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Home My WebLink About1000-78.-8-5.1 Rental Permit 1306 Owner: Barbara Rathborne-Head Occupied as: Single Family Dwelling Located at: 1160 Goose Creek Ln Southold 78.-8-5.1 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: 05 07 2025 Expiration: 05/07/2027 code E owe n official This Notice must be posted by the main entrance at all times � C �aC�� I TOWN OF SOUTHOLD—BUILDING DEPARTMENT "M Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax(631) 765-9502 pu i :// 1 q i ai i 0Y RENTAL PERMIT APPLICATION Rental Permit Fee $300 (Application must be renewed every tw rs ' Y 22,:.x I Section A. Property Information: Rental Property Address: l ( ® &DOGE Tax Map Number: 1000 SECTION.-_____ 9 -BLOCK -LOT $• t - SECTION B. OWNER INFORMATION: Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) 40$ V�tcGG►NS 5 " . {• 0 • 'Dox 1554 fLC� t r•� S 0 vT-f oL�p �ga7 Telephone Number (s): Daytime C 1-7'93V,Evening Emergency Property Owner Email Address: bOCne @ mai C 6(n 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, 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: Requested Maximum number of persons allowed to occupy Dwelling Unit: 8 Number of rooms in Rental Dwelling Unit: I t Use and Dimensions of each room in Rental Dwelling Unit: «y• ' 2(�'bl�x 2g qu OFFICE 121-3x y2" XtT 1�'-tt`sc fLF�-Z'I pin KMt$I-q",ctA'�2•l• . I_ « 1-C-t i o L&20 (►'t. 1, a �� r �, BCoe m 441 131-2"x 13l-D" O AXtt m to o op-o-t Iri` z 11 l/ rlS�-8l/ x I o'-$ �ArTbtKM 3 9 -1 11� 71 1r Qe�7R m #4 I_q-�r 3PC 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. ❑ 1 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 W. DECLARATION: Signature must he notarized and MUST hfr the owner of the dwelling unit. Texas S T A T E 01 ftWnW) Dallas ) COUNTY Of-XXr)KXIiOXK) I Barbara Susan I;athhorne Head, t ettify ttnrlor twilalty of ltr'I jury, tile, follo.,r�irlg i lam ihe, ov"ner cif the ptopMty id(sntificld in "Section A" of thi, aplilk.ation The property ownei's legal address set. forth in "Section B" of this applir.ativrr i,,my If'p)I 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 (S) 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: Barbara Susan Rathborne Head Property Owner's Signature _ Sworn to before me this _ "'day of March, 2025 . Rtchardang 70 Richard Ang bray f � _ ID NUMBER ' � „ �, "" 1&U35772 Official Nota Public Si nature and Ors final Nota Stam � � � � COMMISSION EXPIRES g g p " e,gl�ggiro'4 November 8,2025 Electronically signed and notarized online using the Proof platform. Page 5 of 4 4� 1 TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 p-g- 5. / INSPEOCTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ j INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ j FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ j FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ j ELECTRICAL (FINA [ ] CODE VIOLATION [ ] PRE C/O [ ENTAL I e,2 41 A-0 u sz I LAM 9"Lld'o V, o&vf eo"4A4nce DATE .2�' INSPECTOR Town Hall Annex � �� ^, Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P. O.Box 1179µ Southold, NY 11971-0959 W ° BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a licensed architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Professional seal re aired for Architect or Engineer, Licensed Home Inspector must provide copy of valid current certification Rental Property SCTM Number: (d 0 Rental Property Address: (0'd G'O OSF_ CR Er1G, CA-"Ja SOU TI-toL-J�;, Owner/Name: g V Rental Dwelling Unit Identifier: l Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom #1 -100 sqft., Bedroom#2-90 sgft., etc.) Ltv. R