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Home My WebLink About1000-117.-3-3.1 TOWN OF SOUTHOLD Rental Permit 0989 Owner Abigail Wickham, Eric Bressler, Gail Wickham Bressler Trt. Occupied as Single Family Dwelling Located at 189 Old Harbor Road New Suffolk 117.-3-3.1 Maximum Permitted Occupancy 8 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. 1 9/14/2023 Cod En r.e nt Official This Notice must be posted by the main entrance at all times P" 0,<, I 4woN Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 � Southold,NY 11971-0959 " eI '/1Jp_ E BUILDING DEPARTMENT TOWN OF 5+C UTHO D SEP - 5 2023 RENTAL PERMIT APPLICATION Building Department a ent Town of SouthoUntal Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Addr Tax Map Number: 1000 SECTION -BLOCK � _-LOT SECTION B. OWNER INFORMATION: � , �� r Property Owner Name:�� w ililt, i `°._.. Property Owner Legal Address: Property Owner Mailing Address: Telephone Number (s): Daytime ',�1� ? Eveningg�9193-�8Emergency Property Owner Email Address:4!:Iwlek Page 1&5 Town Hall Annex " Telephone(631)765-1802 54375 Main Road a4 Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized 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 , M Evening Emergency Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: -� Address of Authorized Agent (no P.O. Bones): 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 Hall Annex $ �' Telephone(631)765-1802 54375 Main Road' Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 ' BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: " Telephone Number (s): Daytime;W Evenin4Emergency w, Email Address: . SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: 0117.6-1 - For f -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 Uni Number of rooms in Rental Dwelling Unit: Z�2 Use and Dimensions of each room in Rental Dwelling Unit: 4 Ed 2 3- Z �� Page of5 Town Hall Annex " Telephone(631)765-1802 54375 Main Road �k Fax(631)765-9502 P.O.Box 1179 + " Southold,NY 11971-0959 � 0, 10 BUILDING DEPARTMENT TOVIN 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: Ylez, ila ' I/ d Property Owner's Signature: n ' Sw r to before met _day of °� 200 -- clal Notary Public` ignature and Original Notary Stamp AMY M.SCHLACHISR TARy PUBUC,STATE OF NEWYORK Registration No.01SC503976' Clualihad in Suffolk County Commission Expires February 27, 0 Page 5 of 5 q. Telephone(631)765-1802 Town Hall Annex 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 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 i� 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. I 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 (pip c� "TOWN OF 60 THOLD BUILDING DEPT. 631-765-1802 [ ] FOUNDATION IST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] AL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F' AL) [ ] CODE VIOLATION [ ] E C/O [ RENTAL REMARKS: � vi lV1.DATE olf� Ayw-\. L64P, I INSPECTOR _ ... FORM PTO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERIC'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ...A.34�........ Date ......................1........+..t4y..7.............. 19.1. .. THIS CERTIFIES that the building located at*/t.. ; .dA1&rb0r-- 0ad.i...Xew-ftff ,t MapNo. —I-1-............... Block No. .......'+k+�..... * x................................................ conforms substantially to the Application for Buildin' Permit heretofore filed in this office dated .................... �Ali>' r... r ., i 9.. i�., pursuant),to which Building Permit No. ...�R. 'xa ........... dated ......................AWIX ..99........... 19..A,was,0 issued,and con"forms to all of the requirements of the applicable provisions of the lo{,'ryg�w, The occupancy for which this certificate is issued is.............. ...........,x.................«...........,x.» !.+` T�'x'd...»':«.«.fix...9'.xx.w+ A MfW� i�dMx'xIkM�N M................................................ This certificate is issued to ..X#liam Wink ,.. ..».: '.......,«...x......,....x».....