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HomeMy WebLinkAboutO'Connell, Barry & Caitlin Glenn Goldsmith,President *0 SUUTTown Hall Annex A. Nicholas Krupski,Vice President ,`O ��� 54375 Route 25 P.O. Box 1179 John M.Bredeme III er k Y l� � Southold,New York 11971 Michael J.Domino G Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 4, 2021 Robert E. Herrmann En-Consultants 1319 North Sea Road Southampton, NY 11968 RE: BARRY & CAITLIN O'CONNELL 4405 S. HARBOR ROAD, SOUTHOLD SCTM#: 1000-87-1-6.3 Dear Mr. Hermann: The Southold Town Board of Trustees reviewed the survey/site plan prepared by Kenneth M. Woychuk Land Surveying, PLLC, dated April 28, 2021, and determined that the proposed construction of a swimming pool and pool house and installation of an upgraded sanitary system, 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 from your project. Such precautions may include maintaining adequate work area 2 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, Glenn Goldsmith, President Board of Trustees GG:dd S.C.T.M.# DISTRICT 1000 SECTION 87 BLOCK 1 LOT 6.3 1 It , I , \ 00 S APPROXIMATE LOCATION ` OF TIDAL WETLAND BOUNDARY---' �. AS DEPICTED ON NY STATE \ TIDAL WETLANDS MAP No.714-546 ., HYD. `\ " ♦ '�/�i�TV , \\ ` O `�\` mow`` — � .�L \` \\ ; ,w Ate/ ` ♦,i� �l ------------10 --- -------10 \ / % ` \ ` / .P `\ *♦ — X11 w•• `` ``V i `���`\� w / DWELLINGS ------------ VACANT `---- VACANT /' \\. < < / - �' `\ W/PUBLIC WATER - 150 ; \ \ \ / `C�' `\ �� t 12- 150' I IP TEPC� I ` i i If it 0 / �\ \ , �, �\ .:..:.24.3'•;;•;•;•;•;•;•;• i '` \\\ ; `��` W.V. W.M , 1 / *� o•'•'•'•' GARAGE� •'•'•'.:- W'''' UNDER GF 12.3 ::::N p \Q10' NFA \\. ................ . .7' o* i N :$.7'::: :: ::07, 117 t Y x 6 :::::::.::::::: : ::BRICK `\\ \ r y + EX . N G r , RE R4DE STOOP '•'�•'•'•:•:•••:•:•:•:•�•:•:•:•:•:•:•:•:•:•:•:•:•:•:•• r I �. { ! C /VC/STp ! ` :' ' ''' ::: . ;;.. ....WALK 2STY FRAME'.•.....:. PROP. INAWR LINE DWELLING o,...•.4. BEDROOIAS.•.•.•.• � yDFi'IVfB,AY �t-.•.•:.•.•:.•#4405:x:•:•::•:•:� 119 / \ FFL , 1 , ,...:..:..:If . EC E IV E , :.::.:.:.:.:...t..... \ EL 8.7 ::::::::::: + , / / EXISTING SANITARY TO BE \ n 1� 3 ...28.3' / v I... \ V TYPICAL CLEAN OUT 1.75'\ " " ' ; :Q���jh.�..;. REMOVED/AQANDONED AND BACKnub)\� U.P. 10 ©z C.O. ;COQ +.:::.�. / WITH CLEAN COARSE SAND. \\ lb SLATE OR r� ::./:.:.:.'`::::' \ / APR 3 0 2021 STOPPER END u� " \ SUITABLE COVE OR PLUG DWELLINGS Q o . �............ / W/PUBLIC WATER 0000, y L.P. \� 150 0 ,N 20M 1'7` / 16 DWELLING Southold Town UNDER CONSTRUCTION Board ofTruste LAND N/F OF l0. W/PUBLIC WATER 30' ELBOW JACQUELINE JONES 48 S T 'C.0 71 ASS / 150' 60' WYE PROPOSEDy�° 5 BEDROOM SYSTEM �, O 1500 GAL. S.T. :/ .� LAND N/F OF FLOW" (i)10'0*13'DEEP LP. :::.