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HomeMy WebLinkAboutStein, Peter & Allison � Ty Glenn Goldsmith,President oOSUFFO�,�COGy, Town Hall Annex A.Nicholas Krupski,Vice President CD54375 Route 25 Eric Sepenoski P.O.Box 1179 Liz Gillooly �y • p��' Southold,NY 11971 Elizabeth Peeples �� Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: ( 2 Completed in field by: �--' v ' � W Finnegan Law on behalf of PETER STEIN &ALLISON KRONICK STEIN requests a Pre- Application Site Visit to discuss proposed renovations to existing single-family dwelling. Located: 63417 North Road, Greenport. SCTM# 1000-40-1-18 Type area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: vChapt. 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 lot Applicable Info needed/Modifications/Conditions/Etc.: N6 01- T IAA1 /\ i eI V" i e � e Present Were: G. G Idsmith /N. Krupgki E. Sep enoski L. Gillooly ✓E. Peeples Rev6m M2&SS S6 ��.� i yYA,u - � 7N1E soma msoae ) ' .) fis � a,6 ���� � ` P� .4i aabsl u3, t,�'°1O•,�°' �'00!.+°�,�. .o��s oso6ls /. I �) 1 4 eFM,sEwE+Y �� �p a 3i a9 °t yea s 6 p2.,ee `'n / a y.\P . a s( sib °p, .,e °"• `^�`5 wNjyi6sf%, , r r` , /�k � o-•' + p x ie° m�,+z a°+' o•ip s vs.« ( +1+A BSA . O. d'�` \ e. « ,A ,7'' .m p,s .•6„s �� COUNTTYOFS FOLK SUFFou 1 OCF r'6a o4\I a OWN"O 'O a �ii'3es.sm FM •, O G �L MAP O000.ESIANO ,1° \, 0 6 ' �yO CONDOMINIUM TYO COUNouc F EUmsa O 0 rYY (FOR UN-SEE SEC 0 SUFF ,, p% so 4 \ O NO oas 01) ,1 ; a° SEE SCE NO,36 / I� LG 15A 1 'f, T P'EO B• y O i GFIE GEO�- / GREENPORT xO/ye) eJ g� W'e �OBAA��B eTwne ` 0 4 x, 3 O seem`/ 28n(cl 32 6R E,uezxm E2«& e i m1 1.TA(q � • , 2 14A O S 1 V O � NORT,a •'�8 i6 y pp a / /,N'' 13 Z O p x36BAlc1 tur g 4 T&,Ic7 P 'l`t' >3A S• IET.scree Ezuasv, 1 ue ag E rn " o I v t' ; mtn 1 MS.D. wmm 1 O '-A v tiAe r +].,A(cl Ez«sarm Ea O O fE NO SEES SEC 6E0 NO as �vA 1 0150]-0651 $: It1 « TOWN OF SOUTHOLD [''''` O _1 T.- -- •� ,A 5 """0306 9 "3p1m M VILLAGE OF GREENPORT A q ti7 eam� 1MSEE MN 6`�� "v�ira�f wl t MATCH MNE i Y 1 MATCH _._Z xx.elIIiE i SEE SEC NO.016 S ty`o'p µw5EE SEC.NOW t� ,� - E "� _�_ eW..~°... "__ '�� "__ v° ° NOTICE f]�o e COUNTY OF SUFFOLK © E ,� SOUTNOLD NNO G _______ d,_, , __ � Real Property Tax Service Agency YtwE °mom —_+_ ��— iOr y l � u �SICIII 4ON r..e x. ^rs . u,Wa1v NYA w —_— =u --.-- mu,,.--xw-- „evn AS;, A rwc,Nox,uqO n° 7000 WsERTY MAP N37°�i -oO.,yy (' S37°o� 65• fc E=%��Ci IO O d O i 10, � � O 1 17 j , rTl 1 y " O �• � Oo ° FRAME AR1tSG & h► "' RESIDENCE OF BLUFF FFN l TOP OF 8LUFF ay co C? ` 15 Op����' co • C° co t� r` � I\ w•9(��LT FRA `O EXISTIN CLEARING Ass47 6,0,Ff RESlD fNCE 8 O / d 1 WALL 12', y 9.9' WOOD DECK �Yp ~ 4 W/ O JH k•a��'�Fi ROPOSE / n 9 m ZC, z / ZONING CHART LOTAREA-.56,812.59 BUILDABLE LOT SIZE.31,936.54 SOFT 56EXISTING HOUSE.2.133 SQ.FT 9' / EXISTING GARAGE 537 SQ FT EXISTING POOL'0]fi SOFT r� TOTAL'3,146 SQ.FT `1•74 / �� LOT COVERAGE:9,9% DD O �� ( a PROPOSED HOUSE:3.135 SOFT EXISTING GARAGE:537 SOFT +'7 EXISTING POOL 476 SOFT y ' < TOTAL:4.148 SO.FT LOT COVERAGE:12,98% O r ^ PERCENTAGE INCREASED LOT COVERAGE:3.13% JL �J EXISTING GROSS FLOOR AREA.2,631 SO.FT •v O PROPOSED GROSS FLOORAREA:5,521 SOFT O ALLOWABLE GFA PER BUILDABLE LOT 