HomeMy WebLinkAbout1000-145.-2-9 e=Z TOWNOF SOUTHOLD
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Rental Permit
1154
Owner Ram Bam Nominee Trt.
Occupied as Single Family Dwelling
Located at 912 Peconic Bay Blvd Laurel 145.-2-9
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.
6/17/2024 `
cede n rc nt Official
This Notice must be posted by the main entrance at all times
on d
TOWN OF SOUTHOLD—BUILDING DEPA
Town Hall Annex 54375 Main Road P. O. Box 1179 Southo 1197 -09�9� ��
Telephone (631) 765-1802 Fax (631) 765-95021 tt 2s://N vVW.S0L1t.hold n .9ov "
RENTAL PERMIT APPLICATION
Rental Permit Fee $300 (Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
Tax Map Number: 1000 SECTION 7 5 9, -BLOCK t � -LOT - Z -
SECTION B.
OWNER INFORMATION:
Property Owner Name: RAM ZAM T�2Lt S T
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
410 114WXg vi,C cry SOX 52144
s SAg 2 Kos . All 1170`
451 - to
Telephone Number (s): Daytime GZ41 Evening Emergency
Property Owner Email Address: S�AI�l�AM�4t2�2Z •r rvtai�. C(9YN
Page 1 of 4
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 Emergency
Email Address:
Section D.
Managing Agent Information: E7i;r;I�
Name of Authorized Agent of dwelling unit, if any: 5 COT EQS
Address of Authorized Agent (no P.O. Boxes): LkW! =a " WrArI LS
Mailing Address of Authorized Agent: 2 OOK evT WAQW-19)VE4 11742
2
Telephone Number (s): Daytl ie ' -117Z Evening Emergency
Email Address: WAVWXY SUCH 4+Ce.? I COM
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):
Mailing Address of Managing Agent:
Telephone Number (s): Daytime Evening Emergency
Email Address:
Page 2 of 4
SECTION F.
PROPERTY DESCRIPTION:
Number of Rental Dwelling Units on propert :
For each Rental Dwelling Unit set forth the R tal Dw g 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:
Requested Maximum number of persons allowed to occupy Dwelling Unit:
Number of rooms in Rental Dwelling Unit: 7
Use and Dimensions of each room in Rental Dwelling Unit:
1 Sf rr Fcnat u40 tzxt� I-'r(-P 4)r f0 x /y !'�ti. Zr t X'/V Fr- Tewf . Ivxly
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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.
C/ I am requesting a fire safety inspection to be performed by a Code Enforcement Official
from the Town of Southold
ff] I am submitting a completed Town of Southold certification form from a licensed
architect or a licensed professional engineer.
Page 3 of 4
I
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SECTION H.
DECLARATION: Signature must be notarized and MUST be the owner�of the dwelling unit.
STATE OF NEW YORK)
)
COUNTY OF SUFFOLK)
I I >
,certify under penalty of perjury,the allowing:
I
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 servicel 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 gown of Southold and
i
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: p
Property Owner's Signature:
J
I
Sworn t afore a 1SA0 ay of yylXiLCW 20
(�/c
4f cial Nota Pu Ic Sign ure and Original Notary Stamp
71 OfNow'
at In SO*CMM
go
Page 4 of 4
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SECTION H.
DECLARATION: Signature must be notarized and MUST be the ownei of the dwelling unit.
STATE OF NEW YORK)
COUNTY OFSUFFOLK) f
l
O ' certify under penalty of perjury,the Following:
i
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 t� a Town of Southold
i
Building Department of any changes of address within five (5) days of any changes
thereto.
i
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 o the information
regarding Authorized Agent, Managing Agent, or Site Manager.
Property Owner's Name:
Property Owner's Signature: f�
Sworn to be re me th s clay of AI?, 2 g
1
Official otary Pu i Si ature an Original Notary Stamp �a�
� $we Of NOW
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Page 4of4
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INSULATION/CAULKINGTOWN OF44OUTHOL ILDING DEPT.
631-765-1802
INSPECTION
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Town of Southold 1/14/2021
r P.O.Box 1179
p 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 41738 Date: 1/14/2021
THIS CERTIFIES that the building ADDITION/ALTERATION
_Location.of Property: 912 Great Peconic Bay Blvd, Laurel
SCTM#: 473889 Sec/Block/Lot: 145.-2-9
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
2/7/20l 9 pursuant to which Building Permit No. 43472 dated 2/14/2019
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:
additi and alterations including c cov arches to 14 exis " sin le-fZ as qRgIL d ftsr.
The certificate is issued to Bann Bam Nominee Trust
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 43472 .1/17/202. 0
PLUMBERS CERTIFICATION DATED 1/9/2020 a K Swee
Signature
. ...........---- ................... ..... ........
sttttlt Town of Southold 6/16/2024
53095 Main Rd
Southold,New York 11971
C
PRE EXISTING
CER r rIFICATE OF OCCUPANCY
No: 45256 Date: 6/16/2024
THIS CERTIFIES that the structure(s) located at: 912 Great Peconic Bay Blvd, Laurel
.............. ..........
SCTM#: 473889 Sec/Block/Lot: 145.-2-9
Subdivision: Filed Map No. Lot No.
conforms substantially to the requirements for a built prior to
APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 4 1.5 2 56
dated 6/16/2024 was issued and confonns to all the requrlements of the applicable provisions of the law.
The occupancy for which this certificate is issued is:
woodefiame —i n 1.e-fam -1 d e.1.Ln..yithaccessory yppd_ 4Me,g_qrag q_with studiopaattnent aktove and two covered
pqrches,*
The certificate is issued to Ram Barn Nominee Trt
...................
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
th ')riz 'i"ignature
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 912 Great Peconic Bay Blvd, Laurel
.............................
SUFF.CO. TAX MAP NO.: 145.-2-9 SUBDIVISION:
NAME OF OWNER(S): Ram Barn Nominee Trt
OCCUPANCY:
ADMITTED BY:
SOURCE OF REQUEST: Ram Barn Nominee Trt DATE: 6/16/2024
DWELLING:
STORIES: 2 #EXITS: 3
FOUNDATION.. .............. cement block CELLAR: full CRAWL SPACE:
BATHROOM(S): 2 TOILET ROOM(S):1-1111 UTILITY ROOM(S):,
PORCH TYPE: DECK TYPE: PATIO TYPE:
.. ........ .... .........BREEZEWAY: FIREPLACE: l GARAGE:
DOMESTIC HOTW'A TER":" TYPE HEATER: floor furnace AIR CONDITIONING:
TYPE HEAT: gas WARM AIR: HOT WATER: 1----1111111-11-1 gas
--
#BEDROOMS: 3............. #KITCHENS: I BASEMENT TYPE: partially finished
OTHER:
..............
....................... ........... . ..... ........... ..........
ACCESSORY ST`RucT()RES:
GARAGE,TYPE OF CONST: wood frame" STORAGE, TYPE OF CONST:
SWIMMING POOL: GUEST,TYPE OF CONST:
OTHER: **2nd floor apartment over garage
............
VIOLATIONS:
..................... . .....
REMARKS:
INSPECTED BY: J01-fNJ DATE OF INSPECTION: 5/20/2024
..........
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