TOWN OF PATTERSON
Approve
Yes/No
Initial
Date
CODE ENFORCEMENT OFFICE
Need
PUTNAM COUNTY
Information
P.O. Box 470
Review by
Bldg. Insp.
Patterson, NY 12563
Review by
Zoning
Tel (845)878-6319
NICK LAMBERTI
Fax (845)878-2019
Director of Codes Enforcement
Rental Registration Application
Registration of ALL residential rental dwelling units is required in accordance with the Patterson Town
Code. Registration of a residential rental dwelling unit does not establish legality of the dwelling unit. In
order to establish legality, you may be required to apply to the Zoning Board of Appeals and/or the Putnam
County Department of Health for compliance and approval.
Type of Application (check one) New________ Renewal_________
(include copy of previous permit or approval)
Application Number:______________
Date:____________
Tax Map #:______________________________
Property Owner:__________________________Address
: _______________________________________
(mailing)
Property Location
_____________________________________________________________________
(911 address)
Address of Property Owner:______________________________________________________________________
(if different from above)
Telephone Number:_____________________________________________________________________________
(of property Owner)
A survey or site plan of the premises showing all buildings, structures, walks, drives and other physical features of
the premises and the number, location and access of existing and proposed on-site vehicle parking facilities
If the rental is a condominium unit, please provide a scale drawing of the floor plan, in lieu of a survey or site plan,
per Section §129-5 E of the Patterson Town Code.
Name of Managing agent/Operator name:___________________________________________________________
Address:____________________________________________ Telephone number:__________________________
Description of Structure
Building Type: Multi-family
_____Single family or condominium_____Accessory Apartment_____
(3 or more units)
Describe dwelling to be used/occupied for rental. Please include the number of dwelling units (If it is a main
residence and one apartment, it would be two units) and the number of persons intended to occupy the premises.
A floor plan showing the number of rooms in the existing dwelling and in each existing or proposed dwelling unit is
required. This drawing must include dimensions of each room, means of ingress and egress, smoke detectors,
number of persons intended to occupy and/or are presently occupying each dwelling unit.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
TOWN OF PATTERSON
Approve
Yes/No
Initial
Date
CODE ENFORCEMENT OFFICE
Need
PUTNAM COUNTY
Information
P.O. Box 470
Review by
Bldg. Insp.
Patterson, NY 12563
Review by
Zoning
Tel (845)878-6319
NICK LAMBERTI
Fax (845)878-2019
Director of Codes Enforcement
Rental Registration Application
Registration of ALL residential rental dwelling units is required in accordance with the Patterson Town
Code. Registration of a residential rental dwelling unit does not establish legality of the dwelling unit. In
order to establish legality, you may be required to apply to the Zoning Board of Appeals and/or the Putnam
County Department of Health for compliance and approval.
Type of Application (check one) New________ Renewal_________
(include copy of previous permit or approval)
Application Number:______________
Date:____________
Tax Map #:______________________________
Property Owner:__________________________Address
: _______________________________________
(mailing)
Property Location
_____________________________________________________________________
(911 address)
Address of Property Owner:______________________________________________________________________
(if different from above)
Telephone Number:_____________________________________________________________________________
(of property Owner)
A survey or site plan of the premises showing all buildings, structures, walks, drives and other physical features of
the premises and the number, location and access of existing and proposed on-site vehicle parking facilities
If the rental is a condominium unit, please provide a scale drawing of the floor plan, in lieu of a survey or site plan,
per Section §129-5 E of the Patterson Town Code.
Name of Managing agent/Operator name:___________________________________________________________
Address:____________________________________________ Telephone number:__________________________
Description of Structure
Building Type: Multi-family
_____Single family or condominium_____Accessory Apartment_____
(3 or more units)
Describe dwelling to be used/occupied for rental. Please include the number of dwelling units (If it is a main
residence and one apartment, it would be two units) and the number of persons intended to occupy the premises.
A floor plan showing the number of rooms in the existing dwelling and in each existing or proposed dwelling unit is
required. This drawing must include dimensions of each room, means of ingress and egress, smoke detectors,
number of persons intended to occupy and/or are presently occupying each dwelling unit.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Rental Registration Application
Number of Dwelling Units:________________
(Separate application required for each unit)
Number of TENANTS occupying unit:_______________Number of rooms:_______Number of Bedrooms:_______
Dimensions of each room:_______________________________________________________________________
Total square footage of rental unit:____________________
This application must also include the name and address of the insurance company, if any, providing the fire and
other hazard and public liability insurance for the owner of the premises and a description of the type of insurance
provided, policy limits for each coverage, and the policy number and expiration date of such policy.
Exceptions to this form are § 129-3 A (1) an accessory apartment, as defined by Chapter 154, for which a special
use permit issued by the Zoning Board of Appeals is in effect shall not be required to comply with the provisions of
this chapter. As well as §129-5 F Notwithstanding the above, no rental occupancy permit shall be required for a
residential-care facility established under New York State guidelines only with respect to housing of persons
requiring such care and excluding any housing provided for employees of such facility or other individuals.
The Code Enforcement Officer and/or Fire Inspector is authorized to conduct inspections, upon consent of the
owner or occupant, of any rental dwelling unit and the premises in which same is located, to determine the condition
of the rental dwelling units and to safeguard the health, safety, morals and welfare of the public. It shall be a
condition of each rental occupancy permit, expressly stated therein, that the Code Enforcement Official and/or Fire
Inspector shall have the right to inspect each permitted rental dwelling unit during the term of the permit, in
accordance herewith, for the purpose of performing his duties, under this Chapter.
REQUIRED FEES for 3 Year Rental Registration – Non-refundable
(yearly payment not acceptable)
$75 per unit
(up to 4 units)
$______________________
$50 per unit
(each additional unit in excess of 4)
$______________________
TOTAL FEE PER STRUCTURE
$__________________
I,
owner/operator
of above referenced premise,
(please print) ____________________________________________,
(circle one)
do hereby certify that the above statements are true, to the best of my knowledge.
Signature of Applicant________________________________________Date_____________________________
2
ADVERTISEMENT