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HomeMy WebLinkAbout1000-107.-4-5 Falk TOWN OF SOUTHOLD
Rental Permit
g. # 0169
Owner Albert Leutwyler
Occupied as Single Family Dwelling
Located at 4573 Wickham Ave Mattituck 107.4-5
Maximum Permitted Occupancy 4
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.
9/12/2023 _
Code nor r� Official
This Notice must be posted by the main entrance at all times
TOWN OF S
631 -765-1802 /0�
IN PECTION
[ ] FOUNDATION IST [ ] ROUGH PLE3G.
[ ] FOUNDATION 2ND [ ] INSULATION/CAI
[ ] FRAMING 1 STRAPPING [ ] FINAL
[ ] FIREPLACE ,& CHIMNEY [ ] FIRE SAFETY IN!
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI
j ] CODE VIOLATION [ ] PRE CIO [
REMARKS: �4" 0/6
,1175
al,a-g e,�-
DATE
� � INSPECTOR
Town Hall Annex
Town of Southold 54375 Main Road
=' Rental Inspection Report PO Box 1179
Southold, NY 11971-1179
!lbw . Tel: 631-765-1802
e.
� Date
SCTM #
Phone
Owner e ,.,._.. w. � _.. _. _.._- __ ..
�� 1 .. , ._ ......
�.
+ � Visible
Addre -
ss `! M �._
Hamlet Inspector
Floor Level Quantities Sub 1 2 3
Smoke Detectors(not located in bedrooms)
Carbon Monoxide Detectors
Fire Extinguishers
Exits
Bedrooms 1 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
Door alarms Pool completely enclosed
Self closing/latching gates Pool fence to code requirements
CO's for all items present Prior Rental
Comments:
Falk TOWN OF SOUTHOLD
Rental Permit
g. # 0169
Owner Albert Leutwyler
Occupied as Single Family Dwelling
Located at 4573 Wickham Ave Mattituck 107.4-5
Maximum Permitted Occupancy 4
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.
9/12/2023 _
Code nor r� Official
This Notice must be posted by the main entrance at all times
TOWN OF S
631 -765-1802 /0�
IN PECTION
[ ] FOUNDATION IST [ ] ROUGH PLE3G.
[ ] FOUNDATION 2ND [ ] INSULATION/CAI
[ ] FRAMING 1 STRAPPING [ ] FINAL
[ ] FIREPLACE ,& CHIMNEY [ ] FIRE SAFETY IN!
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI
j ] CODE VIOLATION [ ] PRE CIO [
REMARKS: �4" 0/6
,1175
al,a-g e,�-
DATE
� � INSPECTOR
Town Hall Annex
Town of Southold 54375 Main Road
=' Rental Inspection Report PO Box 1179
Southold, NY 11971-1179
!lbw . Tel: 631-765-1802
e.
� Date
SCTM #
Phone
Owner e ,.,._.. w. � _.. _. _.._- __ ..
�� 1 .. , ._ ......
�.
+ � Visible
Addre -
ss `! M �._
Hamlet Inspector
Floor Level Quantities Sub 1 2 3
Smoke Detectors(not located in bedrooms)
Carbon Monoxide Detectors
Fire Extinguishers
Exits
Bedrooms 1 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
Door alarms Pool completely enclosed
Self closing/latching gates Pool fence to code requirements
CO's for all items present Prior Rental
Comments:
ice,
TOWN OF SOUTHOLD
Rental
016
Owner Albert Leutwyler
Occupied as Single Family Dwelling
Located at 4573 Wickham Ave Mattituck 107-4-5
Maximum Permitted Occupancy 4
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.
9/15/2021 I
- ' 3-
Code Enfore Official
This Notice must be posted by the main entrance at all times
Town Hall Annex
SOUTHOLD TOWN
w � 54375 Main Road
PO Box 1179 Southold,
Rental Inspection
NY 11971-1179
' .
a ' Tel: 631-765-1802
R'
„a Fax 631-765-9502
SCTM # — �f'` Date
Owner kr'F ZeQT-Wvle,( Phone 6q6 - F3_911?
