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HomeMy WebLinkAbout1000-114.-12-13.1 TORN OF SOUTHOLD Rental Permit 0423 . Owner Niloy Banerjee Occupied as Single Family Dwelling Located at 400 Ole Jule Lane Mattituck 114.-12-13.1 Maximum Permitted Occupancy 7 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. 4/24/2024 Code E or ent Official This Notice must be posted by the main entrance at all times I � 631 78551802 //� INSPECTION [ FOUNDATION 1ST [ ] ROUGH PL13G. [ FOUNDATION 2ND [ ] INSULATION/CAt [ FRAMING / STRAPPING ] FINAL FIREPLACE & CHIMNEY [ ] FIRE SAFETY INS 1 FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PE [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (TI [ ] CODE VIOLATION [ ] PRE C/O [ REMARKS: ok- "r-hnve-W DATE ,, INSPECTOR Town Hall Annex I've Town Of Southold 54375 Main Road w` �w Rental Inspection Report PO Box 1179 p p ZL- 4W� Southold, NY 11971-1179 PR, Tel: 631-765-1802 5UM# /a — �• Date �...�, �. „��m...w , ,....,.. � ... �... _... ... �................... �.,.,. ._. .� .... Owner "Phone .�,n.�� ��.9,. . ... . .. ..,.mAA-n .-_.. _ .... .... _�. _.... .........m........ Address j/ Visible Hamlet �� .. ..... ... .._.. w.... ... .�..........�Inspector ......' �.. Floor Level Quantities Sub 1 2 3 Smoke...R.w .. . .... .,,.... . .µw _. ..... . M...,. _ .... ... Detectors not located in bedrooms �....� ..... . ... „a.� � � ,.... . .......R. ...��.�.m�...�..�. . Carbon Monoxide Detectors , . . I Fire Extinguishers Exits Bedrooms 1 2 3 4 5 6 � .., Smoke Detectors �.. ... .... ......�._. .w�. ., . I I { Egress � µ_..._...�� ...f �.�..w...... �.. ...._....... � .......µ,. .. I ..... ...... t.� Occupant Count __� �... ..� a. ... . '..... ..... ,._......... .........1 . .w. ._ . hl.. ., .... e..e,,.,.W. ..�..u., w ...�.�,,.,.............� ...... e,., ...,o,.a.,, ,,,,, ...,...„. ..w.. ...... .......,.,� ,,.��..,....., BuildingSystems Maintained&Operational y nal Condition of Property Heating Building interior ........,, _ A... �.. �.... . �n .......� ... . _ ..,..�. .... . .��,, . Hot water Building exterior �m... . ........ .mRm..� ... , . , Electrical 'Property clean, maintained &safe ..�. !�I w �.. . .��.... . � �.� ails&guards installed &secure Mechanical �.,_....�, rya_. ... ..... Handr ..�... ......... . ........ ....� ,. .._ .....�.... ..,..�. Pool Safety Pool on Site ... ti......w_. . �..,� ,.. �.y ..ro.���,ww �..... ... �a. .... .. �.....,. Surface water alarm Date of CO issuance ....w. . �Ro..w. _ a. . w... ..... ._u.�. ��. . ,......,.�.�..�..��.��..,� Door alarms Pool completely enclosed latching gates Pool fence to code requirements Self closing/��.a�._ ... a ......�N ,, ...�_.. ...__m� .... ......... . ....�.M . ,,a .�........... ... ...,. .. ... .. �,C...�. items O s for _..a�.._.��....�. sent..... Prior Rental ...�W ....�. . .,.�� ...� �.� .�� Comments: _.....,. ... .., .. . .. ..,.,... ..,,,,,,.. .... ............ . . ........ 1 ............ .................. .. ........ ... ........,..,., ... ,,. .. ..........., .,., , ..,. . .... ...,... ........... ...,..................., .._.. ... ......., . ....,.,,........................................., ...,.,. .._.... .., .,.... ...,...,,,,,_.....,_ _....._ .. .,,..,.. ..v.,,.,..,.... ......,,,.,w� TOWN OF SOUTHOLD Rental Permit 0423 Owner Niloy Banerjee Occupied as Single Family Dwelling Located at 400 Ole Jule Lane Mattituck 114.-12-13.1 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. 