HomeMy WebLinkAboutGlassman, Matthew & Heller, Tracy S.C.T.M.# DISTRICT 1000 SECTION 111_-BILOCK 9 LOT 11
t 1
t I
1
o. 1
1
I _ J
� —1
O cn a _
v o -o t
O =7 1 1
-ae O 1 FFFO 1 1
o- pp J 2 STY FRM. 1
t� DWELLING 1
Uri O Iv 1 —J
CDm
tl j ZONE X'1 1 I i, I o ZONE VE(EL 11)
'1 41YaE6
1� 111 1,111 II'l IINII Wjl N
_M I P o
I II Ipli '�
LOT 31 -9 317.50' I j I 11 j
BQ
6 ev+�'eI �Il;Ilil�iilllll',� I �_
S BD
B ? \ I\11'11t111\I``:'\\l )J i� /�
WEE.
N 78o;62D„
6254
54
S CO ,e•oac I �/ ',•MAPLE Irwv/s I I j\\`'\ l`\\I,1 1 1,I 11 I I I
/F\ 6 D, t
�� \ \1i 'II11j1 i,ll
\ \ WE. ® N 1 1111 i t 1 i i I lis
O S e° �� 'I� ,tMnrtE N ,1'1'\11 1 1 1 1 I i 1 G; '•O
,eoA6 a
\ O
,reAK
1' 1. \ gJ o® ,zPi® 1
ZONEX IIII 1o1'I!1'I l LAl I'1, 1'
`` ` 1rPIrvE � I l �\ 1 i , It• I I ��
EL 52.5 45'39
1'',�'1 II 11�'I ltl�i�lltollll 0 1 •� CA
'z 6 \ \` \ \ ` LOT32 , EL 52.9 1I 1d 188,
5.5
,roa` \\ \ \ N8 �11 it 111�IIt11`I\, Il �"
1l � •� \` \`\ \ LOT 33 \-52^',• �I i I 1 1 I'I 1
a \ 11 �8
ea �m \� b
N \\ \\ I o o.a'.
srrGVY .
o
uP. I i 1 i5• � 1 --^ t4.DWE LING \ y\11 i 1 1 111 I'1 ill,I`Ill'`
j.��U i,1•oAx' 7 p� R' •o ,pg995'.
7 5y.'N.Af r0
I �rcoAK, // `� I COH h — 4Y 7 ill ll',i 11 l t i 1 1'1 1'1 1 1 Ell—
o f / C , r I I I I It N E
O i�oRAw A c 11'I'1',11' I111 24.3
� c.� �J 1 6.1`'.'' 1a.6' S? s \\It 111' I`11,I,I1 III � � N
9
1 Il 1 1
d ;I 1 '\ FsroH� ` :g�' �'D•i 11 1 II 1 III 1 111�1111 m
I
ZONE VE(EL 11)
`�c I 20.4' �' xcI'1111i 1�w11; p'111 to '° 4
� co EL 52.3
l
EL 523 1} I
`LONEX N o
1 \�\� _ FEMA FLOOD ZONE BOUNDARY
320 00' ro
62 60 ''ww•ss'oai 1 24'oAK��
/-� OS \ 1 LOT 34
Sig 36-20
u.� \ B
roar 2Y]AI(
LOT COVERAGE
DWELLING:1882 S.F.
COVERED STOOP:135 S.F.
DECK:81 S.F.
ENCLOSED PATIO:312 S.F. I II DECK
BLUFF DECK:165 S.F. I 2STY FRM I
COTTAGE:788 S.F. I
COTTAGE DECK:644 S.F. I GARAGE r—
TOTAL:4007 S.F.or 8.1% I I
I _J
I 1
1 I
2 STY FRM. II DECKI
I DWELLING _J
r--- 1
I
I _J
FEMA MAP N36103C0164H
1 r THE WATER SUPPLY, WELLS ORYWELLS AND CESSPOOL
I _J LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS
__ AND OR DATA OBTAINED FROM OTHERS.
I—_ BUILDABLE LAND(LANDWARD OF TOP OF BLUFF):49,441 S.F.or 1.14 ACRES
AREA:63,621.2 SQ.FT.or 1.46 ACRES ELEVAnON DATUM: NAVD88
UNAUTHORIZED ALTERA7701V OR ADD17ION TO THIS SURVEY IS A WOLA71ON OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY
MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF 70 THE 177LE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS71TU7ION
LISTED HEREON,AND TO THE ASSIGNEES OF THE LENDING INS717U770N•GUARANTEES ARE NOT 7RANSFERABLE.
THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE 57RUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE
NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE CREC71ON OF FENCES.ADDIRONAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS
AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHMCALLY EVIDENT ON THE PREMISES AT THE 77ME OF SURVEY
SURVEY OF:LOTS 32&331NCL. CERTIFIED TO: MATTHEW GLASSMAN;
MAP OF:AMENDED MAP OF NASSAU POINT TRACEY HELLER; EMINENT ABSTRACT,INC.;
FILED:AUGUST 16,1922 No.156 " WESTCOR LAND TITLE INSURANCE COMPANY;
SITUATED AT:NASSAU POINT I('r% y CITIBANK,NA.ISAOA,ATIMA;
TOWN OF:SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC
SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design
P.O. Box 153 Aquebogue, New York 11931
FILE g 223-8q SCALE:1°=30' DATE:JUNE 3,2023 PHONE(631)290-1500 FAX(631)29B-1568
N.Y.S.LISC.NO. 050882
Glenn Goldsmith,President �O��SOFF01,��oGy Town Hall Annex
A.Nicholas Krupski,Vice President > < 54375 Route 25
0
Eric Sepenoski o ,? P.O.Box 1179
Liz Gillooly �y • �� Southold,NY 11971
O
Elizabeth Peeples l �a Telephone,(631)765-1892
Fax(631)765-6641
Southold Town Board of Trustees
Field Inspection Report
Date/Time: 2 L4 Completed infield by: L • ����f�'!
Martin Finnegan, Esq. on behalf of MATTHEW GLASSMAN & TRACY HELLER
requests a Pre-Submission Inspection to discuss the reconstruction of the existing
storm damaged bulkhead, beach house, and decking. Located: 4995 Nassau Point
Road, Cutchogue. SCTM# 1000-111-9-11
Type of area to be impacted:
_Saltwater Wetland Freshwater Wetland Sound X -Bay
Part of Town Code proposed work falls under: Chapt. 275 Chapt. 111 other
Type of Application: Wetland Coastal Erosion Amendment
Administrative Emergency Pre-Submission Violation
Notice of Hearing card posted on property: Yes -No, X Not Applicable
Info needed/Modifications/Conditions/Etc.: Qu I' A Adel o-r-
rC4 2 a
CA 45c+cY' A.r C.V,_
Present Were: G. Goldsmith N. Krupski E. Sepenoski
L. Gillooly yE. Peeples
! ri
FINNEGAN LAW, P.C.
13250 MAIN ROAD
P.O. BOX 1452
MATTITUCK, NEW YORK 11952
(631) 315-6070
MARTIN D. FINNEGAN, ESQ.
MFINNEGAN@NORTHFOKK.LAW
By Hand & Electronic Mail
April 5th, 2024 D E C E J E
Southold Town Trustees APR - 8 2024
Attn: Elizabeth Cantrell
54375 Main Road Southold Town
PO Box 1179 Board of Trustees
Southold, NY 11971
Re: Trustees Pre-Submission Conference
Owner: Tracy Heller and Matthew Glassman
Premises: 4995 Nassau Point Road, Cutchogue, NY 11935
SCTM # 1000-111.00-09.00-011.000
Dear Liz:
This office represents the Owners of the above-referenced property. My
clients are proposing to reconstruct the bulkhead and the beach house that
appear on the attached survey which suffered extensive damage in the recent
storm. In accordance with Section 275-8(A) of the Town Code, we are requesting a
pre-submission conference with the Trustees on Tuesday, April 9th, 2024 to
discuss the proposed construction and obtain feedback from the Trustees in
advance of submitting an application for emergency relief.
Enclosed please find an attorney escrow check in the amount of$150.00
representing the required pre-submission conference fee. The executed Owner's
Authorization and Owner's Affidavit will be provided under separate cover.
Thank you for your attention to this matter.
Very t s
Martin D. Finnegan
MDF/as
Encl.
Board of Trustees App13, Lion
AFFIDAVIT
TRACY HELLER AND MATTHEW GLASSMAN BEING DULY SWORN
DEPOSESAAND 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.
