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1000-12.-2-11
TOWN OF SOUTHOLD } � - Rental Permit Permit No. 0055 71 Owner Charles Kadushin & Ghislaine Boulanger Occupied as Single Family Dwelling Located at Off Oriental Avenue Fishers Island 12.-2-11 Village Maximum Permitted Occupancy 6 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. 5/21/2021 Code Enfo ement MAI This Notice must be posted by the main entrance at all times 12— -:Z- I I NG DEPT. *' TOWN OF SOUTHOLD B . cr1802 00, 7 • a [ ] INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND INSULATIOWCAULKING FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY '[ FIRE SAFETY.INSPECTION ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) I [ ] CODE VIOLATION [ ] PRE C/O 1 REMARKS: INSPECTOR9ACDATE X� fa6 TOWN OF SOUTHOLD gas Rental Permit x Permit No. 0055 Owner Charles Kadushin & Ghislaine Boulanger Occupied as Single Family Dwelling Located at Off Oriental Avenue Fishers Island 12-2-11 Address Village S/B/L Maximum Permitted Occupancy 6 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. 5/15/2019 Mike Verity Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times Town Hall Annex Telephone(631)765-1802 54375 Main,Road F R (631)76. 4)5 � o P.O.Box 1179 � � ' � M nD I « ontholdiNY, 11971-0959 i 4 APA - 4 2019 1, TOW. 'N OF.SOUTHOLD T. y: F T RENT'ALPERMIT APPLICATION 4 r Rental,-Peorm it F ,ftpi zati ,rt-bereligwed eve,;fit years) r . t I Section A. Property Information: R . Rental Property Address a Tax Map Number: 1000 SECTIONOLO Ck INFORMATION:SECT,kQN B, OWNER Property Owner Name,'? Property,.Ownr Legal Address: .Property Owner Mailing Addressi (Cannot be the same,as Re ,wt I,Prope�ty.,Address) u J i /ST :._ e r o, Telephone Number(s):,� .,., Property Owner Email Address: „_ ✓ r )od c, Page 1 of 4 SECTION F. PROPERTY DESCRIPTION: �mm Number of Rental Dwelling Units on property: „ For each Rental Dwelling Unit set forth the Rental Dwelling,l pit,id ljtifjer(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. m .... N ---Far-properties_with_multiple Rental-Dwelling Qnjts use ",Rental Permit AppJi_. iQ(i .,. Addendum." Rental Dwelling Unit Identifier:.. m number of persons allowed to occupy Dwelling Requested Maximum y Dweg Unit Number of rooms in Rental Dwelling Unit. . Use and bimensions of eacFT®om�in Rhia( wellirig UnG ;, v SECTION G. INSPECTION: Pursuant-to-the Town-Code of the-Town.of-Soutlibld �liab er`207(R��riYal.i'ro�iorti�sh a safety< inspection by Code Enforcement Official is required. If the owner chooses not to have said insp-ection per-formed by-the-Towrr,a-certification fr`•bl-WAYS licoh5red1bi'thittit,406, fitensed 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 t'hd'prdwist6fit Uthe co'dL�obfth60,4 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:bode Cou'n'cil: [� I am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold. Page 3 of 4 ❑ 1 am submitting a completed,Tdwn f outhbld certification form from a licensed architect, a licensed professionak i�iner, a.l,icensed home inspector who has a valid New York State Uniform Fire Pr Ventidh B'uIl ing code Certification. SECTION H. DECLARATION: Signature must be°notar`ize'd and MUST be the owner of the dwelling unit. o . STATE OF NEW YORk) COUNTY P SUFFOLK) mortify urmder�l enai�i,y ' icer@u ;,-the,�follc�..Vw1ng:? � .. 1. 1 am the owner of the property identified in "Section A: pf this app.li ;aion. I 2. The property Owner's legal address set forth in "Section 6" of this application is my-legal y address and I understand the Town will use the address for service pursuant to all P 9 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 pf 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 Sworn to before me tl1" day of Official Notary Public Signature and Original Notary Stamp TRICIASEWELL Notary Public-State of New York NO.01SE6164490 Qualified in Kings County Page 4 of 4 Ll y Commission Expires Apr 23, 2019 �� Parti BUILDINGTOWN OF SOUTHOLD d n 802 INSPECTION III„ „111 IIS II VIII IIS �„ „� ROUGH 11PUBG, III „N III N I III I IIII III III III ri IIIA I IM IIS "' /S"'I°"RAIRIFNING � „� 1 II III,,,,,,, IIIII II EI1,,,,ACIIE & Cl°°1 III IIS IIS SARE I Y IIINSIPEc riIIS 111111-III° III III II I I- II ���„ III°III14E III IU T° II r III')E III,,,,TIU° °III ELllEc rII III III (114 11H) ���„ 1� II lEc rII III II (I1MI IIh) „IISCOIDIE V111011LATION „ CAUI,,,,.KING �u w e r r a a, i 4 � I u LA 01 xEr CIL tF �_ �.a Fireplace,Malm 368 Yolanda Rvenue - Santa Rosa, Ca. 95404 (707) 523-7755 Fax: (707) 571-8036 0 Tested to U L737 & ULC ULC-S627-00 LabTest C us Assembly And Installation Instructions LEAVE THESE INSTRUCTIONS WITH THE OWNER. SAFETY NOTICE If this fireplace is not properly