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Home My WebLink About1000-107.-9-15 $$ OWN OF SOUTHOLD Rental Permit s 0967 Owner Terri Ann DiVello & Ors. Occupied as Single Family Dwelling Located at 3370 Wickham Ave. Mattituck 107.-9-15 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. 8/3/2023 Code nfor e en Official This Notice must be posted by the main entrance at all times tj 2-S t�a) S. Town Hall Annex f" t Telephone(631)765-1802 54375 Main Road �r Fax(631)765-9502 P.O.Box 1179 "a �z r Southold,NY 11971-0959, BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPUCAT1ON Rental Permit Fee $200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: •Q M a Tax Map Number: 1000 SECTION SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: u3 --I�kC��ca LY-1 Telephone Number(s): Daytime Evening_Emergency Property Owner Email Address: Page 1 of 5 Town Hall Annex „' Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1174 Southold,NY 11971-0959 N,� BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: � � ��►'2��o Address of Authorized Agent(no P.O. Boxes): 3-'-�-Lcj A Mailing Address of Authorized Agent: Telephone Number(s): Daytime_ Evening Emergency Email Address: rl ► \� ° '� �� , Co�'� 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: Address of Managing Agent (no P.O. Boxes): Page 2 of 5 Town Hail Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1]79 pM` Southold,NY 1 1971-0959 � BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent:.— Telephone gent: —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: 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:-16 Din r "X t t' '' t 'V''X t' '' 1916"X Page 3 of 5 u� p �6 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.flax 1179 Southold,NY 11971-0959 � j" 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. )d I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ 1 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) 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 /a Ifs I Town Hail Annex " Telephone(631)765-1802 54375 Main Roads !% Fax(631)765-9502 CAR � P.O.Box 1179 . Southold,NY 11971-0959 BUILDING DEPARTMENT Towle OF SOUTHOI.D 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: Property Owner's Signature: S Hca afore me this LKy of , 203 Official N a li1.c Signature and Original Notey Stamp EVE L.GATZ-SCHWAMBORN NOTARY PUBLIC.STATE OF NEW YORK Registration lstration 'tt.OICYA627 4026 Qualified in Suffolk County Commission Expires Inc.24,244 Page 5 of 5 �+ qv sou TOWN OF SOUTHOLD BUILDING D� 631 -765-1802 /007- INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATIOWCAI [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY IN! [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FIN [ ] CODE VIOLATION [ ] PRE C/O [p4'1 REMARKS:ok, DATE -' ' � INSPECTOR - V Q _ - - \\�� \\vyvvy \ \ \ MOM Drinire ROM ",,,Wn 00 -10 ,_ A INco `V y� F Town Hall Annex Town of Southold 54375 Main Road y Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 i0 4W Tel: 631-765-1802 �SCTM.# �D .. —�� Date Owner Phone Address I/ t" �✓ Visible _ Inspector Hamlet � . .a _........ Floor Level Quantities Sub I 1 2 3 onoxide(Dete toted m bedrooms) Carbon My Detectors not Smoke De _..,. ......_._ Detectors Fire Extinguishers _v Exits Bedrooms 1 2 3 4 5 6 Smoke Detectors Egress Occupant Count Building Systems Maintained &Operational Con11 dition of Property Heating Building interior Hot water Building exterior ElectricalProperty clean, maintained &safe Mechanical.. m /Handrails &gurds installed & sere .... ._ . r.._..w....