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Home My WebLink About1000-103.-13-10 � at TOWN OF SOUTHOLD MY3 Rental Permit Permit No. 0196 x� Owner Thomas & Gekee Wickham Occupied as Single Family Dwelling Located at 1230 West Creek Ave Cutchogue 103-13-10 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. 10/17/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times y �mr Town Hall Annexe�`1 �' J� l%�� 6Telephone(631)765-1802 54375 Main Road Fax(6311765440 P.O.Box 1179 Southold,NY 11971-0959 IG I 'Po 9 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION Rental Permit Fee $200 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: Tax Map Number: 1000 SECTION V 3 BLOCK �� —LOT—R)— SECTION OT _R)—SECTION B. OWNER INFORMATION: Property Owner Name:�� Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) Telephone Number(s): c Property Owner Email Address: ..... _ .. .. Page 1 of 4 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: f N Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each roo ru in Rental Dwelling Unit: 2 5 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. 11 am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold. Page 3 of 4 ❑ 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) 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, Site Manager. 1� r Property Owner's Name. 8 i Property Owner's Signature: _ .. Sworn to before me this[—<)—day of 201---1 —L-6 _ Official Notary Public Signature and Original Notary Stamp e_u':wGtiRG11 D,M MCH Pu.u1:u11 ,State of New Ycgk Page 4 of 4 No, 0'11"U6185050 in Suffolk Corm' �, E xcires a+'Worth '1 ,,2..:. � � v 1 .— t � i * TOWN OF SOUTHOLD BUILDING 0EPT. 765-1802 I [ ] FOUNDATION TI 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND n [ ] INSULATIOWCAULKING [ ] FRAMING/STRAPPING ] AL [ ' FI L I [ Vf FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ]--FIRE I TT PENETRATION [ ] ELECTRICAL f ) [ ] ELECTRICAL (FINAL) [ ] °SIO L TI [ ] C/ w 711111111 toAt — Or 6�n DATEN INSPECTOR °' °' m up - :� :� :� , -n 0 0 0 -n to 0 C: 0 > r— EA CL t, C, > X Z z A CD 0 3 CL G) -"" C) C.0 .. .......... Ln (D co OL >n E- m r 4 (DNJ CD z b 31 Ln ....................... -n < 0 oj c 0z I fl) IM 0 C M 70 70 m 0 n 0 C) 0 0 M 7K --I Z z uj > T --I --I "I"", , < > > m m to Cl r 0 0 0 Z z ..................... CD v" U3 0�,3 0 x X ' > O tN N 0 O 7 _ a CDfD ,� to� N• �.. � O O O m N � INJ V O 1 IN v W r I lY Y f p CJ " m o- T' p X �% O O � Z 0 co m C CD 3 -0 i 3 a LE f,. r =ry "V r O p D O O O S7 O O (�. � � O w I. v N � O I T a �'+ _. O a Ar r f 1 p W p y4 r m v I d , ti a W y y. rn 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-23981 Date OCTOBER 24, 1995 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 1230 WEST CREEK AVENUE CUTCHOGUB NY House No. Street Hamlet County Tax Map No. 1000 Section 103 Block 13 Lot 10 Subdivision Filed Map No. Lot No. conforms substantially to the Requirements for a one Family Dwelling built Prior to: APRIL 2,_1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z-23981 dated OCTOBER 24, 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 A ONE FAMILY DWELLING WITH ACCESSORY GARAGE. The certificate is issued to THOMAS & GEKSE WICKHAM (owner's) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. iBuiAding�Inspector Rev. 1/B1 11111 1.1)111C Ul•:1'AIt I tIL•'N 1' TOWN (1l' SOUTHOLD 11OUSING, (;01)1°. INSPECTION 1tE1'OItI. 1230 WFST CREEK AVVNUH CUTCHOGUE NY LOCATI ON: _... ., (�num ... Cr 6 sl:ric (uuurrc)pnli(y b.. O SUBDIVISION HAV 1189). H.Q')°ll"( ......._._... NAME 01' OWNLI( (s) T31011AS WICRHAM & WIFE. OCCUPANCY A-I RFS OWNER �.._. - - Zlylx..._ (nvncr (enruiL'1 Alkll'L"flip BY. JANE COTTRELL n00019PAtJ11sD ISY JANE COTTRELL _...... ... ._._..._ ........ ...._. C°f1. "PAX HAP Nlr. I000 103-1 10 KEY nVA B Lnl3l V _ _ _ .. _ -- CEKFE WICKHAM DATE 0/17/95 ` SO 1 1/2 ONE :iOIIRCE OI' ltl y111;S'1 _ _ ,... _.._. ---- - RAMS f S U O I t I t,) f I•.x I T., '1'YI'1•; OI' CONS'1'Imcn.ION •, .. .__. D CFmNT BLOCKOO (1'L1 FOI1NpA'I'Il)N All PARTIAL _ (;ItAWI. Sl'A(l�"� 'V'0'tl'AL ROMV . IST 11119.1(. 4 VIA) 11^11.11(, 219VCVa - ]SA'1'p ItOUN (s� ST SIDEI(1 I 1 I"I' ROOM (s)❑LCK� '. .-- _�, I'OR(:II 'I,yI,I-' NCLOSED WE I)'1'IL1'1'Y R(70H SLATE I 2 IYPL' LAAO Cly .� .. Ill(EEZEWAY I lV(IGI'I.nCPi? ONE GARAGE I)ONHST I C II0I'WA'1'I.It - 'IES I'YI'li 111'.A'1'lilt OFF BOILER A l iwo O I ri m IN(: OIL WARR Alit IIOTWA'fEl( AC.(:IiSSOItY STHUC IMES: GARA(.C, SYI I OF (ON"T. ONE CAR WOOD FRAME STORAGE, -I'YPI-- CONST.®� SNINMING i'001, GUEST, 1'YI11i CONST. ®� _.._............. OTII ER: _._,__. ....�,.�....._ ._.._..._._ __._ VIOLATIONS, l'IIAI fLl( r5 N.Y. >fA'I'L UNIF - >v � � •-�-�^ • �.0 �ORAf 111R[E I'IOiVF,I('1'lON 6 ISIJII,DITIG Co I.00ATIIVI _. I w N::h 'rC(,Ilili BY .�� . � llAll. OV INSI I{( 1'IDN ,10/23/95 GARY J. '1 1'IHIi STAR 1" 9: 15A.H_ END 9:30A.M. FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-32632 Date: x7/07 � ,.. ._. .... _. THIS CERTIFIES that the building ALTERATION & ADDITION„ Location of Property: 1WEST CREEK AVEVE_ — CZTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No- 473889 Section 103 Block 13 Lot 10 Subdivision Filed Flap No Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 142006 pursuant to which Building Permit No. 31808-Z dated FEBRUARY 23, 2006 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 ADDITIONS & ALTERATIONS T.. AN EXISTING "� O XI SINGLE FAMILY DWELLING AS�..m,,,,, _ ' ._ . APPLI. ED FOR. _ ... . The certificate is issued to THOMAS & GEKEE WICK—HM BM .. _._ �...T (OWNER) of the aforesaid building. SUFFOLK COUlT1'Y DEPARTM TT OF HEALTH APPROVAL N/A �............._......,...._. ELECTRICAL CERTIFICATE NO- 3025625 .5!%;3207. PLUMBERS CERTIFICATION DATED 0m1/071]wT2, WICKHAM �...J.... t Ay hoxized Signature Rev. 1/81