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Home My WebLink About1000-107.-9-18 TOWN OF SOUTHOLD Rental Permit 0950 Owner John & Amy Elliott Occupied as Single Family Dwelling Located at 3770 Wickham Ave. Mattituck 107.-9-18 Maximum Permitted Occupancy 10 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. 7/11/2023 C de for e e t official This Notice must be posted by the main entrance at all times Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 �r Southold,NY 11971-0959 JUN 22 2023 BUILDING DEPARTMENT TOWN OF SOUTHOLI} RENTAL PERMIT APPLICATION Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: 3770 Wickham Avenue Mattituck, NY 11952 Tax Map Number: 1000 SECTION 473889 a BLO("g_.-._... 107 -LOT 9 18 SECTION B. OWNER INFORMATION: Property Owner Name: John F. Elliott/Amy M. Elliott Property Owner Legal Address: Property Owner Mailing Address: 3770 Wickham Avenue __ „M, 770;Wick �Li ve iys_-._ Mattituck NY 11 952 - Telephone Number(s): Daytime l7-593-3554 Evening same Emergency 917-593-3554 Property Owner Email Address: elliott'f me.com �Da �,�, C, I p y gsS Page 1 of 5 a. d P ,o Town Hall Annex � w"` Telephone(631)765-1802 54375 Main Road ; -- Fax(631)765-9502 o� P.O.Box 1179 �� Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SO :SOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: __Erica Stype McKenzie Address of Authorized Agent (no P.O. Boxes): 12985 Main Road, Mattituck,NY 11952 Mailing Address of Authorized Agent:12985 Main Road, . . Bo _ Matfi!jLcI,PY11952 631,-298-8760 631-603-408� Telephone Number (s): Daytime_,,___,,__,__Evening mergency -- Email Address: erica s e.com 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: w ._,-._ Address of Managing Agent (no P.O. Boxes);p Page 2 of 5 W Np k Town Hall Annex � �� Telephone(631)765-1802 54375 Main Road � � Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 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: Unit 1 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." Bdl,Bd2,Bd3,Bd4,Bd5,Kitchen,Den,Family Room,Living Room,Br1,Br2,Br3,112 Br,Laundry Room Rental Dwelling Unit Identifier: Unit 1 a occupy Dwelling Uni 10 Requested Maximum number of persons allowed t py g ., �.�...... Number of rooms in Rental Dwelling Unit: eµ15 .. "� Use and Dimensions of each room in Rental Dwelling Unit: Page 3 of 5 3770 Wickham Avenue, Mattituck, NY 11952 Use and Dimensions of each room in Rental Dwelling Unit: 1. Bed Room #1: 17'1" X 23'9" 2. Bed Room #2: 15'9"X 10'11" 3. Bed Room #3: 15'6" X 10'11" 4. Bed Room #4: 11'11"X 10'11" 5. Bed Room #5: 9'6" X 8'10" 6. Kitchen: 187" X 13'8" 7. Dinning Area: 17'3" X 715" 8. Den: 12'10"X 11'9" 9. Family Room: 12'10" X 12'6" 10. Living Room: 23'0" X 15'6" 11. 1 st Floor 1/2 Bath: 5" X 5'9" 12. 1 st Floor Full Bath: 8'5" X 9'3" 13. 2nd Floor Full Bath: 8'4" X 11'4" 14. Basement Full Bath: 8'2" X 8'0" 15. Laundry Room: 7'4" x 11'11" JAJ� r Town Hall Annex ; Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 aco P.O.Box 1 179 � (13 Southold,NY 11971-0959 ' � um' 1 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. ❑ I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold X 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) John F. Elliott I w.. , 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 Town Hall Annex I Telephone(631)765-1802 54375 Main Road `i i' Fax(631)765-9502 P.O.Box 1179 , „ Southold,NY 11971-0959 � M 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: rcwO .lo Elliott .n �. Elliott Property Owners Signature: Sworn to before me this day of � _ .. « 2003 Official Notary ublic Signature and Original Notary Stamp FRA14CINE CHEMUINN GRAWAM Notary Public-Stab of Now York NO. OIGR6342620 Qualified in New York Coun~,i My Commission Expires May_: .024 w Page 5 of 5 ;r Town Hall Annex fl'"� Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 � Southold,NY 11971-0959 " 6° A �dn BUILDING DEPARTMENT TOWN OF SO THOLD 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 i rgf ssi to tl e treqfor ArchiLect,9r t qi tger..licensed Hotne itisp aor r l p qy c ps valid urrent et1j ica iot2 Rental Property SCTM Number: �_�_ _,._..�......