Signa a of Property Owner Signature of Property Owner
TRACY HELLER MATTHEW GLASSMAN
SWORN TO BEFORE ME THIS S DAY OF a Y ,2024
STATE
Notary Public _ ; OF NEW YORK �
NOTARY PUBLIC i
► 5-I ao5
, 0e1C1amry ®N
0 N
�Ss�Q f E oPeR�-
g``\\
Board of Trustees Applii .'ion
AUTHORIZATION
(Where the applicant is not the owner)
UVVe, TRACY HELLER AND MATTHEW GLASSMAN
owners of the property identified as SCTM# 1000-111.00-09.00-011.000 in the town of
SOUTHOLD ,New York,hereby authorizes
MARTIN D. FINNEGAN, ESQ. 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.
zx
Prope Own s Signature Property Owner's Signature
TRACY HELLER MATTHEW GLASSMAN
SWORN TO BEFORE ME THIS DAY OF A prt , 2024
,\G _ly
-SN STATEC-it
OF NEW YORK®(P
Notary Public = i NOTARY Pi
�<, WaG6edMtdavYwkCalrty /N�
%C ry O` 01CH6414253 r;
�I'il-s/oy EXP1V�5����
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Furies prohibits conflicts of intcrest on the Hart of town officers and employees.'life nurnose of
this form is to rLrovidc in'foiinatioir which can alert the town of Wssiblc conflicts of inten;st and allow it to take whatrvcr action is
necessary to avoid same.
YOURNAME: TRACY HELLER AND MATTHEW GLASSMAN-:
(Last name,fii-st narne,jqniddle initial,unless you are applying iri 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 Tie --�-----
Change ofZone Coastal Erosion
Approval ofplat 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 chip!)have a relationship with any officer or employee
ot the Town of Sotthold? "Relationship"includes by blood,Marriage;or business intcrest."Business interest"means a business,
inclriding rt:parinersrij);.in which the town offccr or.cnrployeetas.even a partial oWncrship of(or employment by)a corporation
in.wirich the.town offices or employee owns more Oran 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(die applicant/agcnVrepresentative)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 acorporation);
B)the legal or beneficial owner of any interest in a non-corporate entity(whett the
applicant is not a corporation);
C)an officer,director,partner,or employee of the applicant;or
D)the actual applicant.
DESCRIPTION OF RELATIONSHIP
2024
Submitted this day of h I
Signature �-=
print Name
T LLER
Forrn TS I MATTHEW GLASSMAN
f
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
Tlr�Town of Southolift`Code of f'thias nrofiifiits conflicts o"f iriterc'st oit the riarl of town 8i iccrs and emplovices.,`I'lie iiur�iosG'of
<....
ifiis fomi.isa o mvrdc infoiiriril ion which can alert the-town of v2ss blc.con'flrcls ofantertst and.allow•rtto tale-whatevcr'action is'
ireccssarY'to avoid same.
YoiIRNAME: MARTIN D. FINNEGAN
(Last name;first name,itiddle initial,unless you are applying iii the name of
someone else or other entity,such as a company.If so,indicate.ft.oiher
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,ynu.personally(or tljrough your.company;sppusa,sitilingi-p "icgt;or'cliild)hava n-n:lationship:with Tiny officer or:ccnployee
of the To.Nwrt.of Southold?."Relationship"iricludgs by blood;.nlarriuge;o�business iiiterest "Bucuress interest•meads t�usiticss,.
iricldding a partnership,in which the town officer:or cniployee:ha`s;cven.a partial lets[ p of(or,cmployn�cnt by)a corporation
in which ttie town officer or erirploycc owns more thin'S%.of the shares.
YES NO X_
if,ydu 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(agont/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)tho;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 oivrier of any interest in a non-corporate entity(when the
applicant is not a corp"pration);
C)an officer,director,partner,or employee of the applicant;or
D)the actual applicant.