�...cu...... Pool Safety I Date of CO Poo on Site Surface water alarm issuance Door alarms Pool completely enclosed Pool fence to code requirements CO's for all items present Prior Rental Comments: LOA, 4-0 _ _ -71C, 3ti ERTY EC TOWN OF SOUTHOLD PROP RORD CARD F OWNER STREET VILLAGE DIST.'; SUB, LOT J` FORMER OWNER N E ACR S W TYPE OF BUILDING ti Lit RES. SEAS. VL. FARM COMM. CB. MISC. Mkt. Value_--- i-4 LAND IMP, TOTAL REMARKS /v DATE -41 � ct e,a 7-77' ay -71 vi Cc N �AGE 1. , BUILDING CONDITION ' F k NQRWU�,Li'll /411 --N- k- NEW BELOW Y E J-1 7 FARM Acre Value Per Vdiue Acres ? FA t V-A " 14 T Tillable 2 -7 ly- Tillable 3 iN- thr i o', —ho Woodland 45 C, Swampland FRONTAGE ON WATER 4� Brushland FRONTAGE ON ROAD House Plot DEPTH ;BULKHEAD Total ' DOCK COLS — - _ tt— E R `f ti - - - - . e } yll t E F � a F. s n Yc _ E _ _ 107:9-15 2107 nz - � _ F t �c _ t., Dinette Extension Basement t Floors- r - Exte psi s i3 Interior Finish _ LR_ -, f lan i Fire Place Heat s �" = DR - •� 'Type Roof Rooms 1st Floor I BR. Porr- Recreation Room Rooms 2nd Floor; � FIN. _. Porch T g R� r r l { Do me tii ti � t Driveway s Garoge14 L pefiv r r 0. B. a i E Tani FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. z4233 Date 'I:ay 7 19 71 THIS CERTIFIES that the building located at Wickham Ave Street Map No. yatt gtg Block No. Lot No. 9 & 10 Lattituek h.Y, conforms substantially to the Application for Building Permit heretofore filed in this office dated Oct. .29 , 19 70. pursuant to which Building Permit No. 45342 dated (pct 31 , 19 7e , 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 private one family -dwelling . . . . . . . . . . . . . . . . . The certificate is issued to Frank Raynor • - hex- (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval YAY 3 1971 . by R.. Villa House # 3375 Building Inspector FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. _. -A5229. . . * Date . . .January. 2.9 , 1 987 . . . . » THIS CERTIFIES that the building INGROUND SWIMMING POOL »& FENCE Location of Property 3376 Wickham Avenue« Mattituck , N .Y . House IVo. Street» Hamlet, County Tax Map No. 1000 Section . . . .l.a . . . . . .Block . , . g. . . . . . . . . .Lot . . . .15. . . . . . . . . . . «. Subdivision . Amd: M/o Mattituck Heights .Filed Map No. . I 84 . . .Lot No. 9 & conforms substantially to the Application for Building Permit heretofore filed in this office dated Aug u s t 2 2 , 1 9 80 pursuant to which Building Permit No. 1 0 874Z. . . dated S e p t e mb e r 19 , 19 8 0 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 . . . . . . . . . INGROUND SWIMMING POOL & FENCE The certificate is issued to . , , FRANK RAYNOR . * ` . . . (owner,l �rlt, of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . . . ./A . . . . . . . . . . . . . . . . . . . . . . . » . UNDERWRITERS CERTIFICATE NO. . . . . . . I . . » . . N520653. ' » . . . PLUMBERS CERTIFICATION DATED : N/A Building«Inspector Rev.1/81 J w FORM NO 4 f TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z1522Januar 29 1987 No . . . -. . 7. . . . Date . . . . . . . . . . .Y. . ' . . . . . . . . . » . , THIS CERTIFIES that the building DECK ADDITION Location of Property House, 3376 Wickham Avenue . Mattituck, New York No Street Hamlet 15 County Tax Map No 1000 Section 1 7 . Block 0 9 . .Lot . . . . . . . . . . . . . . Subdivision Amd. M/o Matti tuck Heights Filed Map No . .1 184 Lot No .9 .& 10 conforms substantially to the Application for Building Permit heretofore filed in this office dated January. 8 , . 1 9 8 7 pursuant to which Building Permit No _ 15 6 14 2 . + . . * . dated January, 9 , 1987 ,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 TO EXISTING ONE FAMILY DWELLING . The certificate is issued to FRANK L . RAYNQR of the aforesaid building Suffolk County Department of Health Approval . . N/ . UNDERWRITERS CERTIFICATE NO. . . . . .N/A. . . . . . . . . . . . . . . . PLUMBERS CERTIFICATION DATED: N/A Building Inspector 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. 