10/26/2022 Code End ent Official This Notice must be posted by the main entrance at all times ' ° SOUTHOLD TOWN Town Hall Annex 54375 Main Road PO Box 1179 Southold, Rental Inspection NY 11971-1179 Tel: 631-765-1802 Fax 631-765-9502 ri/iii//i Z-2 b � D t 0 ii/ /%/r % r, 111/3r jW/ //// /��i/�/�//�/r�i Ad(�rBSS61A / rr i%lrl ' �, a i,�.,. Me ���/irr 0%j�%� �. . NOrVO,%�//r s-r ,%rt IT ////J /,bf Ini /, / //, /,r rrii LEVELS " ., UB,,/; / /` /, Smoke Detectors (#- bedroom detectors excluded) ' Carbon Monoxide Detectors (#) Fire Extinguishers (#) Exits ( ` BEDROOMS Smoke Detector Alarms (#) Carbon Monoxide Alarms (#) Egress (windows) (Y/N) f BUILDING SYSTEMS N CONDITION OF PROPERTY CIN Heating system maintained/operational Building Interior is clean/maintained Hot water system maintained/operational Building Exterior is clean /maintained Electrical system maintained/operational Property is clean/safe/maintained Mechanical system maintained/operational Handrails & guards present POOLS Lo Y POOL BARRIERS Pool present Pool is completely enclosed Pool surface alarm and/or door alarm Barrier is a min. 48" high resent POOL GATES All openings in barrier less than 4" Self-closing, self-latching Max. 2" clearance @ bottom of barrier Latch on pool side of gate, meets height Barrier capable of being locked &child- requirements proof when unattended COMMENTS: TOWN OF SOUTHOLD g Rental Permit Permit No. 0423 Owner Niloy Banerjee Occupied as Single Family Dwelling Located at 400 Ole Jule Lane Mattituck 114-12-13.1 Village 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. 4/29/2021La.e_�� Code Enforcei!feffi Official This Notice must be posted by the main entrance at all times YF)TownHallHall Annex R` Telephone(631)765-1802 5 54375 Main Road t` Fax(631)765-9502 P.O.Box 1179 ^ Southold,NY 11971-0959 BUILDING DEPARTMENT = TOWN OF SOUTHOLD ' RENTAL PERMIT APPLICATION JAN 1 3 2021 Rental Permit Fee$200(Application must be renewed every two years) F. TT. Section A. Property Information: Rental Property Ad ress: Lam— fflafh44 c� Tax Map Number: 1000 SECTION _i L _-BLOCK SECTION B. OWNER INFORMATION: Property Owner Name: 1 �u ,!_SC e �-1 Property Owner Legal Address: Property Owner Mailing Address: 74 v. --L-- - Lx� 0STel7�i (p4la -Wo- 10S- Telephone ephone Number(s):Daytime Evening_"aiM-2_Emergency ot�►�-2- Property Owner Email Address: u`^� S U X13�0 I�a'LI` Cd�M e f�4e �r\d�, 0 Page 1 of 5 � 16141 Phone(631)765-1802le Town Hall Annex ��' "� � Te 54375 Main Road ` Fax(631)765A502 tA P.O.Box 1179 r Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF S)OUMOILD Section C. 9.0 . Authorized Agent Information: Name of Authorized Agent of dwelling unit, any: Address of Authorized Agent(no P.O. oxes): o� �OL�k (DD__ Mailing Address of Authorized Age t: N L1 /qLJ ( U U 1 1�5 Telephone Number(s):Daytime (Q � �� Lvening.Sar�.2_ Emergency Sc N`'e. Email Address: � , cu�� 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 - J 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 hel P.O.Box 1179 i Southold,NY H971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s):Daytime Evening Emergency Email Address: SECTION F. PROPERTY DESCRIPTION: i Number of Rental Dwelling Units on property: �(��60�t P_ [ R7t Ia _ 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 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 I Requested Maximum number of persons allowed to occupy Dwelling Unit: I� � 1� ovJy Number of rooms in Rental Dwelling Unit: I Use and Dimensions of each room in Rental Dwelling Unit: '-�hsio��vy r+�s � � .��'�,ruU•rvLS ��� ti w� r c`� ✓�� ����� Page 3 of 5 Town Hall Annex .