DESCRIPTION OF RELATIONSHIP
2T 2A
Submitted this
Z D2�
-Sigitatdre -
Print Name A
Form TS 1
p1aaa'�� +-,� -
A
, ,flaa_RaJ_ y / /O v,�:at. a f awY L �'—'_r°'-----'i �. '1/v) .4 �'a 1 \ r�„ .< .a• _.-d �4 ems
D&2455� .•Yr:b�.. t1a�a Aa4EiarD °i 0 • /3u'
arum - _^.\ {` t sz/ i �-1,)`�.`�G/� -I _ _a y :`• ! .n \ '. � '• •,,� / �,,.: •`tir ,.-'� �,.. 1 _
03,BeD �- { �/..� 4uy�i�.".�- rYl�Z R••��•��!b' a +� .! ° •,.L` �L SI \�\`,% , •�A •y)�q\'2�'.a � ac �'g '-��/<j „�• b :s SCp�•' l__./ �.,y, y .pp....� / `,S ) faAlcl��'
Io-zam Y%� °`__ �"I,gia 4, �.�fi£,1,�,.� :''T D' ls,J--.,,, / 5_ -`..s•�'. e;v � :r ��. /"F«.. 1`" .. ro
,x4Tm ' ^✓ 6 s,-'y°�s) rr-6. �.'�.•:. _..;�,, Wi ;:•a.w °°�i ti"�r 9\, a, �a!-\ • 0.5. ., r _ . � '�1t //
/ I2u �° i / ,w ._ !ti. 1 6/ ti• A >. 9 ,., 7 M1a / "r%` .!' '�a�'i '2 /�i
�-liax _ <•'•%r``(" >o19,
B^'�,x err o}A �„ni'_ a :'.: ] R a 1) r,� ro.�N_.c!S,� e +'4 a" •p/ lam d 1, +r= 't ',
.c�°r^�'c� �O 'J'41 _ n 01 \'It $1'}/ }:�1'\, .Qf1 • ,1 i,` J 'v. �V; ,� "a ! ,Cll d
�1�/' � �'`!_��^+`•/�`;�E O°Wlymt_�`�: -��M/.e J n. ! a`c •'.�,.`.�'4.p)� ���i d ' °,. ,p!-.��_ !:�/'`'� ]aµ�,- 9 jj,
Drz°oa ..y�m - .er'. -'.�`-"--�'x_! ti.� � 0 8! �•)e': /...`� Z,:Y •'� F'�
�mo4 . �t ems-- a°� �Yi. a'e �,., � '�'L�..� ., �.�!� •ti\-'\i $� J" �I p'i " �`''?"ti y�1�°% 3 .-�' l
0T.36ee a�
°I '
�1- nM �!� �-_-
N _7 G�'•,1. / , 34 f.%,� !�s:1`}c9--aoT' n ,. 1S
��16 N� °f+A 1 12] /$ I ��•v"R `'�'`,,- 0 NI EM r /�J/ :{ %,..• "!1,` / ' /'/31
y I
o4nnx )F 1 F`K'�.,4 918.A�«.I t•i ��,J-� a. tr L 1. '^-..i t� 4 TTq�U /. ,v 9 /;.,/�' .�„
1M1ta13 9D -' 0 99,, .wlCe' ,_n Na 4 b ° ] 0 1 m° ' ,S'j y•�2i �'`! .v,'N`,a
Int W3 \`' ���•Er+:'-sT iltDel`..�J� +� ° '`!1 •�,J! 1 r z( ` .`t1
. `,`.. M16+ tr,1 Nv 1l ffr'' 'µ�0�: �y, /f`l._i°µ��••�/,• -y ,,
121GIT p 08
tx lose '�-___-t_"— �1t j , wc`J 1°�`'1 •a'� t �4�1��� �/V�l
ial $, °° w an Cn.° ;T
uAil
f�sl /! � � /h e l�a�a',„ ���Six �"M,��r,,.�,9 _ •t/ .tac��'r ''°j• o i o".�
t'-',i
r4 ta^LI -•=�' 11`� �0 _
- - °cc, "e�\r °,w T] l:•`�`\/ a., �,r,w,.��t�I'�"',-t as`o n � 14 w' '�./4/„ °�.,Si'� '',,., `�
' /`t 't� �� Y S 'Ni 1, "" ]l� 1°y 1 .7" t•A1. `',i. �' 11� '6� 1'• ,91,
`q�„ �/e '^/ �5�' ,Sacl ;� � J^ +':h~> a` za'"C n 1.4"- 11' -'- a? /"`� ]��� r• 2_
/ .��� �. ( t��''��..uu.��',,��� ,° `1\\ _ te\ y, i :, .+••� t r} pail, ,t
` } °w ` �+ .v. n `L f o,n~ D'Y, !\� Or/•�'y2 :"°�/� \`—iTat w\-�-d•`i r .%a`.. 24ac1. tfa/,ra I1 lz`��eCr` U'}l� ____ - _
dJ' 1'E `E �,i/J, ,2\b ',t ,y 1TA \ �5:a'1y/��' �.�' � �Sk .•C]
� )/.mow� $:.` f ;: � S�,3 ..Ste':. 'tgC em /" hF9\, r'i g/ '}1✓"' /YG 5'.
