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HomeMy WebLinkAboutWexler, Donna (2) I Glenn Goldsmith,President so Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President O P.O. Box 1179 Eric Sepenoski Southold,New York 11971 Liz Gillooly G • Q Telephone(631) 765-1892 Elizabeth Peeples �`0 Fax(631) 765-6641 �yOWN,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 2 epcivis �3 ulo ryni+k-eA cv� 2 I,20 23 C1e P i C-� S i✓10�.Le a �A%4'� O4ev- U tic 5�► -�'aa'F' r,1•� -� e r Ch 27 C . � �e r�����`a�s �� -�,►; s CIS � � S►�,. I1 oar re f ✓"2, Q. �r rM�-+- -�ir -- e. -� �(a-LAJ '. IMCc.C ctrl J<MIvn 4A-1 G,v1 Vt 6la h� Sot+W- e 'I ccd(eA Va6er� �vjkv-sov) ib c L. z Glenn Goldsmith, President ,e�®f S0 Town Hall Annex A. Nicholas Krupski,Vice President ®amu ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski4 Southold,New York 11971 Liz Gillooly CA Elizabeth Peeples ® Telephone(631) 765-1892 a Fax(631) 765-6641 C®UNT1,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD NON-JURISDICTION INSPECTION DATE OF INSPECTION: w INSPECTED BY: o k6c) Ch. 275 Ch. 111 COMMENTS: 2ert- i S ly cls Ld 0 \)_er a. Y M6 OA J 1 G C` `dv► rbc �c� 6e- Sy w eci -fo rz,SAte— le �eiocir�Cl Ivi o3e t,-25-,.2---) 5avr ovq aF, too jor-5 e � 6d.&rSM. are no�, s no+ 6e �6f- ad m�n ;s A is d wes��.%(. ( a VrQL (1)UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW.(2)DISTANCES SHOWN HEREON FROM PROPERTY LINES TO EXISTING STRUCTURES ARE FOR A SPECIFIC PURPOIE AND ARE NOT TO RE USED TO ESTABLISH PROPERTY LINES OR FOR ERECTION OF FENCES.(3)COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURYEYWS INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. 4 CERTIFICATION INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON,AND TO THE ASSIGNEES OF THE LENDING NSTITUTION.CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS (S)THE LOCATION OF WELLS(W),SEPTIC TANKS(ST)h CESSPOOLS(CP)SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. 400 Ostrander Avenue, Riverhead, New York 11-1ol tel. 631.727.2303 fax. 631.727.0144 odmineyoungengineering.com Howard N. Young, Land Surveyor Thomas 0. wolpert, Professional Engineer t Douglas E. Adams, Professional Engineer 3, Robert C. Tost, Architect SITE DATA S LOTAI AREA 25,202 50. FT. +1s.as INF-5 - HIL + 'R(s A D LOT 2 AREA = Ict,g51 50. FT. � 1 T-T J� I� l'� +12.95 - ' - - - - - - - _ _ _ _ WATER MAIN '� 5UBDIVI510N - "MAP OF GALVE5 NECK" FILED IN THE OFFICE 16.41 588052'40"E /i3.74 256\ O' - r - - - - - - - - - OF THE CLERK OF 5UFFOLK COUNTY ON FEB. 15, IR?2 A5 FILE ... .___....... � -- u 12.52 NO. 5675. SLATE WALL WMR O LIL IB \ WV . - - 1 .03 13.74 GMF - - - - 13.77 13,92 I vERTICAL DATUM = NAV DATUM (I0188) y \ 15.68+ 1 6.00' I 14.79 Pr,NAIL I 1 100.00' 1 \SET IN WALL - I SGTM.NO. 1000-70-4-22 D SCTM NO. 1 O 1000-?0-4-25' I O Lot I I o I "Calves Neck" 15.09 1 + 4p ' O ' +4.37 O 1429+M I 51 6 LOt 2 ' i CTl +16.2 . 9� I I "Calves Neck" I 14.71 � a1 i I Tr i 1 14.6 . 