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HomeMy WebLinkAboutLondono, John & Kelso, Courtney 4 Michael J.Domino,President q soUry Town Hall Annex John M.Bredemeyer III,Vice-President ,`O� Old 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G Telephone (631) 765-1892 Greg Williams '� �� Fax(631) 765-6641 0010 f BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD October 9, 2019 Robert E. Herrmann En-Consultants 1319 North Sea Road Southampton, NY 11968 RE: JOHN LONDONO & COURTNEY KELSO 505 POINT PLEASANT ROAD a/k/a 4328 WESTPHALIA ROAD, MATTITUCK SCTM#: 1000-113-9-11 Dear Mr. Hermann: The Southold Town Board of Trustees reviewed the survey/site plan prepared by Paul Barylski Land Surveying, last dated July 10, 2019 and determined that the proposed renovations to an existing single-family dwelling, including a proposed second-story addition and porch reconstruction on the captioned property are out of the Wetland jurisdiction under Chapter 275 of the Town Wetland Code and Chapter 111 of the Town Code. Therefore, in accordance with the current Wetlands Code (Chapter 275) and the Coastal Erosion Hazard Area (Chapter 111) no permit is required. Please be advised, however, that no clearing, no removal of vegetation, no cut or fill of land or removal of sod, no construction, sedimentation, or disturbance of any kind may take place within 100' landward from the top of the bluff, or seaward of the tidal and/or freshwater wetlands jurisdictional boundary or seaward of the coastal erosion hazard area as indicated above, without further application to, and written authorization from, the Southold Town Board of Trustees pursuant to Chapter 275 and/or Chapter 111 of the Town Code. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction and Coastal Erosion Hazard Area, which may result 2 from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and the coastal erosion hazard area and your project or erecting a temporary fence, barrier, or hay bale berm. This determination is not a determination from any other agency. If you have any further questions, please do not hesitate to call. Sincerely, Michael J. Domino, President Board of Trustees MJD:dd i Michael J. Domino, President O��QF SO(/jyOl Town Hall Annex John M. Bredemeyer III,Vice-President Q 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A. Nicholas Krupski �Q Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD NON-JURISDICTION INSPECTION DATE OF INSPECTION: 1®1,6190) INSPECTED BY: Ch. 275 Ch. 111 COMMENTS: 1yot1 AUC\�� ����a6>p �• \S r,\ace- �' ad► 100 " �t GrA SURVEY OF: PROPERTY LOCATED AT MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C.T.M. # 1000-113-9-11 AREA = 117.670.1 SF. = 2.70 ACRES SCALE: 1"=40' NOTE: THE EXISTENCE OF RIGHT OF WAYS. TEST HOLE DATA WETLANDS AND/OR EASEMENTS OF RECORD (NOT TO SCALE) IF ANY. NOT SHOWN ARE NOT GUARANTEED. BY: MCDONALD GEOSCIENCE 4/17/2019 UPLAND AREA OF PROPERTY = 106.808.8 SF. COVERAGE cALcs: MA PES MIXED SAND AND LOAM 0.5' EXISTING COVERAGE = 9336 SF.= 9% PROPOSED COVERAGE = 9336 SF = 9V CREEK BROWN SILTY SAND 2' WELL AND SANITARY LOCATION BY OTHERS FLOATING PALE BROWN FINE SAND ELEVATIONS REFER TO 1988 NAVO DOCK17• y NO WATER ENCOUNTERED 9++E N �5p•Op / 0 11'23 TIDAL WETLAND BOUNDARY AS / toNC" \ DELINEATED BY EN-CONSULTANTS, MON. JULY 10. 2019 --.....- ql 4 wood 6.....-. .... DECK 0 \ 8 ..... 10 ...... "•,�oP of e� •• 0� 12 14 �• .... ;FUG- 16 POLE 20...