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Home My WebLink About26621-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27165 Date: 06/28/00 THIS CERTIFIES that the building ADDITION Location of Property: 3500 NASSAU POINT RD CUTCHOGUE (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 111 Block 4 Lot 33 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 28, 2000 pursuant to which Building Permit No. 26621-Z dated JUNE 28, 2000 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 ADDITION AND BATHROOM RENOVATION "AS BUILT" TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to NORMAN HOROWITZ (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. H 068172 06/01/00 PLUMBERS CERTIFICATION DATED N/A thorized Signature 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-27164 Date: 06/28/00 THIS CERTIFIES that the building ACCESSORY Location of Property: 3500 NASSAU POINT RD CUTCHOGUE (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 111 Block 4 Lot 33 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 28, 2000 pursuant to which Building Permit No. 26621-Z dated JUNE 28, 2000 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 RENOVATION OF ACCESSORY BUILDING "AS BUILT" AS APPLIED FOR. The certificate is issued to NORMAN HOROWITZ (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. H 068173 06/01/00 PLUMBERS CERTIFICATION DATED N/A //h/hosed 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. 26621 Z Date JUNE 28, 2000 Permission is hereby granted to: NORMAN HOROWITZ PO BOX 814 CUTCHOGUE,NY 11935 for RENOVATION OF EXISTING ACCESSORY BUILDING AND ADDITIONS AND BATH- ROOM RENOVATION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. at premises located at 3500 NASSAU POINT RD CUTCHOGUE County Tax Map No. 473889 Section 111 Block 0004 Lot No. 033 pursuant to application dated JUNE 28, 2000 and approved by the Building Inspector. Fee $ 110. 00 Authorized Signature ORIGINAL Rev. 2/19/98 TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPAN - JUN 2 6 LOGO A. This application must be filled in by typewriter OR ink and jubmitted- to - the buil,inspector with the following: for new building or new use: .., 1. Final survey of _property with accurate location of all buildings; -property `li, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 foz 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contair less than 2/10 of 1% lead. S. Commercial building, industrial building, multiple residences and similar buil and installations, a certificate of Code Compliance from architect or engineei responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings "pre-existing" land uses: 1 . Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applic If a Certificate of Occupancy is denied, the Building Inspector shall state th reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.0( Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildine - $100.00 3. Copy of Certificate of Occupancy - .25G, 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Addition and Bath renovation as built. Date . 6/22/00 . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. .$. . . . . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . . Location of Property. . , Cgt;ghqBVQ,. I'M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House No. Street Hamlet Onwer or Owners of Property.. . ..$Ptmau.Horowitz . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . .lll . . . . . . . .Block. . �. . . . . . . . . . . . .Lot. . .13 . . . . . . . . . . . Subdivision. .//. .. . . . . . .Filed Map. . 50. . . . . . . .Lot. . .07 . . . . . . . . . . Permit No.llWl 9 .a- . . . . .Date Of Permit`-:�a �' 0.�. . . . . . .Appl.icant. . . . . . . . . . . . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . Fee Submitted: $. . .25.00 , , , ,, , , , , , , , , , , , _ OLS ijol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �� l� APPLICANT Norman Horowitz TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 26 A. This application must be filled in by typewriter OR ink and submit;91_&.to the 'Wild inspector with the following: for new building or new use: 1. Final survey of .property with accurate location of all } iz-gs-'p'Y'operty lin streets, anti unusual natural or topographic features. 2. Final Approval from Health Dept, of water supply and sewerage-disposal(S-9 for 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contain less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buil and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings '.'pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applic If a Certificate of Occupancy is denied, the Building Inspector shall state tb reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.0 Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildine - $100.00 3. Copy of Certificate of Occupancy - .251,. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 6/22/00 Renovation of accessory bldg. as built Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction, x . . . . . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . . Location of Property. . . 3500 Nassau Pt. Road, cutcho&ue, NY . .. . . . . . . .. . . . . . . . . . . . . . House No. Street Hamlet Onwer or Owners of Property. . .Norman_Horowitz . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . .111. . . . . . . .Block. . . A . . . . . . . . . . .Lot. .33. . . . . . . . . . . Subdivision. Amended Map.A.Nassau.Point. .//. . . . . . .Filed Map—% . . . . . . .Lot. .33. . . . . . . . . . . Permit No.vSkP�9.%'�J . . . . .Date Of . . . . . •Applicant. . . . . . . . . . . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . 25.00 Fee . Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . . . . . �0 a� , �y . . . . Jp . P� �- 5 i W Norman Horowpi.tzCANT GARY FLANNER OLSEN ATTORNEY AT LAW , 1 G�? C U +y�yy� JW CINV ASSOCIATE: rr DAVID WORTHINGTON OLSEN BLDG. D1:t'T. ATTORNEY AT LAW "QNU OF SOUT40Lb P.O. BOX 706 • MAIN ROAD CUTCHOGUE, LONG ISLAND, NEW YORK 11935 PHONE 631-734-7666 FAX 631-734-7712 June 22, 2000 Re: Norman Horowitz 3500 Nassau Pt . Rd. Cutchogue, NY 1 HAND DELIVERID 000-111-4-33 Dear Gary: Enclosed herewith please find the following in re the above matter. 1 . Application for addition/ bath in main house and renovations to accessory building. 2 . Fire Underwriters Certificate for main house and accessory building. 3 . Two sets of drawings for renovation of garage and closet addition prepared by Joseph Fischetti P.E. 4 . Check in the sum of $135 . 00 ($75 . 00 + $35 . 00) for Building Permit fees . 5 . Two checks each in the sum of $25 .00 each for two Certificates of Occupancy. 6 . Two applications for Certificates of Occupancy. All of the items you wished Dr . Horowitz to complete after the inspection have been done . If there is anything further you need please advise. We would like to schedule a closing for J y 7, 2000 . Anything you can do to expedite the issu ce of the Certificates of Occupancy would be grea ly appreciated. Very tr 1 yours, ` AF ANNER OLS GFO: lmk Enclosures Southold Town Building Dept . Main Rd. Town Hall Southold, NY 11971 THE NEW YORK BOARD OF FIRE UNDERWRITERS PACE 1 8080053 BUREAU OF ELECTRICITY F 40 FULTON STREET, NEW YORK, NY 10038 Date JUNE 07,2000 Application No. on file 10201300/00 H 068172 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of NORMAN HOROWITZ, 350- 0 NASSAUPOINTROAD, CUTCHOGUE, NY th in e following location; iiI�� IN rl Basement ist FE ❑ 2ncf Fl. Section Block Lot was examined on 'NNE 01,2000 and fund to be in campliance with the National Electrical Code.. FIXTURERFCEPTACIES SWRCNES - IXTU ES _ E - COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCE- RUORISCENT I OTNIe I AMT. I K.W. - AMT. I 'K.W. I AMT. I K.W. I AMT, I K.W. AMT, X.P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS $PECIAL FAC'PT, TIME CLOCK$ SELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K.W. OIL X.P. GM H.P, AMT, NO. A.W.G. AMT. I AMP, AMT. AMPS. TRANS. AMT. H.P. NO.OF FEETAMT. WATTS SERVICE DISCONNECT NO,OF - S E - - R - V I C E METER NO. C ND. A.W.G. A.W,O. A.W.G. AMT. AMP. TYPE EQUIP. 10 RW 7 e 7W S E SW S e 4W C. N NO.OF HbIEG ,NI, NO.OF NEUTSALE OTHER APPARATUS: MAIN HOUSE ADDITION-1 "NO VISUAL DEFECTS: "Art electrical survey has been made of the exposed electrical equipment in the premises indicated. " "No obvious unsatisfactory condition was found. I 1., NORMAN HOROWITZ P. 0. BOX 814 GENERAL MANAGER CUTCHOGUE, NY, 11935 ms a Per } 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. THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 8080048 BUREAU OF 94RCTRICITY F 40 FUI,TON BTRCRT, NEW YORK, NY 10438 Date 'TUNE 07,2000 Applieadon No. on file 10200000/00 H 068173 THIS CERTIFIES THAT ono dire eircoleal equipment as described below and leyrpdviced by#;f applicant named on the above application number is in the premises of NORMAN HOROWITZ, 3500 NASSAU POINT ROAD, NY In the following location; 0 Basement ® 1s9 Ft 11 4ad Fl. OUT Section Block Lot was examined on `TUNE 01,2000 and found to be in compliance with the National Electrical Code.- FIXTURE RECFPTACLEE -SWITCHES i S OOKIN ECK OVENS DISH WASHERS EXHAUST FAN$ OUTLETS INCANIntCE FLUOMSCKHT OTHER AMT. K.W. -I AMT, I K.W. AMT, I K.W. AMT, K.W. PRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS 13PECIAL RECTI,I TIME CLOCKS I BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. R,W. OIL H.P. *A$ N•P• AMT,- No. A.W.o, AMT. Aur. I AMT.- I RMPA. TRANS.I AMT. H.P. NO.SYSTEMS OF FEET AMT. wAin ` SERVICE OIOQNNECT NO.r2P - - .; - 1 - R - V.. t C E _ METS" AMT, AMP, TTW lOUIP. 