1 ti� y�pOp � Ve I , 1 4.25 ��4IGlc �S14.36I;✓;� 16.8200 14.48 FFL cGIG + + / 3_ N * SURVEYORS GA 9E�^9R TIFIGATIO- N 0 )496 . � 107 al 14.21 '+10.11 13.5 73+ 8 7.55 9.95 3.52 YE HEREBY CERTIFY TO DONNA WEXLER THAT T H15 5URVEY ps GF wA5 PREPARED IN ACCORDANCE WITH THE CODE OF PRACTICE o 1 + .43 \k.\' N 1 I O _N (1 - 0 FOR LAND 5URvEY5 ADOPTED BY THE NEW YORK 5TATE 113.7s O 12 sl fl N cT A55OCIATION OF PROFE55IONAL LAND 5URVEYOR5. k 1 .os 9.77 \ 1 Ul O + BRICK WAL T��1\'( +13.26 0 10.10 \O K 1 12.15 i '0, U1 3 JE t 14� ' Oi t N �12� \ 1 I "01, FFL 7 \ 10.24_ 1 `^�:e--'t� ��✓.�a U\ \ ' \ 13.57 \5 � \ o' 1 5+8.4 10, � (\ O�a!' k� � r, Cr. �f•. 7.82 \ 9.97 -1-9.96 +11.07 I iw FRAp P�� /j +s.sa 891 _ / 110.23 �` �0 °. bA N, PROPO5ED CONDITIONED 6 10.14 s '� S% o/ 0.04 \ 10.221 '� ;B�° \4�5z ' _SPACE OVER EXISTING DECK _ 2' �6 O � s�QQ O 00 a6% 8.30+ \+ j Sao' o\z� BFIL \ ✓ BFL �,\c .90 i , S +8.79 I .9 10_ o9 -6. 1-- M r, + u' 45g� ' 6.83 k26'Ro 6 HOWARD w. YOUNG, ". .5. L.S. . 458-13 t A N D ptP�/ \pG 8.22/i O I a/ ; Po +6.41 N s � 7,04 6.66 I +6.49 SURREY FOR -__-P- ' 8 15 MAG NAIL 2nd STORYPADD�TION i/ IecpC$ - --- -_T -T=-- ------ ---- � DONNA r EXLER I b�0.00 +5.03 JOCKEY GREEK SHED 05 15 ag°52'4o"E � "DREDGED CANAL" LOTS 1 4 2, "MAP OF CALVES NECK" 6.05 }7.51. y(T \F ' 1_ /p E e ET i o \ �; - l o at Southold, Town of Southold 6.52 -- 62 -; - Suffolk County, New York V-sn yT 5.9D o , 4.88+ v o N86 51 20"W `LF 123.32' MA&NAIL - -- V Q m " SET SU I LD I NG PERMIT SURVEY 0 , Z now or formerly / 1000 70 04 22 Mebus Qualified PersonalCounty Tax Map District 1000 Section -10 Block 04 Lot 25 Residence Trust # II - now or formerly Patrick H. Maloney � FIELD 5URVEY COMPLETED MAR. 02, 2022 a LEGEND �� Carol Lynn Maloney MAP PREPARED / Record of Revisions MAR. 03, 2022 CC =CONCRETE CURB CIC =CAST IRON COVER REVISION PATE CLF =CHAIN LINK FENCE AMENDED BUILDING PERMIT DATA _OST. 26,2022 CMF =CONCRETE MONUMENT FOUND AMENDED BUILDING PERMIT DATA NOV. 18, 2Q= CM5 =CONCRETE MONUMENT SET DI =DRAINAGE INLET OL =ON PROPERTY LINE N g PVCF =PVC FENCE SANITARY MEASUREMENT5 WSF =WOOD STAKE FOUND WSS =WOOD STAKE SET A $ DO WMR = WATER METER 30 O 15 30 60 -1O WV =WATER VALVE 5T 20.51 32' 0 227 =UTILITY POLE LPI 30' 45.5' SGAIe: I'I = 30' • =END OF DIRECTION/DISTANCE LP2 55' 55' JOB NO. 2022-0035 DWG. 2015_0064_2022_0035_bp I OF I Suffolk Environmental Consulting, Inc. Newman Village Suite_E2310 Main Street PO Box 2003 ® Bridgehampton NY 11932-2003 ;l t 6� '5160 f 631537.5291 Bruce Anderson,M.S.,President :: °HAND DELIV RED February 151h, 2023 - Board of Trustees J Town of Southold P.O. Box 1179 Southold, NY 11971 y-� ','."`! - '`�� !`` FEB 2 1 2023 RE: WEXLER Property Re u st for N Letter Situate: 1175 West Hill Road - Sout ;` 11971 SCTM#: 1000-070.00-04.00-022.000 Dear Members of the Board, As per your instructions via email, please find a revised site plan prepared by MICHAEL HAND, last dated February 15th, 2023, which omits the proposal of 'f _ conditioned living space above the existing seaward deck. Thank you for your time and consideration regarding this matter. Kindly issue the requested Non-Jurisdiction Letter at your earliest opportunity. Yours Truly, Robert W. Anderson (enc.) C.c. D. Wexler T. Quarty SITE DATA: SCTM # 1000-70-4-22 DESCRIPTION: SQ. FT.AREA: LOT COVERAGE: EXCAVATE: FILL: PROPERTY: 43198.8 SQ,FT. PROPERTY WETLANDS: 1363.0 SQ.FT. BUILDABLE LAND: 41835.8 SQ.FT. ESTIMATED AREA OF 12,000 SQ.FT. GROUND DISTURBANCE: 1N-!