HomeMy WebLinkAbout1000-139.-3-25 1 TOWN OF SOUTHOLD
affV � 4i
Rental Permit
0712
Owner Nicolas Rieger & Teressa Son
Occupied as Single Family Dwelling
Located at 2200 Wickham Ave Mattituck 139-3-25
Maximum 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.
8/2/2022
ode f rce a Official
This Notice must be posted by the main entrance at all times
F so(YTZ y,
Town Hall Annex .yam Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 • _-INC
Southold,NY 11971-0959
oul.m, a ® E
APR 2 5 2022 Dk
BUILDING DEPARTMENT E,
TOWN OF SOUTHOLD BUILDING DEPT.
TOWN OF SOl1THOLD
RENTAL PERMIT APPLICATION
Rental Permit Fee $200(Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
2200 Wlcl<lwi /QVC ; Mlt-1-f-1-rVCk , NY II 9372
Tax Map Number: 1000 SECTION . 13 g -BLOCK 3 -LOT 2 S -
139- 3- D5'
SECTION B.
OWNER INFORMATION:
Property Owner Name: IVIcol-AS RIEGEK T-ERCSsfi- SdN
Property Owner Legal Address: Property Owner Mailing Address:
I?- AEkK-1 S7-9 ET-, f 3L �Z 86AA-f 91R�c�, 3C
eAOOKLIN. IV`/ lmg BA00AL-IN iN-1 1f2�ya�_
Telephone Number(s): Daytime LO-%3- 0 1ning N Emergency
Property Owner Email Address: �l GO LfS l���P(� f✓ll •C
Ta MA , CW 64MIN L- com
� d .
Page 1 of 5
U 4�
Town Hall Annex Telephone(631)765-1802
54375 Main Road hic Fax(631)765-9502
P.O.Box 1179 O
Southold,NY 11971-0959 Q
COU
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
RENTAL PERMIT APPLICATION INSTRUCTIONS
Rental Permit Fee $200 (Application must be renewed every two years)
The items listed below are required to be submitted with the completed
application.
❑ Floor Plans: Floor plans of each Rental Dwelling Unit, please show location of
all smoke &carbon monoxide detectors.
❑ Certificates of Occupancy and Pre-Certificates of Occupancy: Certificates of
occupancy or Pre-Certificates of Occupancy for each rental dwelling unit.
❑ Certification of Code Compliance (form enclosed): Must be submitted by a
license architect or engineer or license home inspector if an inspection by Town of
Southold Inspector is declined.
❑ Rental Permit Fee: $200.00
� Vr son
Town Hall Annex Telephone(631)765-1802
54375 Main Road cn Fax(631)765-9502
P.O.Box 1179 • o
Southold,NY 11971-0959 Q
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Mailing Address of Managing Agent: ` " I A
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, Q the use of each room in the Rental Dwelling Unit
(for example, Kitchen, Bedroom 1, Bedroom 2jiving 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 loccupy Dwelling Unit:. �j
Number of rooms in Rental Dwelling Unit:� t '.J.' V
"l.
Use and Dimensions of each room in Rental Dwelling Unit:
C 6L �W) I3e4 r avw 2 7 s a Fr K+-Fdwk- I72- SQ 7
x424 r"-M :3 —✓ o� SQ f7
L-jv,-V-La P-0-v-m — 30S Sq P
Page 3 of 5
Sao` Fso
Town Hall Annex Telephone(631)765-1802
54375 Main Road c� Fax(631)765-9502
P.O.Box 1179 9Z
Southold,NY 11971-0959 Ol.
fi=�«tet
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Section C.
Authorized Agent Information:
1\,II
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 D.
Managing Agent Information: f
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
if q��pF SOUTyof'�,
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 G •
Southold,NY 11971-0959
Tenn
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.
JV/1 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)
I J\/1 GO LA-S Al E�i�� „certify under penalty of perjury,the following:
1. 1 am.,thgo.v ner,.,gf;the,pr..operty.: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
addr'ess`andllunderstand the Town will use the address for service pursuant to all
Page 4 of 5
�oF Sy
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 • �-24C
Southold,NY 11971-0959 Ql
UM,I,�a�
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:
Property Owner's Signature:
Sworn to before me this2 day of ( , 207-Z—
Official Notary Public Signature and Orig I otary StWinp
SETH G BANK
Notary Public-State of New Yark
NO.01 BA6427783
Qualified in Suffolk County
My commission Expires Jan 3,2026
Page 5 of 5
I
OF SOUIyOIo
* # TOWN OF SOUTHOLD BUILDING DEPT.
courm 765-1802 aCrb (A LOAPM AA
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG. z
[ ] FOUNDATION 2ND [ ] -INSULATIOWC-AULKING
[ ] FRAMING/STRAPPING [IFIRE
INALFIREPLACE & CHIMNEY [ SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL:-(FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:
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TOWN OF SOUTMOLD PROPERTY RECORD
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,OWNER WJ'cr- c,
• STREET VILLAGE DIST.
_
FORMER 6WNER., N
E ACRS'
W TYPE OF BUILDING
SEAS. VL. FARMCOMM. CB. MISC. Mkt. Value `= `
LAND 'IMP. TOTAL DATE REMARKS
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FARM. Acre Value Per Value g
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139--3-2503/09/2018
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M. Bldg.
adation _ Bath Dinette
.ExtensionoZ 'Basement # Floors ,r'm K.Ext ns€on . c 1�4
t. Walls Interior FinishI
MFire.