installed, a house fire may result. To P p P Y reduce the risk of fire, follow the installation instructions. Contact local building or fire officials about restrictions and installation inspection requirements in your area. This stove must be connected to (1) a chimney complying with the requirements for Type HT chimneys in the Standard for Chimneys, Factory-Built, Residential Type and Building Heating Appliance, UL 103, or (2) a code approved masonry chimney with a flue liner. Please read this entire manual before you install and use your new fireplace. Failure to follow instructions may result in property damage, bodily injury, or even death. DO NOT INSTALL THIS UNIT IN A MOBILE HOME. Zircon 34 3/13/15 ASSEMBLY AND INSTALLATION INSTRUCTIONS 1. Carefully remove all components from the shipping cartons and inspect for damage. If any damage is noted contact the shipping company or your dealer immediately. DO NOT INSTALL THIS UNIT IF DAMAGED OR MISSING PARTS. 2. Protect the flooring near the intended place of installation with an old rug, blanket, or cardboard. Place the firebox on this material. 3. Mix and install the Malmcrete hearth refractory as follows: a. Obtain a sturdy water-tight mixing container such as a wheelbarrow or large wash tub, a bucket or can for transporting the mixture, a cement trowel, and a source for clean mixing water. It is suggested that the Malmcrete be mixed outside to avoid spillage or splatters in the dwelling. b. Pour the dry Malmcrete mixture into the mixing container. c. Use 1 quart water for each bag. d. Add 1/2 to 3/4 of the water to the dry mix and mix thoroughly.Add additional water in small increments, mixing thoroughly between additions. Do not add more water than is necessary to get a somewhat dry mixture; to much water in the mix may cause the refractory to crack excessively, and will reduce the strength of the refractory. To test for proper water content, cut vertically into the mixture with the trowel, push the trowel sideways to open a 3 inch deep by 2 inch wide cut in the mixture, then slide the trowel back up out of the cut. The cut should stay open with very little "slumping" back into the cut. Next, run the trowel over the surface of the mixture with the blade at a slight angle to the surface of the mixture, like spreading butter. The mixture should become relatively smooth with few voids after 6 or 7 passes of the trowel using moderate pressure. Water should not float to the top of the mixture. e. Transfer the mixture to the hearth (floor) area inside the firebox, spreading the mixture out as it is added. Use the trowel to spread the mix into the firebox area. Continue to add refractory until there is a minimum of 2 inches thick over the entire hearth area. To measure the depth of the mix, place a piece of tape 2 inches from the pointed end of a long nail. Insert the nail vertically through the mix every 6 inches (front to back and side to side) across the hearth; the mix should come to a uniform height up the nail, at or slightly above the tape. Trowel in the nail holes when completed. f. Allow the mix to cure at least 48 hours.Additional curing time is necessary in cool temperatures. The longer Malmcrete is allowed to cure before the first fire is lit, the stronger and more durable it will become. g. Make the first 3 or 4 fires very small and of short duration to allow the refractory to adjust to the high temperature of a fire. Hearth Requirqments A floor protector is required to protect the floor in front of the fireplace opening from sparks. The floor protector must be a minimum of 3/8 inch thick non-combustible material such as brick, concrete, slate, ceramic tile, or a listed floor protection board such as Wonderboard or Homosote. The floor protector must extend a minimum of 16 inches in front of the fireplace opening and 8 inches to either side of the fireplace. The Zircon has been designed to provide floor protection allowing for flexible design of the hearth setting. Clearance to C Mbustibles The Zircon requires a clearance to combustible walls of 10" measured from the back of the unit. For locating the center of the chimney the measurement is 16"from the back wall and 49"to the sidewall. See figure 1, page 3. For corner installation the center of the chimney is 19". See figure 2, page 3. C arto to NoLi-combuslibles, The Zircon clearance to a combustible wall may be reduced with proper wall protection.Accepted methods for wall protection would allow reduction of the wall clearances. For appearance if desired a non-combustible wall covering can placed on the wall. The covering should consist of a listed wall protection board installed to the manufacturer's specifications.Approved