m - b 4 2 r� OfFt c-e 157 tt KIT. 15-4-4 vlei R m 24o5- qh 1 L-Acu nu o - 52 thz rat 1 t o " t -4 tirr%t F .O 180 Property Description (Include all improvements indicated on survey) JWC NCT aaL W F I e�Tta, I certify that I have done a physical inspection of the subject rental dwelling unit and find that it fully complies with all the provisions of the Code of the Town of Southold,the Residential Code of New York State,the Building Code of New York State,the Plumbing Code of New York State,the Fuel G6 'QQ e of New York State,the Fire Code of New York State, the Property Ma` ten ce C bf Npw l'brk State and th Energy Cor► eration Construction Code of New York Print Name and Title Original Signature . Please place Professional Seal: f TOWN OF SOUTHOLDPROPERTY RECORDS OWNER STREET VILLAGE DIST.! SUB LOT FORMER OWNER N E ACR. - f S W TYPE OF BUILDING m y, RES. SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE I REMARKS f f v �. f 1 / f 7�fo odd, � �1�)f f `, .'._ Imo' � _�� ( � � - f , AGE BUILDING CONDITION ��, _ z _ Z3 i3 ,L I 1 1-r' NEW NORMAL f BELOW ABOVE ,` Z I`t�- I—f(`�s, �C� r 7 _ FARM Acre Value Per Volue Acre Tillable ! FRONTAGE ON WATER 3 Woodland FRONTAGE ON ROAD , Meadowland _ DEPTH House Plot , BULKHEAD f Total I DOCK � s TOWN OF SOUTHOLD PROPERTY RECO I )0)Zq l$ OWNER !STREET VILLAGE DIST SUB. LOT ft x — FORMER OWNER E ' ACR. .. �,.z _ _ S W TYPE OF BUILDING a ad RES. SEAS- VL. FARM COMM. CB: MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS a i Ie 1 3 I AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value I Acre Tillable ! FRONTAGE ON WATER Woodland FRONTAGE ON ROAD E Meadowland DEPTH i House Plot i BULKHEAD E i Total _ DOCK i i - I i .OR r.J h'.` " A TRIM 4 =a , , 3 ' i I i111� q 78.-8-5.1 3/06 M. Bld °3 ' 9 , Extension _ i Extension Extension ` undation ' , Bath 'Dinette Porch Basementf Floors K. I Ext. Walls Interior Finish L.R. o y Ck, i r J � �� E IC _ FirePlace Heat `p 1 t =r DR. rage _ hype Roof Rooms 1st Floor L3R. - x 20 3:�o 25 Q/�C? Recreafian Room ;Rooms 2nd Floor FIN B -C !Dormer ;Driveway - Total " � 0i�- / FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 28170 Date: 01 15 02 THIS CERTIFYES that the building DWELLING AND ACCESSORY Location of Property 1160 GOOSE CREEK LA SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 078 Block 0008 Lot 005.001 Subdivision Filed Map No. Lot No_ conforms substantially to the Requirements for a ONE FAMILY DWELLING built prior to APRIL 94 1957. pursuant to which CERTIFICATE OF OCCUPANCY NUMER Z- 28170 dated JANUARY 15 2002 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 ONE FAMILY DWELLING WITH ACCESSORY TWO CAR GARAGE.* The certificate is issued to SAMUEL EPSTEIN & WF (OWNER) of the aforesaid building. SUFFOLK COMrff DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. NIA PLIUMBBRS CERTIFICATION DATED N/A „ *PLEASE SEE ATTACHED INSPECTION REPO Authorised. Signatta 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: Z-31201 Date: 10/11 05 THIS CERTIFIES that the building ALTERATIONS Location of Property: 1160 GOOSE CREEK LA SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 78 Block 8 Lot 5.1 Subdivision Filed Map No. Lot No_ conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 20, 2004 pursuant to which Building Permit No. 30644-Z dated SEPTEMBER 20, 2004 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 STRUCTURAL REPAIRS & ALTERATION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. �www The certificate is issued to GRAHAM & BARBARA HEAD (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTXMT OF EEALTH APPROVAL, ELECTRICAL CERTIFICATE NO. 1044034 04/11/02 