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Place - Heat DRr
` Type Roof Rooms 1st Floor � ? � BR. - --_
,Recreation Rooms ;, Rooms 2nd Floors } a t Flit.
Porch' t
r �t4) .. _ .� Dormer f
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Total :. -
�g�pfoj,�d Town of Southold 12/11/2017
�o c 53095 Main Rd
Southold,New York 11971
oy oN"
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: 39398 Date: 12/11/2017
THIS CERTIFIES that the structure(s)located at: 2200 Wickham Ave,Mattituck
SCTM#: 473889 Sec/Block/Lot: 139.-3-25
Subdivision: Filed Map No. Lot No.
conforms substantially to the requirements for a built prior to
APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 39398
dated 12/11/2017 was issued and conforms to all the requriements of the applicable provisions of the law.
The occupW for which this certificate is issued is:
wood frame one family dwelling and accessory wood frame garage.*
Notes: Updated Pre-existing Certificate of Occupancy replaces Z-38700 dated 12/28/2016.
BP 4521 carport addition to accessory garage COZ-3770;BP 20522 deck addition COZ-38700:BP 42161 "as built"
alterations COZ-39397.
The certificate is issued to 2200 Wickham Ave Fmly LLC
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT. sne•
fi YA
ut ed Signature
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 2200 Wickham Ave,Mattituck
SUFF.CO.TAX MAP NO.: 139.-3-25 SUBDIVISION:
NAME OF OWNER(S): 2200 Wickham Ave Fmly LLC
OCCUPANCY:
ADMITTED BY:
SOURCE OF REQUEST: 2200 Wickham Ave Fmly LLC DATE: 12/11/2017
DWELLING:
#STORIES: 2 #EXITS: 3
FOUNDATION: cement block CELLAR: full CRAWL SPACE:
BATHROOM(S): 1 TOILET ROOM(S): 1 UTILITY ROOM(S): yes
PORCH TYPE: DECK TYPE: PATIO TYPE:
BREEZEWAY: FIREPLACE: yes GARAGE:
DOMESTIC HOTWATER: yes TYPE HEATER: OR AIR CONDITIONING:
TYPE HEAT: ho of WARM AIR: x HOT WATER: oil fired
#BEDROOMS: 3 #KITCHENS: BASEMENT TYPE: unfinished
OTHER:
ACCESSORY STRUCTURES:
GARAGE,TYPE OF CONST: wood frame STORAGE,TYPE OF CONST:
SWIMMING POOL: GUEST,TYPE OF CONST:
OTHER:
VIOLATIONS:
REMARKS:
INSPECTED BY: JOHNJ DATE OF INSPECTION: 12/11/2017
TIME START: 9:45am END: 10:20am
FORM NO. 4
TOWN OF SOUTHOLD �6%AP a r+
BUILDING DEPARTMENT
Town Clerk's Office - PJ��►�
Southold, N. Y.
Certificate Of Occupancy
No. Z 3770. Date . . . . . April. 2 , 1970
THIS CERTIFIES that the building located at Wickham & Bayer Rd Street
Map No. Matt Rts Block No. . . . Lot No. .29&30 Mattituck K.•Ys
conforms substantially to the Application for Building Permit heretofore filed in this office
Oct
dated 19. 69 pursuant to which Building Permit No. 45292.
dated Oct 2 19€9 , 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 . .Priv.ete• Garage . .("Cessrry.Bldg). . . . . . . . . . . . . . . . . . . . . . . . .
The certificate is issued to Carail J- Zarvey . . Owner
(
w er-
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval X.R.. . .
Building Inspector
Souse # 2200 Wickham Ave
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z--20650 Date APRIL 16, 1992
THIS CERTIFIES that the building ADDITION
Location of Property 2200 WICKHAM AVE. MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 139 Block 3 Lot 25
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 1, 1992 pursuant to which
Building Permit No. 20522-Z dated-, APRIL 3, 1992
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 AS APPLIED FOR
The certificate is issued to CARROLL J. HARVEY
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
ov-
RiffldAg In actor
Rev. 1/81
�p�SnfFot,��oa Town of Southold 12/11/2017
P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 39397 Date: 12/11/2017
THIS CERTIFIES that the building AS BUILT ALTERATION
Location of Property: 2200 Wickham Ave,Mattituck
SCTM#: 473889 Sec/Block/Lot: 139.-3-25
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
11/15/2017 pursuant to which Building Permit No. 42161 dated 11/20/2017
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:
"as built"alterations including renovation of kitchen and bathrooms,air conditioning and gas heat and hot water heater,
in an existing one family dwelling as applied for.
The certificate is issued to 2200 Wickham Ave Fmly LLC
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 17-37070 11/1/2017
PLUMBERS CERTIFICATION DATED 11/27/17 a Piecu
ut oriz d Si e
Town of Southold 2/16/2018
P.O.Box 1.179
a ! 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 39517 Date: 2/16/2018
THIS CERTIFIES that the building RESIDENTIAL ALTERATION
Location of Property: 2200 Wickham Ave.,Mattituck
SCTM#: 473889 Sec/Block/Lot: 139.-3-25
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
12/20/2017 pursuant to which Building Permit No. 42291 dated 1/10/2018
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:
WINDOWS AND DOORS ONLY IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to 2200 Wickham Ave Fmly LLC
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
ut Signature