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Home My WebLink AboutTri Par Corp �}SUFFO(� " Michael J. Domino �Town Hall Annex , ®�Q John M. Bredemeyer III, Vice-President y,, 54375 Route 25 Glenn Goldsmith c '`t P.O.Box 1179 A.Nicholas Krupski Southold,NY 11971 Greg Williams ?' ®r Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in field by: < Suffolk Environmental Consulting on behalf of TRI PAR CORPORATION, c/o NATHAN WILLENSKY requests a Pre-Submission Inspection to discuss a proposed dock on the property. Locate: 1440 Kimberly Lane, Southold. SCTM# 1000-70-13-20.10 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual 'Footage or OK=q Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice f Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: I II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: -C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: I have read & acknowledged the foregoing Trustees commen Agent/Owner: / Present were: edemeyer Domino `/ G. Goldsmith ---/N. Krupski _/G. Williams Other O' 7 - ,-7v�,!7777 .77` NO063 I-TCH Q z T-T 3 3 2" 3 F .(c) 9 42 MID 5 Of tj sOOTNow�NOOLDMTR�NO5 In —w 7 E3 1. A41) 3C 3 21 IN VA PIP 14 oRICLNO SEE SEQ NO9 199 1910 1913 12A(c) 1.2A(c) IA(c) . 3Nc) mg194 3I w Z I.? i291 15 DR- M 72k, 211 2 lo 13 1. 11910 Y12 1� 16 17 C) 11( wo L 711 4 ' TOM Si >A-—2.1 MA(C4 5 MA(c) MY L 304 303 33 8353 3 4 17A I to 12 I to 10 13 bi 3. AVE to , 49 20 393 47A 5 6 fi1� 63 62 61 -0 FORPCILNO 0 'N 0-01-035 — —————----N— 666m -ml 45 +' nV TOWN OFw g 2B2 204 1gNcj Z91 233`. 0m� LWN NE 3: — Ip L NOTICE COUNTY OF SUFFOLK K SOUTHOLD SECTION D (D E E (2-1) Real Propedy Tax Se A G rvice gency Y —GE01 0( C—ri—1,MI N Y 1190' IM 070 N wr A P l000 PROPERTY MAP Suffolk Environmental Consulting, Inc. Newman Village, Suite E,2322 Main Street,P.O.Box 2003,Bridgehampton,New York 11932-2003 (631) 537-5160 Fax: (631) 537-5291 Bruce Anderson,M.S.,President Hand Delivered September 30, 2019 Board of Trustees Town Hall P.O. Box 1179 Southold,NY 11971 Re: WILLENSKY Property Situate: 1440 Kimberly Lane • Southold,New York • 11971 SCTM#: 1000—70—13—20.10 Dear Members of the Board, Our Firm formally requests a pre-submission meeting at the property referenced above to consider the on-site construction of a dock. attached herewith please find the following; 1. Check made out to the Town of Southold in the amount of fifty dollars($50.00)to cover the requisite fees 2. Open Government Disclosure Forms signed by agent and homeowner: one(1) copy of each and; 3. Authorization Form signed by homeowner: one(1) copy. Please schedule the requested on-site meeting at your earliest opportunity. Thank you in advance for your anticipated cooperation. Yours truly, Bruce A.Anderson I Rn SfP302019 Soeti;cid Boar of T, ^_s Michael J.Domino,] !dent SO�/o�a Town Hall Annex John M.Bredemeyer I1I,Vice-President54375 Route 25 Glenn Goldsmith P.O.Sox 1179 A.Nicholas Krupski Southold,New York 11971 Telephone(631)765-1892 Greg Williams p Fax(631)765-6641 C'ollt ,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Chapter 275-8 A. "Presubmission conference. Applicants are encouraged to"schedule a voluntary presubmission site visit to discuss the proposed operations.with the Board. Discussions in the field are purely advisory and nonbinding, but this meeting Is intended to facilitate communication between the applicant and the Board. There will be a$50.for this conference,which may be applied to an application fee for a wetlands permit made within six months of the site visit-and which application involves structures that were the subject of the site visit." I HAVE READ THE FOREGOING AND AM AWARE Of ITS CONTENT: Board of Trustees Application County of Suffolk State of New York Nathan Willerrskv 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 TRUSTEE THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY�TO INSPECT THE PREMISES IN,CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature -SWORN TO BEFORE ME THIS ? DAY OF_ 5C.)+crv,L�f' • Notary Public- REBECCA A LUCAK Notary Public-State.of New York No.01 LU6386882 oualified in Suffolk County My Commission Expires deb.04,2023 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: Bruce A.Anderson (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name) NAME OF APPLICATION:(Check all that apply.) Tax grievance Building Variance_ Trustee X Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold?"Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO X If you answered"YES",complete the balance of this form and date and sign where indicated Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 30th dav of Se tember 2019 SignatoA_A-_ AJ-, Print Name Bruce A.Anderson Form TS I APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL, DISCLOSURE FORM c- ou'n of Southold's Code_of Ethics- rohibits.conflicts of interest on the an orthe ifmn oflicws and cm loeces. The u ase f this form is to d same. Info ation which can alert the town of oss'hle conflicts of inter, and allo�r it to take �ti atever action 'z —necessary to avoid same. YOUR,NAME: Tri Par Co ration c/o Nathan WillenskY (Last name, first name,middle initial,unless you are applying in the name of someone else of other entity,such as-a company. If so, indicate the other person's or company's name.) NATURE OF APPLICATION: (Check all that apply.) Tax-grievance Variance Building Change of Zone Trustee X Approval of plat Coastal Erosion Exemption from plat or official map Mooring Other Planning (If"Other,"name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officeror employee of the Town of Southold?"Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares._ YES NO X If you answered "YES,"complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee. Either c appropriate line A)through D)and/or describe in the space provided. y Itecl: The town officer or employee or his or her spouse, sibling, parent,or child is(check all that apply): A) the owner of greater then 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B) the legal or beneficial owner of any interest in-a non-corporate entity(when the applicant is not a corporation); C) an officer, director,partner,or employee of the applicant; or .. . �. D) the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 7 of _ `X01 Signature Print name athan Wi lensk Bard of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, Nathan Willenskv of Tri Par Corooration residing at 5 East 22 d Street • Suite 29C • New York NY • 10010 does hereby authorize Suffolk Environmental -Consulting. Inc to apply for permit(s)from the Southold Board of Town Trustees on our behalf. Nathan Willensky