�` , Telephone(631)765-1802 54375 Main Road {� Fax(63 I)T6.5-9502 P.O.Box 1179 Southold,NY 11971-0959 h � 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. V1 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 r'fify 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 yF r # Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 + Southold,NY 11971-0959 arze?:� 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 t'e.qarding Authorized Agent, Managing Agent,or Site Manager. Prop rt Owner's NamL- Property Owner's Signature: Sworn to before me thiJ Clay of 20,;Q. Official Notary Public Signature and Original otary Stamp CONNIE D.BUNCH Notary Public,State of New York No.01BU6185050 Qualified In Suffolk County (;OMMisslpn Expires April 14,20 Page 5 of 5 SOUTHOLD TOWN Town Hall Annex 54375 Main Road y Rental Inspection PO Box 1179 Southold, n' NY 11971-1179 d • Tel: 631-765-1802 Fax 631-765-9502 SCTM # L — 3 Date ,Z Owner 1110 o fL,� Phone 6� -10 Address qdo ® I� tu Zip Hamlet Inspector Address visible from street? LEVELS SUB 1 2 3 Smoke Detectors (#- bedroom detectors excluded) Carbon Monoxide Detectors (#) Fire Extinguishers (#) Exits (#) BEDROOMS 1 2 3 4 5 Smoke Detector Alarms (#) Carbon Monoxide Alarms (#) Egress (windows) (Y/N) BUILDING SYSTEMS Y CONDITION.OF PROPERTY Y N Heating system maintained/operational Building Interior is clean/maintained Hot water system maintained/operational Building Exterior is clean/maintained Electrical system maintained/operational Property is clean/safe/maintained Mechanical system maintained/operational Handrails&guards present POOLS YA1 POOL BARRIERS Y& Pool present Pool is completely enclosed .Pool surface alarm and/or door alarm Barrier is a min.48" high present POOL GATES Y/ All openings in barrier less than 4" Self-closing, self-latching Max. 2"clearance @ bottom of barrier Latch on pool side of gate, meets height Barrier capable of being locked &child- requirements proof when unattended COMMENTS: SCREENED PORCH 12'11"x 1118" Ivv, 4 10 01 1 Rte, KITCHENT J 16'2"x 12'0" RECREATION ROOM * DINING ROOM 18'2"x 23'9" 11'10"x 12'0" BREAKFAST STORAGE F 91 10'5"x 22'10" 19110"x 1410" GARAGE 1916"x 27'9" i LIVING ROOM FLOOR 1 17'10"x 12'5" i i FOYER 10'3"x 12' FAMILY ROOM 8" 14'9"x 1615" FLOOR 2 '4�• BEDROOM 15-9"xy,6 C �4n J14'10"x 3 0" J � MASTER BEDROOM BEDROOM / p ✓l z'i 0 Y.s 16'5"x 1717" 11'10"x 13'5" BEDROOM 818"x 12'9" y. f� . FLOOR 3 `51� SIZES ARID DIMENSIONS ARE APPROXIMATE, ACTUAL MAY VARY, TOWN OF SOUTHOLD PROPERTY RECO OWNER I STREET e VILLAGE DIST. SUB. LOT "s F,ORMER OWNER UX N, E ACR. yp- S gg W TYPE OF BUILDING ZAI RES. 21 n1 SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS 3o g � 716 . . . f Gi s9:� t..�, T�C'e...'� �v^ �`'fl �-r'<'l""_@ ^_i 64, 'Cn ' { ?'i m AE ids nc 51077- Lig'a-S71ap ra 4-- Tillable ( FRONTAGE ON WATER W Woodland FRONTAGE ON ROAD :3 >> > Meadowland 5,C) 6EPTH House Plot / t BULKHEAD Total :" r :1 i r :OLOR TRIMx • 114-12-13.1 3/03 - _ Extension 1 rj Y P Extension ,t. _ _ . .-- Extension 4" - _— -- — _ j < � Foundation Both -- -- - Finett e - Por&l . _a Basement - Floors Porch �.r 1 Ext, Walls �� >� Interior Finish �� C LR. Breezeway - -� � -t-- -----, __ Fire Place .r Heat DR. Garage t Type Roof / Rooms 1st Floor BR. t� Patio Recreation Room Rooms 2nd FloorEd O. B. Dormer Driveway i t ----- Total �� FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28656 Date: 08/06/02 THIS CERTIFIES that the building NEW DWELLING Location of Property: 400 OLE JULE LA MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 114 Block 12 Lot 13 .1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 5, 2002 pursuant to which Building Permit No. 28168-Z dated MARCH 12, 2002 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 SINGLE- FAMILY DWELLING WITH GARAGE UNDER COVERED FRONT PORCH AND REAR WOOD DECK AS APPLIED FOR. The certificate is issued to ANTHONY ALIPERTI (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF EEALTH APPROVAL R10-01-222 07/28/02 ELECTRICAL CERTIFICATE NO. 62904H 07/24/02 PLUMBERS CERTIFICATION DATED 07/15/02 SHOREHAM PLUMB.