_ Rental Property Address: 3ri ON kk,a m AJeu�1k6' MATT rTu-c is my t i Owner/Name: v�✓t E I l:o�.T_ . . ... _ _.._ ...._ �_ �_. Rental Dwelling Unit Identifier:1 NIT Number& Square footage of each bedroom as depicted in the attached floor plan: (i.e. Beroom#1 -100 sq., Bedroom#2-90 s ,, etc.) 00 to,h�i v l'I X 23`9 / . �,►� ' x it 0'' Propertyall improvements indicated on survey) 7 S*F sc (include Erourn6 ticusE 0�'me/-C,J r04� or;� . r�'�/cd ._.. �� ? ..1 arc L, nc� 1d C f 1 n 4 r1 S �:�"�l.t6 �w; � � n Gnc. 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 Nar ' hflJl�� t � ' E^'�,v�s2 Original Signature Pleasgsle profellal y vs 4�01-�� OF SOUTHOLD BUILDINGDEPT. 631-765-1802 I Z INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI L) [ ] CODE VIOLATION [ ] PRE C/O RENTAL E 1 j f i I ! x�o 3 Z v o E _• v L(r t eG� f�'l i f ( 3 e ` '� ,psi 1= a i t E =14i F i s i Of i 9c et e i �✓ 6, e- 1 E s Amo r i , TOWN OF SUTHD PROPERTY RECON 11 30 �► OWNER STREET VILLAGE D I STq SUB. � LOQ,. FORMER OWNER N E ACR - _ =' I S i W TYPE OF BUILDING RES SEAS. °VL. FARM ' COMM. CB. MISC. Mkt. Value \ l i LAND IMP, ; TOTAL DATE REMARKS f } s n 3 E AGEB�IIPGING ND1T1� f _ -ttEW _ FAR,° i f Acre Value Per VolUe Acre l _ - Tillable 1 _ Tillable 2 Tillcble 3 a Woodlond g FRONTAGE ON WATER Swampland67 s , ` FRONTAGE ON ROAD Brushland d f DEPTH House Plot �— a t fd LE\ I Ca'iD1tF ` k `'� -7I j ` co - - r Tl DOCK -17 LOQ` r f s f s 333 � r I � 4 107:9-18 4/13/2019 M. Bldg . r Foundation "1 F Bath - Dinette Extension t ;BFlooasement r K S i -"Sion ` f Ext. Walls Interior Finish LR. � x Exten,lio = fC — b '£F= Fire Place ' - `: sHeat QR. A r wjf� e Roof Rooms ist Floor BR. C a i !Type p ' � t tE fF.,� - - - - dor#h' 9n Recreation RM_ Rooms 2nd Floor; ;FIN B Porch tl x _ .� Qrme � i VT Garage 1 3Z Patio`-tl j 0. B. _ Total `17 q 7 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- 30749 Date: O O8Z 5 THIS CERTIFIES that the building DWELLING Location of Property 3770 WICKHAM AVE_ MATTITUCK (HOUSE NO.) - (STREET) (HAMLET) County Tax Map No. 473889 Section 107 Block 0009 Lot 018 Subdivision Filed Map No. Lot No. conforms substantially to the Requirements rements for a ONE-FAMILY DWELLING built prior to APRIL 9 1957. pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 30749 dated FEBRUARY 8, 2005 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 ACCESSORY GARAGE The certificate is issued to DOROTHY E BUGDIN ._.......�.� (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NIA ELECTRICAL CERTIFICATE NO. _ N/A......mm. PLUbSK RS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. t _......w_............._. Authorized Signature .ww.._............_. 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-33464 Date: 12x/23/08 THIS CERTIFIES that the building ALTERATIONS Location of Property- 3770 WICKHAM AVE MATTITUCK� .._.. (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 107 Block 9 Lot 18 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 11, 2008 pursuant to which Building Permit No. 33833-Z dated APRIL 18, 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 S TO AN EXISTING ONE F XIS is ALTERATION FAMILY DWELLING TO AN TING ONE FAMILY EXISTING DWELLING AS APPLIED FOR. The certificate is issued to JOHN F & AMY M ELLIOTTm (OWNER) of the aforesaid building„ SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 40124.04 12p"µ1„5/„08 PLUMBERS CERTIFICATION DATED 12/08/08 PERFECTION PLUMBING mm w _................... ....... .......... uthoz'ized Si nature Rev. 1/81 � 1FO4 Town of Southold 7/27/2021 P.O.Box 1179 53095 Main Rd ` AN Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42201 Date: 7/27/2021 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 3770 Wickham Ave,Mattituck SCTM#: 473889 Sec/Block/Lot: 107.-9-18 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 10/4/2018 pursuant to which Building Permit No. 43141 dated 10/16/2018 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: acl jf ons a dIt ration djU c vga it d ftorlt porccll�wto e llipl g„l -f4mfly dWlltnZ.Ls a �l tied_ iarM The certificate is issued to Elliott,John&Amy of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-18-0063 10/9/2019 ELECTRICAL CERTIFICATE NO. 43141 12/28/2019 _. .. .. _..... PLUMBERS CERTIFICATION DATED 3/6/2020 � an McCaz .�..,.. ..... ... ahori,.::. .Signature