protection boards at the time of this publication are Wonderboard, Dura Rock and Homosote.A non-combustible material can then be placed over the wall protection board. With most of the protection boards the clearance can be reduced to 8 inches from the original combustible wall. Be certain to check with your local building officials and or fire inspector for accepted methods in your area. Refer to NFPA 211. Page - 2 Ziroon343/13/15 CLEARANCES SIDEWALL AND BACKWALL INSTALLATION CORNER INSTALLATION Unit to S id ewa I I----------------------------------------- 32" Unit to Adjacent Wall------------------------------------10" Unit to Backwall---------------------------------------- 10" Connector to Adjacent Wall --m-----------------------15" Connector to Sidewall --------------------------------45" Center of Connector to Adjacent Wall--------------19" Center of Connector to Sidewall-------------------49" Connector to Backwall-------------------------------- 12" Center of connector to Backwall------------------- 16" Minimum Hearth Size----------------------------------50" x 32" Hearth is not required to extend under the Zircon's base. 50" —) I 16" 32„ 10" -8m 8" 19PY 15" 32" 45 2" 1 s$9 5 10" 19 49" 10" FIGURE 1 FIGURE 2 Hearth dimensions shown are minimum requirements. It may be desired to exceed these minimum dimensions for a more decorative installation. The hearth material must be 3/8" or thicker noncom- bustible material. It is not required for the hearth material to extend under the base of the fireplace. Page - 3 Zircon343/13/15 ASSEMBLY AND INSTALLATION INSTRUCTIONS Continued DO NOT CONNECT THIS UNIT TO A CHIMNEY FLUE SERVING ANOTHER APPLIANCE. This stove must be connected to (1) a chimney complying with the requirements for Type HT chimneys in the Standard for Chimneys, Factory-Built, Residential Type and Building Heating Appliance, UL 103, or (2) a code-approved masonry chimney with a flue liner. DO NOT CONNECT TO ANY AIR DISTRIBUTION DUCT OR SYSTEM. Chimney Connector Installation The connector pipe included with the Zircon is 1 - 8" x 24" damper pipe, 1 - 8" x 24" pipe section and 1 - 8" x 24" slip connector. The slip connector is identified by 3 holes at the top of the pipe. The slip connector has one flair at the top with the 3 holes. The bottom is smooth. The damper section and intermediate pipe section have flaring at both ends. The male end is always at the bottom. Simpson Dura-Vent Chimney System It is required to use a Dura-Vent Connector part number 8DVL-ADC or 8DBK-ADSL to install the chimney connector. 1. Follow the directions for installation of the 8DVL-ADC or 8DBK-ADSL. The 8" x 24" slip pipe is then connected to the 8DVL-ADC or 8DBK-ADSL. 2. The 8" x 24" intermediate pipe section is then slid over the slip connector pipe. Slide the 24 inch pipe over the slip pipe only far enough as necessary to facilitate installation of the 8" x 24" damper pipe in to the unit. 3. Slide the 8" x 24" pipe down onto the damper pipe installed on the Zircon. 4. There must be a minimum of 2 inches of overlap between the 8" x 24" and 8" x 24" slip connector pipe. Metalbestos or Security When using Metalbestos or Security chimney systems it is required to use the Metalbestos Selkirk Stovepipe Adaptor Single Wall Connector pipe. Security users must use the ICC Excel Flue Extension (8EX). 1. Installation of the Metalbestos or the ICC Excel Flue Extension (8EX). must be done first. Follow the manufacturers installation instructions. 2. Attach the 8" x 24" slip connector to the Metalbestos Selkirk Stovepipe Adaptor Single Wall Connector pipe or the Security, ICC Excel Flue Extension (8EX) adapter with 3 -#8 x 3/8 inch screws. °° the 3. The 8 x 24 pipe section is then slid into the slip connector pipe. Slide the 24 inch pipe into slip pipe only far enough as necessary to facilitate installation of the 8" x 24" damper pipe into the unit. 4. Slide the 8" x 24" pipe down onto the piece installed on the Zircon. 5. There must be a minimum of 2 inches of overlap between the 8" x 24" and 8" x 24" slip connector pipe. Other Chimney Systems There are many other manufacturer's of chimney systems. It is beyond the scope of this publication to cover installation with all of the different systems available. Most systems have a method of connection to the Zircon's connector pipe. Confirm installation procedures with your dealer or the manufacturer of the chimney system you have purchased. Page-4 Zircon 34 3113/15 to Chimney Connector Instructions Type HT Insulated Pipe Chimney System Ceiling I Single Wall Chimney Adapter Support Box W Sheet Metal - - - Screw-3 Minimum Slip Connector. Sheet Metal Screw to Slip Connector Chimney Connector. I DuraVent 8DVL-ADC or 