&HEATING 9 ;��_ A or' ed Si ature Rev. 1/81 Town of Southold Annex 7/31/2011 4`�� 54375 Main Road ' Southold,-New York 11971 CERTIFICATE OF OCCUPANCY No: 35099 Date: 7/31/2011 THIS CERTIFIES that the building RESIDENTIAL ADDITION Location of Property: 400 Ole Jule Lane,Mattituck, SCTM#: 473889 See/Block/Lot: 114.-12-13.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this offiiced dated 7/1/2010 pursuant to which Building Permit No. 35714 dated 7/16/2010 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: roof over deck with stairs on an existing one family dwelling as applied for. The certificate is issued to Myers, William&Myers,Marie (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED horiz Sign re /// r Illll , Neer York State Bar Association New York Statutory Short Form Power or Attorney,8/I8/10,Eff.9/12/10 POWER OF ATTORNEY NEW YORK STATUTORY SHORT FORM (a) CAUTION TO THE PRINCIPAL: Your Power of Attorney is an important document. As the "principal,"you give the person whom you choose(your"agent")authority to spend your money and sell or dispose of your property during your lifetime without telling you. You do not lose your authority to act even though you have given your agent similar authority. When your agent exercises this authority,he or she must act according to any instructions you have provided or,where there are no specific instructions,in your best interest. "Important Information for the Agent"at the end of this document describes your agent's responsibilities. Your agent can act on your behalf only after signing the Power of Attorney before a notary public. You can request information from your agent at any time. If you are revoking a prior Power of Attorney,you should provide written notice of the revocation to your prior agent(s)and to any third parties who may have acted upon it,including the financial institutions where your accounts are located. You can revoke or terminate your Power of Attorney at any time for any reason as long as you are of sound mind. If you are no longer of sound mind,a court can remove an agent for acting improperly. Your agent cannot make health care decisions for you. You may execute a"Health Care Proxy"to do this. The law governing Powers of Attorney is contained in the New York General Obligations Law, Article 5,Title 15. This law is available at a law library,or online through the New York State Senate or Assembly websites,www.senate.state.ny.us or www.assembly.state.ny.us. If there is anything about this document that you do not understand,you should ask a lawyer of your own choosing to explain it to you. (b) DESIGNATION OF AGENT(S): NILOY BANERJEE 7 Jalan Merchu,Bukit Tunku,Kuala Lumpur 50480 Malaysia (name of principao (address of principal) hereby appoint: Kathryn J.Thompson 246 East 4611 st,Apt 7N New York NY 10017 (nanie of agent) (address of agent) (naine of second regent) (address of second agent) as my agent(s). 2010 N.Y.Laws ch.340 Page 1 of 6 illll New York State liar Association New York Statutory Short conn Power orAuornty.8/18/10.Eff.9/12110 If you designate more than one agent above,they must act together unless you initial the statement below. (_) My agents may act SEPARATELY. (c) DESIGNATION OF SUCCESSOR AGENT(S): (OPTIONAL) If any agent designated above is unable or unwilling to serve, I appoint as my successor agent(s): (nanze of successor agent) (address ofsuccessor agent) (name ofsecont successor agent), (address ofsecond successor agent) Successor agents designated above must act together unless you initial the statement below. (___)My successor agents may act SEPARATELY. You may provide for specific succession rules in this section. Insert specific succession provisions here: (d) This POWER OF ATTORNEY shall not be affected by my subsequent incapacity unless I have stated otherwise below,under"Modifications". (e) This POWER OF