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HomeMy WebLinkAbout1000-110.-8-33.1 TOWN OF SOUTHOLD Rental Permit 0819 Owner Parnel Wickham Occupied as Single Family Dwelling Located at 4299 New Suffolk Rd New Suffolk 110.-8-33.1 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. 2/14/2023 de Er) nt fficial This Notice must be posted by the main entrance at all times ' ', s' Telephone(631)765-1802 Town Hall Annex fl r ` a;J 5-9502 ~ ';:r ,.'':;. .•:,.:1 `' Fax (631)76_ 54375 Main Road s �i'•=' P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT [ (� TOWN OF SOUTHOLID RENTAL PERMIT APPLICATION D Rental Permit Fee $200 (Application must be renewed every two years AUG 2 2 2022 E 4/IT,D 111\V DEPT. TOWN OF SOUT1101,D Section A. Property Information: Rental Property Address: dVFr Tax Map Number: 1000 SECTION 116. -BLOCK �_- SECTION R. OWNER INFORMATION: Property Owner Name: ?Ak lv L Property Owner Legal Address: Property Owner Mailing Address: Telephone Number (s): Daytime _� Evening Emergency Property Owner Email Address: 45 a�b vZe-e- Page 1 of 5 Town Hall Annex hone 631 Tele 765-1802 µ4 P ( ) 54375 Main Road "'= :: ';'. ; ' .$ Fax (631)765-9502 P.O.Box 1179 ^ " Southold,NY 11971-0959 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. IQ/ Rental Permit Fee: $200.00 `•:: 1'';y ro= Telephone(631)765-1802 Town Hall Annex a•= :. = �:; Fax(631)76.5-9502 54375 Main Road Y.O. Box 1 179 Southold,NY 11971-0959 4� 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: 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: Ufa l 1 Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: 9 Use and Dimensions of each room in Rental Dwel)ing Unit: 3y Page 3 of 5 Town Hall Annex °"" ¢i r pig`^ Telephone(631)765-1802 54375 Main Road z'<: Fax(631)765-4502 P.D.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: 1VUll�� 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: 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 Hall Annex " %3 ,'`; 1,.- ". '' '. Telephone(631)765-1802 �~ s ,E v ;.a 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. M 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) I -JklJL L �1&g/44m- , 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 �` ; ,^ �.r,,•,,-.4 Telephone(631)765-1802 Town Halt Annex ` E -•" .A� _ � Fax(631)765-9502 54375 Main Road P.O.Box 1179 Southold,NY 11971-0959 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: Swornbefore me thisL3 day of US� 20aa Official Notary Public Signature and Original Notary Stamp DARLENE K BRUSH Notary Public-State of New York NO.01BR6318051 Qualified in Suffolk County My Commission Expires Jan 20, 2023 Page 5 of 5 I ............... I ull- t7=7 ............ x a + h i { ,, � �,.• � 3 � � j FFA` ays a...- � ���_...„..••°..y ,, t .r, "� 4., ' `{ �� o �. ° �' k 'rE, ---f ,._•``� � i j ;i-y��^' - BA 54.E s � K 3 c, ,«.....,r..-.,_.-.» ..._.-.«.r «.an. _.,......_._....., .m _ -.___...�,...... � _ ...w.».�.....,,..�,,,,,, ....,�...>-ter aunr.w.,>..,wes:+-•.....r....-.v...T�,,... wev oo , •�� •k ���' � IAC�_ '1 y?k,\ ' t 1.•r' �r_..j t'm � , a �s ^!"O'•Lsw.-.ria �: ��" .. ,.�"'4t,�. ��..,,ry S �c � uw...-.a..»..«_,..,....«,.... .....,...,.wJ } . F S_.- eo '-'+.T j„-,� .. .}��, �,,.,,,,., J� u�.1,°� >tier Av:^'�}.qC.� •,n'. �° ff, aty Y.-:r ,wrvn''C..,.)`$l% Li Parnel Wickham, Ph.D. , 19 Crosslands Dr. �A 1 `n� Kennett Square, PA 19348BUILDINGD 631-513-6325 wickhamjp@gmail.com Town of Southold Building Department 54375 Main Road PO Box 1179 Southold, NY 11971-0959 January 13, 2023 Re: Rental Permit Application and Building Permit Application I am writing to report that my legal address has changed from 4299 New Suffolk Road, PO Box 211, New Suffolk, NY 11956, to 19 Crosslands Dr., Kennett Square, PA 19348. Furthermore, I have engaged Mr.Thomas Wickham to act as my authorized agent. His physical address is 28700 Main Road, Cutchogue NY 11935, and his mailing address is PO Box 928, Cutchogue, NY 11935. His phone number is 631-734-5454, and his email address is tomwickham39@gmail.com. Please include this information on my Rental Permit Application dated August 23, 2022 and also on my subsequent Building Permit Application. I can be reached at the above address if additional information is required. Sincerely, Parnel Wickham cc: Mr. Thomas Wickham Parnel Wickham, Ph.D. JAN 18 203 19 Crosslands Dr. Kennett Square, PA 19348BUILDINGDEP 'MWNOFS®P1�®�.