4,495 SO FT J� VARINCE REQUIRED:1,026 SO FT v 4n1 \ EXISTING FRONT YARD SETBACK 141'2' REAR YARD SETBACK.66'5' - \ SIDE YARD SET BACK EAST:52' R SIDE YARD SET BACK WEST 1216• { PROPOSED 23, 4 Woof) EEN. \ DISTANCE TO PIER LINE EST 5T6' 6" GA TE FRONT YARD SETBACK:10310' REAR YARD SET BACK 763• f , SIDE YARD SET BACK EAST 45 SIDE YARD SET BACK WEST 147 ,y z tNGRpU COVERED OOL (14•X,34') 1 M SLATE 24.1• It~ o co ci r,o M j a 24 $ o " n� o /� �-._.. mot• / O WIRE F£N. nr Y >,2,2 39 , 68 40' co 99' w b . 50� o ( jA0- ?anti i 1 �9St����.00 1 -3 F;mm `" ,pp'E p1 � I 2 �Sayopm r £ r <oagg azmi~�: C) ?E m J ► j► %�o � D���E��a g►�®fs9� � EyT°/ j5/// £� gs C1 65 A s, N �r rmj/ r1 cr 1 M t o m V s N or q,,ufY y ye��iF_ 01� 4•50'00"6 15.00.1 Q, .s. ... .. S64'16150" W�At) V / RESaENG£ /�aoM :C%'' , Tn ' •• . S \\ ,1< 1 sa6' \ :).r \ .. O § wpy. GAZE \�POO o 1' 1 F -1E w /u - ��NG>u,m n IHG' OOOm00 ./ in / rY N ON"ON N N W U G W W W O • .. mo OHO o'COm C[� m 'I A>Ozz D�DtSn >� N I v I S� •� yOm OOOO y .� O n n ZATADpA ®>i D 91 F 1 N �y � • ^'c n — oe 5 Gio O -- --- 59.99' ... - m�.. a 68.40' z Ezlo� WAY 1Z,Z.S9goyft I"I 4 cm >i ws � - - --- - OAD H Z°s � NORT R o N -f <�ImKK -- —.NORTH ROAD o • �o=� � � � SHEET SURVEY OF PROPERTY TAX MAP No. (EOFNEWY SCALICE LEAD ° 63417 NORTH ROAD, GREENPORT 1000-040.00-01.00-018.000 y o� NEW YORK 11944 "''� 1 * 9 �-` SITUATE JOB No.S22-3998 %' ) land r surveying o GREENPORT, TOWN OF SOUTHOLD DATE SURVEYED: 11/21/2022 mjs1cnd'survey.com P:631-957-2400 m sF 05073g ...SUFFOLK.000NTY, NEW YORK DR.:MC' CREW.:NB SCALE:1" = 30' 1 South Bay Avenue, Islip, NY 11751 �tANDS (A)owzzn ur[vnrcx aR eocmoN ro Yx�s sumcY u.v w'""iv s[o uxo ww[mxs nic,ss'a-1011smx "'"aacs03s+urow°.oN50suR"+[zo ,w'4Fc.,m°"[` r<> w,.a�wn eoux r sw«n uws xnx "'��nE mw w[roj1A°ne°'"wsv�n'wN[C0"`>r*u..�.[c:,µ�"'"forss�vswc'.xnnu�r.�'us`x,[°Vo ox'),ws""ewRw'm wm'[v i w�"(•>,xer'a'mR,"u°;w`s"x�uzw'.�ur rawsr[�c.o(si n,[r r ar Nn0"uwREo vrasvN .a. s rouwucrry mi"vwv°fY .(s)rxc arse(a+mu.�sos)smn.tmex rxou n,c sm�nums ro w[vaovun IX.ss na[roa.svmie vvxvrLsc aw ux um rxrarrcws ws xor ixrc+,oeo m cvmc - ai[,���wisroais.�v'�r�ios vswm`vc'�wus�'.nm*wns wivares,u�'ro u r`monax m'vc o'r'Ncooimucrvau".(n vnoim�r conRicv wx�rs x'sxE xoi m.ss vim'�rMs suxv[v:(e)n�z sum.ss vwo.�.n`�nmm a"'m,.,iairs w meant rou srnon.(e)*�s ousiv+a or ac�Rs.or wr moiort swsrrRrs or uscaro it.m'.nrn vrc�u�[uor uwwa[rn.(,a)v nrs suav[r.ss vrsrr.•xs ' - P.oiw Rwms s xa.o.Nzcoa.�r urr,wr xor sE v�wsx aR.ncusun"+n.ure wr cowwneu ND ISSUED: 8/13/2024 LO NG ISLAND LAND SOU 140.00. DESIGN DEVELOPMENT 1 N37'01 p0 mSNOWDoN a� 'o w 7g.f0 ' Consulting Arch itecVDesigner N3ro�••e� a r pp . . iS3r01 0�"1/ SNOWDON II LTD W• 1 5.44 --- 85 Willow Street#71 —' Orient, NY 11957 o �$ 1000-40.1-18 DAVID SNOWDON-JONES (T)212 518 1818 �� to Acreage 1.34 (E)dsj@snowdon.us Land Use Low Density ENGINEER sF, Residential Nick Mazzaferro P. E. N `y Protected PO Box 57, Greenport, NY 11944 Community Facilities (T)516 457 5596 (E) nickmazzaferro@verizon.net Class One Family Year - ----- Fll. Round Residence ��. Ag District Info od. rb -_--- II---- �_ _ Zoning Primary R-80 Zoning Secondary r ------- �:`� Zoning acres in 0.00 } i SOPOSE - � Ar Secondary Zone J d � Freshwater Wetlands 0.00 Address Tidal Wetlands 0.00 STEIN RESIDENCE Peter&Allison 63417 County Rd, Greenport, NY 23,-6. =A �� 11944 ZONING CHART Article XXXVI Residential Dwelling Size Limps —--- 1 ?' 