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HomeMy WebLinkAboutStritzler Family Trust Glenn Goldsmith,President ���\O COGy.► Town Hall Annex A.Nicholas Krupski,Vice President .� 54375 Route 25 CO Eric Sepenoski W ,? P.O.Box 1179 Liz Gillooly �y • ��� Southold,NY 11971 Elizabeth Peeples �Ol �a Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: Completed infield by: AMP Architecture on behalf of STRITZLER FAMILY TRUST requests a Pre-Application Site Visit to discuss proposed construction of a detached garage, dwelling addition, deck extension, and outdoor shower; as-built decks and sauna; removal of existing vegetation and replacement with grass from existing deck to CEHL Line. Located: 955 Soundview Avenue, Mattituck. SCTM# 1000-94-1-8 Type of area to be impacted: Type Wetland 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 need ed/Modific`ations/Conditions/Etc.: Ck eC� Present Were: J G. G Idsmith fN. KYE. ki �E. Sepenoski L. Gillooly Peeples A M P Arch i t e ct u re Address:10200 Main Road,Unit 3A,PO Box 152,Mattituck NY 11952 Phone:(631)603-9092 Design + Build April 8, 2024 Re: Fenster Residence Pre-Submission Site Visit 955 Soundview Ave Southold, NY 11971 SCTM No. 1000-94-1-8 To Whom It May Concern, Please find copies of the site plan, owner forms,and application fee for the above address enclosed. The owner and agent, AMP Architecture,would like to set up a pre-submission meeting with the Trustees to discuss the following: - Proposed detached garage, dwelling addition, deck extension &outdoor shower - Legalization of existing deck and Sauna at East side of dwelling - Legalization of existing deck seaward of CEHL Line - Removal of existing natural vegetation to replace with grass from deck to CEHL Line. The following people will be attending the meeting: - Anthony Portillo,AMP Architecture After review, please let us know when the meeting is scheduled. Please contact our office if you have any questions. Thank you, E C E Y E _ Mathew Smith, RA LEED AP D !� Design Director 6 2024 A M P Architecture SEP Design + Build Office: 631-603-9092 SoutlfT BoatdotTrustrustn ees www.amparchitect.com Page 1 of 1 i I I STREET ADDRESS: 955 SOUND VIEW AVENUE g0 ,� SURVEY OF PROPERTY AT MATTITUCK } D TOWN OF SOUTHO L r �� ll 6�� SUFFOLK COUNTS; N. Y. y0e ��� 1000-94-01-08 SCALE 1'=30' OCTOBE R 16, 2012 NOVEMBER 29, 2017 JUNE 25, 2023 I Cl� N EL•44.2 Fti�v� AREA OF SEPTIC I �oQOEif� jP °F B� DECK Q TEST HOLE DATA obi $�' j MCDONALD GEOSCIENCEE\'4g, 0612512023 TORE x < EL. 48.4 �� R\gG 0.5MIXED CRUSHED STONE, SAND, LOAM MIXED SAND AND LOAM 2• Z � =y97 (B) DEC FLOOR BROWN SILTY SAND SM O 5a° ou DECK T (C) ` 4' � O �-\ T`J•�41`'�HpuSE s.'+� ELFS•4 J / RIDGE HEIGHT (A)=67.5'(EI.) RIDGE HEIGHT (8)=73.3'(EL.) 22 3,9 i x RIDGE HEIGHT (C)=73.3'(EL) BROW PALE FINE SAND SP '3 RIDGE HEIGHT (D)=73.3'(EL.) (A) r Z � C P"�O vER� N WELL �2 Sytibg Q F crrp x 17' �G F i W:, 6 SPP j25 NOTE. NO WATER ENCOUNTERED ��� �23t (D) DECK GPI \ AREA OF SEPTIC i �G R 4 O 49 4 U/G PROPANE j I .. U•(\\.