� � EXISTING HOUSE: 2080.0 SQ.FT 5.0 5 EXISTING PORCH/DECK: 722.0 SQ,FT. 1.7% EXISTING ACCESSORY BLDG. 748.8 SQ.FT. 1.8% TOTAL: 3550.8 SQ.FT. 8.5% METES AND BOUNDS BY: YOUNG AND YOUNG 10/18/2017 �o 00 - O ./ 40 00 OCkEY .(/_83 C) _ �0� •---------------- --------+ O `���PO / - - - _ ' C) ONE- - - - - - ZONE 4E CEL 8) v t i ZONE x - - a o i0 i0o Cy �, ' R 1 TZ 2 ZONE 4Z a-0• „F 1� - , , - ' W ZONE X Iz 1, 42.5' .66.7' W EXISTING DECK `6 c 3 / f $ � t 23.9' O w v o i 32.5' i iN m PROPOSED 5, ! 2ND STY ' 6 / N . .12.6' ...:N � ��c P 0 g ; ADDITION 0 t i A UJ A AREA GRADE TO TOP OF FINISHED fLOOft 13241 SF 10.0116— j •/ �Q�� P PERIMETER TOTAL LINIALFOOTAGE zeR.7' EXISTING 1 STY HOUSE �+'��� / \ ��0� Q L /?- - t �--� O -oo e57'AVG HT(GRADE TO TOP FINISHED FLOOR) - DEVELOPED � W e PUBLIC WATE .G I \ V oo 28.7' \ e ' 428' / \ — J �4 n SILT FENCE O 4 I (TYPICAL) \ \ F-10/ p� �'_I 0 cp CE) b \ .xsnrz rirvisrvEe riaos 16311 nxen oni,rsono F,.IF o Z1L ' FEB 2 1 2023' GRADE PLANE CALCULATION SILT FENCE I (TYPICAL) L EXISTING- ACCESSORY - / BUILDING cl / , Q� t / UNDEVELOPED O / NO WELL o L Ow GRAVEL S ^ DRIVEWAY �L /8 J0 X00 0 / i 0 11 C / (MFR�F w 1000 o' / /9988 �rr oO'�J4z?J I/ / 6Q FJ- 1 CENTRqcCTI o0 .000 (S)TEST HOLE QWM / 9 ' 000 0011 � F m N DRAWN BY: MH �°o � 2/15/2023 SITE PLAN SCALE. 1 - 20-0 O - ,� SCALE: SEE PLAN 3 sQ Fr 1 S T 60001 SHEET NO: DiSalvo, Diane From: Gillooly, Liz Sent: Thursday,January 26, 2023 2:13 PM To: Robert Anderson; DiSalvo, Diane Subject: Re:Office Hours January 18th, 2023 Follow Up Flag: Follow up Flag Status: Flagged Robert, If you remove the section that is located over the deck and limit the addition to over designated living structure, it would be exempt. If the first floor or foundation needs to be reconstructed to support the addition,this activity would not be.exempt from Trustee review. Please resubmit and verify that the first floor and foundation will not need to be rebuilt to qualify for a letter of NJ. We will not require an additional fee at this time. Best, Liz From: Robert Anderson<robert@suffolkenvironmental.com> Sent:Wednesday,January 25, 2023 11:51:11 AM To: DiSalvo, Diane Cc:Gillooly, Liz Subject: Re: Office Hours January 18th, 2023 Thank you so much, I am speaking with the owner to reduce the proposed addition so that it is no longer located above the existing deck. I will submit revised plans ASAP in hopes for a new determination.Will this require an additional fee? Please advise. Robert On Wed,Jan 25, 2023 at 8:46 AM DiSalvo, Diane<diane.disalvo@town.southold.nv.us>wrote: Attached please find field notes of Trustee Gillooly relative to your request for a NJ Letter for 1175 West Hill Road, Southold. p�ane r iLSPLvo of face�tss�stawt i 1 5outnoLc Towv,Trustees P.o. gox 225 Suffolk Environmental Consulting, Inc. Newman Village . Suite E ® 2310 Main