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Home My WebLink About1000-107.-2-12 'of so- TOWN OF SOUTHOLD Rental Permit co 1483 Owner: Claire Bouffard , Bouffard AE Cred Shltr Trt Occupied as: Single Family Dwelling Located at: 405 Maple Ln Mattituck 107.-2-12 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 amangin for the b` al' ection. Issued: 05/20/2026 Expiration: 05/19/2028 Co En f official This Notice must be posted by the main entrance t all ryes . I �1 1� 0 + �ti A t TOWN OF SOUTHOLD—WELDING DEPARTMENT , Town Hall Annex 54375 Main Road P. O.Box 1179 Southold,NY 11971-0959 � I Telephone(631) 765-1802 Fax(631)765-950211t ww.so�atl�oidtownn , Yov ss:flw RENTAL PERMIT APPLICATION Rental Permit Fee$300(Application must be renewed every two yedd)�� 0 Section A. Property Information: Rental Prope Address: Tax Map Number: 1000 SECTION -BLOCK -LOT - SECTION B. OWNER INFORMATION: I Property Owner Name: `sc is -5' f-v�r) L_, Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) qc _ fsp.N . ..." ICJ .. Telephone Number(s): Daytim Evening Emergency Property Owner Email Address: C Page 1 of 4 Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent(no P.O. Boxes): Mailing Address of Authorized Agent: �. � " L4 Telephone Number(s): Daytime vening Emergency Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent(no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening Emergency Email Address: SECTION E. SITE MANAGER INFORMATION:(required for rental properties containing 8 or more rental units) Name of Managing Agent of dwelling unit, if any: LA'- Address of Managing Agent(no P.O. Boxes): Mailing Address of Managing Agent: Telephone Number(s): Daytime Evening Emergency Email Address: Page 2 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: u 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: 0 Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: J' �r i �4 Y tRzC i n �C ��i ' �. SECTION G. t INSPECTION: �( f ;° Pursuant to the Town Code of the Town of Southold Chapter 207 (Rental Properties),a safet inspection by Code Enforcement Official is required. If the owner chooses not to have said j inspection performed by the Town, a certification from a licensed architect,a licensed -)J 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. M I am requesting a fire 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 H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) ) COUNTY OF SUFFOLK) I 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:" Property Owner's Signature: 6A Sworn to before me iszday of LAa(4 _,202, Official N6tary Public Signature and Origirldl Notary Stamp Notary Publf -Stattl Of hC�w y+�r1a y t t11PR,SW�j 06 Quail 1N to sur'lk aunty Page 4 of 4 am B slan S t it s t7ct 19, 2026 1 0 � � � TOW � S O SOUTHOLD BUILDING DEPT. 631-765-1802 _Z I N E%C`T 10 N [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] INAL [ ] FIREPLACE & CHIMNEY ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL?( NeAL) CODE VIOLATION [ ] PRE C/O [ RENTAL R M RKS: t)A N, DATE INSPECTOR , a TOWN OF SOUTHOLD PROPERTY I OWNER 2STREET VILLAGE I DIST. SUB LOT FC RMER OWNER N E ACR. f W i TYPE OF BUILDING L RES.