HomeMy WebLinkAboutMarra, Daniel Glenn Goldsmith, President O��� ��OG Town Hall Annex
A.Nicholas Krupski, Vice President y�' 54375 Route 25
Eric Sepenoski H „;, P.O. Box 1 179
Liz Gillooly �y • ask Southold,NY 11971
Elizabeth Peeples *r ��pi Telephone(63 l)765-1892
Fax(631)765-6641
Southold Town Board of Trustees
Field Inspection Report
Date/Time: Completed in field by: C,. (�,1,�5,�.•�1-,
AMP Architecture on behalf of DANIEL MARRA requests a Pre-Application Site Inspection for a
proposed two-story dwelling. Located: 9450 Main Bayview, Southold. SCTM# 1000-87-5-22
Type of area to be impacted:
Saltwater Wetland J Freshwater Wetland Sound 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 Not Applicable
Info needed/Modifications/Conditions/Etc.:
Present Were: ✓ G. Idsmith ./ N. Kr�Pski .� E. Sepenoski
,L. Gillooly ✓ E. Peeples
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AMP Architecture Address:10200 Main Road,Unit 3A,Mattituck NY 11952
Phone:(631)603-9092
Design + Build
July 3,2023
Southold Town Trustees
54375 Main Road , �Southold, N.Y.11971
RE:9450 Main Bayview
Southold, N.Y.11971 JUL 3 4
SCTM #1000-87-05-22
Pre-Submission Application Site Visit Request Southold Town
of Trustees
To Whom It May Concern,
Enclosed please find 1 copy of the site plan and survey for the above address.
The owner and agent,AMP Architecture,would like to set up a pre-submission meeting with the
Trustees to discuss the following:
- Proposed 2 story new dwelling.
The following people will be attending the meeting:
- Anthony Portillo,AMP Architecture
- Dan Marra,9450 Main Bayview LLC
Afteryou review please let us know when the next meeting is scheduled.
Please contact our office if you have any questions.
Thank you,
Amp Architecture
Page t of t
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Soutbold's Cade of Ethics prohibits'confiicts of interest bn the part ofiowri ofliaem and eingioyees The ovrpose of
this form.is.to,provide inforination.which can alert,ihe:fowri ofpbssible conflicts.,ofinterest and allow it to take whatever action is
necessary to avoid same.
YOUR NAME: Portillo,Anthony
(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_
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 bmpany;spouse sibling,parent,or.child)havGa felationship with atiy office or.employee
of the To vn,of Southold? "Relationship"includes.by.blood,marriage„orbusiness interest"Business-interest"means:a business,
including&.partnership,in which the tocwtoflicer or.cmployee has,even& ers partial ownhip,of.(or,employment by)'-acorporation+
in which the town officer or.employeg•owiis more than 5%0 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= .
-Descriihe'the:relationship between yourself(the applicanttagendrepresentative)and the town officer or employee.Either check
the appropriate'line A)through.D)aa_d 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.owiter{of greater-'than 5%;of the shares of the corporate stock of the applicant
(when.the,applicant is-a corporation);
l3).the legal or-1i66ficial.owner of any interest in-anon-corporate entity_ (when the
applicant is not'a corporation);
G)an-officer,di*-tor,partner,or'employee of the applicant;or
D)the actual applicant.
DESCRIPTION OF RELATIONSHIP
Submitted this of t)\ 20?�-�
Signature
Print Name OY
Form TS ]
Board of Trustees Application
AUTHORIZATION
(Where the applicant is not the owner)
I/We, .Y C.6 �L M GC-(—
owners of the property identified as SCTM# 1000- 0 5 �a _ in the town of
6 U � 0I ,New York, hereby authorizes
AM? AnG 6 � -sA U f e- to act as my agent and handle all
necessary work involved with the application process for'perinit(s) from the Southold Town
Board of Trustees for this property.
Property Owner's Signature Property Owner's Signature
SWORN TO BEFORE ME THIS DAY OF —J v I , 20, "I
AL/// oeoDARCEE A�""UF7NEW
u NOTARY PUBLIC,STARegistration No.Qualified in SuCommission Expire
Board of Trustees Application
AFFIDAVIT
�'���-` M 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.
3
1
x
a
Signature of Property Owner Signature of Property Owner
SWORN TO BEFORE ME THIS DAY OF :f(-) ` , 20
DARCEE AUFENANGER
D. NOTARY PUBLIC,STATE OF NEW YORK
t ubl c Registration No.01A00019644
Qualified in Suffolk County
Commission Expires January 9,2028
`/
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers an&emplovees.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
necessarvto avoid,same.
YOUR NAME: j9-
(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
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 F] 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 applicantlagent/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,o'r child is(check all that apply):
f1A)the owner of greater than 5%of the shares of the corporate stock of the applicant
f2 (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 day of TU 1\� 20 9[4
Signature_
Print Name_a-W EL. hAAW 9 P-6
Fonn TS I
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