Street PO Box 2003 ® Bridgehampton NY 11932-2003 t 631.537.5160 Q f 631.537.5291 Bruce Anderson,M.S.,President HAND DELIVERED February 6th, 2023 Board of Trustees Town of Southold P.O. Box 1179 Southold, NY 11971 RE: WEXLER Property—Request for NJ Letter Situate: 1175 West Hill Road • Southold, NY • 11971 SCTM#: 1000—070.00—04.00 —022.000 Dear Members of the Board, As per your instructions via email, please find a revised site plan prepared by MICHAEL HAND, last dated January 31St, 2023, which omits the proposal of conditioned living space above the existing seaward deck. Thank you for your time and consideration regarding this matter. Kindly issue the requested Non-Jurisdiction Letter at your earliest opportunity. Yours Truly, Robert W. Anderson (enc.) 3 I FEB 7 2023 ap C.c. D. Wexler T. Quarty SITE DATA: SCTM # 1000-70-4-22 DESCRIPTION: SQ. FT.AREA: LOT COVERAGE: EXCAVATE: FILL: PROPERTY: 43198.8 SQ.FT. PROPERTY WETLANDS: 1363.0 SQ,FT. BUILDABLE LAND: 41835.8 SQ.FT. ESTIMATED AREA OF +/-12,000 SQ.FT. GROUND DISTURBANCE: EXISTING HOUSE: 2080 SQ.FT. 5.0% EXISTING PORCH/DECK: 722.0 SQ.FT 1.7% EXISTING ACCESSORY BLDG. 748.8 SQ.FT. 1.8% DRIVEWAY AREA:2000 SQ.FT. PROPOSED ADDITION: 27.0 SQ.FT 0.1% 15 CU.YD. 8 CU.YD. AT 100%WATER RUNOFF:334 CU.FT. (2-RAIN/HR.) PROVIDE(2)8'DIA.X 4'DEEP DRYWELLS PROPOSED PORCH: 18.0 SQ.FT 0.1% 8 CU.YD. 4 CU.YD. TOTAL DRYWELLS CAPACITY:338 CU.FT. 2 HOUSE ROOF AREA:3855 SQ.FT. A/ PROPOSED DRYWELLS: 6-8'dia 4'deep - 30 CU.YD. 15 CU.YD. AT 100%WATER RUNOFF:644 CU.FT. 111 (2-RAIN/HR.) tki PROVIDE(4)8'DIA.X 4'DEEP DRYWELLS /'vTOTAL DRYWELLS CAPACITY'.676 CU.FT Co - 0 TOTAL: 3595.8 SQ.FT 8.7% 53 CU.YD. 27 CU.YD. ,N8,40,, ' NOTES: OGEEGUTTER-STANDARD 5" 0� O joC//(' 1' METES AND BOUNDS BY: YOUNG AND YOUNG 10/18/2017 1).EXECUTION: O� rsv "`6Y CO A).DO NOT BEGIN INSTALLATION UNTIL SUBSTRATES HAVE BEEN PROPERLY PREPARED. , ��� 2).PREPARATION: r^ SPO / A).CLEAN SURFACE THOROUGHLY PRIOR TO INSTALLATION. "/ B). PREPARE SURFACES USING METHODS RECOMMENDED BY THE MANUFACTURE FOR ACHIEVING THE BEST RESULTS FOR THE SUBSTRATE UNDER THE PROJECT CONDITIONS. Q. PAINT CONCEALED METAL SURFACES AND SURFACES IN CONTACT WITH DISSIMILAR METALS WITH PROTECTIVE BACKING PAINT. 1Z 3.INSTALLATION: A).PERFORM WORK IN ACCORDANCE WITH CDA HANDBOOK AND THE DRAWINGS. Vu• 1).GUTTER TO BE PITCHED TOWARDS LEADER 1-TO 2"FOR EVERY 4(r OF RUN. 2).SHEET METAL JOIN LENGTHS WITH WATERTIGHT JOINTS, O Z0 a).COPPER/LEAD:FLASH AND SOLDER GUTTERS TO DOWNSPOUTS AND Q B)ALUMINUM: LU ACCINUMRRIVET S. AND CAULK WITH A BUM SEALANT SLIP JOINT Q S / / _ - - _ _ ZONE 3).CONNECT DOWNSPOUTS TO STORM SEWER SYSTEM AS INDICATED.SEAL '4 SEL $) CONNECTION WATERTIGHT. O• / / Z&N DRY WELLS TO BE 10'MIN. 4).PROTECTION: O as AWAY FROM HOUSE A).PROTECT INSTALLED PRODUCTS UNTIL COMPLETION OF PROJECT. N �- 8).TOUCH-UP,REPAIR OR REPLACE DAMAGED PRODUCTS BEFORE SUBSTANTIALZ N£ '4E S COMPLETION. _ _ .- �� - ,�► ' '� - �� ZON - � ZX 121, 42.5' 66.BO 1, .661, i EXISTING DECK 16 zn ♦ - / I / i N 23N ` I ►�1 I_ .9' t� 32.5' EONCRET`E �N PROPOSED MIASHOUTI Z n/ 1 2ND STY ♦ / I 6 5 / O I / 1 .6' ADDITION F, 2 R t I :.