1 R WWII e JW 7 e SW R e 4W NO.OF HbW, NO tta A. W.OF NEUTRAM OTHER APPARATUS: e STORAGE BLDG-1 *NO VISUAL DEFECTS: "An electrical survey has been made of the exposed 71 electrical equipment in the premises indicated. " "No obvious unsatisfactory condition was found. t last. L. L I i NORMAN HOROWITZ P. 0. BOX 814 GENERAL MANAGER CUTCHOGUE, NY, 11935 NPer44 This cedl0cate must not be altered In any manner;return to the office of the Board it Incorrect. Inspectors may be identified by their Credentials_ THE NEW YORK BOARD OF FIRE UNDERWRITERS PAc_F - 8080053 BUREAU OF ELECTRICITY 40 FULTON STREET, NEW YORK,NY 10036 Date JUNTE 07,20W Application No. on file 102013.10/00 H 068172 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of NOR7t4N HOROWITZ, 3500 NPLSSAU POINT ROAD, CUTCHOGUE, NY in the following location- ❑ Basement 21 Ist Fl. ❑ 2nd Fl. Section Block Lot JULTE 01,21NIZ, was examined on and found to be in compliance with the National Electrical Code.. FIXTUREFIXTURES I RANGES I COOKING DECKS I OVENS I DISHWASHERS EXHAUST FANS OUTLET! RECEPtACU13 SWITCHES 1INCANDISCENT FWOR95CENi I OTHER I AMT. I K.W. I AMT. I FIX I AMT. I K.W. I AMT, I N.W. AMT. I N.P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS ISPECIALREC-PT.1 TIME CLOCKS I BELL I UNIT HEATERS MULTI-OUTLET DIMMERS AMT. N.W. OIL N.P. OAS H.P. AMT. NO. I A.W.O. AMT. AMP, AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATn SERVICE DISCONNECT No.OF S E R V I C E METER NO.OF CC CON'. A.W.G. A.W.O. A.W.O. AMT. AMP. TYPE EQUIP. 1 e SW 1 e 3W 3 R 3W 3 e AW PER a OF CC.OOND. NO.OF HI OF NLLF4 NO.OF NEWRAa OF NELTRAL OTHER APPARATUS: 1 AIN HOUSE ADDITION-1 "NO VISUALI DEFECTS: "An. electrical survey has been made of the exposed electrical equipment in, the premises indicated." "No obvious urisatisfactory condition was found. t.�. LL NOMIAN HOR01dI'rZ F. 0. BO{ 814 GENERAL MANAGER CU'iTC'HOG-UE. NY, 11935 Per 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 CERTIFICATE MUST NOT RE ALTERED IN ANY MANNER THE NEW YORK BOARD OF FIRE UNDERWRITERS =°r' Pc3; 'Srrr3 BUREAU OF ELECTRICITY F 40 FULTON STREET, NEW YORK, NY 10038 Date JIJDfE 07,20410 Application No. oafile .w: l!:10 N* H 068173 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of NORMAN HOROWITZ. 3500 NASSAU POINT ROAD, NY in the following location• ,, ❑ Basement ElIst FL [I 2nd Fl. `'UT Section Block Lot was examined on `UkE 01,204Y3 and found to be in compliance with the National Electrical Code., FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCE"FLUORESCENT I OTHER I AMT. I K.W. I AMT. I N.W. I AMT. I K.W. I AMT. I K.W. AMT. H.P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECPT. !Mf CLOCKS BELL UNIT HEATERS M SLTI O'Tg T DIMMERS AMT. K.W. OIL H.P. GAS X,P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATn SERVICE DISCONNECT No.OF S E R V I C E METER NO.OF cc GOND. A.w.G. A.w.s. A.w C: AMT. AMP• TYPE EQUIP. T e TN 1 e SW 1 e 1W 3 e 4W PFR a OF CC.GOND. NO.OF HI-LFG OF HbLEG NO.OF NEUTRAM F NEUTRAL 07HER APPARATUS: STORAGE BLDG-1 *P0 VISUAL EEPECTSt "An electrical survey has been made of the exposed electrical equipment in. the premises indicated. " "No obvious unsatisfactory ronditicn was found. LdE.r,� NORMAN HOR'.OWITZ P. 0. SCri 81$ GENERAL MAIJAGER CLUCHOGUE, NY, 11935 Per I 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 F BLAi DIN N -THIn CERTI 1 A MUST NOT 8E ALT EREO IN ANY MANNER - - - - BOARD OF HEALTH . . . . . . 3 SETS OF PLANS . . . . . . . FORM NO. 1 SURVEY . . . . . . . . . . TOWN OFSOUTHOLD CHECK . . . . . . • . . . BUILDING DEPARTMENT SEPTIC FORM . . . . . . . . . . . . . : TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL . . . . . . . . . . . . • • • • MAIL TO : Examined . . . . . . . . . . . . . . . .. 19 . . . Approved . . . . . . . . . . . . . . . .. 19 . . . Permit No G�Z/-4� . Disapproved a/c . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . JUN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ? 6 200 . . . . . . . . . . . . . . . . . . . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date , 6/22/00 . , , , , , , , .� 19 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector,w 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 st or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this A cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such p.- shall €shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occup shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant t. Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws,Ordinane Regulations, for the construction of buildings, additions or alterations, or for removal or demolition] as herein descr The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, a, admit authorized inspectors on premises and in building for necessary inspections. 