ATTORNEY DOES NOT REVOKE any Powers of Attorney previously executed by me unless I have stated otherwise below,under"Modifications". If you do NOT intend to revoke your prior Powers of Attorney,and if you have granted the same authority in this Power of Attorney as you granted to another agent in a prior Power of Attorney,each agent can act separately unless you indicate under"Modifications"that the agents with the same authority are to act together. (f) GRANT OF AUTHORITY: To grant your agent some or all of the authority below,either (1) Initial the bracket at each authority you grant,or (2) Write or type the letters for each authority you grant on the blank line at(P),and initial the bracket at(P). If you initial(P),you do not need to initial the other lines. I grant authority to my agent(s)with respect to the following subjects as defined in sections 5-1502A do4gh 5-1502N of the New York General Obligations Law: ( �y,"j ) (A)real estate transactions; (`) (B)chattel and goods transactions; (C)bond,share,and commodity transactions; ( (D)banking transactions; ( ) (E)business operating transactions; (F)insurance transactions; 2010 N.Y.Laws ch.340 Page 2 of 6 II : • Ncw York State Bar Association New York Statutory Short Form PowerofAttomcy,8/I3/10,EIl:9/12110 (_) (G)estate transactions; (� (H)claims and litigation; (� (I)personal and family maintenance: If you grant your agent this authority, it will allow the agent to make gifts that you customarily have made to individuals,including the agent,and charitable organizations.The total amount of all such gifts in any one calendar year cannot exceed five hundred dollars; (_) (J)benefits from governmental programs or civil or military service; (_) (K)health care billing and payment matters;records,reports,and statements; ( ) (L)retirement benefit transactions; ( (M)tax matters; (N)all other matters; �) (0)full and unqualified authority to my agent(s)to delegate any or all of the foregoing powers to any person or persons whom my agent(s)select; (� (P)EACH of the matters identified by the following letters: You need not initial the other lines if you initial line(P). (g) MODIFICATIONS: (OPTIONAL) In this section,you may make additional provisions,including language to limit or supplement authority granted to your agent. However,you cannot use this Modifications section to grant your agent authority to make gifts or changes to interests in your property. If you wish to grant your agent such authority,you MUST complete the Statutory Gifts Rider. This power is limited to the purchase and financing of the property known 400 Ole Jule Lane,Mattituck New York 11952 and including the execution and delivery of any documents, including but not limited to mortgage documents,related thereto with the United Nations Federal Credit Union, under loan number 7010148372, and to sign any and all documents necessary in this transaction. (h) CERTAIN GIFT TRANSACTIONS: STATUTORY GIFTS RIDER(OPTIONAL) In order to authorize your agent to make gifts in excess of an annual total of$500 for all gifts described in(I)of the grant of authority section of this document(under personal and family maintenance), you must initial the statement below and execute a Statutory Gifts Rider at the same time as this instrument. Initialing the statement below by itself does not authorize your agent to make gifts. The preparation of the Statutory Gifts Rider should be supervised by a lawyer. (__) (SGR) I grant my agent authority to make gifts in accordance with the terms and conditions of the Statutory Gifts Rider that supplements this Statutory Power of Attorney. (i) DESIGNATION OF MONITOR(S): (OPTIONAL) If you wish to appoint monitor(s),initial and fill in the section below: 2010 N.Y.Laws ch.340 Page 3 of 6 H 11111 -••• New York State Sar Association New York Statutory Short Fonn Power of Attorney,8/18/10,EIr.9/12/10 �)I wish to designate ,whose address(es)is(are) as monitor(s). Upon the request of the monitor(s),my agent(s)must provide the monitor(s)with a copy of the power of attorney and a record of all transactions done or made on my behalf. Third parties holding records of such transactions shall provide the records to the monitor(s)upon request. 