8DBK-ADSL Adapter ICC Excel Flue Extension (8EX) Middle Pipe Section Bottom Selkirk Stovepipeve ie Adaptor Fits Into Damper Section Or Single Wall Chimney Adapter Adapter Not Included Damper Pipe Bottom Fits Into Unit Unit The above illustration represents the installation procedure for dripless pipe installation. This installation method of installing the connector pipe with the male end down allows for any moisture to remain on the inside of the connector pipe. At first glance you may become concerned that smoke will escape the pipe and enter the room. This is not how the system will work. The vacuum in the chimney system will always pull air into the chimney. If you experience a downdraft with your installation it indicates that additional chimney height or a specialty draft cap be added to your chimney system. Contact your dealer for further information regarding downdrafts. Attach and secure the chimney connector with a minimum of three screws to the Zircon and each adjoining section. Material List Included with the Zircon 34 is the following: 1 - 8 x 24 damper pipe 1 -8 x 24 pipe section 1 - 8 x 24 slip section pipe 4-61b bags of Malmcrete refractory. Page - 5 Zircon 343/13/15 MASONRY THIMBLE V V11 2" Clearance Clearance From Studs To Chimney Walls ea e r 2" Of Brick From Liner To Combustibles 5/8"Fireclay Liner Minimum or Equivalent 12" Of Brick From Liner To Combustibles 12" MinimumIF Sill/Support Figure Masonry Chimney If using a masonry chimney, it must meet the minimum standards of the National Fire Protection Association (NFPA) Standard 211. The chimney must have at least a 5/8" fire clay liner or a listed chimney liner system. The chimney must be inspected for cracks, loose mortar, or any other signs of deterioration. It is best to have the chimney inspected by a professional. Make certain the chimney is cleaned prior to installation of this fireplace. The size of the chimney should be between 36 and 96 square inches. Larger chimneys should be relined to meet these requirements. Incorrect sizing of the chimney may affect the draft and result in poor fireplace performance. Do not install more than one appliance to any chimney. There are different accepted methods of connecting the fireplace to a masonry chimney through a combustible wall. This type of installation requires the use of a thimble to protect the surrounding combustible materials. Check with your local building officials or consult NFPA211. See Figure 4, Page 6. Page - 6 Zircon 343/13/15 OPERATING IST CIO S Failure to properly use and maintain this appliance may void the manufacturer's warranty and could result in a house fire. CAUTION: HOT WHILE IN OPERATION. DO NOT TOUCH. KEEP CHILDREN, CLOTHING AND FURNITURE AWAY. CONTACT MAY CAUSE SKIN BURNS. SEE NAMEPLATE AND INSTRUCTIONS. Do Neat aver fore,. If any portion of the unit or flue starts to glow you are over firing. This is a free standing fireplace, do not use for any other purpose. 1. The first few fires should be small in order to properly cure the painted surfaces and refractory. During the first few fires, some smoking may occur as the paint cures.You may wish to open a window to minimize discomfort during this curing period. 2. 00 N.Qj BQRN TM98 OR QARBA,.Q9,-1,bj THI9j UNIT,When building a fire, be sure the damper is fully opened and sufficient combustion air is available. Place dry kindling on dry wadded paper then ignite with a match.Add progressively larger pieces of wood until the fire is well established. Leave the damper fully open. Close only after the fire has burned out completely.Add additional firewood as needed to maintain the fire. 3. The fire screen must be in place during operations. THIS FIREPLACE STOVE HAS NOT BEEN TESTED FOR USE WITH DOORS.TO REDUCE THE RISK OF FIRE OR INJURY, DO NOT INSTALL DOORS. 4. Keep the pipe damper in the full open position when the fireplace is being used. 5. CAUTION: Heating the air in a closed building decreases the relative humidity of the air, which will dry wood and other combustible materials.This drying lowers the ignition temperature of these materials thus increasing fire hazards. To reduce the risk of fire, some provision should be made for replenishing moisture to the air whenever a structure is being heated for extended periods. 