Address ,7 Zip �a2
Hamlet M4L Inspector.
Address visible from street?
LEVELS SUB 1 2 3
Smoke Detectors (#-bedroom detectors excluded) C� �
Carbon Monoxide Detectors (#)
Fire Extinguishers (#)
Exits (#)
BEDROOMS 1 2 3 4 5
Smoke Detector Alarms (#)
Carbon Monoxide Alarms (#)
Egress (windows) (Y/l' )
BUILDING SYSTEMS N CONDITION OF PROPERTY '°'N
Heating system maintained/operational Building Interior is clean/maintained
Hot water system maintained/operational Building Exterior is clean/maintained
11,111,
Electrical system maintained/operational 1 Property is clean/safe/maintained
Mechanical system maintained/operational Handrails &guards present
POOLS Y POOL BARRIERS YIN
Pool present Pool is completely enclosed
Pool surface alarm and/or door alarm Barrier is a min. 48"high
resent
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 Barrier capable of being locked &child-
requirements proof when unattended
..............
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Town Hall Annex ��` s Telephone(631)765-1802
54375 Main Road �, �� Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-09590 I �
w"w
CoU
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION
Rental Permit Fee$200(Application must be renewed every two74h
JUL 1 0 2019
Section A. PIjr
Property Information:
p y Address
7 A un ,Z
Rental Proert A �� U � � �Y ��
Tax Map Number: 1000 SECTION -7 _--BLOCK -LOT—F---
SECTION
LOT _-SECTION B.
OWNER INFORMATION:
Property Owner Name:
Property Owner Legal Address: Property Owner Mailing Address:
IM I
Telephone Number (s): Daytime W 3 Bening Emergency
Property Owner Email Address: S i' fa(fiV0 �
Pagel of 5 m
lbo i4�l�q� F
., UJ1�M�w �d4'✓�r
� d� � (�
Town Hall Annex °ira Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 ,
Southold,NY 11971-0959 u� �
�,� �
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Section C.
Authorized Agent In, or ion:
Name of Authorized Agent of dwellini unit, if z6y:
Address of Authorized Agent (no P.O. e
Mailing Address of Authorized ens ^
t. µ,
Telephone Number (s): gime__ Evenings Emergency
Email Address:
Section D.
Managing Agent I for tion.
Name of Authorized Agent of dwelt/ti' nit, if any:
"
Address of Authorized Agent no P.O. Boxes
a�
g ( s`,
Mailing Address of Authorized Agent:
i g m _...
Telephone Number(s): Daytime Evenin Emergency
Email Address:
�7'W_ _ .................. --- .
SECTION E.
SITE MANAGER INFORMATION: (reqs Iced for e tal properties containing 8 or more rental units)
Name of Managing Agent of dwelling unjt;„�if any
,N
Xg g g ""
Address of Managing Agent (no, . Boxes):
Page 2 of 5
Town Hail Annex °�` Telephone(631)765-1802
54375 Main Road u' Fait(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 A
BUILDING DEPAR NT
TOWN OF O
Mailing Address of Managing Agent:
Telephone Number(s): Daytime ... Ing 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: 5 7 6 /
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:
MBF, �'�3
Page 3 of 5
u
'rw u r �ilhtinU�p �yJ
Town Hall Annex �ldTele hone(631)765-1802
Fax(631)765-9502
54375 Main Road
P.O.Box 1179
&"u'Ae'
Southold,NY 11971-0959 r�✓� °�� �pl �✓ �� `"
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.
XI 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)
IA � 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
d�
B h1�11W1
Town Hall Annex Telephone(631)765-1802
�
54375 Main Road Fax(631)765-9502
P.O.Box 1179 f 7 r
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOUN OF SOUTHOLD
applicable laws and rules. I further acknowledge that I will notifythe Town of Southold
Building Department of any changes of address within five (5) days of any changes
thereto.