-. 10.0' EXISTING 1 STY HOUSE yp0 A vi USLIC UJATE 28.7' W a 1 .6' 3. ' / m r ' ' PROPOSED �� , ` /` ' SILT FENCE 8 X4 / ( DW I 1 STY ADDITION 4 _ I (TYPICAL) O ` ADW / r1 O $z SILT FENCE (TYPICAL) / 1 - 1 \ / 22.5' ---------- - -- CIONCRETE 1 1 TOP SOIL 1 ♦ / 1 1 _ �6 �� AASHOUT/ ` LOCATION ♦ EXISTING- - � ♦ / / ACCESSORY -�=� BUILDING 1 /8'X4` UNDEVELOPED O / NO WELL O� DW 0� / - - /8'X4'` / DW � I � Oy / ♦ _ I 8' r / i r A AREA GRADE TO TOP OF FINISHED FLOOR 1114.1111 P PERIMETER TOTAL LIN IAL FOOTAGE 233.7' aOOwe P 5.7'AVG HT(GRADE TO TOP OF FINISHED FLOOR) / o � GRAVEL m o J 900 RIVEWAY a § 00 00 ro SSM #100 01;10 /1000./0 1968 OA' �T y1ooa-1242 L O � SQ Rr \♦ C NSTRUC / `a .xenror7 fNrRgNCT/ Q O `C 00 00 / (S TEST HOLE gaff � 0 na"co r�on�s3sr .nrarorwunEorwav Hess S 9 QWM / ' 0001 11 , GRADE PLANE CALCULATION 00 F . DRAWN BY: MH If SITE PLAN �0 1/31/2023 � r O SCALE. 1" = 20'-0" O - SCALE: SEE PLAN z3 o6�p�Rr t R�To 6000/ SHEET NO: FEB 7 2023 Suffolk Environmental Consulting, Inc. Newman Village ® Suite E e 2310 Main Street PO Box 2003 ® Bridgehampton NY 11932-2003 t 631.537.5160 f 631.537.5291 Bruce Anderson,M.S.,President December 21, 2022 Board of Trustees Town of Southold P.O. Box 1179 Southold, NY 11971 RE: Wexler Property—Proposed within footprint house addition Situate: 1175 West Hill Road • Southold, NY • 11948 SCTM#: 1000 Dear members of the Board, This Firm represents the Owner of the subject parcel, who is to renovate and construct a second story addition all within the footprint of the existing dwelling. I believe the proposed renovations and second story additions within the footprint of the existing dwelling qualify as an Exception pursuant to §275-4 (A) (j) of the Town Code. Accordingly, a Letter of No- Jurisdiction is requested. Enclosed herewith, please find the following application materials: 1. Authorization executed by the property owner; and 2. Survey prepared by Young and Young, Surveyors last dated November 18, 2022 (four copies) Thank you for your time and consideration regarding this request. Should you have any questions or concerns pertaining to this matter, please feel free to reach out to this Office at any time. Yours truly, Robert W. AndersonD E 0 E I. P „ §f� enc. � - .. . OEC 2 2 2022 Ei ilidlalu Rim C.C. D. Wexler Board ofrrusten Suffolk Environmental Consulting, Inc. Newman Village . Suite E a 2310 Main Street PO Box 2003 o Bridgehampton NY 11932-2003 t 631.537.5160 f 631.537.5291 Bruce Anderson,M.S.,President HAND DELIVERED D Er C E 0 Id E December 21, 2022 JAN 1 a 223 Board of Trustees Southold Town-- 10 Town of Southold Board of Trustees P.O. Box 1179 Southold, NY 11971 RE: WEXLER Property—Authorizations and Signings Situate: 1175 West Hill Road • Southold, NY • 11948 SCTM#: 1000—70.00 —4.00—023.000 Dear members of the Board, As per your instructions please find the applicants Open Government Disclosure Form and Owners Authorization, attached herewith. Thank you for your time and consideration regarding this request. Should you have any questions or concerns