PLUMBERS CERTIFICATION DATED 09/27/05 GARY STAHL Authorized Signature Rev. 1/B1 t FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31202 Date: 10 11/OS THIS CERTIFIES that the building ADDITIONS/ALTERATIONS Location of Property: 1160 GOOSE CREEK LA SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 47:3889 Section 78 Block 8 Lot 5.1 Subdivision Filed flap No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 10 2004 pursuant to which Building Permit No. 10645-Z dated SEPTEMBER 20 2004 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 ADDITIONS & ALTERATIONS TO AN EXISTING SINGLE FAMILY,DWELLING AS APPLIED FOR & AS PER CONDITIONS OF ZBA #5541 DATED 8 24 04. The certificate is issued to GRAHAM & BARBARA HEAD (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT, OF E$ALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO_ 1044034 11/04/02 PLUMERS CERTIFICATION DATED 09 27 05 GARY STAHL A thorized Signature Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 30645 Z Date SEPTEMBER 20 2004 Permission is hereby granted to: GRAHAM & BARBARA HEAD 55 WALKER ST APT 5A. NEW YORK NY 10013 for ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR PER ZBA DEC W FLOOD PERMIT AS REQUIRED at premises located at 1160 GOOSE CREEK LA SOUTHOLD County Tax Map No. 473889 Section 078 Block 0008 Lot No. 005.001 pursuant to application dated SEPTEMBER 10, 2004 and approved by the Building Inspector to expire on MARCH 20 200 _ Fee $ 457.60 oried Sagaure ORIGINAL Rev. 5/8/02 k FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town. Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-32370 Date: 05 28 07 THIS CERTIFIES that the building ACCESSORY Location of Property: 1160 GOOSE CREEK LA SO OLi (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 78 Block 8 Lot 5.1 Subdivision Filed Map No_ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DEC ER 2 2005 pursuant to which Building Permit No. 31654-Z dated DECEMBER 6 2005 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 ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED .FOR. The certificate is issued to GRAHAM & BARBARA HEAD (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 114577C 02 07 07 PLUMBERS CERTIFICATION DATED N/A ,17 thor zed Si nature Rev. 1/81 OF NEB &N r 69AR-017'S MEW- 07 , N k y WTO Ell P.O. Box I447, Mattituck, IVY I ]952 «► (63I) 445-I46I l - _t� as LL 3ac*T HaY3 II j'I-LG F` -t £RI%T.!k.b -�sA'e 9"/•F n� 1 a _` waenaa eraau ��3', F� � Fi RST FL Gti PtAJJ ^. - LNG�+<LY PLAN •_ i_ � t - - _Z>ti ccp 5llt r t i � -` � -� 4•Hw+.rtoas �,�nr/.��za� .__ �� _ �•$'� ,. 3 stt+�cnu';se { /:JAxMc�M Y'�L1.i45 l '.�b �z -'�__ - -�SrGF�t 3�ouVUG _ < • -— F C ea.RAcirK '. � as(o}Y•rSII ION _ � - - - - - � [ i t - = E.�.. %y OK iTa�N Slew kx - �s*a N+%•oa�e5 _ - - 3 � r7ma rwA.X nr.rc �� p!L FN.r-i•+e \ $;E � � s mite 34ib r�Ta 3 �7HM1\lI�5 Y3l U�J CP- PJ•eSYYLb l =�1 fJ�M9f iF JCIm'C. �^ j € Ua t a��^ -R •wfW S��y ty RrgS 1 ° / � "Fy11ritL4 "R�fi�5C�C1�N. _ —Y.iM*5 5,yE V 1- -MOM - ( rFF. � � -�EviS `�: � �rx;tas�,.E �xc. j CLOSET :� UTILITIES L iGARAGE KITCHEN DINING ROOM Q ®fli LIVING ROOMI OFFICE _ N LAUNDRY RM s g 1 I �a t S c " os RATHBORNE RESIDENCE " N HALLWAY # 1160 GOOSE CREEK LANE N1101. � nGG SOUTHOLD SCTM# 1000-788-5. 1 FIRST FLOOR PLAN 3/16" = 1'-O' 3.20.25 t6-4 _ aa.Be eW - @ATHRhi #3 =e BEDROOM#4 E �' n €� z HALLWAY s=. f � - 3 ` f '.. S MBATHRM III to � R^G.:..E @A R}; #? L—� t e 3 o- , 5 HALLWAY - 'c, F �.-. � �..— }$„"_` BEDROOM#3 _ ILp i I Liu BEDROOM# € o BEDROOM#2 3 k G :T RATHBORNE RESIDENCE 1 160 GOOSE CREEK LANE SOUTHOLD SCTIVI# 1000-788-5. 1 SECOND FLOOR PLAN 3/16" = 1'-0' 3.20.25