1 I 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:
Property Owner's Signature:
Sworn to before me this day of , 20_qAjl -- — �
Official Nota y lic Si nature and Original Notary Stamp
THERESA M,vATTAjj
Notary Public Scala of Now
No.0144832984
aaar l'QuIlam lrJanuaryed in Suffolk,co��37,
Page 5 of 5
o --
so
765-1802
I NSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] F AL iT
[ ] FIREPLACE & CHIMNEY [V FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
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FORM NO, 4
TONIN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN N CL'ERK'S OFFICE
SOUTHOLD. N. Y.
CERTIFICATE OF OCCUPANCY
No.Z. P-979 . . . . Date . . . . . . . . . . . ....January . . . '1.1 ., 19.67.
THIS CERTIFIES that the building located at . i+/end. )Pvt. load,, 'Off N. x 1j& &m .Ave
Map =. R+,Ti)t2.:L.j,j Block No. . . . . . . . . .Lot No. xxx. . . .Mx3ttItuiakt. 141.. . . . . . .
conforms substantially to the Application for Building Permit heretofore filed in this office
dated . . . .. . . . . 341.).y . . . .1.0. . . . ., 19.65 pursuant to which Building Permit No. .274iz. .
dated . . . . . . . . .jVza7. . .11. . . . . . .. 19_65, 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 . . .One. f.o t-j, .y. —atmme�F i'$3ttag$ . . . .
The certificate is issued to . .. .. • • • • . .
(owner, lessee or tenant)
of the aforesaid building.
,Suffolk County Department of Health Approval . . . 44.11 . . 9.6 . . .by . . xlet. . . . . .
Building Inspect
. ................................... .................... ...............................
.. ..............
,F04 Town of Southold Annex 12/7/2012
P.O.Box 1179
4,
got 54375 Main Road
Southold,New York 11971
................. -------
CERTIFICATE OF OCCUPANCY
No: 36074 Date: 12/7/2012
THIS CERTIFIES that the building ADDITION/ALTERATION
........... .........................
Location of Property: 4573 WICKHAM AVENUE,MATTITUCK,
.................................................
.................
SCTM#: 473889 Sec/Block/Lot: 107.4-5
.. . ............................................
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
8/28/2009 pursuant to which Building Permit No. 37068 dated 3/15/2012
..................
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:
1Das bUflt"altcralion and deckaddition to all existingRpq ibaii1ildw IVi I a4a led /1810'9.
P
The certificate is issued to DIANE DELUCIA&ALBERT LEUTWYLE
........................... --.1-11,--------..........................................
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 37068 12/3/10
PLUMBERS CERTIFICATION DATED 3/27/12 Mattituck Plumbing& Heating
...................... ...
Aufl�Vized Signature
..............................
tt r Town of Southold 5/18/2018
P.O.Box 1179
An 53095 Main Rd
" Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 39652 Date: 5/18/2018
THIS CERTIFIES that the building RESIDENTIAL ADDITION
Location of Property: 4573 Wickham Ave,Mattituck
SCTM#: 473889 Sec/Block/Lot: 107.-4-5
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
5/11/2017 pursuant to which Building Permit No. 41698 dated 6/5/2017
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:
alterations and additions,, :tcludi�lq � vgll.in�for llc tl e,)napliangpjedk, -fi-oqLqq.ry deck, second stgly bal gray
end outdoorA__�
owe.r stall ¢1rc to s.tar: qne Jam _il d r llzng : ap11tt #7Q22, dated 2/16/2017,
The certificate is issued to Leutwyler,Albert
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 18-46932 1/24/2018
PLUMBERS CERTIFICATION DATED 3/20/2018 To Cola(
t tsar , Signature.... —........
a