� 0 SEAS. FARM ICOMM. CB. MISC. Mkt. Value LAND IMP, TOTAL DATE REMARKS 7--- ----------- AGE BUILDING CONDITION NEW I �EMAL F BELOW ADOVF Tillable I Tillable-2-- 7 12 w Woodland Swampland !FRONTAGE ON WATER 1 Brushland FRONTAGE ON ROAD House Plot ' DEPTH BULKHEAD Total 1DOCK ~\ ~ 7171 �CR i I _ I i I I = f f - M r f, ELI : s - 107.2-12 3110 M. Bldg r` 4 3' 'F ndotion Bath # Dinette Extension i asement 1 Floors K. 6 Extension i Ext. Walls Interior Finishb LR. Fire Place Heat DR. F_ — Type Roof I Rooms l st Floor BR Porch f o '� ecreation Roonj Roams 2nd Flood FIN. B._ Dormer Breezeway 'Driveway Garage - /� ' o � v O. B3 Total `� l FORM NO. 4 TOWN OF SOUTHOLD ry BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 4265 . . . . . . . . . Date . . . . . . . . . . . . . .JTvne. .22. . . . . .. 19. .7.1 THIS CERTIFIES that the building located at . .hT/S_ 11arle .La. .(.r—L. .RD) Street Map No. . . x . . . . . . . Block No. . . . xx . . . .Lot No. . .xx. . . . .lrj,t.t i tack conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . . . June. . . .22. . ., 19.71. pursuant to which Building Permit No. . .53707 dated June 22 , 1971. ., 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 . - Frivate .one. .f� .i,1.y. dwelling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . .Frankii.n Born . . . . . . .Uz�jne�. of the aforesaid building. (owner, lessee or tenant) Suffolk County Department of Health Approval . . . I'+.•R• House 7 405 L'arle La � . . .6A . . . Building Inspect FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. . . . .Z14107. . . . . . Date . . . . .December .lg. . . . . .. . . . . . . 1985. THIS CERTIFIES that the building . . . . . adds t:;LQn. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property . 4.0.5 . . . . . . . . . . . . . .Map�-�. Lcjne. . . . . . . , . . . . . . . .Mattituck House No. Street Hamlet County Tax Map No. 1000 Section _ . . 107 . . . . .Block . . . . . . . .?. . . . . .Lot . . . . 12 . . . . . . . . . . Subdivision . . . . . . . . . . . . X. . . . . . . . . . . . . . . . .Filed Map No. . . . X . . .Lot No. . . . . . . X . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated October. 11 19$5 pursuant to which Building Permit No. 14379Z dated . . . octobex. 1.7. . . . . . . . . . . . . 19 .Q5,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 .. . . . . . . . . Ad�utiQn. ,tQ. existing.accessory,buildinca.. . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . , . . . . . .ALFRED E. & CLAIRE B07FARD . . . rt . . . . . . (owner, W of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . . . . . . . . .N/A . . . . . . « Building 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. Z 1 1 02.0. . . . Date . . . . . , . . . June, 4. . . . . . . . . . . . . . . .. 1982 THIS CERTIFIES that the building . . . . . . . . „ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Location of Property 405 Maple Lane Mattituck House No. Street Hamlet County Tax Map No. 1000 Section Q7. . . . . . . .Block . . . . . . . . . . . . .Lot . . . Al . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . „ . .Filed Map No. X. . . . . .Lot No. . .X. . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated . .S g p t e m b o r. .10. . . . . . 19$1. pursuant to which Building Permit No. dated . . . . . �e.pt;QUbe,r, 22. , , . . . . . 19$1 . ,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 . . . . . , . . . . . . . . . .ar� . ac.c.esso.rat. gar4ge.•. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . „ . The certificate is issued to . . . . „A 1 f r e d. F... ,& . C l,a i r e M. , B o u f f a r d (owner,fessee-or tenant) of the aforesaid building. Suffolk County Department of Health Approval . . . . .n�a. . . . . . . . . . . . . . . . „ . . . . . , . „ . . „ . