01NC COUr OGA.,_° flUll lil11'r l(71I Ilf SI —11 ,..... -,...�..m _.._— P 023157-Z OPENPERMIT FOR ALTERATION._TO LIVING ROOM 995 IlF,I CC'I'[ili IIY ��"� llAl'I: OF iFISI L(a'fOH GJ. F i s m h TINT STAit'r 9:30 AM 1,Nu 9.50 AM r Town of Southold Annex 7/14/2014 it° P.O.Box 1179 " 54375 Main Road Southold, New York 11971 CERTIFICATE CCU NCY No: 36791 Date: 3/6/2014 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 1250 Pequash Ave,Cutchogue, SCTM#: 473889 Sec/Block/Lot: 103.41-10 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 9/3/2013 pursuant to which Building Permit No. 38327 dated 9/17/2013 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 alterations, �cludin cxistin attach l a:c� c convert c9,t_o stoma .and..living.. Pac � faagigy dwel jim as applied for. The certificate is issued to ADJS Assoc. LLC ........ (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 38327 1/27/14 PLUMBERS CERTIFICATION DATED 3/3/14 J Zee's Plumbin r t o " ed Signatu