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Home My WebLink About1000-26.-3-4 so '11OWN OF SOUTHOLD Rental Permit 1356 Owner: John Carter Occupied as: Single Family Dwelling Located at: 235 Douglass St Orient 26,34 Maximum Permitted Occupancy: 2 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: 07/24/2025 Expiration: 07/24/2027 ca Ens r ent fcial This Notice must be posted by the main entrance aoall ' es( TOWN OF SOUTHOLD —BUILDING DEPART r ^r" Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, 971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 hltp,; r� QUt;holdtown + + lows RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every two years) Section A. fC1 I�00 NLIF t t 650 Property Information: Rental Property Address: 235 Dou las Road. Orient NY n Tax Map Number: 1000 SECTION 0�� -BLOCK -LOT SECTION B. OWNER INFORMATION: Property Owner Name: John P. Carter Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 272 W. 117th. St.#4D 5 Telephone Number (s): Daytime 917.209..67§g Evening Emergency Property Owner Email Address: Cartern w orkCD rnaii.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 Dwelling Unit Identifier: Requested Maximum number of persons allowed to occupy Dwelling Unit: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit;. Bedroom 1: 11 x 9 feet. Bedroom 2: 11 x 9 lest. „„„ Bathroom 2: 5 x 4 feet. 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. L 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) 1ca aer , certify under penalty of perjury,the following: 1. I 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, I I 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: Property Owner's Signature: i 41 Sworn to before me this day of 20 _�' Official Notary Public Signature and Original Notary Stamp CONNIE D. BUNCH Notary Public,State of New York No. 01 BU6185050 Qualified in Suffolk County Commission Expires April 14,2_01:� Page 4 of 4 TOWN OF SOUTHOLD BUILDING DEPT. u 631-765-1802 [ ] 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 (FIN [ ] CODE VIOLATION [ ] PRE C/O RENTAL =RARKSO ... ............ __ _q 9-f SO V� 0:�x ` RATE INSPECTOR ILI TOWN OF SOUTHOLD PROPERTY RECORD OWNER STREET — - -- e VILLAGE DIST. SUB. LOT FORMER - OWNERf t� f _ _ems a� ACR- V./ � TYPE OF BUILDINGPiz- - e, RES� � f ' SEAS. � VLt 'FARM COMM. C.B. MISC tv'tkt. Value LAND EMP. TOTAL DATE REFAARKS �- � J, � s , e _ f r.�..a e { a _ sr �s FARM Acres—Value Per Value fr A Tillable, - - � a Tillable � . labl - Wood'and ics FRONT AGE ON WATER s -A rush'ar;d FRONTAGE ON ROAD House _ `ot DEPTH Vy t 1 Tato t DOCK a r COLOR I �� . - I TRW P o - -- - — --., �... - - x �a t � v i9 26,34 2/14/2025 i Dinette , ldg _ rc.�nd�ticn i` t t t osement - Floors Exte sib =N Ext. Wally r r Finish -- x = Inter iQ F n sh LR 'Fire Place He-a' { - - Type Roof 1 ,` Rooms 1st Floor I FIN B, Porch — -- - f l>m Q 1 CJ, Dormer n� r r. i i u = a FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. -1-210. . ......... Date ..........................AW........7........... ... 19,65.. THIS CERTIFIES that the building located at . ......DOUglagg-RCM&............................. Street Map No. ..X=............. Block No. Lot No. . .........er!jerkty...Nv.lv................... conforms substantially to the Application for Building Permit heretofore filed in this office dated —. ... ..... ..........................JW"j3*r.. .j)+ 19-64. pursuant to which Building Permit No. 2-01,1. dated ................. ..........ftt0b=.....3-4, 19.&. ., was issued,and conforms to all of the requirements of the applicable provisions of the low The occupancy for which this certificate is issued is ........ ........................................................................................... The certificate is issued to Edu=d.....)Wbleeh- .......10mex....................................................... (owner, lessee or tenant) of the aforesaid building X.D. Approval April 309 1965 by R. Villa ....... ..ct.�..............I............ ....... Building Inspector FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Date . . . . . . . . . . .IM . . . . 29 . . . . . .. 19. 67 THIS CERTIFIES that the building located at . . . 3a . Street Map No. . . . . , . . . Block No. .XXt . . . . . . . .Lot No. # . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . . t. . . .if., 19. °$`T pursuant to which Building Permit No. . .356 dated . . . . . . . . . . . . 4. . 9 ., 19. .67, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . ,MV*to. cat. f=. 13.y. .dWe11111g. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . 14vemd.ftiblech . . • • • • • •OM=r. . . . • • • • • • . • • • • • • • • • - (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . , • • . • . . . . . . . . . . . . . . . . wilding Inspector FORM NO. 4 TOWN OF SOUTHOJ,,D BUILDING DEPARTMENT Town Clerk's WE& Southold, N. Y. i Certificate Of Occupancy No. ,Z5406 . . . . . Date . . . . . . . . . . . .August. .2��. . . ., 197.3 . THIS CERTIFIES that the building located at . .nou4.a-9 .Road . . . . . . . Street Map No. . .XX . . . . . . . Block No. . XX. . . . . .Lot No. . . . . . . . . . . . . . . . . . w conforms substantially to the Application for Building Peimit heretofore filed in this office dated . . . . . . . .July.p2-j. . . . ., 19. .73 pursuant to which Building Kermit No. . .6762.Z dated . , . . . . . .truly.301 . . . . ., 19.73., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . • • PxIvate -one- •f ly.