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WoodlynneGreen Risk

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Business Inspection

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VALUE: TBD

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Executive Summary

This document outlines the requirements for the Annual Business Registration within the Borough of Woodlynne, NJ. It includes an Owner Identity Statement as per N.J.A.C. 5:29-1.2 THRU 5:29-2.2 and N.J.S.A. 46:8-27 THRU37. The form requests information regarding property ownership, managing agents, emergency contacts, mortgage holders, fuel oil usage (if applicable), and requires submission of a building floor plan. It also includes sections for store owner information, state license and tax ID numbers, and County Board of Health application (for food-related businesses).

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Document Text

--- Document: Business Inspection Document ---
      BOROUGH OF WOODLYNNE
                     Annual Business Registration
Owner Identity Statement N.J.A.C. 5:29-1.2 THRU 5:29-2.2
Building Address: ____________________________________________________
Woodlynne, NJ 08107
PURSUANT TO N.J.S.A. 46:8-27 THRU37
1.
The names and address of all record owners of the building or of the rental business (including all 
general partners in the case of a partnership) are as follows ( name, address and phone numbers):
______________________________________________________________________________________
__________________________________________________________________________________
______________________________________________________________________________
2.
If the record owner is a corporation, the names and addresses of the registered agent and of the 
corporate officers are as follows (name, address, and phone number):
______________________________________________________________________________________
__________________________________________________________________________________
______________________________________________________________________________
3.
The name address of the managing agent is as follows ( name, address, phone number):
______________________________________________________________________________________
______________________________________________________________________________
4.
The individual representative of the record owner or managing agent who may be reached or 
contacted at any time in the event of any emergency affecting the businesses, including such 
emergencies as the failure of any essential service of system and who has authority to make 
decisions concerning the building, including the making of repairs and expenditures, are as 
follows: (name, address, phone number):
______________________________________________________________________________________
______________________________________________________________________________
5.
The name and address of the holders of recorded mortgages on the property are as follows:
______________________________________________________________________________________
______________________________________________________________________________


6.
If fuel oil is used to heat the building and the owner furnishes the heat the name and address of the 
fuel oil dealer servicing the building and grade of fuel oil used are as follows ( name, address, 
phone):
______________________________________________________________________________________
__________________________________________________________________________________
______________________________________________________________________________
(   )  The building is not heated by fuel oil      (    ) The building is heated by fuel oil, but the owner 
does not furnish heat.
7.
A Floor plan of the building must be submitted.   Note if there is a floor plane on file at the 
Woodlynne Fire Department you do not need to submit a new one, unless there has been a change 
in the floor plan of the property.
    (   ) floor plan attached    (    ) floor plan on file with the Woodlynne Fire Department w/ no changes
8. Driver’s License Number for the registering owner: __________________________State: ______
9.
Name of the Store Owner: ________________________________________________________
10. Store Owner address: ____________________________________________________________                                       
        _________________________________________________________________________________
___________________________________      ___________________________________   ________
   Building Owner Signature                                              Print Name                                          Date
___________________________________     __________________________________    _________
    Store Owner Signature                                                    Print Name                                        Date
--------------------------------------------------------------------------------------------------------------------------
State License Number: _________________________________________
Tax ID Number: ______________________________________________
Provide a copy of the County Board of Health Application. (Food Only)               Risk Type: __________  
 
Woodlynne Mercantile Licenses: _________________________________Date: ___________
                                                            Do not write below this line
Check number: ____________________ Amount: ________________ Date: Received: ____________