® 631-513-6325 wickhamjp@gmail.com Town of Southold Building Department 54375 Main Road PO Box 1179 Southold, NY 11971-0959 January 13, 2023 Re: Rental Permit Application and Building Permit Application I am writing to report that my legal address has changed from 4299 New Suffolk Road, PO Box 211, New Suffolk, NY 11956, to 19 Crosslands Dr., Kennett Square, PA 19348. Furthermore, I have engaged Mr. Thomas Wickham to act as my authorized agent. His physical address is 28700 Main Road, Cutchogue NY 11935, and his mailing address is PO Box 928, Cutchogue, NY 11935. His phone number is 631-734-5454, and his email address is tomwickham39@gmail.com. Please include this information on my Rental Permit Application dated August 23, 2022 and also on my subsequent Building Permit Application. I can be reached at the above address if additional information is required. Sincerely, Parnel Wickham cc: Mr.Thomas Wickham OE So(/j y° �{tiN� S LID ADA f TOOF'SOUTHOLD BUILDING • �� �ob � c courm, 631-7654802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] AL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FIN [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REMARKS: in d(2?A AD h?A6 M, tIVAI /D 61aVal0✓ PW G DATE Of I 11170 INSPECTOR so qAq �luj &OLUIL'.. TOWN OF SOUTHOLD BUILDING DEPT. coulm, 631-765-1802 INSPECTION FOUNDATION 1ST ROUGH PL13G. FOUNDATION 2ND INSULATIOWCAULKING FRAMING/STRAPPING [rAL FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) ELECTRICAL (Fylial-) CODE VIOLATION PRE C/O RENTAL REMARKS: - ,5 V440 nt DATE INSPECTOR TO V�//N OF SOUTHOLD PROPERTY RECORD . ._ : OWNER _ - STREET VILLAGE DIST SUB. LOT C. F' "f c - ---- t d IS FORMER OWNER N E� — ACR Of oe S W TYPE OF BUILDING �y AM RES. SEAS_. VL. FARM COMM. CB. MICS. Mkt. Value LAID IMP. TOTAL DATEREMA KS l, : e s. �!z? 't a °'`' 1 p' Y J tit $ — — --- C��-2,lt � p W,h i ''tea �•'�«, t s»f,4a" { 4.> F 3 Sdj.. A"' .` iB4 F+b f 4 f Y 4L/'4'`Fti%t'6 �' $'E �t ,:3 C i AA Tillable FRONTAGE ON WATERT Woodland FRONTAGE ON ROAD , Meadowland DEPTH `-- House Plot BULKHEAD —_._ - �— ---- — - --- Tot--! "Al - - Z 7 ' COLOR s ti K w P M ' R � TRIM -k tp �x��� 2�1 3g_ _.— 3 � t38fo - - i2 J.31 �� BIFoun n P Bath Dinette Xis$ 3� 45- iUL 4' Exen ?ti �5 1R Basement SLAB L Floors (_ Kit. Ex n i nKB _ - Ext. Walls �e Interior Finish L.R. Extension — t32 �42Z. 5 ' '�$ { Fire Place �j�.. Heat w1$�3 D.R. Patio Woodstove BR. Porch ati Ct© 4o S—� 2p Dormer Fin. B. Deck , � �2 -- ------- — Attic Breezeway 12 X.i,?S: BOO Rooms 1st Floor � Garage ' Driveway Rooms 2nd,F't�r . , � --- --- O.B. 2t2. Pool 1 COLOR TRIMi .._�. �.... _ _... ➢ I`f � F A , -- E; i I t M. Bldg. _ { E ►al , Extension Extension Extension >� Foundation T Both Dinette Porch Basement A16Floors K, e ell - Porch Ext. Walls „ interior Finish LR_ toob - Iwo Breezeway Fire Place Heat DR. i Garage Type Roof Rooms 1st Floor BR. Patio Recreation Room Rooms 2nd Floor FIN. B D• B. Dormer Driveway Total FORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20602 Date MARCH 19, 1992 THIS CERTIFIES that the building NEW DWELLING Location of Property 4299 NEW SUFFOLK ROAD NEW SUFFOLK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 110 Block 8 Lot 33 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 26, 1990 pursuant to which Building Permit No. 19607-Z dated DECEMBER 26, 1990 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 ATTACHED WOOD DECKS AS APPLIED FOR. The certificate is issued to SANFORD SEARL & PARNEL WICKHAM-SEARL (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 90-SO-83-MARCH 12, 1992 UNDERWRITERS CERTIFICATE NO. N-221981 - JANUARY 27, 1992 PLUMBERS CERTIFICATION DATED MARCH 17, 1992 - MATTITUCK PLUMBING Building Inspector Rev. 1/81 .\ SUFFo� r �o�o coGy Town of Southold 4/4/2023 P.O.Box 1179 H 53095 Main Rd W�y��� Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43984 Date: 4/4/2023 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 4299 New Suffolk Rd,New Suffolk New Suffolk SCTM#: 473889 Sec/Block/Lot: 110.-8-33.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 12/14/2022 pursuant to which Building Permit No: 48804 dated 1/25/2023 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" interior alteration and wood ramp to existing single family dwelling as applied for, The certificate is issued to Wickham,Pamel of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 48804 2/21/2023 PLUMBERS CERTIFICATION DATED § N fi A o 'z S gnature OCT 2 � , , � 1pf a4-&� I n �s /19 1 ,fill �I� � ,��/�'�4T/✓��� �c��� j� � 1 �✓ -Idb '5/3 la 3--7, s &)r� J Horton, LisaMarie From: Horton, LisaMarie Sent: Friday, December 9, 2022 9:44 AM To: 'wickhamjp@gmail.com' Subject: BUILDING PERMIT APPLICATION Attachments: Building Permit Application.pdf Please see attached building permit application. If you should have any questions, please feel free to give the building department a call. Z&aMarie.Morton Town of Southold Building Department Annex Building 54375 Main Road Southold,NY 11971 (631) 765-1802 i Y f: ' 2 • �M1 at �`{ ! \ \ I L rq.,• _ 4 ! _...___� _... ;�- �V` ..- _ -"'--` .. ^[-�-;-�-�-j � I At WIcr'K`r'HIAM - o" EARL RE ' I ru'% E N u E f t - S T . E E . L !vl A N q _. 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