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Home My WebLink About1000-73.-1-1 TOWN OF SOUTHOLD Rental Permit 0797 Owner Shahzad Pirzada Occupied as Single Family Dwelling Located at 15105 Oregon Rd Cutchogue 71-1-1 Maximum Permitted Occupancy 12 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. 12/9/2024 ode � c �Official 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 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 hj!p :�/w w. o th�� g RENTAL PERMIT APPLICATION Rental Permit Fee $300(Application must be renewed every two years) Section A. Property Information: Rental P operty Address: l s51 O 0� ►� `�� V Curc4+0 6 u 6 N V I l R Tax Map Number: 1000 SECTION W_ BLOCK -LOT SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) _6kou,Qb R �i 6 ._ l"�, A7� Telephone Number (s): Daytimes ""w0: 5rvening.. .-.. Emergency Property Owner Email Address: �- 'cI "ct c' Page 1 of 4 Section C. f 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: 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: 1 1 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 property: t 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: [" Requested Maximum number of persons allowed to occupy Dwelling Unit: { a Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: 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. J I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ I am submitting a completed Town of Southold certification form from a licensed architect or a licensed professional engineer. . ' -age 3 of 4 in-5 SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) ) COUNTY OF SUFFOLK) 1 �} (Z � �t IEZZ�►4 , 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: > ?�P, r Property Owner's Signature: Sworn to before me this day of D��3�z , 20� CL PATRICIA M.O'CONNOR Official Notary Public Signature and Original Notary Stamp Notary Public,State of New York No.01bC6242103 Qualified in Nassau County Commission Expires May 31,20 Q'7 Page 4 of 4 Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 Southold,NY 11971-0959 a cou BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION INSTRUCTIONS Effective September 27th 2023 Rental Permit Fee: $300 (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, engineer or license home inspector if an inspection by Town of Southold Inspector is declined. ■ Rental Permit Fee: $300.00 4y oZ� � -C� C vs Utr Pe- ° TOWN OF O THOLD BUILDIN DEPT. 631-765-1802 J�. , I 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 (FI I-) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL R MARKS: 04 INSPECTOR _ __ U 5E JR, 7�fli7, ----------- = _ � - C. - . > ; � \ : - ^ o \pen % . » J ) \ § m NUT FOR REQLHATORY -- \ - t � � } - - - : . , - y yvr . . - � « . ! ~ — .IV NR = x . . . . . . . : z \ ��^ . . _ . . .. . . . . Q»- _ , - hs �_ 1 k k ti c t ml a _ Spe h k —+ #� k j k HMO I : i r � f -- _ 1 s c sF a��xi NOT FOR REGULATORY 1 _ X -__ '`F a APPROVAL,PERMITTING, - _ OR CONSTRUCTION AX rxacness-orur 6 _ i Xacd Peaitlm�e I 1f7&jt@P1 IN—T. Al. i 4 £r± t 1 r (pp — u , I t Specht NOT FOR REGULATORY V _ APPROVAL,PCTIERMITTiN6, OH CONSTRUON 0 PxOGP6x-OxAFT �r J+ r I t xaa#xeNaee [[ Laxv Pmi 6 C4uiory%aa 91 14 Wr Plan A101 'BRLLLlWH3d'lVAOHddV AUO1Vln93U HOA ION F777 IqoodS