HomeMy WebLinkAbout1000-56.-2-19 of p OWN OF SOUTH OLD
Mental Permit
00 IN
1386
Owner: Joseph Romano , Ashley Romano
Occupied as: Single Family Dwelling
Located at: 70 Arshamomaque Ave Southold 56.-2-19
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.
Issued: 10/21/2025 ::! a 1� a
Expiration: 10/21/2027 cV
fo me t Official
This Notice must be posted by the main entrant at II times
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TOWN OF SOUTHOLBUILDING DEFT.
631-765-1802
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1 NIS` P E(Ck T 1 O N
[ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
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[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FI
[ ] CODE VIOLATION [ ] PRE C/O RENTAL
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DIrE JO INSPECT
TOWN OF SOUTHOLD—BUILDING DEPA'RTMFN fta �di:i5�
Town Hall Annex 54375 Main Road P. 0. Box 1 179 Southold,NY 1. 1471-0959
Telephone (631) 765-1802 Fax (631) 765-9502 lilt s://ww�V.sout,lioldtow!I . ,(..wv
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RENTAL PERMIT APPLICATION CK 0, Ua U
Rental Permit Fee $300 (Application must be renewed every two years)
Section A.
Property Information:
Rental Property Address:
ZQ Arahammaque Aye, Southold, NY 11779
Tax Map Number: 1000 SECTION 56 - LOC2 -LOT 19 -
SECTION B.
OWNER INFORMATION:
Property Owner Name: Joseph and Ashley Romano
Property Owner Legal Address: Property Owner Mailing Address:
(Cannot be the same as Rental Property Address)
22 Virginia Ave, Ronkonkoma, NY 11779 22 Virginia Ave, Ronkonkoma, NY 11779
Telephone Number(s): Daytime 631-617-7785 Evening Emergency
Property Owner Email Address: josephromano23@gmail.com
Page 1 of 4
SECTION F.
PROPERTY DESCRIPTION;
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 DwellingUnit Identifier: 1
Requested Maximum number of persons allowed to occupy Dwelling U 10 �.. w.° "
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Number of rooms in Rental Dwelling Unit: 14
Use and Dimensions of each room in Rental Dwelling Unit: Living Room- 18x12'8",
Dining Room-11'5"x12'8',Kitchen-157"x12'8",Laundry 1-72N12'8",Bedroom 1-17'9"x13'4",Bath 1-1611"x5'3",
Bedroom 2-13'x12'3", Bath 2-6'6"x10'8", Bedroom 3-15'7"x10'11", Bath 3-57'x9'1", Bedroom 4- 12'8"x13'8",
Bath 4-5'11"x8'8", Laundry 2-8'9"x6'4", Bath 5-5'x5'9"
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.
I am requesting afire 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.
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 Joseph Romano 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: Joseph Romano
"
Property Owner's Signature:
Swor o before me this Vday of (el- r� -cr' , 20�
0ffi o I qotary Public Signature and Original Notary Stamp
Q CE L CAIB ERA
NOTARY PUBLIC,STATE OF NEW YORK
NO. 01 CA6212407
QUALIFIED IN SUFFOLK COUNTY Page 4 of 4
MY COMMISSION EXPIRES APR 5,2026
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TOWN OF SOUTHOLD PROPERTY RECORD CARD
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