15228 . .. . . . Date . . , . . , January 29 , .1 . . 7 . . . . . . . » . », THIS CERTIFIES that the building » . , . . A»C C E S S 0 RY SHED. . . . . . . . . . . . . . . . . . . . . . . » . . . . . . Location of Property , N. 3376 Wickham Avenue Mattituck , N .Y. House o. triaet . . *Hamlet County Tax Map No. 1000 Section . . . .1.0.7 . . . . .BIock . . . , 0.9 . . » . . . . .Lot . , . .1 S. . . . . . . . . . , . AmdSubdivision . . . . . . . . Mattituck Heights Filed Map No. .1.184. . . . .Lot No. .� »& 1«0. . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated May 9, 1973pursuant to which Building Permit No. . .6557.Z. . . . . . . . . . . . . dated . , . w May . . 1987 . * . . . . ,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 . . . . . . . . . ACCESSORY SHED FRANK RAYNOR The certificate is issued to , . . . , . . , . . . . . . . . . . . . » . » . . . , . . . of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . . . .N/. . . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . . . . . A. . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBERS CERTIFICATION DATED: NSA , . . . . . . . . . . . . Buildixg Inspector 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-27335 Date: 09/29/00 THIS CKRTIFIRS that the building ALTERATION Location of Property: 3370 WICKHAM AVE MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) Qxmty Tas map wo. 473889 Section 107 Block 9 Lot 15 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 28 2000 pursuant to which Building Pe m t No. 26525-Z dated MAY 25 2000 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued La ACCESSORY APARTMENT RENOVATION & DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR & AS PER ZBA #4665. > v-- The certificate is issued to FRANK L & BERTHA RAYNOR (OWNER) of the aforesaid building. SOFFCWX OOUNTY DEPAR729 NT OF EMALTH APPROVAL N/A ELECPRICaL CZW1FIC2kTS NO. N-485835 04/16/99 PLUMMERS C EWIFIC7MON DA?ED N/A c /)"tho, zed S nature 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-32814 Date: 12 28 Q7 THIS CERTIFIES that the building ADDITION & ALTERATIONS Location of Property: 3370 WICKHAM AVE MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Hap No. 473889 Section 107 Block 9 Lot 15 Subdivision Filed Hap No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 23, 20�L.5 pursuant to which Building Permit No. 31332-Z dated OCTOBER 7, 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 ADDITION & ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR & AS PER CONDITIONS OF ZBA #5709 DATED 6 9 05. ...... The certificate is issued to TERRI A. DIVELLO & ORS. (OWNER) of the aforesaid building. SUFFOLK COUNTY DRp TtgM OF HEALTH APPROVAL R10-05-0051 121 07 E[.R[`7'RTCAL CERTIFICATE NO. 2087172 IV10L07 PLUMBERS CERTIFICATION DATED jyL4 07 J.ZEES PLUMBING & HEATING Au orized Signature Rev. 1/81 Town of Southold 7/25/2016 " P.O.Boz 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 38407 Date: 7/25/2016 THIS CERTIFIES that the building SOLAR PANEL Location of Property: 3370 Wickham Ave,Mattituck SCTM#: 473889 Sec/Block/Lot: 107.-9-15 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/10/2016 pursuant to which Building Permit No. 40525 dated 3/15/2016 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: Roa SOON n D SOLAR PANELS TO AN ENISTING ONE FAMILY i $—AP UEP h"QR The certificate is issued to DiVello,Terri Ann of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO., 40526 06-14-2016 PLUMBERS CERTIFICATION DATED Authcar�e Signature