$welly. . . . , . . � . . . . . . . . . . . . . . . . . . . . . . . . . . . . : The certificate is issued to . . . .EdVard HoSb.I;o614. . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . M (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . . . . . . .'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSE NUMBER . . . .235 . . . . . . Street . . . . Douglas', Road• . . . . . . . . . . • . µ w . . . . . . . . . . . . . . . . . . . .pr , $. . . . . . . . . . . . . . . . . . . . . . . . Building Inspect W rolm NO. 4 TOWN OF SO OLD BUILDING DEPART30VT Town Clerk's Office SottthoK N. Y. Certificate Of Occupancy No.Z.b.Q43. . . . . . . Date . . . . . . . . w . . . . A149. . . .9. . . . . .. 1974 . THIS CERTIFIES that the building located at . P093A9_A0.44. . . . . . . . . . . Street Map No. . .?X . . . . . . . Block No. . . .?� . . . .Lot No. . . . . . . , . . .Or ; at A'To. . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . , . . . . . . . . , . . . �. ., 19.74. pursuant to which Building Permit No. .731 OZ . dated . . . . . . . . , June. . . ._ i. . ., 1914. ., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is X#4. 00.090. . . . . . . . . . .. . . . . . . . . . The certificate is issued to . $award, AgWdo. . . . . . .14mox . . . . . . . . . . . . . . . . . . . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval A oR. . . . . . „ . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE No.A aR.. . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSE NUMBER . W. . . . . . . . . Street . . O" .R*&d. . . . . . .. . . . . . . . . . . . . . . . . . . Building Ins FORM xo 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ,Zq,4,� . . . . . Date . . . . . March . .15. . . . . . . . . . . .. 19. 79 THIS CERTIFIES that the building located at . . . ?43.5 .Douglas. 4?. . . . . . . are a ata Map No. . . .xxx Txx. Block No. . . xx-4=Lot No, . . . . . X , . n . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . APril . . 25 . . . . . . . ., 19. 7 pursuant to which Building Permit No. . . 9.7.21 Z dated . . . . . . ?. . . . . . . . . . . .. 19. 78, was issued, and conforms to all of the require. ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . . . .Private bne Family _Dwelling with4 Addition The certificate is issued to . . . . . .Edward Mosbleahµ „ µ n . , . (owner, of the aforesaid building. Suffolk County Department of Health Approval N . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE No. . . . . ITO A 399. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . HOUSE NUMBER . . . R35. . . . . . . Street . . . . . . Poug];ae.Rd. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . .QrtpAt .New.York. . . . . . . » . . . . . . , . Building Inspector Tax Number 1000-26-3--4 FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. . . . . . 71 QQ6.6 . . Date . p. . .+pt. .7 . . . . . . . . . . . . . . . . . . . .. 19 .$Q THIS CERTIFIES that the building . . . . . , . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . • . . . . . . . . . Location of Property . . . � 5, Aougla Road . . . . . . . . . . . . . . . . N.Y. House No. Street Hamlet County Tax Map No. 1000 Section . . ..26 . . . . .Block . . .Q3. . . . . . . . . .Lot . . . . . . Qa4. . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . .jgl y, , 11. . I . . . , 198Q .pursuant to which Building Permit No. . . 1M5Z. . . . . . . . . . . . dated . . . JtaY. 15 . . . . . . . • • « . • 19 SQ ,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.4Xg3#9 . . . . . . . . . . . . . . The certificate is issued to . . . . . . . . . . . . . V rd XP,0 , . . . . . . . . . (owner,AMOnDMOM of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . Y3f R, . , . . . , • . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . .N/R. . . . . . . . . . . . . . • . . . « « . . . . . . . , • » . . . . . . .. . . . . . . . Building Inspector Rev 4179 e FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Halt Southold,N.Y. Certificate Of Occupancy No.Z1182.? . . . . . . . . . . Date , . « . , . August. « . . . . . . . . . . . . . . . .. 1983. THIS CERTIFIES that the building . ,with alteration/enclosure . Location of Property . .�° . , . . . . . . , . . „ . , , „Douglas Road w Orient House No. � Street Hamlet County Tax Map No. 1000 Section . 0 2.6. . . , . , . .Block . . . a.3. . . . . » , . , ,Lot , , 0 0 4 Subdivision , . . . X . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. .X. . . . . .Lot No. X , . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated A p r i 1. .1. . . . . . . . . , 19$3.pursuant to which Building Permit No. „ *12 2 6 4 *Z . . . . . dated . . . . .A p r i 1 15. . . . . . . . . . . . . . 10 3. ,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 . . . . . . . . . . . .a one-family dwelling:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . The certificate is issued to . . . . , wEDWARD & ^VIOLA MOSBLECH %vvrrer. .ems. 1, of the aforesaid building. Suffolk County Department of Health Approval . . . . . . .VA A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . , . . , w . . . . .VA I . . . . . . . . . . . . . . . . . . . . « . . • • < . . ;;� .�. . . . . . . . . . . . Building Inspector Rev.1/81 A �.. « W, ------------------4 n lo I E c E W E UE LL_ KITCHEN Building Department Town of Soulhol d I? z (o Lo ED CD cy) CD .-T A-1 FLOOR PLAN All 4.26.24 7.21.25 FLOOR PLAN ecK 4.26.24 1/4" = 1'-0" REVISED 7.21.25 JOAN CHAMBERS. (631)294-4214