«.......... ........x....... (owner, lessee or tenant) of the aforesaid building. Building Inspector ."x« HOWARD Mo TERRY Town of Southold 1/14/2023 1-11 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43767 Date: 1/14/2023 THIS CERTIFIES that the building ELECTRICAL Location of Property: 189 Old Harbor Rd,New Suffolk New Suffolk SCTM#: 473889 Sec/Block/Lot: 117.-3-3.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/21/2022 pursuant to which Building Permit No. 48515 dated 11/21/2022 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: t3C�u1w� �.a�tder kround elcck,ar,�, ervicJ, », The certificate is issued to Wickham Bressler,Gail of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 48515 12/7/2022 PLUMBERS CERTIFICATION DATED _..............._ �_._mm,.. ............... _.w.... ...__. __w._ ... Authorized ignature 3. Nature of work (check which applicable): New Building......»,...,..,.,"..Addition ...............",...Alteration ..........,...,.,,.. Repair ....................Removal ....................Demolition....................Other Work (Describe) ,,,.,...«........... 4. Estimated Cost................. ., .0 ,�..?d,..«..»..»»,..,«..»Fee «.,..,,..« ........,...... .,,. .. ,..«...... . ...... «..»........ ....,,.....,.»,,. (to be paid on filing this application) 5. If dwelling, number of dwelling units...............(............."Number of dwelling units on each floor..........,1......«"..,...". If garage, number of cars................................»..,....„..,..,.....,,.,.,,....,..»,....»,,.«..,,.,,.,...,..„.....»..,,.,.,,..«,.......,,...... ,.».,,.,..... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use................:.........»... 7. Dimensions of existing structures, if any: Front.... .....___........... Rear............................ Depth .....„.„...............,,,.„ Height ..................".........Number of Stories .........«.,................».....,.......,,..„..,...,,.,.,...,..,.............»...,.»..,...,........ ....».», Dimensions of some structure with alterations or additions: Front ........................«....,.. Rear .,».,.»....«...,..,»............ Depth ...........__....»........, Height .....,».,....«,»......,.,.».,„Number of Stories ................................ 8. Dimensions of entire new construction: Frant,.,.9,Q.n.e.............. Rear ,,...9CJ=,k”........... Depth ... ...... ... Height ........../A.../.......... Number of Stories ........f...,,..«,.,..,... 9. Size of lot: Front ...... 4??. ............ Rear ....../'f;p......I.... Depth 10. Date of Purchase ..................!R._.7.....I..................Name of Former Owner .... .,. :.; ,. .. ," .„,,pr.............. 11. Zone or use district in which premises are situated............1...��....... ..........................I.............. 12. Does proposed construction violate any zo Ing law, ordinance or regulation? ....., ».....».»...... 13. Name of Owner of premises ... .............Addres�. . . , .;» cs:� ,.�r�t"» ..Phone NO Name of Architect .......,Addre r� c.`c..rr ” ...,..Phone NO. ..........,«....,.. Name of Coa'rtm°actar( r ,L.r Addre a ” .....Phone Ne�.lt SU� PLOT DIAGRAM Uxote clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street nomes and indicate whether interior or corner lot, LANv OF— 51,&,4 F/Y Q � V i 0 HAM � .._._..,.. _�_�..� 160 V 4AND ice,#ovsc ti ZZ aF ry 374. ..2 6 a V i STATE OF NE ) S S. COUNTY OF ) ........ ,, , .." ., �ual s _ being duly sworn, deposes and says that he is the applicant (Name., of individual signing ap cation) abovehomed, He is the.... ... ., ».., ,....».. .:... ....... . ....,.., «. „»»., ....... (Contractor, agent, corporate officer, etc,) ,of said owner or owners and is duly authorized to perform or have performed the said work and to make and file this application; that cl( statements contained In this application ore true to the best of his knowledge and belief; and that the work will be performed in the monnet»� t nth In the applicpll n filed t rewi� w Sworn to before me this �a F°ar4 ,��/•� d f +V iw '" "n 'a^� . day of �a a rt f m nota a of applicant) Notary Public, ......« unt` C - P- ROPERTY RECO O K"ER STREET VLL_AGE DISTRICT ISOB LOT - -- E ACREAGE _ d_ Vj TYPE OF BUILDING RES.Ti a S, V! FA RA, CO eIND CB. 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