1 LOT AREA:56,812.59 "•> .-` I BUILDABLE LOT SIZE:31,936.54 SQ.FT Added 10-18-2022 by L.L.No.10-2022; mended l2-13-2022 by LL.No.16-2022] Description EXISTING GROSS FLOOR AREA:2,631 SO.FT 280-207 Maximum gross floor area for residential / EXISTING HOUSE:2,133 SQ.FT dwellings in R-80 District. TOTAL: HOME REMODEL LOT COVERAGE:9,8% ,Maximum grass Floor area(GFA):The gross floor area shall ggQ wnet exceed the permitted square footage calculated as follows: .4 + / PROPOSED HOUSE:3,135 SO.FT d)Lots containin up to 40,000 square feet of lot area:4,350 p', EXISTING GARAGE:537 SQ.FT square feet plus 7.5%of the lot area in excess of 30,000 o .�`Y fl i•,, n. EXISTING POOL:476 SQ.FT square feet up to a total of 5.100 square feet maximum. TOTAL:4,148 SQ.FT a)Lots up to 80,000 square feet of lot area:5,100 square feet LOT COVERAGE:12,98% plus 5%of the lot area in excess of 40,000 square feet up to a • "� GROSS FLOOR AREA:5,566 SQ.FT total of 7,100 square feet maximum. `+ 2)In determining the maximum permitted grass floor area,the i. ALLOWABLE GFA PER BUILDABLE LOT:4,495 SQ FT follow Ing provisions shall apply: EXISTING a)"Lot area"shall have the same meaning as the area of a lot a FRONT YARD SETBACK:1417 pr parcel defined as"buildable land"in this chapter. REAR YARD SET BACK:ll >2 BB.�p• SIDE YARD SET BACK EAST.52' 39 SIDE YARD SET BACK WEST:12'6" DATE 6 1 t. PROJECT N013I2021 PROPOSED >•-^� ` 9.4q ZO„� �� �- "� DISTANCE TO PIER LINE EAST 40'2" !' f V E r` DRAWING BY:VA DISTANCE TO PIER LINE WEST:57'6" FRONT YARD SET BACK:103'10" ''1f i q -� REAR YARD SET BACK:76'3" I `, CHECKED BY:DSJ .s _ ,1 4 t [( Jj SCALE: AS NOTED SIDE YARD SET BACK EAST 49' i SIDE YARD SET BACK WEST:14'3" S E P b2024 NORTH ROAD SouUxW Town PAGE NOR O ROAD Board of Trustees A-2 Site Plan AD Scale 1/20"='I'll DOB APPROVAL STAMP FINNECAN LAW, P.C. 13250 MAIN ROAD P.O. BOX 1452 . MATTITUCK,NEW YORK 11952 (631) 315-6070 MARTIN D. FINNEGAN, ESQ. MFINNEGANONORTHFORK.LAW By Hand & Electronic Mail September 4, 2024 Southold Town Trustees Attri: Elizabeth Cantrell Thomas Hobson 54375 Main Road PO Box 1179 Southold, NY 11971 Re: Trustees Pre-Submission Conference Owners: Peter Stein and Allison Kronick Stein Premises: .63417 North Road, Greenport, NY 11944 -SCTM # 1000-040.00-01.00-018.000 Dear Liz and Tom: This office represents the owners of the above-referenced property. My clients are proposing to renovate the existing single-family dwelling on the premises. In accordance with Section 275-8(A) of the Town,Code, we are requesting a pre- submission conference with the Trustees to discuss the-proposed construction and obtain feedback from the Trustees in advance of applying for a Wetland Permit. A copy of the survey and proposed site plan are attached for your review. Enclosed please find an attorney escrow check in the amount of$150.00 representing the required pre-submission conference fee, along with the executed Owner's Authorization, Owner's Affidavit, and