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . .N. 5.5 7 9.4.8 . . . . . . . . . . . . . . . . . . . „ . . . . . . . . . . . Building Inspector Rev. 1/81 Town of Southold 1/27/2016 :. P.O.Box 1179 53095 Main Rd Southold,New York 11971 .�a CERTIFICATE OF OCCUPANCY No: 38065 Date: _......._...1/27/2016.............._.. . THIS CERTIFIES that the building RESIDENTIAL ADDITION p Mattituck _....... Location of Property: 405 Maple n, ,m SCTM#: 473889 Sec/Block/Lot: 107.-2-12 _... Subdivision. Filed Map No. Lot No. m confors substantially to the Application for Building Permit heretofore filed in this office dated 10/27/2014 pursuant to which Building Permit No. 39341 dated 11 111./5/2014 .._.... was issued,_a ..,,...._.._. 11 nd conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued isw 211.1120dM" t 1 "I C ff :11Ctf" k ( 19 C1 :f1Nr (&L. T7Vi I�LI (a c a, l':t';1 TI'1 1 . The certificate is issued to Bouffard,Alfred&Bouffard,Claire _. of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 2 ELECTRICAL CERTIFICATE NO. .,. .W 201 39341... 12 0..- PLUMBERS CERTIFICATION DATED ..... ......... .w.W...._ tareSign , re FAMILY ROOM 9'9"x 1 7'4" LAUNDRY 5'4"x 6'8" BATH DINING AREA �- - 6'1"x 11'9" 9'8"x 10'6" 'f I I"DROC)M 3 a 13'8"x' LIVING ROOM [ 165"x 207' GARAGE I 11'0"x 20'9" KITCHEN HALL ' 9'9"x 1010" I BATH ' 810 x51 6'8"x57' FOYER 9'5 xT1 PRIMA Y BEDROOM 13'1"x 11'9" TOTAL: 1971 sq.ft Basement:0 sq.ft, 1 st floor: 1339 sq.ft,2nd floor:632 sq.ft EXCLUDED AREAS: STORAGE: 128 sq.ft, BASEMENT:902 sq.ft, GARAGE:222 sq.ft, FIREPLACE:7 sq.ft,WALLS:252 sq.ft BATH 915" x 9'6" �tDROOM BEDROOM 101511 x 91611 1101211x96 OMMMM HALL - 3,6„ x 3,6„ HALL SITTING ROOM OFFICE � 71511 x 91311 � ' 1013" x 913" 1014" x 9'4" TOTAL: 1971 sq.ft Basement:0 sq.ft, 1 st floor: 1339 sq.ft,2nd floor: 632 sq.ft EXCLUDED AREAS:STORAGE: 128 sq.ft, BASEMENT:902 sq.ft, GARAGE:222 sq.ft, FIREPLACE:7 sq.ft,WALLS:252 sq.ft FAMILY ROOM 47W LAUNORY 5.1•x6'9` ' 5ATH DINING AIEA SATH :� =t �" >• BEDROOM BF6RO041 �ECROOM - 10'S`x9'5" EO'2'x§'6" i <HALL LIVING DOOM - 'D'x 3'S* 15'5"x 20'7' GARAGE . 10, p KITCHEN &4TPt H-I'L a .�...... 99' iG'i@' E. _ HALL SITTNGROONI OFFICE 6'e-.5'2' 'x9'3' -3d z3'L' RYE.'+ ° .. •. JS'X®'3` .. -. R "0 fl 13 9 PRIM 1Y GEO L P— ,j t_ BA EMENT 42'S F"x?9'i` ETOpACIE 8o4PmEnC TOTAL: 1971 sq.ft Basement:0 sq.ft, 1 st floor. 1339 sq.ft,2nd floor.632 sq.ft EXCLUDED AREAS:STORAGE:GE: 123 sq.ft, BASEMENT:902 sq.ft,GARAGE: 222 sq.ft, FIREPLACE:7 sq,ft,kNALLS.252 sq.ft Building Sketch (Page - 1) Denise Cheshire _a s Ate a aNe Lane .......... _�.. ��.� m ...., �o Mattituck County Suffolk State NY Zip Code 119 .. lr �—�. �...."_ ..__ . M.._._M. ,,f M iaire M. l ouffard 11' 11" 34' 1 bo I � N 6' Bath Bedroom Bedroom Deck Dining o N Utility N o 39' 1 6, �Ft Bedroom 12' Bath Breakfast fpl 34' 2nd Floor Living a N b Garage M Kitchen Bath 34' Porchm::.` , rn Bedroom a_ 34' 16' Subject Dwelling 1st Floor TOTAL Skctch by a o motle Area Calculations Summary Living Area Calculation Details First Floor 1400 Sq ft 7 x 6 = 42 16 x 10 = 160 11' 11' 34' -------- r � iiJ - Bedroom Bath Bedroom � it 6' Deck Dining o i 39" Utility 6' loft Bedroom 12' Bath fPl 34' 2nd Floor bed Breakfast � Living o cV N rn Kitchen Garage Bath 34' N 12' Porch rn Bedroom a 34' 16' Subject Dwelling 1st Floor TOTAL SkMch by a la male Area Calculations Surrrnlary Living Area First Floor 1400 Sq ft Calculation Details ]x12 42 160 198 Second Floor 1000 660 Sq ft 660 Total Living Area(Rounded); 2080 Sq ft Non-living Area Open Porch 204 Sq ft 204 1 Car Attached 264 Sq ft 264