'7 +'VO,�' .°Q\ __�.___ ]1z� `4:�,.wmt At �,y,S � yit'' •'`,• `���W'' #i.,M<y���•�•�.x'�-�'�'�-rb%�° 'i�� -�-4
( f r 15i
r o;roa, t try• �q1' .g� !__------'---------- ,aZ.�;. `. v. N 1 '1 -'' / / �a. •, .1y'�' , "�: a .,,
'T'wEas :eo% l..p..:?-a,oll;�o..��.\ y._ = :+, �.oG�'+'Y °, ..S•'� \ \1,v � �S /s xbp `•\.• = ,.aAul'�•�', �,,./�a9�'
_r+n 4m•' .p •�"j_�" '� i7�' a 's ,,,, `� 9 ? mow... S' `°,•.o/�:'-f`;$ /'.r/>,;,Dm 1.'.,�' c. � �-',e, +>n '\ r �•�
-� send •'l �=?!§ii°,�°�"----- --�'�t•`�. �..,1'•� �'' ''�,, " � %`"'r-' j--- '" �.��-', +ar,�'`:;�• /�\
2 P 1 \•;. � sir' �� 2, �1 S.-'- -�vi2 S �` O.�1_` m 102 �/° ,�1 / 1°b\ � / •b 1'/ 1 /�`., k %
- (\ ,a•]3 w " u .2 '1 i 1�`'•„ / rS -"K.2, / '\
o T w-� 4`1., ,�.p, t- "� lo• 'Y„ 1 zsinAAA '1 /„r 12 isad t`• l T ./✓ i�
�n' a� `t�.,:r`�i m,•� :t�-•'� -- a .Y/ 1( SI
. scslb fao Y.-^ 'S",,pa.. °• lbw�.3 __ � .�,:'/J'' �, o`/t`'~°/.._�1 15 n to i l..�a9m� `` i�__,,.._�i:.�'- •aa,°Ia,1' / r•O
- -'Y '.- 'S ��° e I��/'�'�,. m'"\„ t• ;\.'/ r/ /I ° ).:..I.� ;•`p3 l.lac ( I ..
t \,Y,'', ,�� "-J'� j],.°�z�.i_�� !.q ;� '� •t'' ,\ ° `if�_=-��J---ems.-
- :n S 1 Y / +r'�.'Tr bl 6L\'S t '� islr $•i / (..,.Da<t oNQ \4
- '�,,A `.��i Y�Y,o ,,.• � ' i? `' •\/F=•_"•-'-=TJ 1 9 $,DA�at �,t�J;;.l tv� •��, ., `1 ' t 11
¢°'•%� ',� e"' t ,/a' „ ,,]1�, 1 1d'',v :.,,!- „a<�'pia°• -4�
'\ i• -.:� i.� C 1AN0,iC)' !.' I ,3 �� � °y -� m°j-, T1 : �``�� �'" w D m
•�: � - r �; _ ✓ •,j `t P/' toad IS �. °^,,I_ y `,J.; '' ,•8', xe r `'".� 'S a
.� �:� o//, pl� ;, ?{•l b, z{rr4\\
- xTr•y%/ .e./r`�:r�.a/. 'L4y r ,.,° •a ,,V' c o 4\et I, �i', ° "- - �J••n.1 1'p . �^ )aaa) e S - �. ''�
�� .t P, M1 r i" .\� \ ,t <. `.�•..�'� :. ,.raa -•1 o DSA
- ta'Feq ,o/' �'�� ,t.•� i'\�_c -�,4�,./� 1 I 20�1� ../t" t;5 e:_t�Y^a �°e�r-r..� f:,..•Hera~� Y_ ri ,,..-"�Aogvcy�1
'pOo - '•,� °i; a°'• i�•, / uaa I . 5 t'�.�,,1 'L FN .;-/ I.a .11' - 6
- r] r'IiI l,t,EYJE fORPC1 NO.`PoN / _ •, b•' .G °� F,'rc''1,_ .� N/ \
14
12
WO
. .,� 1 S.C_ .t,:4-2 ^'� � eEESEG NO D-. in^'✓ jre' U F eI ��2 -Y�""� /,..� .r•
9p \,1�, _:`..•'�.<- -Y .� •�--------'. S `.:.� ,s i '�I `4 +•
ev
" ` .`\,�{ �•-- '; I t �- `��__- �fg,5.[00
,_ +' COUNTY OFSUFFOLK O
______ N Nonce R\ ] lo�m.�w ,DDo sEcrlaln
�_ —�— �_ 'f Reat P-pm Th.Ser,ioe Agenec uawrlwrs.a,wuTe.a xuarw v '
N W E lasmlal)la+naurceonmrlx,l,4 T..w sourxo�u 111
1. /aDcueal•..m'�:Ta<.t.,r/mu bIfWIN C4)T'Ta(WF6 R2S0°IED A
Board of Trustees Application
AFFIDAVIT
TRACY HELLER AND MATTHEW GLASSMAN 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 ft 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,VITH 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.
