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Home My WebLink About1000-107.-9-7 TO WN OF SOUTHOLD Rental Permit 0083 Owner Frederic Sizaret & Tasha Gill Occupied as Single Family Dwelling Located at 3725 Wickham Avenue Mattituck 107-9-7 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. 8/5/2024 Code o ent 4f'sci This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 1; l 19 � Telephone (631) 765-1802 Fax (631) 765-9502 littps://www.sout, o*nn� to oot RENTAL PERMIT APPLICATION utdn0A Sto 0 Rental Permit Fee $300 (Application must be renewed every two years) Section A. Property Information: Rental Property Address: 3725 Wickham Avenue, Mattituck NY 11952 Tax Map Number: 1000 SECTION 107 -BLOCK 9 -LOT 7 - SECTION B. OWNER INFORMATION: Property Owner Name: Tasha Gill and Frederic Sizaret Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 274 Water Street 274 Water Street, 1 R New York NY 19938 New York, NY 10038 Telephone Number(s): Daytime 917-216-5510 Evening Emergency 917-346-1771 Property Owner Email Address: gill.tasha@gmail.com Page 1 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: one 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: 1 Requested Maximum number of persons allowed to occupy Dwelling Unit: 6 Number of rooms in Rental Dwelling Unit: 3 Bedroom, Use and Dimensions of each room in Rental Dwelling Unit: 3 Bedrooms, 1.5 bathrooms, 1 living room, 1 dining room, 1 kitchen 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. N I am requesting afire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ lam submitting a completed Town of Southold certification form from a licensed architect or a licensed professional engineer. Page 3 of 4 SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) ) COUNTY OF SUFFOLK) I Tasha Gill ,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 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 s to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager. Property Owner's Name: Tasha Gill Property Owner's Signature: Sworn Ztoe me this ° day of��AL _ , 201L\ Official-Not ublil Ignature and Original Notary Stamp Gamy Bowon Commissioner of Deeds„City of New York No.2-14535 Cart.Filed in New York County commission Expires Nov 1,2025 The UPS Store 82 Nassau St NY,NY 10038 212.406.9010 Page 4 of 4 TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 /07-9 7 INSPECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ENTAL REMARKS: -1- 7/ «r vJ Qe- ---- .. RA" "E � � -a INSPECTOR @ell� Town Hall Annex TOwn of Southold 54375 Main Road Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 Te1: 631-765-1802 a. e .. . SUM# �Q�—� �- Date .d`�a ® _ ,....m......... _, _ _,. „e Owner � Phone m ... _, n_ • _ ..., _._... .._ ..._ Address j �" ,S All e'IC AAw1 Visible l�T Hamlet Inspector a � - _..._. ....._....... ®_ ....__.. ® _ ,.. ...._ �..... Floor Level Quantities Sub 1 2 3 Smoke Detectors (not located in bedrooms) Carbon Monoxide Detectors Fire Extinguishers E xit,sam .. �.......,,,,, „ Bedrooms 1 2� 3 4_ 5 Smoke Detectors Egress .. _........ ®, _ .,„ ........ ........m e, .,. . . ..... ... _ e, Occupant Count Building Systems Maintained &Operational Condition of Property Heating Building interior Hot water Building exterior Electrical Property clean, maintained &safe Mechanical Handrails&guards installed &secure _... . .... �.... ,... ... .. .... ............ ....._ . . Pool Safety Pool on Site Surface water alarm Date of CO issuance Door alarms Pool completely enclosed Self closing/latching gates Pool fence to code requirements � . _.._. _ Co's for all items present Prior Rental Comments: ID-10143270-018 ABSTRACTERS' INFORMATION SERVICE %igorii . 3000 MARCUS AVE,SUM.'_W02 I.AKE SUCCESS NY 111142 PHONE:(516)918-4600 F.4X:(516)918-4540 CERTIFICATE OF OCCUPANCY Prepared For:Spann Abstract Corp. tauntp SUFFOLK TITLE NO.0568-SP420325 Order Date:4/24/2019 PREMISES:3725 WICKHAM AVFdKLF- MATTIT[iCK TORT OFSOUTHOLD DISTRICT:1000 SECTION:107.00 BLOCK.09.00 LOT:007.000 SEC: 107.00 BLOCK: 09.00 LOT: 007.000 A SEARCH OF THE RECORDS CONDUCTED BY THE DEPAR726M OF BUILDINGS REVEALS THE FOLLOWING INFORMATION: CO# Z11121 DATED: 08/09/1982 PERMIT# Z11121 ONE FAMILY DWELLING AND DETACHED ONE CAR GARAGE CO# Z1485 DATED: 10/23/1962 ADDITION TO ONE FAMILY DWELLING IMPORTANT NOTICE ABOUT SEARCH INFOEMIATION ABOVE DATA 7R.10E MOSMITIO\SERVWn LLC DOCLAMS s.Y.\w.%LL LLMULTrY TO ATYPERSOQT WI WITTT FOR THE PROPER FERFORMANCZ OF SRIYTCES REFIEC MG THE CC"- MON OF 111LE 10 REAL FROPER[Y.THE SLRYICLS ARE PROVIDED*A&W WIIROC[WARRAT7Y OF A.\Y kE%D.EIIHRR ERRESXD OR DIPLMD6 LSCLCDLSGARTHOLZ LMITAINV ANY WARMT10% OF UERCH&MARILITY OR FIT.TESS FOR A PART aLU PMPOSE,OR WARRATTHS BASED O.T COCRSR OF DEALLTG OR CRAM OF TRADE OR ERRORSOR OVMIONS RESGL7m FROV%.mG IGLCL TOTS R TOT AT IVII7ED SFOTTfi:7111R DIRCIAIMER SL7ERSEOFS All PRIOR ATSI f MFMPM4NT.Or.% ERS7A\TIIT('S.TRR SF.DNCPS ARF.WIISIM.X TOR Sp.w AO.Y..I Cal.ATD T07 FOR THE DE%MW OFATY7HOID PARTEM IQo.i TOWN OF SOUTHOLD BUILDING iAIO T TOWN CLUKI OPFW1 SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ANtY M......lNnn Date ....................n llll+.. i ....NN..N., 19 R. ,/� THIS CERTyII7yyRES that the building located at . ' i - .`yy. "I .i..n . ..+�1R:�ati... Street Map No. ...W. �.4N.fNfn..Y.Block No ........ .".NN.N tot No...........N�lG conforms substantially to the Application for Building Permit heretofam filed in this office dated .........—...N.N.,. ..N w !.........................NNN, 19N 0 pursuant to which Building Permit No. ........2.742 dated ............. ...4.............................. 19NN ' was issued,and conforms to all of the requirements of the applicable provisions of the low The occupancy for which this certificate is Issued is ....... .....N.•�� N. N� / N.N.NM...N.rN....N....N...NN...•............NN..............NN.... The certificate is issued to ............................. (owner, News or tenant) of the aforesaid building. OWW..•r.... 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