- ...... 22 * / t1� \24 .... .. e �y� 6' O 26 2 6 s s s � Z Z \fit^F m ° LAND N/F pF ALBA RAGUCCI & � y RALPH RAGUCCI --_, ........ y�",ss• J � \ cr 26 N ° O 03 / \ O 01 9. 20'0 Z PRE CAST t _ WELL 30 f CESSPOOL PIIN-T� O p B 2 HARD BLOCK 4' PRECAST O 'Y I HOME PIKE 16.0 r m ~O SEPTIC TANK CESSPOOL �p :)Q s vil RECONTRUCTION 1� -- �m OF EXISTING p FRAME eiD�°F COVERED PORCH y����0 GARAGE e� op 110 SF. CVD. PORCH ADDITION y X10 SLATE a PATIO / ,�2yQ��? \ L 60'3' ma 23 -B FF E30� ENCLOSED 7() moo; PROPOSED WELL ' 0 PORCH TEST y 2ND STY G �� Z2. HOLE \ Z� ADDITION C+ GRAVEL DRIVEWAY \ � W/BELG. BLK. CURB r C7 STONE \ 311-11—UTiL c POLE FENCE I CONC. 6.6'/E NG OE f E E MON. SSOGKO.5 OHO , Z�j 2 LAND N/F N 34052'30"W POLE KENNETH G. BROWN - 50.98' JAMES BROWN & PAUL BROWN /WPB RESIDENCE WITH PUBLIC G X60, /�s�� WATER & SEPTIC /� I LAND N/F FRANK SWOTKEWIZC & JUSTINE SWOTKEWIZC /p RESIDENCE WITH PUBLIC �- / FSjOeN WATER & SEPTIC p '.N G^b A� I co h'f c A L UNAUTHORIZED ALTERATION W ADDITION TO THIS SURVEY IS A VIOLATION �� k ' ( � n ' +` r OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. �-0 k1 �^ �'� + Vii.,, ` � r ,.�+`�.fit+'F✓ COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS INKED c� a OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BEA VALID TRUE COPY. GUARANTEES OR CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO /�Ar THE PERSON FOR WHOM THE SURVEY IS PREPARED.AND ON HIS BEHALF TO THE TITLE COMPANY.GOVERNMENTAL AGENCY AND LENDING INSTITUTION 7 [ OCT 219 i LISTED HEREON.AND TO THE ASSIGNEES OF THE LENDING INSTITUTION. GUARANTEES OR CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. CERTIFIED T0: __� SURVEYED BY: JOHN LONDONO , PAUL BARYLSKI LAND SURVEYING��- --- - COURTNEY KELSO __•__._..._ PATCHOGUE NY 11772 INSIGNIA-BNT NATIONAL TITLE AGENCY PHONE 631-294-6985 OLD REPUBLIC TITLE INSURANCE COMPANY FAX 631-627-3186 BANK OF AMERICA. N.A., ISAOA.ATIMA PAULBARYLSKIaYAH00.COM 2411-P NOVEMBER 23. 2016 7-10-2019: TOPO/WETLAND RIBBBONS v 91 � .Flap v CUM �.t iti. thy'+ �,•. �� f��• � e����/�h �A� :f' ,•�I � ...�. �� Iy, � Jim-.tea. �;�• � �` 4 -,y ��� Ff�s� F� k'aK} ,,i", M.f � <Iy Il",��Ya.A1. ,'it�l F., w .r mow PW .� y....z �' t ••• ��.�. , � 777``` - .gig• c T + 4 t y 'Y�ii• 'Tr7,N f / kf Y OCT i e i I I IIIIII VIII VIII IIII INOCT - � ?019 so� r SUFFOLK COUNTY CLERK 8crarr _, s RECORDS OFFICE RECORDING PAGE Type of Instrument: DEED Recorded: 01/23/2017 Number of Pages: 5 At: 11:19:04 AM Receipt Number : 17-0012688 TRANSFER TAX NUMBER: 16-18766 LIBER: D00012897 PAGE : 453 District: Section: Block: Lot: 1000 113.00 09. 00 011. 000 EXAMINED AND CHARGED AS FOLLOWS Deed Amount: $1,525,000.00 Received the Following Fees For Above Instrument Exempt Exempt Page/Filing $25. 00 NO Handling $20.00 NO COE $5. 00 NO NYS SRCHG $15 .00 NO EA-CTY $5. 00 NO EA-STATE $125.00 NO TP-584 $5. 00 NO Notation $0 .00 NO Cert.Copies $0. 00 NO RPT $200 .00 NO Transfer tax $6,100. 00 NO Mansion Tax $15,250.00 NO Comm.Pres $27,500. 00 NO Fees Paid $49,250 .00 TRANSFER TAX NUMBER:' 16-18766 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JUDITH A. PASCALE County Clerk, Suffolk County F1 F2 RECORDED 2017 Jan 2:511.19:04 All Number of pages ` JUIDITH A. PASCALE CLERK OF SUFFOLK COUNTY This document will be public L D00012897 record.Please remove all p 45; Social Security Numbers DT# 16-10766 - -_-- prior to recording. D r= C _•i' } Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing St p 3 FEES i � CT - 1 719 Page/Filing Fee Mortgage Amt. I 1 Basic Tax �— Handling 20. 