\� 255 �WALKEtp STEPS OTANK o WELL ZCI POOL NEATER E.V. CHARGE (0 POOL O� STATIONO Q FILTER TEST HOLE CONTROL � EL 48.4• PANEL J z WELL •0 \ tom^ AREA = 37,291 SQ.FT. ® y � 43 6' y 9 Qom TO TIE LINE AREA LANDWARD OF COASTAL EROSION HAZARD LINE =23,007 SQ. FT. F 1Op CL£L +=SPOT ELEVATION qz 41' A� CONTOUR LINES AND SPOT ELEVATIONS ARE EL= REFERENCED TO NAVD.'88 518' COASTAL EROSION HAZARD LINE FROM COASTAL EROSION HAZARD AREA MAP PHOTO NO. 58-541-83 Q 000 FLOOD ZONE FROM FIRM MAP NUMBER 36103CO143H CLEL SEPTEMBER 25, 2009 4ss ., N.Y.S. LIC. NO. 49618 ANY AL7ERA710M OR ADD177ON TO THIS SURVEY IS A VIOLATION ) f .Y.S LIC. NO. 051132-01 OF SEC77ON 7209OF THE NEW YORK STATE EDUCATION LAW. PECO* G BUR YORS, EXCEPT AS PER SEC77ON 7209—SUBDIVISION 2. ALL CER77RCA77ONS 765 5 (631) 765-1797 0 FAX P.C. HEREON ARE VAUD FOR THIS MAP AND COPIES THEREOF ONLY IF — 2 P.01). BOX 909 SAID MAP OR COPIES BEAR 7HE IMPRESSED SEAL OF THE SURVEYOR P.O WHOSE SIGNATURE APPEARS HEREON. SOUTHOLO�� 1 971 11-213 51TE PLAN HATCH KEY: SITE PLAN NOTES: PROPOSED BUILDING ADDITION I. PROPOSED NEW CONNECTION FROM NEW TOP OF BLUFF d FLOOD DETACHED 6ARA&E TO EXISTING MAIN HOUSE SEPTIC, SYSTEM. 100' SETBACKS ZONE LINE ZONE VE ( EL I6) WOOD o- ® PROPOSED ACCESSORY STRUCTURE 2.NEW PLUMBING CONNECTION WILL BE INSTALLED AND BE FILLED WITH BD. FROM TOP OF� BULKHEAD_ a BANKS COASTAL EROSION HAZARD 1 Lu Lu LINE I W I � cc I I BOTT BLUFF of Q � I ? cu Lo o m / - ❑ EL. = 54.0' I I I + c�Lor Lo N�r _ EXIST. 0� Gjw 1H 1( ) I EL. = 50.0 0 c_Z O EXIST. a- i goo i 1 i I i�I i-III-1 11=1 I_i=i I I�11=1 I 111 I--I I I-I I H I-1-11=1 11=1 I H I IE11.=11-1-!�I i 1=1 I H I i= �- I >, �CO � II_II�I(il lll��11111111 1HE_I�II11111111 Tll II III IIII II�II�IIIIT 1 1-L,ILIII1111=1111 11111 1111-_ I I 0 oo�� zN„ I I I M I I ! I I I la I I I I I_II i I_;,I I I;I I_I I I-I I I-I I I=E l�I I I I 1.I 1=1�i IEI�1=1 I H11 1-111-_ I +, o 00�� \o oo,,/� !L-i I r 1I;-!_�-�i--1 I 1 -11r=111-11r-I�_ , )I_i I I;III,-1 I I�I i�I is aL I I-1 I I-1 11-I�a 11-1 11=1 ��1=1 I l cud cc =zll III 11- 111=111=111=1-[L=lll;=ill E�15T EARTH I1=111 ll1 11�LI-II I-II i_E 111=11=1i_ o 6% 1 11=L 11=1 i 1=1 11=1 1 6=1 11=11= 11-I l= I-I 11=1 1=11 I-III I I-I 11�11�I I-I 11=1 I I I l I I Q r-a O i -l11=1 i t-! 1=1 I I�i I f-_I 1=1 11=1��-III"=1 11=1 I i-I I=I 11=!11-III-III__'I I-III-111-111-11 I�i I-I I I-1-111=1 11=1 I H I i=l 1 i-' L=1 1 I 1=!11-1 i-1 I I I i-I I I_I i 1=!II=1 11=11=1L=1 11-1 11=1 i'_-=�1 =111=1 11=1 I i-1 11=i=111=1I--1 11=11 I I I 11El I I- I, L. = Io.o' _-1 I-11 =1 EXIST. 11=III-I I_lTi�I i-1 I HI 1=1 I I I I-i I-I I i I I-III-I I-III I I 1 I 1=1 1=I I=1-11=I.;�1 I I-=1 I I- '11 LONG ISLAND SOUND Q� i� i I-1 115 I III-1!1=1 I!it I I 11=1 11=1 1 1=,,- I I, III I!_i 1=i I H I H I I_I I I I I I_I I H I H I L_I 11=1 I I I 1 I i _I I-__I� I I I I _I I _III- 11 I (I1 I i I I i �I I�11=1 11=I4L zI 111=1 I I I!- I_I I-;i H I 1=111=111-111=1 11=1 11__1 I i-III=1 11=1��I 11=11 I�I I--I I!