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HomeMy WebLinkAboutMcGoldrick, Neil & Amy Glenn Goldsmith,President 4'��� COGy Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 Eric Sepenoskico" ? P.O.Box 1179 Liz Gillooly �y • O���t Southold,NY 11971 Elizabeth Peeples ��1 ,� Y Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report , l Date/Time: I Completed in field by: f,SM 1 David Bergen on behalf of NEIL & AMY McGOLDRICK requests a Pre-Submission Inspection to discuss a proposed jetty replacement. Located: 1671 Meadow Beach Lane, Mattituck. SCTM# 1000-116-4-16.4 Typ5 of area to be impacted: Saltwater Wetland Freshwater Wetland Sound ✓Bay Part of Town Code proposed work falls under: -­-�Chapt. 275 Chapt. 111 other Type of Application: Wetland - �Qoastal Erosion Amendment Administrative Emergency ✓ Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: Present Were: V G. Goldsmith ✓ N. Kr pski E. Sepenoski L. Gillooly E. Peeples 40 46 Box 1008 Cutchogue, NY. 11935 October 20, 2023 Southold Town Trustees Southold Town Annex Box 1179 Southold, NY. 11971 Ref: McGoldrick Presubmission Request Dear Trustees, 16 71 ;26APOY) C6 I am requesting a presubmission conference for a proposed jetty replacement at the property of Neil and Amy McGoldrick, SCTM 1000-116.-4-16.4. We are requesting confirmation that the existing jetty which protects the mouth of Halls Creek meets your minimum requirements for replacement so that the McGoldricks can proceed forward with a formal wetland application. Also enclosed is a check for$150. Please let me know when the conference is scheduled for. You may contact me at davebergen78@gmaii.com or 516-848-6438. Thank you for your consideration of this request. Sincerely, Lid Bergen, ent for Neil and Amy cGoldrick 2023 C 2 OCT � S,^.Lrd'IJ cv,r Board a"ms eas AUTHORIZATION (Where the applicant is not the owner) j 6--c- owners :ryowners of the property identified as SCTM# 1000- 1 16' `i in the town of u • '��� f` ,New York,hereby-authorizes _���• d. G <�_L'y 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. PropertyOwner's Signa e Prerty er's Signature SWORN TO BEFORE ME THIS 20 DAY OF Cb4 ,20 Z No Public GREGORY r.RAPHAEL ' Notary Public,Stated Ptet wyk No.4889763 Qualified in Nassau Caary Commission Expires March 23, ZpL 3 AFFIDAVIT + A ekq tnC6-, BEING DULY SWORN DEPOSES AND AFFIRMS THA HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO TM BEST OF HIS/HER KNONVLEDGE 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 GRAIN-TED. 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 CONDITIOINT OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Ile _ //AD'c Signature of Property er i e operty Owner SWORN TO BEFORE ME THIS Zo ' DAY OF co, ,20 *public GREGORY-l.RAPHAEL O h� Wary Public,State of New"'ZA No.d8897G3 auciffled in Nassau county y�G � commission Expires Match 23,IW.20 y 3 'PZ ICSIAGEi 1JRE- RES IFIL 1-1 TRANSACTIONAL DISCLOSE FORM The Tower of Southold's Coda of Ethics rrrobr'bits conflic—t,of interer-t an the Hart of tarvn officers and emnlovees The se of this form is to rovide inforFnation which can alert tile town of ssible conflicts of ihpmvst and allow it to take whatever action is nerssary to avoid same. vOUNAN inn `G� ��:. t� z ' M `C«� � �_•l� .-►1 (Last naFme,fiist name, . dle initial, --you=applyitsg id the name or-,- Someone rsomeone else or oilier entity,such as a company-if so;indicate the_other. peason'-s or company's name.) NA-,,,M OF APPLICA'I SON: (Check all that apply.) Ta.,grievance Building variance Trustee k. Change ofZone Coastal Erosion Approval of plat Irioorins Exemption from plat or official map PIanning Other (If"Other',name the activity-) Do you personally(orthrough your company,spouse,sibling,parent;or child)have a relationship-with any officer or employee of the Towns of Southold? =Relationship"includes by blood,nlarriage,orbrrsmess iAteres#-'Business interest'means o business, including a partnership,in which the town officer or employee has even a partial ownership of{or emnlo}ment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO Ifyou ans%vered"YES",complete the balance of this form and date and sign where indicated. blame of person employed by the Town of Southold Title or position o€that person Describe the relationship between yourself(the applicantlag+intlrepresentative)and the town officer or employee.Either check the appropriate lire 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#fiat 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-corpomts entity(wben the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;dr D)the actual applicaant. DESCRIPTION OF RELATIONSHIP Submitted ', f CJG 20 Z�0AJ`�'}�i Signaxure- %j'l% ,S ✓/y f Print Name Form TSI /1Me lb 6G4&,t 26 La LjGtERtd-RA1P APPLICANUAGENUREPRESENTATI VE TRANSACTIONAL DISCLOSURF,FORM The Town ofSouthold's Code of Ethics prohibits conflicts of interest on the oatt of town officers and employees The auroose of this form is to provide information which can alert the town of possible conflicts of interest and allow it 16 take whateveraction is necessary to avoid same. YOURNAME: Bergen, David (Last name,first name,spiddle 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 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.cempany,spouse,sibling,parent,or child)have a rclationship with any officer or employce of the Town of Southold? "Relationship'includes by blood;marriage,or busidess.interest:"Business interest'means a business, including a partnership,in which the town officer or employce_has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than:5%ofthe shares. YES NO n 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 David Bergen Title or position of that person Boat O(JeratOr 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): JJA)the owner of greater than 50/o 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 nonmcorporate entity(when the EIapplicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 2hj ay f OC er 2023 Signature Print Name David Bergefi Foran TS 1 . ' .orAu,4�:RIAI�rISM.',: ,•„1+ .. . w,s,lu1•' trr+o..tt•-rw^.•—• .. 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