pertaining to this matter, please do not hesitate to contact this Office. Yours Truly, Robert W. Anderson (enc.) L Board of Trustees Application County of Suffolk State of New York Donna Wexler 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 AGENTS) OR REPRESENTATIVES(S),,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. Signature(s) SWORN TO BEFORE ME THIS O DAY OF �A ,20 2I otaryPublic MATTHEW D. IVANS NOTARY PUBLIC-STATE OF NEW YORK No.01 IV6053859 Qualified in Suffolk County My Commission Expires 01-22-t*119 � W, Di X08 22,06:38a --.-Arty Construction 16317659301 p,1 i Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, Donna Wexler residing at 1175 Hill,Road.West, Southold,NY . 11971 do hereby authorize Suffolk Environmental Consultipg,.lnc. To apply for permit(s)or letter of non-jurisdiction from the Southold Board of Town Trustees on our behalf. Donna Wexler i. I/ Y' APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The T wn of Southold's Code of Ethics prohibits.can flkLs of interest<on_the part.of the town officers,and emnlovem The;purpose of this form)s,t�_�{�vid ipfa at' n w �tt alart the town of_possihle.conflicts,,of intzrgst acid it o„w i!to take-whatever action is necessam to avoid sain YOUR NAME: WEXLE&DONNA (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 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?.' 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 applicantlagent/representative)and the town officer or-employee.Either check 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 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 MATTHEW D. IVANS NOTARY PUBLIC-STATE OF NEW YORK No.011V6053869 Submitted this �� day of� v 2QZ3 Qualified in Suffolk County Signature My Commission Expires 0.1-22-IJIM print name DONNA WEXLER 2C)W� Form TS 1 i' e' P i - a MEMO •t. TO: Elizabeth Cantrell, Sr. Clerk Typist FROM: Robert Anderson DATE: December 22nd, 2022 Re: WEXLER Property-Application Fee Situate: 1175 West Hill Road ■ Southold,NY■ 11971 SCTM#: 1000-070.00-04-22 &24 MESSAGE: Hi Liz, M °`. As per your instructions, please find a check made payable to the Town of Southold in the Z x amount of fifty dollars ($50.00), in satisfaction of the requisite application fee for o Jurisdictional Inquiry. H � Z Let me know if you need any additional information regarding this request. Cn . . z � • ° Best, O a IVE P D M ~ DEC 2 7 2022 N Sot�;ie'; ;ens Board of Trus'ces, ■ o 7 f M 3 � y M .A -0497 SEE SEC.Na 083 4Ry MATCN ..__— _LINE _ 0yz� naTCH- -___ __,me- d,. VV�� � 3a No. 4t c# •® �l 1 � dd f C WEST HILL RD. (m'B / { F t.Wc) Town Creek ,sa 2Wo 0,.mo, O z x z13 = ` o bm A r eP` a i Y u e q S 3' 2 ^m. ;4� J •, n r-I Torm of souTNDln 0&1001 m _ 2 a• _•. t ,• NECK 2Z� Y fl8 5 m 232 \ p6t2N �C• w'7�u fi9my '•10tl i T SOUIHOLIT SCMOOLD,SIRICTNOS 2 au �PG •b,m,Ra-,a �^F M1 tB )r r `.\ l"' 4 P G9 152A — w /. 'al T � 00803 •68�a e u h a°" P b "e 9 \ e x . rl °ammo.°°° $ JASwNEw 1a ,Bm^ e 3 •p.°°' � "� - ., 4�\�' �=�-^ r'-'> / �/ 3-5 ;001-—12 06 S 10 ® M1 . 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