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Home My WebLink About1000-115.-1-1 � of so � TOWN OF SOUTHOLD Rental Permit 1278 Owner: Eziah Syed Occupied as: Single Family Dwelling Located at: 290 Village Ln Mattituck 115.-1-1 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: 03/19/2025 Expiration: 03/19/2027 Code Enforce ntOffic I This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 PE T � � S � ION [ ] ,FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ �/RENTAL REMARKS: Co2WeC,hO?,5 0 ,�►� a DATE INSPECTOR �. TOWN OF SOUTHOLD BUILDING DEFT. 631-765-1802 //S-/ -/ 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 AL) [ ] CODE "VIOLATION [ ] PRE C/O [ RENTAL REMARKS: IL751 s� Asr,6t-ll ........:.. �: _ Irn_ V'pew-, see ce, w�maw. DATE �� _ INSPECTOR r�Jm t �+ Town Hall Annex � Town of Southold 54375 Main Road W. ;; Rental Inspection Report PO Box 1179 4 �^ ;} Southold, NY 11971-1179 Tel: 631-765-1802 SUM# Date l Owner Phone Address Visible Hamlet Inspector Floor Level Quantities Sub 1 2 3 Smoke Detectors(not located in bedrooms) Carbon Monoxide Detectors I' Fire Extinguishers f Exits GD Bedrooms 1 2 3 4 6 Smoke Detectors Egress Occupant Count o?. -- a- Building Systems Maintained&Operational Condition of Property Heating Building interior Hot water Building exterior Electrical Property clean, maintained&safe Mechanical Handrails&guards installed&secure Pool Safety Pool on Site Surface water alarm Date of CO issuance Door alarms Pool completely enclosed Self closing/latching gates Ifool fence to code requirements CO's for all items present Prior Rental Comments: NfPkgt 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 hgps://www.soutbgldtownn�ov RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed erevagerl Section A. Property Information: gullding DePartme"t Town of Southold Rental Property Address: 290 Village Lane, Mattituck, NY 11952 Tax Map Number: 1000 SECTION 115 -BLOCK 01.00 -LOT 001-000 SECTION B. OWNER INFORMATION: Property Owner Name: Eziah Syed Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 290 Village Lane, Mattituck, NY 11952 same Telephone Number(s): Daytime 917-488-987 Evening 646-417-2208 Emergency 347-622-7417 Property Owner Email Address: eziah.syed@gmail.com ankegeertsma@gmail.com Page 1 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: 1 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: 1 Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: 12 Use and Dimensions of each room in Rental Dwelling Unit: Downstairs: Family Room:23'x 13' Dining/Living Room:27'x 13' Kitchen: 19'x 13' 1/2 bathroom: 5'x 5' Bathroom: 13'x 11' Master bedroom: 15'x 13's Kids room 1: 14'x 10' Kids Room 2: 10'x 10' Upstairs: Front Bedroom: 20'x 20' Back bedroom:20'x 15' Office: 9'x 9' Bathroom: 9'x 8' 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 ❑ 1 am submitting a completed Town of Southold certification form from a licensed architect or a licensed professional engineer. Page 3 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: 1 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 Dwelling Unit Identifier: 1 Requested Maximum number of persons allowed to occupy Dwelling Unit: 8 Number of rooms in Rental Dwelling Unit: 12 Use and Dimensions of each room in Rental Dwelling Unit: 1 living room, 1 dining room, 1 kitchen, 5 bedrooms(3 downstairs,2 upstairs), 1 office, 2 bathrooms, 1 half bathroom for dimensions see floor plan 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 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. 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) 1 Eziah Syed 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: Eziah Syed Property Owner's Signature: Sworn to before me thiVa f 20 2 Official No Publi d Original Notary Stamp s ARTH fi MULfA ANDO NOTARY PUBLIC, STATE OF NEW YORK Page 4 of 4 NO. 01 MU6341246 QUALIFIED IN QUEENS COUNTY MY COMMISSION EXPIRES I: rl�1 / '� t 1�YA-) - H 7).