Transactional Disclosure Forms for Owner and Agent. Thank you for your attention to this matter. ery truly y rs, ' . � E _ ._J Martin innegan 8EP 5 2024 MDF/as Encl. SoummTown BoaidofTmtm Board of Trustees AppliCation AFFIDAVIT PETER STEIN AND ALLISON KRONICK STEIN BEING DULYSWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBE' D PERMIT(S)AND THAT ALLSTATEMENTS CONTAINED HEREIN ARE TRUE TO THE REST OF-HIS/HER KNOWLEDGE AND BELIEF,,AND THAT ALL WORK WILL HE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED.BY THE SOUTHOLD TOWN BOARD OYTRUSTEES, THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM A L DAMA NY AND AL . GES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE THEIRAGENT(S)OR REPRESENTATBIES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PEE MISES'IN CONJUNCnON WITH THIS LICATION,, INCLUDING A FINAL INSPECTION. I APP FURTHER AUTHORUE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TOINSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. SigAature of Property Owner Signature of Property Owner PETER STEIN ALLISON KRbNICK STEIN SWORN TO BEFORE ME THIS DAY OF 20 24 . L---Notary Public MARTI"q.,OINNEGAN tiotaty public-state of New Yodc No,01FI6056707 Qualified in Suffolk County Commission Expires Match 26,20-t:, Board of Trustees AWlication AUTHORIZATION (Where the applicant is not the owner) I/We.PETER STEIN AND ALLISON KRONICK STEIN owners of the property identified as SCTM# 1000- 040:00-01 tOO-01 8.000 in the town of SOUTHOLD —..,New York,hereby authorizes MARTIN D. FINNEGAN, ESQ., AND FINNEGAN LAW, P.C. 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. ape Ay Owner`s Signature Property O er's Signature PETER STEIN ALL18ON KRONIOK STEIN SWORN TO BEFORE ME THIS DAY OF 20—- Notary Public UMW!t.).FWNESM Natwy Pubil"We Of NOW Y01k NO'611:16OW97 Owiffied In Suffolk C*uW Cmrn1ss1on Expires March 26,2*Z1 APPLICANT/AGENT/REPRESENTAIM TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Cade of Ethos orohlitc,,cmilicts of interest on the hart of town officers and ems numose of this form is to Provide inforinatlon which can alert the town of Passible conflicts of imemst and allog it to take whatever ogIm Is necessary to-mid sme— YOURNAML, PETER STEIN (Last now,fast mama,jtiddle initial.unless you ate applying in the name of someone else or other entity.such as a company.if so,indicate the other person's or compaWs ttmrte.) NAME OF APFUCA17ON: (Check all that apply.) Tax grievmtce Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption fmm plat crofflcial map Planning Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a tebtionship with my officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business imerese means a businen 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 m of the shares. YES NO R - If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by die Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/ageWi a ttative)and die town of&ceror employee.Either check the appropriate Une A)through D)and/or daml a In the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): ELA)the owner of greater than 5%of the shares of the corporate stock of the applicant 1 (when the e pp t is a corporation), B)the