6. Be sure to provide combustion air into the dwelling when using this or any other wood burning appliance.A partially open window or outside air register in the vicinity of the unit would be acceptable. Combustion air must be supplied in conformance with the Uniform Mechanical Code. 7. CAUTION: NEVER USE GASOLINE, GASOLINE TYPE LANTERN FUEL, KEROSENE, CHARCOAL LIGHTER FLUID, OR SIMILAR LIQUIDS TO START OR"FRESHEN UP"A FIRE IN THIS HEATER. KEEP ALL SUCH LIQUIDS WELL AWAY FROM THE HEATER WHILE IN USE. 8. DISPOS L OF ASHES. Ashes should be placed in a metal container with a tight fitting lid. The closed container of ashes should be placed on a noncombustible floor or on the ground, well away from all combustible materials, pending final disposal. If the ashes are to be disposed of by burial in soil or otherwise locally dispersed, they should be retained in the closed container until all cinders have thoroughly cooled. 9. READ MAINTENANCE INSTRUCTIONS. I !2OF A CLINNEY F1 A safe and correct installation and extra care will help prevent a fire, but accept the idea that there could be a fire. Be prepared to handle it. Make certain everyone in the house is familiar with the warning signs of a chimney fire: 1. Call the Fire Department immediately, before doing anything else. 2. Discharge a dry chemical extinguisher into the fireplace opening. If an extinguisher is not available, toss baking soda into the opening. Do not pour water on the fire. 3. Close all air intakes to the firebox and leave closed until the fireplace, stove or stove pipe is completely cooled. 4. Watch for sparks on the roof. If necessary, hose down the roof around the chimney. DO NOT pour water down or on the chimney. 5. After the fire is completely out, inspect the chimney for any signs of damage. If you are not certain, have your local Fire Department inspect the chimney for you. Never use a flammable liquid to kindle or rekindle a fire. 6. Never use coal in a fireplace. Coal should be used only in stoves especially designed to burn coal. If the toxic gases produced enter the room they can be fatal. Page - 7 Ziroon 34 3113/15 MAINTENANCE INSTRUCTIONS Failure to properly use and maintain this appliance may void the manufacturer's warranty and could result in a house fire. 1. Always keep the area around the unit clean and clear of furniture and other objects. Keep all furniture a minimum of 48 inches away from the heater. 2. Periodically the entire unit, chimney connector, and chimney system must be inspected for leaks, broken or malfunction- ing parts, and loose connections. If any problems are noted, contact your dealer for repair services. Do not operate the unit until repairs have been completed. INSPECT AND CLEAN CHIMNEY FREQUENTLY - UNDER CERTAIN CONDITIONS OF USE, CREOSOTE BUILDUP MAY OCCUR RAPIDLY. CREOSOTE FOEIMATION Abig THE NEED EOR REMOVAL. When wood is burned slowly, it produces tar and other vapors, which combine with moisture to form creosote. Creosote vapors condense in the relatively cool chimney flue, and creosote residue accumulates on the flue lining. When ignited, this creosote can make an extremely hot fire. The chimney connector and chimney should be inspected at least twice monthly during the heating season to determine if creosote buildup has occurred. If creosote has accumulated, it should be removed to reduce the chance of a chimney fire. HOW TO REMOVE CREOSOTE, 1. Clean the chimney with brushes and equipment available at local fireplace shops. 2. Chemical chimney cleaners are used by adding them to the fire, but they are not intended for use in chimneys already containing heavy soot deposits. Rather, they are intended to inhibit soot buildup. They can be used in metal chimneys provided the manufacturers instructions are strictly followed. Generally these commercial cleaners are quite effective. 3. Call a professional chimney sweep in your area. They possess the experience and tools necessary to make the task easy. Maintenance other than the items specifically mentioned herein are to be performed by a qualified serviceman only. Contact your dealer. For further information on using your heater safely, obtain a copy of the National Fire Protection Association publication "Using Coal and Wood Stoves Safely," NFPA HS-10-1978.The address of the NFPA is Batterymarch Park, Quincy, MA 02269. File these instructions for future reference. NEVER STORE OR ALLOW PAPERS, KINDLING, FIREWOOD OR ANY OTHER COMBUSTIBLES WITHIN 48 INCHES OF UNIT. Irys Maim Fireplaces, I 368 Yolan cr Avenue Santa Rosa, Ca 95404 (707) 543-7755 - (800) 535-8955 Fax: (707) 571-8038 www.maimfireplaces.com info@malmfireplaces.com Page - 8 Zircon 34 311IJ11 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.X. CERTIFICATE OF OCCUPANCY No: Z-25356 Date: 11/12/97 THIS CERTIFIES that the building ADDITIONS Location of Property: PRIVATE FISHERS ISLAND (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889Section 12 Block 2 Lot 11 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 1, 1983 pursuant to which Building Permit No. 12924-Z dated MARCH 12, 1984 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued FAMILY DWELLING AS APPLIED FOR. is THREE ADDITIONS TO EXISTING O_NEmm -., The certificate is issued to CHARLES KADUSHIN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. H-055962 07/03/97 PLUMBERS CERTIFICATION DATED N/A ld° g Inspecto Rev. 1/81 FORM NO. a 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) N9 12924 Z Date ..... .. : .........1..