�^a 08' a�� TIMBER PROPERTIES LLC \ \, N 73" PROPOSED 20'O0// N DRYWELL FOR 3s 86, - POOL WASTE WATER HOUSE FFL 20.3 PIPE�Z POOL HOUSE FFL(18.0) Cover to grade j if drop••T"is j used on inlet. Locking cast-iron ! GRADE 18.0 cover to grade. GRADE 18.5 i! CLEANOUT , himney 20" Min 0 Min Locate drop"T"under access Z opening for maintenanceE71 E7� E79 b EJ House Invert(17.69) (17.2) 0) N outlet ® ® ® mmo(17.01 Pool House Invert(17.45) ^^^^^^^^^ ^""' °> ® ® m m o Min.4"dia.SDR 35 i (16.75) ® ® ®° P t+ (16 7) ® ®ac or equal.Pitched 1/4"/ft. Flow Baffle in.4"dia.SDR 35 Leaching Pool(typ) 00 Ua pipe of equal. 10 min Pitched 1/8"per foot. I- T collar ELEV. 18.2 a ' Back fill material to be 8 min 10' Dia, clean sand&gravel OL BROWN 1 O, 1500 GAL.PRECAST S.T. NDY LOAM ® �a GO i to ® R!a ® ® e in "_ BROWN ® ® � �a Bottom of Leachin Pools r E1(4.0) SM LOAMY SAND 2.3 •' HIGHEST EXPECTED WATER EL 1.0 FLOOD ZONE X SP BROWN TOWN OF SOUTHOLD Sanitary Cross Section MEDIUM 3.8' LOT COVERAGE FIRM MAP#36103C0166H SAND (BUILDABLE LOT AREA: 16,615 S.F.) AREA: 16,615.09 SQ.FT. or 0.38 ACRES ELEVA77ON DATUM: NAVD88 UNAUTHORIZED ALTER4770N OR ADD17/01V TO TH/S SURVEY/S A WOLA7701V OF SEC7701V 7209 OF 774E NEW YORK STATE EDUCATION LAW. COP/ES OF 774S SURVEY DWELLING: 1 725 S.F. MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VAUD TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN PALE REAR DECK: 48 S.F. ONLY TO 774E PERSON FOR WHOM 714E SURVEY IS PREPARED AND ON HIS BEHALF TO THE 777LE COMPANY, GOVERNMENTAL AGENCY AND LENDING 1NS777U770N SW MEDIUM ' LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INS77TU77CK GUARANTEES ARE NOT TRANSFERABLE. TO 9'9 TOTAL EXISTING: 1 773 S.F.Or 10.7°7. THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM 774E PROPERTY LINES TO THE S7RUC7URES ARE FOR A SPECIFIC PURPOSE AND USE ]HEREFORE 7HEY ARE COARSE NOT INTENDED TO MONUMENT 774E PROPERTY LINES OR TO GUIDE THE ERECRON OF FENCES, ADD17IONAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTSCOARSE PROP. SWIMMING POOL: 560 S.F. AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT 77-IE 77ME OF SURVEY SURVEY OF: DESCRIBED PROPERTY CERTIFIED TO: BARRY O'CONNELL PROP. POOL HOUSE: 210 S.F. MAP OF: TOTAL PROPOSED: 2543 S.F. or 15.37. FILED: NO WATER 17' sITUATED AT. SOUTHOLD APRIL 14, 2021 TOWN OF:SOUTHOLD SUFFOLK COUNTY, NEW YORK KENNETH M WOYCHUK LAND SURVEYING, PLLC K. WOYCHUK LS Professional Land Surveying and Design THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL WF P.O. Box 153 Aquebogue, New York 11931 LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS FILE # 221-41 SCALE: 1'=20' DATE:APRIL 12, 2021 Ai YS USC. N0. 050682 PHONE (831)298-1588 PAX (831) 298-1588 AND OR DATA OBTAINED FROM OTHERS REVISED 04-28-21 Glenn Goldsmith,President �'QF S0(/�y Town Hall Annex 54375 Route 25 A.Nicholas Krupski,Vice President ,`O� ��� P.O.Box 1179 John M. Bredemeyer III l Southold,New York 11971 Michael J. Domino G Q Telephone(631) 765-1892 Greg Williams �� �� Fax(631) 765-6641 1�00UMY BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD NON-JURISDICTION INSPECTION DATE OF INSPECTION: Z I INSPECTED BY: /Ch. 275 COMMENTS: 1 ,�v V✓� oil o f m � .