00 2 Additional Tax SuIi, .•,1 TP-584 Sub Total Bokx ,,_v;, Notation SpecJAssit. or EA-5217(County) Sub Total Spec./Add. EA-5217(State) TOT.MTG.TAX R.P.T.S•A. Dual Town Dual County Held for Appointment Comm.of Ed 5. 00 Transfer Tax Affidavit + a Mansion Tax Certified Copy i RD The property covered b t s mortgage is or will be improved by a one or two NYS Surcharge 15. 00 family dwelling only. Sub Total YES or NO Other Grand Total If NO,see appropriate tax clause on page# f this instr ment (/P 4 Dista 17001049 300 5 Com nity Preservation Fund f 1000 11300 0900 011000 Real Agency 11-JAN-17 Ill�lllllllf�ll11111�ill�llllllll�lll�11111 CPF Tax Due Amount$ Tax Service R CWH A Venficatioi `— Improved_ 6 Satisfactions/Discharges/Releases List Property Owners Marling Address RECORD&RETURN TO: Vacant Land INSIGNIA NATIONAL TITLE AGENCY,LLC TD_ 6 EAST 39TH STREET SUITE 700 TD NEW YORK.NY 10016 TD ATTN:RECORDING DEPT Mail to:Judith A.Pascale,Suffolk County Clerk 7 Title Company Information 310 Center Drive, Riverhead, NY 11901 Co.Name NSIGNIA TITLE AGENCY vvww.suffolkcountyny gov/clerk Title a ITA-7045-5-160R 8 Suffolk County Recording & Endorsement Page This page forms part of the attached DEED made by: (SPECIFY TYPE OF INSTRUMENT) ROBERT G.SMITH The premises herein is situated in -- SUFFOLK COUNTY,NEW YORK. TO In the TOWN of SOI ITIiOI.D JOHN M.I,ONDONO In the VILLAGE COI IRTN-.Y KELSO or HAMLET of BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. over �J Bargain and Sale Beed ®CT - 1 2019 THIS INDENTURE, made as of the 16th day of December, 201 - --� Between, Robert G. Smith, surviving tenant by the entirety, residing at-155 Greenway South, Forest Hills, New York 11375, party of the first part,and John M. Londono and Courtney Kelso, husband and wife, residing at 121 Reade Street, Apartment 8M,New York,New York 10013,parties of the second part, WITNESSETH that the party of the first part, in consideration of$10.00 and other valuable consideration paid by the party of the second part, does hereby grant and release unto the party of the second part, the heirs or successors and assigns of the party of the second part forever, \b0� All that certain plot,piece or parcel of land, situate, lying and being in the Town of Southold, G�.. 113.4b County of Suffolk and State of New York, bounded and described as follows: y ' �� SEE SCHED TILE A 116�p 0 BEING and intended to be the same premises conveyed to the party of the first part by deed dated December 29, 1986 and recorded on January 2, 1987 in Liber 10207, Page 528 of the Suffolk County Clerk. Said Premises being know as 505 Point Pleasant Road, Mattituck, New York 11952 TOGETHER with all right,title, and interest, if any, of the party of the first part of, in, and to any streets and roads abutting the above-described property to the center lines thereof; together with the appurtenances and all the estate and rights of the party of the first part in and to said property; To Have and to Hold the property herein granted unto the party of the second part_the heirs or successors and assigns of the party of the second part forever. And the party of the first part covenants that the party of the first part has not done or suffered anything whereby the said property has been