1 .. . 1111 . . . 1111 . . . . . . (Signature of applicant, or na e, if a corporation) $orman Horowitz 3500- NasEau,Pgt4.F-pad,.Cut cbogue, MY.119" (Mailing address of applicant) State whether applicant is-owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bui . . . . . . . . .Oca°ker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . Norman Horowitz , , , , , , , , , , , , , (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) ALL CONTRACTORS MUST BE SUFFOLK COUNTY LICENSED Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . . Plumber's License No. . . . . : . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . I . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3500.;411ppitil.l'P?*P,{toads .GPCC>?PPVe 1 1 1 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section . . 111. . . . . . . . . . . . . Block . . .4. . . . . . . . . . . . . . Lot . . .33 . . 1 1 1 1 1 1 1 1 Subdivision , . , Amended Map A- Nassau,Point, , , , , , , Filed Map No. —156 . . . . . . . . . Lot . . .L67. . . . . . .. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Addition to Main House/Bathroom and renovations to accessoU , , , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .building as IL b. Intended use and occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3, Nature of work (check which applicable): New Building . . , . ... . . , . Addition , . . . , . . . . . Alteration Repair . . . . . . . . . . . . . . Removal , , . , . , . . . . , , . Demolition . . . . . . . Other Work . , . . . . . . . . . (Description) 4. Estimated Cost , . . . . . . . . . . . . . . , , . . , Fee . . . . . . . . . . . . . . , . . . , , . . (to be paid on riling this application) '5, If dwelling,number of dwelling units , . . . . I . . . . . . , . . Number of dwelling units on each floor. . . . . . . . . . . . . • . . If garage,number of cars , . . , . , . . . . , , . , , . 6. If busine$s, commercial or mixed occupancy, specify nature and extent of each type of use , , , , , , , , , , , , , , I , , , , , 7. Dimensions of existing structures, if any: Front . . . . . . . . . . . . . . . Rear . . . . . . . . , • • • • . Depth . . . . . . . . . Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . , . . . . . Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . , . , . . . . , . . Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . , . . . . , . . . , . . , - 8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . , . . . Depth . , . . . . . , . . . . . . . Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . I . . . . Rear . . . . . . . . . . . . . . . . . . . . . . Depth , . . . • . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . . , , . , . , Name Of Former Owner 11. Zone or use district in which premises are situated . , , . . . , , , . I . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . , . , . . . 13, Will lot be regraded . . . . . . . . . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No 14, Name of Owner of premises . . , , , . , . , . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . , . , . , Name of Architect . . . . , . • . . . , . . . , . . . . . . Address . . , . . . , . . . . . . , Phone No. . . . . . . . . . . . . . . . Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . , , . . . . . . Phone No, , . . . . . . , . , , . . . . 15, Is this 'property located within 300 feet of a tidal wetland? *Yes , , , . . No *If yes, Southold Town Trustees Permit may be required, PLOX1 DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all setback dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YOORLK� S S COUNTY OF . A . . . . . . . . . . . . . . NORMAN HOROWITZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that lie is the appli, (Name of individual signing contract) above named. OWNER Heisthe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent,corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file application; that all statements contained in this application are true to the best of his knowledge and belief;and tha work will be performed in the manner set for h in the application tiled therewith. Sworn to before me this of. . i �v : . . . . . . . . . . .,. Notary Public, . , . . . . . . .Su€€olk County f ��i � NNER OIR �/ (•fATiY FCASEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Notary Puok�QZd ate 0, D York (Signature of appl Qualified in Suffolk County commission Expires 11 � quniutn r-�z^e 1 � wCu k i C� - r _ o 1 RAJ r/��iX _�•(d•A.,�X-n—�-� ---• i • „t NEY0� SO 61V z 1_7 _ LZ�dj _ 1 1 (211 i Not —�I,-�t � f-- �� r � uY?°rp�Yu op u d I �i G• t !O4Ld 1G�G � `V kg y. n DG 2 FLIM til }a C� Oji ay `jLb1 E14, I;p° dCJL . OP NE k liv�1-�vt.'rUL I 'F�i.� ., - H�. 0526�� SAO