- r 4405 SrOrbor Rd oogle Earth N \ zoo ft Aw yrs 4,:.��.,�i:- n, /i! s d � I •,��- s•+�w �'; P —I it \\9 AIR • / F � is ��� �f� '��'�':t. 17 MA low � W 04 � `���I�i11 G•I'l��l +�ii�t` � �• a4y Pi 1. ��R�h.��.`Yi ��� 4��A J �rl 1 ! i • ' � �'! �� tv �!�1a". f All' r'� ► .'� .� ; �� �tF ��i��� 11,.j�i����i S ' 4 4�1�� Vol— yo +s t yg y..c Y , DM 1 . - r y a '�' r h. i aE6l 1 A MAN enYWI ' wo o -n3 eX E �OnJ.:. an.._... 6x '�' �rw • 4 2`€ "rte z,? „' 3 • �\r ` j,M p' i�+e3 h° q as 1 RD c Ia ems osa 06.06-0° G ., ra d C/.1 '••.q .fA-i' ) w 1� -(i q /' � � 'f „i� - os-.>-r, rY SEE arts ,•Is 13M r:_ - z E SEG Ml 01 xJA 1� 3 v? s ' 3?•til .., ^was 1 a rl r. y Ae Sap `. d�'-_'i THE COVE AT SOUTXOLD 9J6 3J A t. 41 i / 1 icwro...r6u `A xu 3ANc1 aY4c1 y $f` _ A �^0A�'*� TONµOFfiWT10LD 11 •,� eM 4t..,1A il • nicl T J A l tvd ,/ P4! 3S.,�L.♦-"q.� a6 erdq , 113 W r 1p �i � 4 .e p1�\ �4>'�� m��L�"{ra�,>ip .s •�s e T �x''ft � t. , aw.' 22 axA(0 sou XULoi i t 1 sN 1'A M tR. F D.28 t 4.0 n n - r A a 4 1 r � r � r • m .bon -__ - COLwTr or suvEaX,2 __ `_... - rovm of souTXOLo ff 'µcc �a $ NECK HAY .. w: u. .rey L .M ,,.. .m,.a•„r ..... — ...,..._ r... COUNTY OFSU F O LK N rioiicE X '� .a�.r.r SECTION N Real P-1-1) Olg-11 a.Ew v rrr,r W E ew.E Nvn n�fi N -o. AooTXoio 087 m anwr+v�w 3 1Y�Y.1� ALS :zed:CSC+eek++�.,�e�a,�d:r��,�'sm�cer.:�unrsJt:ts9r��cwLi:3a�Cx+r1Awutuvftit��5`trc�)a�'�`�'3'L:�t��.`:� txt`Mrt.T YOUR LAWYER IXFORF,I(;xtNg• up, BE USED 0Y t.A%IT F5 O.%I.a• TIMS TNi3F.'irfit`tJM mare ft &V of January. ,in diC Vicar 2021 BETWEEN E IRY Realty,IeM keels un addre-as at 235S Late`i( i,€aurel,NY 11945. ;Mv.,o!'the fa t part, f Harry O Cottrmefl and Caitlin aCs nntll,residin;at 4405 South Harbor Rtwd,Southoll,NY 11471, _ ' f Pw; I i y of tge sevond per, Wrf NUSSETH.that thak jmW of the fust Inn,in owmiditmLim of Ten Mars wl other lmluabte cumiAer-oian 144 by�hc parte of thr c jraf glut.ckU�holaby grant and reuse wito the party of itw i=ianl tin.th.,hem,arxttceessr�r�aid;tvxiy#rstsf dw'pay of the second pan forever. ALL di remEn pk5 pt.ve orgarce]ot"�.W,.,Airh 4t.tscildikp wd i:t4xutivtix3ta gine esi ttie ' t Town of Southold,County of Sui!'ttlk and State of New York,more particulur3�w.tags dviciibed 1611 Sefiedule"A"attached hereto and xiodu a ftp.hemef. BEING:AND INTENDED TO BE the same pTiembes cdawy i to the Oaxty orih�'ftz dated September 2gff 2017 antl•rc�rrdt:d Octobw 17',20'17 in,Li�c I29.431'ra ttire of rite Clerk of the County-of S'ui'f613-. �'$ t;LT' [I:Ii sirfllstttt tt :tills�r �ntt ?.ifiirs , f rmartscsfrtiefsr aq, ih ta=y, rdm'=dte tl s�ttia tiae`" rrn r rr.' fj Pth -pint rzap :shca TT 9ti '&I R�uitIa ii»pissiitm,', cv end sli ,�.t rilrz tiffs #gid }otEi €?s' airs': iiltxxaic�_� _'s3 .� R .i " '1 ,H . . c`prsatiakaeters�' E , rr d t the heie rs + sirs 'a sti of tie�Z7rcr tli acfpar, I3:zI ' ti fii t z:t± 'i ,titt :' 'y z3cltw.l"sro1'g ii c d, hat >_ - - � _ '�? � �e=� �o+;e�3c�f�.:a"`��'sn�nj;�+r,iy':gtiEzai>i:r�i �ss��-,k�s�.