encumbered in any way whatsoever, except as aforesaid. And the party of the first part, in compliance with N.Y. Lien Law & 13, covenants that the party of the first part will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any part of the total of the same for any other purpose. Old Republic National Title Insurance Company by its Authorized Agent IL's -.400111PAP, opm� EOCT 2079 NAYi6NA� T176 Q A661V C Y t Title Number: ITA-7045-S-16OR E"�P'ag'e-1°itf-1 SCHEDULE A—DESCRIPTION AMENDED ALL that certain plot,piece or parcel of land,with the buildings and improvements thereon erected, situate,lying and being at Matlituck,Town of Southold,County of Suffolk and State of New York, bounded and described as follows: BEGINNING at a point formed by the intersection of the southeasterly corner of the hereinafter described premises with the southwesterly side of land now or formerly of Map of Point Pleasant, filed No. 720,and the northwesterly side of land now or formerly of Kenneth G. Brown,said point being distant the following two courses from the northerly side of Westphalia Avenue: (1)North 70 degrees 45 minutes 00 seconds East 55 L60 feet; (2)North 70 degrees 45 minutes 00 seconds East 253.24 feet to the true point or place of beginning; RUNNING THENCE along the division line between the southeasterly sideof the subject premises and the northwesterly side of lands now or formerly of Kenneth G. Brown and lands now or formerly a E.V. Rasanen,South 70 degrees 45 minutes 00 seconds West 253.24 feet; THENCE North 34 degrees 52 minutes 30 seconds West 50.98 feet; THENCE North 14 degrees 48 minutes 50 seconds West 520 feet to the southeasterly side of Mapes Creek; THENCE along the southeasterly side of Mapes Creek on a tie line of North 74 degrees 47 minutes 30 seconds East 150 feet to land now or formerly of Map of Point Pleasant;and THENCE along said land South 27 degrees 08 minutes 00 seconds East 562.28 feet to the point or place Of BEGINNING. TOGETHER WITH Easement(s)or Right(s)of Way 15 feet in width, in common with others,running from premises to Westphalia Road,as reserved in deed made by LIZZIE Y. MEDAY, widow,to WILLIAM B.CODLING dated April 18, 1906 and recorded on April 27, 1906 in Liber 584 Cp 549 and in deed made by LAURETTA HELEN MEDAY and HENRIETTA AUGUSTA MEDAY to MABEL L. BUBIER,dated September 4, 1919 and recorded on September 12, 1919 in Liber 984 Cp 99 and also recited in vesting deed recorded on January 2, 1987 in Liber 10207 Cp 528,as well as in prior deeds recorded in the chain of title FOR INFORMATION ONLY: PREMISES are designated as District 1000 Section 113.00 Block 09.00 Lot 011.000 on the tax map for the Town of Southold, Suffolk County. FOR CONVEYANCING ONLY: TOGETHER with all the right, title and interest of the party of the first pan, in and to the land lying in the street in front of and adjoining said premises. The word "party" shall be construed as if it read "parties" whenever the sense of this indenture so requires. IN WITNESS WHEREOF, the party of the first part has duly executed this deed the day and year first above written. In presence of: Witnes R e G. Smit D E G ACKNOWLEDGEMENT IN NEW YORK STATE Oct �- 1 �'-319 !