legal or beneficial owner ofwW interest in a non-corporate entity(when the . applicant is not a corporaffonp, C)an officer,d iector,partaw,or employee of the applicant;or D)the actual appikant DESCRIPTION OF RELATIONSHIP Submitted this da SeegmW 2o1'-' Signature Print Name PETER STEIN Form 73 1 APPLICANUAGENTIREPRESENTATIVE TRANSAMONAL DISCLOSURE FORM The Town of Southolds Code of Ethir.1mbibitsponflicts ofjnw_�a on-ft Maortowaofficers am SmEjum.' f tbkf whichcannLpit Iblegd &-mamiamidam." fttownofUg§fi: YOUR NAME-- ALLISON KRONICK STEIN, (Last name,flat name.ipiddle initial,upless you are applying in the name of someone else or other entity,such as a company.Vso,indicate the ether Person?$or company's Uwe.) NAME OF APPLICATION. (Check all that apply.) Taxtrievance Building Variance Trustee Change orzone Coastal Erosion Approval of plat Mooting Exmptionfimm plat or official map Planning Other (if"Olher';name the activity.) Do you'personally(or through your company,spousex sibling,pamnL or child)haven miolonship with any officer or employee of the Town ofSoutholdl "Relatlons!W includes by blood,marriage;or business interest."Business intawr means a busiv4sr' including a paitnership,in which the town officer or,einployee has even a pattial ownership or(or employnust by)a corporatim in which the town officer or employee owns more than 51%of the shares, YES NO El If you answered"YES".complete the balance ofthis form and date and sign where indicated. Nam ofperson employed by the Town of'Southold Titlebr*ition ofthat person Descift the relationship between yourself(the applicant/agerWmVesentative)and the town officer or employee.Either check the appropriate Bite A)through D)andfor describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply). f1A)the owner of greater than 55/a ofthe shams of the corporate stock of the applicant 12 (Whm the applicant is a corporzffion} 13)the legal or beneficial owner ofmW interest in a non-corporate entity(when the Bappikwt,is not at corptiration), 12an otTuw,director;parw�or employee of the applicant;.or )the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this 201q sionature PrintName ALLISON'KRONICK STEIN Form TS I i 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 rovide 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: MARTIN D. FINNEGAN (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.) TYPE OF APPLICATION:(Check all that apply) Tax grievance Building Permit Variance Trustee Permit )( Change of Zone Coastal Erosion Approval of Plat Mooring Other(activity) Planning 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 that 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 day ,20,14 Signature Print Name MARTIN D. FINNEGAN i 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 : MARTIN D. FINNEGAN (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.) TYPE OF APPLICATION: (Check all that apply) Tax grievance Building Permit Variance Trustee Permit X Change of Zone Coastal Erosion Approval of Plat Mooring Other(activity) Planning 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 that 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 -day 20 2q Signature Print Name MARTIN D. FINNEGAN