The URL can be used to link to this page

Home My WebLink About1000-123.-5-2 TOWN OF SO T0L Rental Permit Permit No. 0225 Owner Madhavi & Hormuz Bathboi Occupied as Single Family Dwelling Located at 2550 Camp Mineola Rc Mattituck 123-5-2 Address s/B/L 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. 11/19/2019 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times Town Hail Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENTIj- TOWN OF SOUI'HOLD RENTAL PERMIT APPLICATION U G 1 6 2019 Rental Permit Fee$200(Application must be renewed every two years) °° <0",`;, ��1)U fl"", �n Section A. Property Information: Rental Property Address: r Tax Map Number: 1000 SECTION 2� -BLOCK .......x-LOT. 2- SECTION B. OWNER INFORMATION: Property Owner Name: _ _. —.......... L` i I l f Property Owner Legal Address: Property Owner Mailing Address: -- ............ ...... ........ . Telephone Number(s): Daytime --_-._ _. Evening __ Emergency..... Property Owner Email Address: _ _.M 141VVAI L® m Cori Page 1 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 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 ... ... Evening_, m_ _ Emergency, y 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___--_.._.. ...... e... Evening Emergency Email Address: SECTION . 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: .___ .;. ._._. ..A _..._. .. _.. _.......... . . _. .. Telephone Number(s): Daytime Evening Emergenew.. -- Email Address: SECTION F. PROPERTYDESCRIPTION: 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 _ _ d t ' J Requested Maximum number of persons allowed to occupy Dwelling Un Number of rooms in Rental Dwelling Unit: rg Use and Dimensions of each room in Rental Dwelling Unit: „ t it t.. I 1�'__. mm. .... 0 UP W _ mm1 a. I41 Page 3 of 5 Town flail Annex Telephone(631)765-1802 54375 Main.lkoad Fax(63 1.)765-9502 P.O.Box 1179 Soudi.old,NY 1197"94) 5 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 frorn a licensed architect, a ficeinsed professional engineer or a home inspector who has a valid New York State Uniform Fire Prevention lBuilding Code Certification is required stating that-the property which is the subject of the rental pprnit 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 Icy the laws adopted 11by-the New York State p::ire Prevention and Building Code Council. I amu requesting a fire safety inspection to be performed by a Code Enforcement Official from the rown of Southold 11 1 am submitting a completed Town of Southold certification-form-from a licensed architect or a licensed pir-ofesslonal engineer., SEC71ION 1 1. DECLARATION: Signature must he notarized and MUS? be the owner of the dwelling unit. STATE OF NEW YORK) COUNTY OF SWTOLK) certify under penalty of perjury,-the following: 1. 1 arn the owner of the Ilpirop erty 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 undefirst andtine Town will use the address for service pursuant to all, Page 4 of 5 Town HaII.Azinex 1elephone(631)'765-1802 54.375 Main Road I;ax.(63 1)'765-9502 Ill.().Box 1179 Southold,NY 1.19"71....0959 BUILDING DEPARTMENT TOWN' OF SOUTHOLD applicable laws and rules. i-further acknowledge-that $will notffy the...1 own of Southold Building Department of any changes of addI--ess within'five (5) days of any changes theireto. 3. 1 have read and received a copy of Chapter 207 of the Code of-the Town of Southold and agreed-to abide lby the same. 4. 1 will notify the Town within -five (5) business days as to any chaingeto'the information regarding Authorized Agent', Managing Agent, or Site Manager, Property Owner's Name: 76tDnAN/) F_,;1A1_T_L I J901 .......... ...................................... ...... ....... Property Ownees Signature., , L Swoirn to befoire me-this day ofAV4 OST 201 . . ................................. WENDY PERAZA ................ --------.. ................ NOTARY PUBLIC-STATE OF NEW YORK Official Notary IN n rlginal Notary Stamp No. 01PE6384971 Qualified in Queens County My Commission Expires 12-24-2022 Page S of 5 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION FOUNDATION 1ST [ I ROUGH . FRAMING/STRAPPING F I N A L 4t4/ /oull l '�- FIREPLACE,& CHIMNEYSAFETY INSPECTION ELECTRICALFIRERESISTANT CONSTRUCTION 'FIRE RESISTANT PENETRATION (ROUGH) I . . I CODEVIOLATION / y H oz 02 r G) O< G) N N 0 cn3 D 3 Z m mo CR yr a o > _ o 0 0 LOS L � 9 z OD 6zm _ CD C m A vIo r w z v '� i 0 m i°� N O m 0 CLOSQ ' CLOSEGo ca T ®� O wv > 0 v o� o m O O v m s' m o r//,ryJ/1y�//lr�,x 'f ELEC. m lu T r rr T� �! rrj Ali' la%I C1 I�j I y/ /tri Ij J n U y m h o p f% 1, �1 I co l' im 4 Is 0o Phi GI Z off 1 v yrs G m Ify� m � ,r/%/�i///i�/lei/riri�/%ri'l�e✓//yii/rr,/y//ri% y(/� r/, f�/ilk req/�/ �iri0��i�i�J�/�p.l�i/iii ,,,,,,. �. 1, _ o ( o m v CL fl co Z17 m a :3 a ! m a w N 70 ,w o Lim � r [ m pM Dy 4 P N, - 0 pip m v G) m aM � o o �' W o " ...__�.._ nary pa W F ' e w �, la m i 0 Q CO m 199 m ? X X X ED m m N r 00 fD *• t v -nm a� T D o :;. X+ m m rn ^r i 3 r� 0 , ua j o 0 0 _ O m p CD I 7 � } IW � .l FORM NO. 4 TOWN OF SOUTHOLD WELDING DEPARTMENT TOWN CLERWS OFFICE SOUTHOLD. N. Y. CERTIFICATE OF OCCUPANCY No. 3834............. Date .... .... --...-....... ........ 19--60 TMS CERTIKIES. that the building located atW/9--Camp--M:Ineal.a,--itowd----�..........- Street Map No.Kpeft.—........Block No. .....X=—....Lot No. -2=-........Hattituck-i......Nwy-i-........—.....- conforms substantially to the Application for Building Permit heretofore it in this office dated ............. J.ul%e ....3...---, 19-60- pursuant to which Building Permit No. .—;42;09#-.... 19-60, was !ssued, and conforms to all of the requirements .1ated ........... 3--...... of the applicable provisions of the law. The occapancy for is this certificate is issued is 1=9-faudly...dW6131ft........— ........m ... ...... This certificate is issued to -- OTT—................ ...... Vra':wne'r, essee or tenant) of the aforesaid building. Building Inspector