•' State of Southold tc,,�n i of 6 -tee County of ss.: On the 16 d/y of bk6SO J 1, ;before me, the undersigned personally appeared Robert G. Smith and personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity and that by his signature on the instrument,the individual or person upon behalf of which the individuals acted,executed the instrument. Notary Public JACK WAINSA Notary Public, State of New'ft* No. 01 WA4846218 oualitied in Nassau County Commission Expires Sept.3®,20� BARGAIN AND SALE DEED District: 1000 Section: 113.00 Block- 09.00 Lot: 011.000 County/Town:Suffolk/Southold Address:505 Point Pleasant Road, Mattituck,NY ROBERT G. SMI`fH C)) E C E ITO OCT - 1 2"19 JOHN LONDONO and Southold Tu,n COURTNEY KELSO Bmd of Tru , ��N7 LG /✓G h1 p� Return By Mail To; go ��Se 6--v�LYtJf y l J 5-�rr-A-2-.- r , .. - W..-..=a:.--h -...-'v_> - � v3..._ _ j•i___ - - � _ _.--. t - - - - .. _} _ � ,:__ -. _ -.," ___ � ,_ - KS:. a1""., n - ---"_ _ 162 16d� 11afit) SFE SEC NO IN SEESEC NO IN Tce m MUN H 'mac)_ IV SEESEC NO 10Ta a —CH uNE MATCN UN a'�a'x' au .� - x 1 13_�1c\ IMTC IINF x FOR PCI.NO $ d TS x Ta FOR PCL NO SEE SEC NO 1 TAIc)e 1 anlc) SEE SEC N v $ 1050 EC N �' zE c 3 �0��� nn 3x e ��i ,. r � T.. •qe ,q m ..• 4 yi gip,• � / j FOR PCL NO N +O�yO'O-a8 1 ycl N 5 F.P� T 3 e nn r Iw 9 5 T 12A(c) 5 �' M1 r R PCL NO SEE SEG NO b M1 P 1 Oryc) PO x X 9 a ra 15 a wY 'E 'A �r SEE SEG NO 1-1m03 Y' O 12 q y z,O a m T m 1TP(�) �q r• 9 +�' / Had2mi3 IV '� 99A(q 4 e �',�al nn O y 4 i;§ 11P11 °z -I aPa°` O'P ne n•,e yarn\' ,. r © w 'V 1 6 w y - 2 ® e'T S �IANxDING 1 / G{� 131 vrmaann aaoee sP l 1fi 1arg OF E. m 4:w1n 1`' 1 I' ISN` � � ``• 4`\, ` ''P. repZe t`\ ' I'i w 'yN\ , ,e`, $��a.♦ `al �+e+P +y-\ n4P� O - zfi 31 25 w \O. 1` rp'3 I •� 7 d asi c;` 1 M1 , 1 193 I a9A � man - q' an�r` °4_ m p`9 z' c,l`c�,+a, d °Ey b r• 1aA(al 'Ta[q l FORPCLNO SEE SEC NO 112-014m L b As •+q2a 1 x�^eq s 1a' .m �y? x x 6;5�1`g1�30,�L�I/yaw N`I�-'I+npL\ j+ +oP `` do � a(4 a e dT�c) /� ' I 182s y� � 9 j3� ' I m1`"" q I,;'[•tri� �� $� +; 3� - S.TA14 UA pa °� 1 00'• E R.'Fn q I iN`�' I '' `�� +eyt qT 'I 'I S' Sp'I 5• 1T14 d 0P � 1911 tfi '' I 6 OA 1 O S,24A(c) Qe �1919 6i1 I.� b A 3 O +�-� y NxNc) —aF9aman U`v£Txf/d'aM51 1941 1924 20A(c) ^ E °• Fri 'I b 1917 e 4 , w 2-1A(c) 1942 pP °•' d 15�61 6 � 1 � y°9� o q' A` 11orsrolmxNn +pP ..II 'N SEE SEC—NO E—C NO w 2 S.m o$19.30 112L14()2 § g19g1 a` a w m P m P 1,A t 1960 , 1 •i O+P o 3/.51a 9 { +pz CNIY OF SUFFOLK 9 21 '23 T q y •14 FOR PCL.NO ------SEE SEG NO 1200.5-001 f�` 4 9 19w ,d'4Y a/\ rem O W 13 l yx`t MATCH -1�---------UNE SEESEC NO 121 0� " s 1937 Z ® 1QA 11 '2 C�49 MpR1N R x o� 18n' e aw 1zP DIE p0 b 19.39 M\D L `� x.ro .n w. ___—__ oruu. --�-- �� --x-- use MATCH —y ---UNE O K tae IOT OF SECTION NO E —�— (21) — -- ,„ti -- -- d NOTICE ax aaawy� COUNTY OF SUFFOLK C sotmtoLu Qz __ __ __ __ Real Property Tax Sernce Agency r a .E...... �... ._______ e ,,,,,d — -- _...,,.--,..-- wfi§Ii AG.pBr,idAaFel6; wxmre..rra.wN�.6 NY—, M 1 1u ""�"� 113 u .uno.nu.- y�c, TwcT xo 1000 :.l� PROPERTY MAP �$.��' i�,r Ort -a d*- "xve. - - M•`,�:1,..�'�*-.. ._E,A' _ :;;„, �t-..3:ae.s •Sv:.:?4'" ' �-„aw 3'rSEE SEC�NU:IOT ri<r•'��"._ "�' �-,„ 'I y. Y P _ .