0) COMPENSATION OF AGENT(S): (OPTIONAL) Your agent is entitled to be reimbursed from your assets for reasonable expenses incurred on your behalf. If you ALSO wish your agent(s)to be compensated from your assets for services rendered on your behalf,initial the statement below. If you wish to define"reasonable compensation",you may do so above, under"Modifications". My agent(s)shall be entitled to reasonable compensation for services rendered. (k) ACCEPTANCE BY THIRD PARTIES: I agree to indemnify the third party for any claims that may arise against the third party because of reliance on this Power of Attorney. I understand that any termination of this Power of Attorney,whether the result of my revocation of the Power of Attorney or otherwise,is not effective as to a third party until the third party has actual notice or knowledge of the termination. (1) TERMINATION: This Power of Attorney continues until I revoke it or it is terminated by my death or other event described in section 5-1511 of the General Obligations Law. Section 5-1511 of the General Obligations Law describes the manner in which you may revoke your Power of Attorney,and the events which terminate the Power of Attorney. (m) SIGNATURE AND ACKNOWLEDGMENT: .000, �) y ort9 P In Witness Whereof I have hereunto sig d m name on th`�� day o 20]e1D Malaysia PRINCIPAL signs hera� > City of Kuala Lumpur ) NILRA JEE Emba6& ftbe United Stat )ss: of America ) ss: On the'',b day of .s') fl� ;20'40 ore me,the and rsigned,personally appeared Allegra NILOY BANERJEE personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her capacity,and that by his/her signature on the instrument,the individual,or the person upon behalf of which the individual acted,executed the instrument. V � Notary Public !_a Lira A. Schierhoff (n) -IMPORTANT Ii4FORMATIONFOR THE AGENT: Notarizing Officer U.S. Embassy Kuala Lumpur When you accept he authority granted under this Power of Attorney,a special legal relationship is created-between Vou and thy:principal. This relationship imposes on you legal responsibilities that continue until you resign or the.Power of Attorney is terminated or revolted. You must: 2010 N.Y.Laws ch.340 Page 4 of 6 a IIIII New York State liar Association New York Statutory Short Eorm Power of Auomey,8113/10,Efr:9112/10 (1)act according to any instructions from the principal,or,where there are no instructions, in the principal's best interest; (2)avoid conflicts that would impair your ability to act in the principal's best interest; (3)keep the principal's property separate and distinct from any assets you own or control,unless otherwise permitted by law; (4)keep a record or all receipts,payments,and transactions conducted for the principal;and (5)disclose your identity as an agent whenever you act for the principal by writing or printing the principal's name and signing your own name as"agent" in either of the following manners: (Principal's Name)by(Your Signature)as Agent,or(your signature)as Agent for(Principal's Name). You may not use the principal's assets to benefit yourself or anyone else or make gifts to yourself or anyone else unless the principal has specifically granted you that authority in this document,which is either a Statutory Gifts Rider attached to a Statutory Short Form Power of