��.............. Permission is hereby granted to: ... .R 3, ......................... ......7 .�..... ........,., �. .. .. ... . ..�. ........ �. »:7 . '.'.�.... .. . ... .... .... .I. 'JAY .. . :: . ;? . ., .. , ......,.. »........ ...... ... .......», .... atpremises located at ................................... ....................................................................................... County Tax Map No. 1000 Section .....01.1.11.''....-.... Block .,,.,. ..... ... Lot No. .......✓1 ....,...... pursuant to application dated ' ' r4......l................... 191a, and approved by the Building Inspector. Fee $. ............ 7 . +a� ..................... ...,.......... Building Inspector Rev. 6/30/80 THE NEWORK BOARD OF FIRE UNDERWRITERS PAGE 1 $056710- BUREAU CF ELECTRICITY I 85 JOHN STREET, NEW YORK, NY 10038 Date JUDY 03,1997 Application No.on file 14188797/97 H 055962 THIS CERTIFIES THAT only the electrical equip~nt as described below and introduced by the applicant namod on the above application nunsber in the premises of CHARLES KADUSHIN, WILDERNESS POINT, FISHERS ISLAND, N.Y; 77 in themlo inKlocation• rnent (n let Ft. ❑ 2nd Fl. CUT Sectiun12 Block2 Lot 11' JU�3E 97 ,1997examanedonand found to be in compliance with the National Electrical Code. FIXTURE WMACLIS RXTUstES RANQU COOKING K 'OVENS DISH WARMS I IXNAUST F OUTLETS SWITCHES NGINMsCENT FtuorcsaNr OTHER AMT K.W. AMT K.W. AML K.W. AMT. LL_W. AMT. H.P. FU MOTORS FUTURE APPUANCI P920M SNCIAL R*C`FTi TIME CLOCKS ua UNIT HEATERS MULTI4XUTIET OLVIAERS , AMT" K.W. OIL H.P. GAS H.V AMT, NO. A.W.G. AMT, AMP. AMT. AMPS. TRANS. AMT. H.P. SYSTEMS AMT. WATTS NO.OF FERT VICE DISCiONNILICT NO.OF S E R V I C E AMT, AAV. TM low. 10 ZW 1 X 3W 3 Y 3W 3./AW ,W CC-CONO' A"w G. NO. HI-LEG e.W �r NO OF NEUTRALS A te+ C CC.CDkD- HI-IEG (X OTHER TUS: ENTIRE PREHISES-1 *NO VISUAL DEFECTS: "An electrical survey has been made of the exposed electrical equipment in the premises indicated. " "No obvious unsatisfactory condition was found. i I CHARLES KADUSHIN F 1.... L 242 WEST 101 STREET GENERAL MANAGER NEW YORK, NY, 10025 Per 13 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTI CATE MUST NOT BE ALTERED IN ANY MANNER. a a w • ' 'ap y � � It �` O pppp— FORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD,N.Y. 11971 TEL.: 765-1802 p L -ee,eiQQa`• Examined la�at"iaa�Nom, Approved . Y.Y)04 .. 10.1.Permit No.) Disapproved a/c . .. ..... .. .... . . . . . .... . ... ... . ... . . . .... '� (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector,with 3 sets of plans,accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appl.i• cation. c. The work covered by this application may not be commenced before issuance o Building Permit. d. Upon approval of this application,the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in wholeor in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to (lie Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of aolathold,Suffolk County,New York, and other applicable.Laws,Ordinances or Regulations, for the construction of buildings, additions or alterations,or for removal or demolition,as herein described.. The applicant agrees to comply with all applicable laws,ordinances, building code,housing anode, and regulations,and to admit authorized laaspectors can promises and in buildiinl,for necessary ins is.ions (Sit;nalaare,o£applicants.or atanre:„if a corporataort) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .N�( .... . . . ... . .... . . .. ... ... . . . . .. . . .. . .. .. .. .. . . .. .. ... . ... .. ...... . .. ... .... . .... .... Name of owner of premises . .. .G'MRc ,�ri} ASN/R/ Ja!r °JIBurt tat" . . .. . ... . . ...:. . (as oar the t;ux 1-oll or 1:atest doed) If applicant is a corporation,signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. .. . . . `� G Plumber's License No. . . . , ,, Electrician's License No. ., . . . Other Trade's License No. .. . .. .... . ... . .. . . . p, 1. Location of land on which proposed work will be done. ,.HoV§'0'Nuip ber Street Hamlet County l,t -M�ap No. 1000 Section , .. . ! . . . . . Block .... . . .'4. ., .. . . .. Lot, ,.✓'/r . ,.., w Subdivision,, . ... . . .. .. .. . Filed Map No. .. . . ,. .,. .. ., haat . . , 2.