__ _ Nape MATCH----1ZZ----- El \A e�r 4\ r e EN-CONSULTANTS R01 ptember 23, 2019 Mike Domino, President OCT " 1 2119 Board of Trustees Town of Southold Southold Town P.O. Box 1179 Board of Trustee Southold,NY 11971 Re: John Londono & Courtney Kelso, 505 Point Pleasant Road (aka 4328 Westphalia Road), Mattituck; SCTM 1000-113-9-11 Dear Mr. Domino: We represent John Londono &Courtney Kelso, who are planning renovations to an existing single-family dwelling on the captioned property, including a proposed second-story addition and porch reconstruction, as depicted on the survey/site plan prepared by Paul Barylski Land Surveying, dated July 10, 2019, two (2) copies of which are enclosed herewith. As all of the proposed work and related site disturbance will occur more than 100 feet from both the tidal wetland boundary and top of bank adjacent to Mapes Creek and thus outside Trustee jurisdiction pursuant to Section §275-3(C)(5) of the Town Code, I am writing to request that you prepare a Letter of Non-Jurisdiction stating that no Town Wetlands Permit shall be required for the proposed work. In support of our request, enclosed with the above referenced site plan are site photographs taken on April 8, 2019; a copy of the deed; a check payable to the Town of Southold for $50; and authorization forms signed by the property owner allowing En-Consultants to act as agent and the Trustees to access the subject property. Should you have any questions or require any additional information to process this request, please do not hesitate to contact me at your earliest convenience. Resp dully yours, Robe . Herrmann Coastal Management Specialist Enclosures 1319 North Sea Road Southampton,New York 11968 p 631.283.6360 1 f 631.283 6136 www.enconsultants.com environmental consulting i Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) 1/We, . John M.Londono owners of the property identified as SCTM# 1000- 113-9-11 in the town of Southold ,New York, hereby authorizes En-Consultants to act as my agent and handle all necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for this property. Preiperty Owner's Signature Property Owners Signature John M.Londono SWORN TO BEFORE ME THIS z DAY OF SfMfM3Al , 20�� N Public KRISTINE LYNN SCHWEINSBERG Notary Public,State of New York No 01SC6247078 Qualified in Kings County Term Exoires�4apast293b J _ _ Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I/Wes _ Courtney Kelso owners of the property identified as SCTM# 1000- 113-9-11 in the town of I Southold ,New York, hereby authorizes r i En-consultants to act as my agent and handle all necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for this property. N/A roperty Owner' ature Property Owner's Signature Courtney Kelso V SWORN TO BEFORE ME THIS DAY OF^ -12 y ota Public KRISTINE LYNN SCHWEINSBERG Notary Public,State of New York No 01SC6247078 Qualified in Kings County Term Expires A4�. Nov /7 aoil t 1 i Board of Trustees Application County of Suffolk State of New York John M.Londono BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S)OR REPRESENTATIVES(S),TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature,John ondono SWORN TO BEFORE ME THIS Z40 DAY OF SV7FMs Notary PuMlf KRISTINE LYNN SCHWEINSBERG Notary Public,State of New York No.OISC6247078 Qualified in Kings County Term Expires A6 W*RR- 6% Nov /7,;0/9 Board of Trustees Application County of Suffolk State of New York Courtney Kelso BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER,KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S)OR REPRESENTATIVES(S),TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. I Sig a re,Courtney Kelso SWORN TO BEFORE ME THIS S' DAY OF '�>CP ,20 J NotaFPubf!Kc KRISTINE LYNN SGHWEINSBERG Notary Public,State of New York No 01SC6247078 Qualified in Kings county Tenn Expires Awje*-R-� NOV17ao17