#'ciir. i� r _ _.- • _'�: '- ��- - '� ttAw tib r sr:'n� utp efu �;"cvtr Sc�tiv il3 f t} '1.ii `E.ac�.sc�slc sai�ii�tat it 'p asp csf it -tip ifizr%;iitl _ "'JrE�s, c., rvstu tis ic�ticttecarasidris �orf,t�c,ai ' ., t1w •.iri�eas ics�vcrt�ht►s��e'��a��ii�pritirrf`ttt3rt�zt�t�F�f��s�mry'f;�'onytst��r_�u{x�cr `' " ' � _ _ the uattti,''p v�a4 It tse�a36�nii� if3t`tfi i1."tiatiir ;a 6c t w er ttzc s ;e of this firtrrEr Mre-�ri 'lim%. j}Ii:l:I""(II stir ct V'r�i t1z .fir n 9; ti't.'S \ �v #`first cave vrittlm- • and_ ar, - Avm Mi7W11Mfj�VJVLWRVfKSTAM(AVIS, rMSoll.- - SwteofNnwV&rk,,COuutyOf Suffulk I S&: StwerNew YEW,"ccwniy or lob tis g�ttlp�or'Jaintmry , ' ft->vzr 2021 On the day fif - its tha yc;z befurt:mt.tht: WWO Inc.the umfem)trml.Irci-saway We James P.N10--vivy, �tfsozmuy IMOV6A to=,cr 1MV=t IQ Mr cwi fl=trams of s;adsfflc-(-1fv jvq�w=11y known to int,or pmvcd to rw m fiv psis of sadsf=orf cvk,k=ca to,itiz ivd1i*L-jAjs)%%hw,,e idmc(s)is Cud)sabscnhrd to lfw, r-,dikr.-x m beftindivic!M(s)-Nnnano-J.-.)is(=):,-,Vbscritoc1 te the ujzbm jnMrtumVxst to we tit; bdAwAbtv exwolmi 'Ai6n im"itusimi Md OCIMcultdri in xw it=bckf&1mqcy cxccutcd I r ry - L4 Ow ww in is cqxviiyfics). and tbz by 4qbp--rAh6r �wrte in hb1x1At;cjF ca;=-9y6",% =d Chat b.- t6srilerf1h r iL- .nat=,cfs)on Lhe 1=11 ML d"bwhidwk-qor the XSWU upon qprn?uwf1;)cm OTC 1w:rUtwit.the ij1&vi&jJ%(5). Or Om rwr%. Vl upkM bdalfef wlich Or b&i&ftJ(S) b&, .-Jf ol'Oudi the irdivide-JOO--iod,mccutt-4 the uWnuikutt 6,,,fz-v*4 u,r- AN-GAN Not-my Public mmac,slyla,of xmvyvi� r Iviva-vNi-w 1,O&,STwM--OxLy. mvnv yori�,&NmfIt}y" Fvft-.pt ........................... On th,. dayd ir1 aw Y= Wfbn�11jr,the ural ln-A - -d -nally qqp��cd On the day of in The yC-4 I _Rnt: _pzNt. tvr=Ine,thv unA--viKMvL p2rSwally Oppeacd ibe Sahwrilka Miness to the f=gcke WWI-AiRan 1:11, ��6nauy tving by 17-P-*duty w"IML ced dc�,Xnw aw permvjally Wwn to nic or pmved.to cron the 4y thM K-AhMMy m4du;sl in ' W %Wn irmwmat to isle that WA-A' ex iw &x mnia in dra biT hi.',W' dlik,,I" tin *bail of Ile.ini-fividLW(s)nzwd,mom.cd 6c iminin-wri,ziid n" fo-mr-Ong, nz&suis uppvolvim lidwe the urytkir-ip-d in die thal 496 ag nimss, P%-=I and raw tau -zA'wxc,theh1as d that s rldf its s th--sme,&wb whwnN, 4 • j IftZb-cirn X&)con M. euct �VLAIRY 01 0 WOOL Ow. Y&Tcivv:� SOUTHOLD 77nand -Ti NSV MANCE lbOM1 I ou '0 faci 11 IT p MAW 952 0 '79, IYestcor Lanit Title Insurance Company SCHEDULE A DESCRIPTION OF PRE,MISES Title No. SP45016-S ALL fl-ial certain plot piece gar parcel of land, .Kith the buildings and improvement's thereon=,Dted situate, lying and being in the Town of Southold,County of Suffolk and State of New York,bounded and dcsciibed as follows: BBGINI',,TKG at a point on the-easterly side of South Harbor Road, distant 952 feet,marc or less,southerly from the corner formed by the intersection of said easterly side of South Harbor Road yvith the southerly side of Himvaaha's Patb; RUNMING THENCE easterly and southeasterly, along-the southwesterly side of a o�rtain right of way along lands now or formerly of John B. Pearson,the following mro courses and distances: I" Easterly, along a curve bcaving to the right with a radius of 6.10 feet, a distance of 13.76 feet.