Attorney or a Non-Statutory Power of Attorney. If you have that authority,you must act according to any instructions of the principal or,where there are no such instructions,in the principal's best interest. You may resign by giving written notice to the principal and to any co-agent,successor agent,monitor if one has been named in this document,or the principal's guardian if one has been appointed. If there is anything about this document or your responsibilities that you do not understand,you should seek legal advice. Liability of agent: The meaning of the authority given to you is defined in New York's General Obligations Law,Article 5,Title 15. If it is found that you have violated the law or acted outside the authority granted to you in the Power of Attorney,you may be liable under the law for your violation. (o) AGENT'S SIGNATURE AND ACKNOWLEDGMENT OF APPOINTMENT: It is not required that the principal and the agent(s)sign at the same time,nor that multiple agents sign at the same time. Uwe, ,have read the foregoing Power of Attorney. I am/we are the person(s) identified therein as agent(s)for the principal named therein. Uwe acknowledge my/our legal responsibilities. Agent(s)sign(s)here: _> _ STATE OF NEW YORK ) ss: COUNTY OF ) On the day of ,20,before me,the undersigned,personally appeared ,personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her capacity,and that by his/her signature on the instrument,the individual,or the person upon behalf of which the individual acted,executed the instrument. 2010 N.Y.Laws ch.340 Page 5 of 6 p , 'AM.; • \ctt YorkStatc liar Association Ncw York Statutory Short Donn Power or Attorney,8/18/10.E0:9/12/10 Notary Public (p)SUCCESSOR AGENT'S SIGNATURE AND ACKNOWLEDGMENT OF APPOINTMENT: It is not required that the principal and the SUCCESSOR agent(s),if any,sign at the same time,nor that multiple SUCCESSOR agents sign at the same time. Furthermore,successor agents can not use this power of attorney unless the agent(s)designated above is/are unable or unwilling to serve. Uwe, ,have read the foregoing Power of Attorney. I am/we are the person(s)identified therein as SUCCESSOR agent(s) for the principal named therein. Successor Agent(s)sign(s)here: _> STATE OF NEW YORK ) ss: COUNTY OF ) On the day of ,20_,before me,the undersigned,personally appeared 'personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her capacity,and that by his/her signature on the instrument,the individual,or the person upon behalf of which the individual acted,executed the instrument. Notary Public 2010 N.Y.Laws ch.340 Page 6 of 6 January 13, 2021 Susan Pontino Building Department Town of Southold Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Re:400 Ole Jule Lane Rental Permit Application Dear Sue, Thank you so much for your help earlier this week with collecting information needed for the rental application for our home.To recap: My husband is the U.N.Ambassador for Malaysia,Singapore,and Brunei Darussalam.We recently purchased our home at 400 Ole Jule Lane in Mattituck. Niloy has had to return to Malaysia, and I will be joining him in the next few months when the borders are re-opened.We would like to rent out our home when I have joined him in Malaysia. I have enclosed the following: -Rental Application -Power of Attorney for real estate transactions -Both C of O's(that you so kindly provided) -Floor plans with the smoke and carbon monoxide detector marked on the floor plans -Check for$200 for the application fee Please let me know what else needs to be provided. I am always available by phone or email. Thanking you again for all of your kind assistance, Kathy Thompson 646-660-1685 Kathythompson136@gmail.com JAN 1 3 2021 BUY L- IFI-1-ISI TG' "_T"I T'LB Y't 1': �y C: .,.