-Stalt existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . .RAS+.Oc G. . . .. . .. . . ... . . . . ... . . . ... .. .. . . . .. ... . . . b.Intended use and occupancy . . .RES,r PILN4 4F.. . .S'.J . .1f V.I . . ... . .. .... .. . . . . .. . .. . .. .., 3, Nature of work(check which applicable):New Building ... .... ... Addition �... Alteration ..,... ..,. Repair . . .. .. . .. .... . Remgval .. ... ....... .. Demolition ., .. .. .. .. ,... Other Work..... .... . .... . (Description) 4. Estimated Cost . 2D�90o . .! 4.... ,. „.. ........ . . ... „. Fee 2 ..... (to be paid on filing this application) 5„ If dwelling,number of dwelling units .... ../, ... . ,. . Number of dwelling snits on each floor. .!... .......... If garake,number of cars , .. I.. . „ , . ..... 6, If busi}aess,conirnercial or mixed occupancy,specify nature and extent pot each type of use .... ... ... ... .. ... 7, Dimensions of existing structurcws,if any:Front. . ......, .. hear .40... ... ..... Depth .;a.4.. ... . .. ... Height . .../2!-/44 . .Number of Stories .. ............ .. . . .. .. .... . .. . ... . Du'nen,sio.ns of same structure wfth alterations or addition Front .. . ...6A,'....... Rear . .G,4... ... .... ,.. Depth,_„ . ”, . .., ., , . ., . _Height ., ./.V- z".^ . ....... . ..Number of Stories ... . ... .......... S« Dimensions of entire;new construction: Front .,. . a ...... Rear .. . .6.0....... . Depth .... ...... ... Numberof Stories „!. ....... ....... ........ ... ... . .... ..... .... .. ... 9ize rat lent. Front . .$A . ,�'t,+ tV.. ., „ .., „ Rear „ Depth ... ......... .. .. . . ... Cil ate of Purc:h ase . „.DDC etaW+�J,' .. .�s Name of Former Owner .p�RC1,V,d i,. ,I.J!,y 1TE,, ....... I < one(�r use district in which premises nre situated, .... ..... .... .. ... . .............. .. . it iiia u we�s arpascr fry zoning law,ordinance or regulation: . .. IYO ... .... . ..... ... . .. .. ... . 1rre-ruded . . . . ....... .. . &0,,, . . ..Will excess fill be removed from premises: Yes No Name of Owner of premlies Ctl)'gQI�CA„X41PY N Address Zev.W9V.7,F.-ih. ..Phone NoAlr?.-IRlyr. Nameof Architect .. ...... ., .. .. . .. .. . .Address .. ... . ...... . . .. ...Phone No. ...,.. , ... ,. .. . Name of Contractor /�4 Mv.'a�9 .A(PV00A... . .Address f?,1X.C45.,-q;S,LrW,0. .Phone No.S/b:,7,987>9.00, PLOT DIAGRAM i Locate clearly and distinctly all buikl ngs, whether existing or proposed, and.,indicate all set-back dimensions from aroperty lines.Give street and block;number or description according to deed,and show street navies and indicate whether nterior or corner lot. i f I i I I1 i ::S'TA11E OF NEWYORKCOUNTY OF S.S ,ChW'99,t,4F. , .k;,,9Q.u..SR1..A1. . being duly sworn,deposes and says that he is the applicant (Name of individual sicn'ing contract) Heisthe ..•OeRaAS �. . . .. . I _. . .. .. . ... .. . .... . . ... . . . .. ..... .. . .. ...... (Contractor,agent,corporate officer,etc.) )f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication;that all statements contained in this application are true to the best of his knowledge and belief;and that the aaa•k will lac performe6 in the manner set forth in the application filed therewith. °boah to before nae this 19ZS Notiry Pubic �� �� � arnt. �, / Kunst;ankfhxa oMzn&bIraxoif. NoterY gajWk SSkke,Of NeW faad p lea,461262U (Signature of applicant) ioluaafffio an eors County �w. a,ronirnis Ion Exp lrg3,114 uroh 30,199'x' G 00 slaOX MON `puulsl s aagslg 3Wrow � HoI�IaQISHId NlHSflGvx aqq 03 u0Psaalld a ......,.......... -yam ,..., ... j I � " P r n d V T V V O ........... ............- IS r s y 4:;1y " TQ 3 IT �� yµ fl N p M ry7ry i i 3110g MON°ppaisf s xays!dIN � W RON aRIIS HU NIHSfl(,IV31 91,11 04 u®e;lRaaq[`d . ................. ..... ..... ................. . ti. k I Irk lylp x yp x S z II 9 �f v+ e N ..... "; z k f, �1 yyw FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ". SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL. COMPLETION OF THE WORK AUTHORIZED) 438oZ Dote ........... ........ ..,.,. w... ., d Permission is hereby granted to: Charles XadUSMU ............. ........................ 1� y�y �y 3 .,. .................... .iY.3.�h 4...►.+ :7 ........... ..........., .tea. to Build. ,an addition.�..�, a...al e tion$,..�'n existing dwelling..... at premises located at ...........,,P.:t..RDSd.%...W:.ldp-rnasz:.P.©lnt....... .......................,. ......... ......................... ......... ............. pursuant to application dated ...„..,.,..•,...• .......•Ju.$••......1.4......1.. .. 19..69., and approved by the Building Inspector. Fee $5*09.............. »w..” .>». ...,.,... .... .... .......... Building Inspector b Folam NO, 1 TOWN OF SOUTH04D BUILDING DEPARTMENT TOWN CLERKS OFFICE SOUTHOL D, N. Y. Examined .... s r,�0 .„...19.. .: l r ( Application No. Approved i' ... 