- 2. South 34 degrees 07 minutes 36 seconds East 151.27 feet TTIETZICE southerly,along he %vasterly side oflandsnow orflibmierly of William-J. Jones, South 29 degices 48 'Minutes 50 seconds West 107.93 feet; THENCE northerly and westerly,slung the northeasmrly side of lands now or formerly af Jucqueline A. Jones, The follouring three courses and distfaices: I. North 73 degrees 20 minutes 00 seconds West 35.86 feet; 2. North 23 degrees:48 minute's 10 seconds',NVest 54.00 fcct; 3. North 73 degrees 20 minutes-00 seconds West 31.75 fect to a point on the easterly side of South Harbor Road; THEN CE'noitherly,Mang the eastcrly side of South Harbor Road, Nurth 16 degrees 40 minutcs. 00 seeonds,East 15497 feet to the point or plate of BEGIS EIG. r, N'q omy TOG MI ER'4i 1:1411 Ii thL ti 13 z ani!ffitvw of miy®}'ax awmm c-r.i.,ar.6 w t ht tr--j tying in L4e mre--I in#Irmt of sad g6jPininj f;Did pjvon)� - DESCRIPTION EN-CONSULTANTS i 1 1� V pril 29, 2021 Glenn Goldsmith, President APR 3 0 2021 Board of Trustees Town of Southold southr�ld Tavrn P.O. Box 1179 Board of Trustees Southold,NY 11971 Re: Barry& Caitlin O'Connell,4405 South Harbor Road, Southold; SCTM 1000-87-1-6.3 Dear Mr. Goldsmith: We represent Barry and Caitlin O'Connell, who are proposing to construct a swimming pool and pool house and install an upgraded sanitary system on the captioned property, as depicted on the enclosed survey/site plan prepared by Kenneth M. Woychuk Land Surveying, PLLC, dated April 28, 2021. As the entire property is located more than 100 feet from the boundary of offsite tidal wetlands to the northeast and is thus situated 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. Because the property is also separated from the offsite wetlands by Old Wood Path, it may also be located beyond Trustee jurisdiction pursuant to §275-4(A)(1)(m) of the Town Code, but I am unable to- determine odetermine whether Old Wood Path is a public,road. In support of our request, enclosed with the above referenced site plan are site photographs taken on February 10, 2021; 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. Respe fully yours, Robert t Herrmann, Coastal Management Specialist Enclosures 1319 North Sea Road I Southampton,New York 11968 1 p 631.283.6360 1 f 631283.6136 www.enconsultants.com environmental consulting Board of Trustees Application AUTHOPJZATION (Where the applicant is not the owner) I/We, Barry O'Connell owners of the property identified as SCTM# 1000- 87-1-6 3 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. N/A Property Owner's