- 1 e. a _ � f . f s- 4 Eli [ I TRIM T1 s r b \\ \\ m� r TT------ 1 i 115,1-1 1/07 M. Bldg. A oun a i n in .3 / � d t'o Bath 1, _ F� e Dinette Extension Basement _ Floors Extension ._ t_ Walls r mi _ L Inte for F sh R r Extension ' 'Fire Place Heat t v —a DR. a Type Roof Rooms 1st Floor (BR, r Porch 4� ' Recreation R m! Rooms 2nd Floor! (FIN B Porch Dormer Breezeway Driveway r Garage i Total 07 30,0 i, TOWN OF S UTH L PR' OWNER JJ STREET , . -, _ _ VILLAGE C�(C1i DIT SUB. LOT rod ►� z JO ER OWNER'' 1' , Etc v i UP - ; N E - d 4 ACR W TYPE UILD� -; PEOF B ING RES. SEAS. FARM VL. COMM. CB. MISC. Mkt. Value LAND IMP, TOTAL DATE REMARKS A _ E A U a _ <3 NEW NOR I � I EELOW BO - F. - FAR ! Acre Value Per - 7 ` l clue Acre r ; Tillable 1 Tillable 2 7 _ _= ,-1 ;� — - , Tillable 3 l - a 1 Woodland I � - Swampland I € I FRONTAGE ON WATER Brushlond FRONTAGE ON ROAD House Plot i I DEPTH I v !BULKHEAD Tota I I I � . DOCR K l I SAI SUPERIOR DATA SERVICEs, 188 MONTAGUE STREET 10th FLOOR BROOKLYN,NY 11201 1471 ROUTE 9 SUITE 203 I IJ)625-9949 FAX 7)896-5551 LCLHTON PARK,NY 12065Title: JUDI 143pI E :(518 785-4892 FA -11111x: 518)78'5-5096 Premises: 290 VILLAGE LN bate: 7/22/2021 County: SUFFOLK Town/City: TOWN OF SOUTIfOLD Village: MATTffUCK(N INC) ('NOT District: 1000 Section: 115.00 Block: 01.00 Lot: 001.000 ATTACHED FIND A COPY OF CERTIFICATE OF OCCUPANCY#Z5493 ISSUED ON 9-27-73-SINGLE FAMILY DWELLING. ATTACHED FIND A Copy OF CERTIFICATE OF OCCUPANCY#Z-22985 ISSUED ON 5-4-94-DECK. NO OTHER RECORDS FOUND. TAX CLASSIFICATION: 210 SINGLE FAMILY DWELLING. SUPh"RIOR I)ATA SU:RVICI,�S jy)IS Rjj JUDICIAL 77'111."AM.N01,Uc, 111E MFORMArjoN ()R))S OF THEAHOWi GOVERNAIENI'AL AGENCY N%%RVIOR11-D 11 A RkWORIEDA110 RfA: ANIINIA)FOR 'X *' JAN AND NO LIA811ji'y IS ASSUM VE IS ATRUEAND ACCURAIE ABSTRACT OF TW-V4FORMATION r'D- 7111S REPORI'Is sumtrrna)1�oR INFORNLA770N P0Rp(),%,S O�Nj y, 0000601) ()O(XX)015 00 FORM NO, q TOWN OF SOUTHOLD' BUILDING DEPARTMENT Town Cleric's Ofliee Southold, N. Y. Certificate Of OcW p�ncy Date THIS T.IVI that the � '• , • •, I „, located at Map xo c lo. . . . . . Street coxalor cat No. rns substantially to the pplic tiou for Building fed , . s office . . l" `runt heretofore filed i th° dated . . / ,pursuant to which Buildin ,p`er;rrnit rnents o the a . . .. , was issued, and conforms to all of flee applicable provisions Of the law. The occupancy for whichquire. 4 issued is . dais certificate . . � cute is The certificate is i shed to r of the aforesaid building. Owner, lessee or tenant, Suffolk Count CountY .l epartnaent of Health Approval l.D1�111a"1t44 f" j?11 " k�("i:°i�"l'CFw Ct"`A°F"f boo. w �' 51 lf1l Rti1? NUMnrlt.� , stl• et. " •�.r. .Q. . ' ter Building 1p.Spector w FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTNT Office of the Building Inspector Town Bail Southold, N.Y. "It TIPT ,TI: OF OCCUPMZY, NO X-229as Date MAY 4 19914 THIS CERTIFIES that the building Location Of Propert ADDITION 2!9�wGb VLzzaE ZARB House No. MATTI YOB Street County Tax Map No. 1000 Section Hamlet I sBloc Subdivision -----:.1 _Lot 1 Filasd Map N° -_..�.,-,---- ' conforms substantially to the Appl ----_Lot No. ication for Building filed in this off g Permit heretofore ice dated UST 16 1993 ursuant to which Building Permit N°, 16 S-- E dated AUGUST 30 was issued, and 15�9 conforms to all of the requirements of the Provisions of the law. The occu applicable issued is DECK AD'DITIOIi Topancy for which this certificate is XI'STINII�-ONR AMILY D The certificate is I AS FOR APPLIED FoR issued to R- CHIC,E (owner) Of the aforesaid building. SUB'FOLIC COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION RTIFICATION DATED N/A s Tiding Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 3'-22986 Date MAY 4 1994 THIS CERTIFIES that the building ADDITION Location Of Property 290 VILLAGB LAM House No. MATTITUCK NEW YORK Street Hamlet County Tax Map No. 1000 Section 115 Block---ILot 1 Subdivision conforms substantially Filed Map No.�_Lot No. to the Application for Building Permit heretofore filed in this office dated A S4 16 1993 -_______,pursuant to which Building Permit No. 21628-E dated AUGUST 30 1993 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 DECK ADDITION TO EXISTING O FAMILY DWELLING AS LIED FOR The certificate is issued to RICW4W R. N�C�tICK (owner) Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED ilding Inspector Rev. 1/81 First Floor I tqwN ^ 1 y, 4NYq;WA pl kd Yt �IY✓f ,a i Second Floor lmf. Basement 777 Tour and Content Copyright 0 2004-2021.This floor plan illustration is an approximation of existing structures and features and is provided for convenience only with the permission of the seller.All measurements are approximate and not guaranteed to be exactor to scale..Buyer should confirm measurements using their own sources J �1 i� IIII�IM1' � uI� J J / on l li J 1 .� „a� „ �.., r�ll��dld��X'"d1 ✓ram,,,, r, 1✓G�1%i'oral rs��/ //�irrirrr �'✓ �� j r H., y�i�, >, r �' i, 11 � � J I i � � /: �/ 1 1�l �!�,. ��% . 1l �� uuuuuuuuuuuuumiuuuuuuuuuuuuuuuiuuuuuuuuuuuuuul�Il�Vuuuuuuuuull�lll I m uuum l% ��s i � ��/ J� I� i i I o� r rq 1 1 Dirr rrrr