Signatuzi of Property Owner Signature of Property Owner
TRACY HELLER MATTHEW GLASSMAN
SWORN TO BEFORE ME THIS S DAY OF A Pf I ,2024
STATE
OF NEW YORK%N
Notary Public = NOTARY PUBLIC
n i l 0mNW1nNmYaakW* 1 N F
CIGH6414M / `
Board of Trustees Application r
AUTHORIZATION
(Where the applicant is not the owner)
UWe, TRACY HELLER AND MATTHEW GLASSMAN ,
owners of the property identified as SCTM#1000-111.00-09.00-011.000 in the town of
I
SOUTHOLD ,New York,hereby authorizes
MARTIN D. FINNEGAN, ESQ. 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.
Prop Own s Signature Property Owner's Signature
TRACY HELLER MATTHEW GLASSMAN
SWORN TO BEFORE ME THIS J DAY OF fl prt.\ ,2024
EC q ,
• �� - - '1Z
STATE
j�OF NEW YORK y ,
No Public = i NOTARY PUBLIC
��1 QureAlnNarYakOoudy �o
i,/�ss'ON'�\?-' �.
� r
APPLICANT/AGENT/REPRESEN`I'ATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Fthics prohibits conflicts of interest on the Part of town officens and cmnlovecs.7 he numose o
this form is to provide inforination which can alert the to ofpossiblc conflicts of interest and allow it to"take whatever action is
nececsruv to avoid same.
YOURNAME: TRACY HELLER AND MATTHEW GLASSMAW
(Last name,ftist name,. lddle initial.unless you are applying in the name of
someone else or other entity,such as a company.If so,indicato thb other
peison's or company's name.)
NAME OF APPLICATION: (Chock all that apply.)
Tax grievance Building
Variance 71 ustco X_
Change of zone Coastal Emsion
AppiwW of plat Mooring.
Exemption from plat oroffiaal map Planning
Other
(If"Other'',name the activity.)
Do you personally(or through your company,spouse,sibling,parchk or child)have a relationship.with any.offteer or employee
of the Town of Southold? "Relationship"includes by blood,marriage,or business ihtcrcst"Business intetcsr-means a business,
including a pn'Mvership,in which the town officer or employee has even apartial ownr:rship 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 answemd"YES",complete the balance of this form and deft 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 applicantlagentfrtprrsentative)and the town officer or employee.Either-chock
the appropriate lure A)through D)and/or describe in the space prWided.
The town officer or employee or his or her spouse,siblingren,Pat;of child is(check all that apply).
A)the owner ofgmaW than 5%of the shoes ofthe corporate Stock of the applicant
(whe ii the applicant is a ewporadonx '
B)the legal orbateticial owner of luny inWest in a non-corporate attity(wbi�the
applicant is not a coipomti*
C)an officer,director,pinata•,or employee of the applicant;or
D)the actual applicant
DESCRIPTION OF RELATIONSHIP
2.024
Submitted this day of h / —
Signature
Print Name T. LLER
Form IS 1 THEW GLASSMAN