19........Permit No. .,......i` Disapproved a/c �(Building Inst ectar,. i APPLICATION FOR BUILDING 411MIT i jDate., . .��?.. �.l. je 1 INSTRUCTIONS a. This application must be completely filled in by typewriter or i4ink and submitted in duplicate to the Building Inspector. i b. Plot plan showing location of lot and of buildings on premises, r r9ationship to-adjoining premises or public streets or areas,and giving a detailed description of layout of property must bedrawre on the diagram which is part of this location. c. The work covered by this application may not be commenced befo° ie issuance-of Building Permit. d. Upon approval of this application, the Building Inspector will. is ue a Building Permit to the applicant. Suth permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any p'rpose whatever until-a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for-tho issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations,.ori`for removal or demolition, as herein described. 11 The applicant agrees to comply with all applicable laws, ordinar,, S ondp regulations. tStg'ataare of applicant,or name, if a corporation) i (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gen .ral contractor, electrician, plumber or builder. Name of owner of premises... ......—.111” .. ......... . ........ ....,,.. ...,.,.,,.. ,...,,. If applicant is a corporate, signature of duly authorized officer. i 6 (Name and title of corporate officer) u 1. Location of land on which proposed work will be done. Map No. ,, ........ Lot No: Street and Number Municipality d 2. State existing use and occupancy of premises and intended use r tl•atctufa rtc" of proposed construction.- tl a. Existing use and occupancy. � ,�.... . b. Intended use and occupancy... ! r. ... ., & , : ......,,.. ....... . ........ . ...... 3. mo»um of vw,k (check which applicable): New BuikjinV--.,-....Addition .../��r....... _ di»n' � A00F. ��UK�� �� � ��� �' �0� /� 4� E��n���� Co,�.._���.. - - -�.���__.-~_-._-.Fo� -._-:��.�,�.��---_.�:�.~.......~....____----. (to be paid on filing this app U 5. If dwelling, number ofdwelling units.--.-,�.................Number of dwelling units on each floor.......1.................. |fgarage, number of cars.-----..-------.-----.^..--..----'-------_____-__. 6. If business, commercial o, mixed mzvpunr» specify nature and extent of each typo ufuse................ --^.-.^. 2 �� 7. Dimensions of existing structures, if any: Fmnt--.~Cnn4`»-..--Rear.-�Y-/----. Depth - w -- ~-- Height - ..........I..,;kv---.Number of 5tohao -' ...... ~.~~~~~~ .................. ....... __ ...... .~ ��v »� Dimensions of same structurestructurewith alterations o, additions: Fm --- . ..- n� =�°-�. . . Rear ..COO../ Depth ........... --, Height .... -.-_.Numbe, ofStories - ........ 8. Dimensions of entire new construction: pront------..-. Rear --._....~-._.., Depth Height -_...... Number of Stories -__..-_..... s\ Size of lot: Front ...... »--- Rvq, -' 630 .~~.'~ Depth ... lO. Dom of Purchase ...23.]*C..-..4.9......................Name of Fn,mo, Owno .Ao#wr-----. ll. Zone or use district i, which p,wnmex are situated_ 4ft............................................................. Does proposed construction violate any zoning b*, ordinance o, regulation? NO-------------. 13. Nome of Owner of premisAddress F&9W.!*..=*A.01i,.NY Al Phone NO.���� Nameof Architect........................................................Address ----.----...~.-..Phone NO. '--...~—.- Nomwof ..........~..Add re^ ......-.--..,..-..-.Phvnv NO. ...~......~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed and show street names and indicate whether imcho, o, corner lot. tool 100 STATE OF NEW No�ary S S. Pubt' WALL COUNT ^ / - _ . QuaNfio'j' M05 ~_.,-._-.~--.bWng d�� u�un� is the op��ar* ^QHa��of �d��uo| mgn�oopp|i ion � above nomedHe |sd�, �����L��_�\ ' ^ ^ ^...- ^ .. ,^,^_, - '� Ow � OLD PROPERTY OWNER STREET VILLAGE DIST.; SUB. LOT _ ,0 s FORMER OWNER N E ACR. F s w TYPE OF BUILDING RES. SEAS. VLACOMM. CB. MISC Mkt. Value -71 LAND I IMP. TOTAL DATE REMARKS � e a� s Y= _ R s -o 7 D 00 4 o - LDING bND1T[ z� l 0 O — v BELOW NEW NORMAL �BOV _� - A �.� _ =z z_ FARM Acre Value Per Value Acre s Tillable 1 ,--./ _ Tillable 2 Tillable 3 a Woodland SwamplandFRONTAGE ON WATER z Brushland - FRONTAGE ON ROAD ` l - r House Plot DEPTH BULKHEAD i DOCK Total r1 a � t il COLOR xji o 1 Gt �. y. TRIM r 47 y y _ Tje F I It e c_ a. f � \: \ \ ma777 y: ..,. s M. B ,� .. ration ...Bath stet 0AAper A. Floors r. � Basement f �. \, AlExt. Walls tenor Finish T n 21 Extension ;Fire Place = Heat DR: e Type Roof Rooms 1st Floor 3 BR. F sRecreafion Room: Rooms 2nd Floor FIN. B_ i VXA2 = /76 . Porch i Dormer 117 Y,28 �[ 5 I Q ;Driveway RjTe 3 Garage Patio O. B. TotalAll 71o6 ��97