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Home My WebLink About24584-ZFORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN ~ SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 24584 Z Permission Is hereby granted to: NANCY STEELMAN(A/C)M&D UDE 25255 MAIN RD, CUTCHOGUE,NY i1955 WAIVER # 4455 05/19/97 FOR DETERMINATION OF MERGER . 1227 PINE NECK RD SOUTHOLD at premises lacated aT ............................................................................................................................... Count/Tax Map No. 475889 Section 070 Block 0005 Lot No. 056 pursuant to application dated NOVEMBER 26 19......~.7. ...... and approved by the Building Inspectar. f - 70.00 Rev. 6/30/80 FORH NO. I · rolex OF SOUTIIOI,D BUll,DING DEPARTHENT TO~/N II^!,I, SOUTI1OI.D.N.Y. 1197 I. TEL: 765-1§02 Iii r~appr~c~! a .................................. APPI.~ ihllnR Insl~-~ctor) / I'ION FOR BUll,DING PERHI'F BOARD OF IIEALTII ............... 3 SETS OF PLANS ............... SURVEY ........................ CIIECK ......................... SEPTIC FORH ................... NOTIFY: CAl.1 ......... .: ......... HAIl. TO: .................... 3 sets of pla~s, ncc'orate plot plan to scale. Fee accordi~g to schedtde. h. Plot plm~ sho~ing leeation of lot ~ of Ixdldit~s ~ ~i~s, relntlon~fip to mljoini~ pr~i~s or ~d~llc struts or areas, a~ fiivi~ a ~tail~ ~ripti~ of l~t o~ p~rty ~t ~ dr~ ~ tl~ dla~ ~dch is lmrt of this Olq~l ication. c. *H~ ~rk ~r~ I~ this n~licati~ ~ ~)t 1~ cm~v~ed l~fore issue of ~dhli~ Permit:. d. Ui~ n~al of this n~licnti~, tl~ l~ildit~ Ins~ctor ~dll is~ a ~ildit~ Pemit tu the applicant. ~ln ~tmit Mmll I~ ~pt ~ ~ ~i~s ~ailM~le for ins~ti~ th~t tim ~rk. e. ~ Imildi~ ~mll ~ ~i~ or ~1 in ~t'~ ~"~ ~e for ~'~ ~mt~r ~til.a ~y~ificate 0f (~ol~at~y M~all h~e l~n ~t~ by O~ ~dldit~ lns~tur. _.. ' ............ ~.l~'rl~ IS I~ ~ tu tim ~ildi~r~nt for O~ isle of a ~ildi~ Pe~it ~rmmnt to the i~,{'{~ii~ z~ ~i~ of t~ ~ of ~,t~ld, a, ffolk ~mty, ~ Yo~, nM other a~licnble l~s, ~i,~es or ~lnti~s, for tim ~st~ti~ of ~fildi~s, ~iti~s or alternti~s, or for tu,~al or ~ltti~, ns I~rein INSTRUCTIONS 'H~is applicaticm tm~at be completely filled in by typewriter or in i[~k ar~l sul~nitted to the B~filding lnspectur ~ State ~d~etber applicant is o~r, lessee, ,agent, architect, enp, it~er, general contractor, electrician, pluni~er or build~ ............................. O0=c ........................................................ ..m. ................... ,.. (as on the tax roll or latest deed) If appljcm~t is a corporatitm, signature of duly rnntborized officer. (~ge at~! title of corporate officer) P~dlders l,icer~e Bo .......................... (~) State existi~ ~ ned <=~y of ffmi~s aed int~a~ um at~ <~ of pro~ ~st~ti~: '1. I~;~h.~: o.I; ~k (d~eck ~ldch ~l~lical~le): l~c4~l~nhhn~ . ..~ .... &kht~ ......... .. ~ .... OIh~r ~ .......... .... ~i~,i~ ............ ~ ............. ~ i~, ,. .... Esl i.~lenl (~sl: ......................... f~ ..................... ~ ................... (lo I~ ~nid zx~ fi ling this nl~licati~) ,ui~.. ........ ~ .......... ~,,i~ o~ s.,~i~ ...~ .................. IH,~nsi;~m o~ttt~re ~ith alterati;~m or ~iti~s: Frr~t ...~ .......... ~r .Z ............ I~pIh ...... ~== -- ...... I~i~l: ............. ~. ..... ~n~i~r of ~lori~s ..... ~ ........ I)in~n~i~;m of ont'it~ ;~ ~w~stn~l:i(~l: Fr~l .... ~ .......... I~ur .......... ~... l~plh .... ~ ........ ILil~nt ............. ~ ......... ~i~r ag 31;orion .......... ~ ......... ~. ~i~ ,,r ~,,~: .,~,~ .... ~.~ ..... ~. ~ ....:~..~ ......~pn, .. ~.~.1 I I. 7z~ or ~m~ disl ~ icl: 'n ~ltil p;t~ni~ i~;e ;il'~t~l . .~..~ ..................................................... / I~. lW~ i.o1~1 t~ml:~t~ti~ violut~ any ~w~inR h~, ordinance or r~ulatJrn: ...8~ ................. 13. ~ill lot I~ te~riM ....... ~ .......... ~ill e~t~ss fill I~ ~1 ~i~ ~ims: ~ ~ ' ' ~ o[ C~l~tor ................................... ~l~ess .............................. It~ ~ ............... 15. ls this [.~ty wlthln ~ [~t o[ a ti~l ~rla~l? ~ ~q .~ ..... ~ . [xx:aLe clearly ~ di~ti~tly all ~ihli~, ~tl~r exi~in~ or pro~, atd i~llc~Le all ~-I~k di~nsions F~n pm[~tly li~. G[~ s~L ~ I)l~ ~i~r or ~scr[pLi~ ncco~inR Lo ~, ~ ~ sLr~L t~ ar~l ~licoLe ~ll~r inlerior or cor~r .';IA'Ilr. (X~ iSl,,%/ Y(X~, Ill~[l"f (~ ....................... (l~.w~. 'of i,Klir~q~4~l signln~ (:o~lttact) duly .,w~)rn, (l~lx)r, es avKI sny,~ that he is the ni)plicni~t ({~tltrnclor, ap, er)t, corlx)rnIe of I-leer, etc.) o1: .mnid cz,a~r or ovaer.% n~l in dtHy ~lll.)[iz~_'d to l~.*rfo~m t~[ Im~e i~_.r[o~.t~l Ibc .~Hd m~lt o~1 to n.ke m~l Ilia lhi.q nppli~:nti~.l; Omi nil .~t.qlt~n~nt~ ~:~la[~l in Ihi.~ nlqd [(:.l:i{~) n~e I:v~e to the bent oF hi.q kntw~l~xli~e awl Ixilief~ Ih;il line ~)rk uill I)e peri-armed i. Ihe ir~,.~er .~ forth in the appllcal:i(.~ filed Iherw[tl~.