Signature Property Owner's Signature Barry O'Connell SWORN TO BEFORE ME THIS 2 DAY OF February 20 21 LISA MEINERO Notary Public-State of Florida AMCommission#GG970633 O` cvT @ Expires on April 4,2024 Notary Public '%„F Notarized online using audio-video communication Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I/We, Cafthn O'Connell owners of the property identified as SCTM# 1000- 87-1-6 3 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. G:��GGGI:!/lli dl3B�X/!� N/A Property Owner's Signature Property Owner's Signature Caitlin O'Connell SWORN TO BEFORE ME THIS 2 DAY OF February 20 21 _ Rrll loi�� LISA MEtNERO o i� Notary Public-State of Florida 2 n otary Public Lisa Meinero = Cornrnl551on#GG970633 Expires on April 4,2024 Notarized online using audio-video communication Board of Trustees Application AFFIDAVIT Barry O'Connell 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 BOARD OF 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, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. rY G.-a.,A.AV l� N/A Signature of Property Owner Signature of Property Owner Barry O'Connell SWORN TO BEFORE ME THIS 2 DAY OF February 320 21 apQQAtlMun USAMEINERO Notary Public -�9 9t/'_ Notary Public-State of Florida Commission#GG970635 o ��'POF FLo4�a �­on AMI 4 2024 ivniuipinuaaa Notarized online using audio-video communication Board of Trustees Application AFFIDAVIT Caitlin O'Connell 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 BOARD OF 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,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. 4w& N/A Signature of Property Owner Signature of Property Owner Cartlm O'Connell SWORN TO BEFORE ME THIS 2 DAY OF February $20 21 \ lgYIIP��6� LISA MEINERO OtP B i Notary public-State of Florida _ ¢ Commission#GG970633 Notary Public Lisa Meinero =9r0. ,� Expires on Apra 42024 Notarized online using audio-video communication 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 ournose 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: O'Connell,Barry (Last name,first name,griddle 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,rrlarriage,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 t 2 da of February 20 21 Signature "3� t�Gs-tiZV Print Name Barry O'Connell Form TS 1 APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL.DISCLOSURE FORINT The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this farm 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: O'Connell,Caitlin (Last name,first name,ipiddle 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 X YES NO 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 2--day of February 20 21 Signature G'�zL�LUiJti aY: � Print Name Caitlin O'Connell Form TS 1 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. HPrnriann, Rnbprl�E, (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 27th d of April 20 2L Signature Print Name o E- 0222. Hert�ann Form TS 1