=1 I I-I I=wHd 11=1!I-i I filli l_I I I_l I-1L�=1=„1 i;_:-I I-- III;I I I L III--I� -111;;- !1,-III,-1L, ITII „I,-J - �I PROPOSED SITE ELVATION C) m Io -�- 41-'-" �' EXISTING LOT GOVERAGE PROPOSED LOT COVERAGE SOUTHOLD TOWN GORE 280-1-4 B 50UTHOLD TOWN GORE 280-124 B DE50RI PTION (FOOTPRINT) l AREA 90 LOT DESCRIPTION (FOOTPRINT) AREA 3o LOT In Q� COVERAGE Al COVERAGE - - ---"""- -_ �- TOTAL LOT AREA �I 37,2Q1.0 S.F. TOTAL LOT AREA 372a1.0 S.F. 111I111 u 1--_-----_-__- __-"-- , ° TOTAL LOT AREA (LANDWARD OF TOTAL LOT AREA (LANDWARD OF 44 - --- _ -__ Irn GEHL) 23,007.0 S.F. GEHL) 23p07.0 S.F. 50 l z i �e> EXISTING MAIN HOUSE 1,734.0 S.F. 7.5% EXISTING MAIN HOUSE 1,134.0 S.F. 7.5% TOP OF BLUFF 52 F�op°io ¢� ' I EXISTING REAR DECK , ci40.0 S.F. 4.1% t EXISTING REAR DECK 140.0 S.F. 4.1% 1 - I-t' Zoe x \ _ EXISTING POOL DECK 1,226.0 S.F. 5.390 EXISTING POOL DECK 1,226.0 S.F. 5.390 =M -- 54 °'�0D0. 1Of' SRASS EXISTING POOL 61b.0 S.F. 2.'190 PP40PSOEP AREA OF ,��, oor5t�-_ -- ..,5 ..1 L EXISTING POOL b15.0 S.F. 2.7% S.F. s SIDE YARD SETBACK - a 1 :• _ 1 EXISTING JAGUZZI 59.o S.F. 0.3% EXISTING JAGUZZI FogR AccEssoRY euILDIN6 1- _ .- '. .", . 5q.0 0.390 ` _ I LIMITS of CLEARING, EXISTING COVERED ENTRY a0.0 S.F. 0.5% EXISTING COVERED ENTRY ao.o S.F. 0.3% PROPOS®AREA OF I` _�' 6RADIN6 AND GROUND 6RABB PLANrIN6 5� :':�':V- .,. : •� - _-- - �• ' I DIBTURBANGE PROPOSED I STORY ADDITION -71.4 S.F. 0.5% LIMI75 of CLEARING, �, •-•" _ _ _: _ `.. :',;� TOTAL AREA OF ALL STRUCTURES 4657.0 S.F. 20.2% 6RADIN6 AND 6ROUND , -.. ' - AREA of EXIST.+,� -- - D15TURBANCE "" SEPTIC. •_._ I r PROPOSED OUT SHOWER 40.0 S.F. - -0.290 •.• _ _ HAY eAU5 ANDioR MAXIMUM LOT COVERAGE ALLOWED: 20% - - - - - • ''.I"21 SLIT FEW-INS _ PROPOSED DECK EXTENSION 24.0 S.F. 0.1% ` ` ` IMPERVIOUS SURFACES < a" FROM GRADE EXIST. PROPOSED GARAGE &75.0 S.F. 3.a% 1 212 I FRAME DECK •: EXISTING SLATE PAVERS '755.2 5.F. 5.2% [ HAY BALES AND/OR AS-BUILT 51DE DECK 86.6 S.F. 0.4% M . su ENU SLIT fib' 1 EXISTING DECK AT GEHL LINE II6.0 S.F. 0.5% 1 Exisme 1 sroRY 8s AS-BUILT SAUNA 4�i.0 S.F. 0.290 F+����E % i . ��' i TOTAL LOT COVERAGE INGLUDING 550b.2 S.F. 23.�1%I f3 BEDROOMS) �--- FROM TOP of F.F.EL=6o.r aco' 4 i a STRUCTURES <b" FROM GRADE [ TOTAL AREA OF ALL STRUCTURES Sal I.O S.F. 25.5% c PROF I STORY la ADDITION q I�EI'X6J' 1 L� MAXIMUM LOT COVERAGE ALLOWED: 20% _ 1 z AS-EVIL FRAME I "� IMPERVIOUS SURFACES < b" FROM GRADE ` 6 _ 0 --1 PROP.EXT. iD�K ' /�\\V`)r `S O6/25/2023 cam, DEcx EXT. rll I o l' I 1 EX15TINO SLATE PAVERS '135.2 S.F. 3.2% p 1 FF.a.ss�' EXI 1q� _ FRsvECK i\\ TEST HOLE DATA EXISTING DECK AT GEHL LINE I 16.0 S.F. 0.5% TEST GEO SERVICES ss 1 POB 1255 TOTAL LOT COVERAGE INGLUDINC 66 S.F. sr. 5OUTHOLD, NY 11ci71 STRUCTURES <b" FROM GRADE �14�0 62.2 201.0% � Exis-ma 16 POOL Iro 1III EL=48.4' PROJECT / ZONING DATA PROJECT. OL MIXED CRUSHED -- ---- �� STONE, SAND, LOAM FENSTER TAX MAP # 1000-a4-0 1-ca RESIDENCE MIXED SAND AND PArAT BMWTANK LOAM ZONING DISTRICT R-40 NO A 2.o LOT AREA O.a ACRES 955 SOUNDVIEW AVENUE EXIST. `� --ktAjXkjAY \\2S-o b'Mi • Mtµ MATTITUCK, NY 11952 o NN ,/ W \I \W I II GofO - ADDITION $ALTERATION NO. Z-27b14 ; O'1/la/01 SM BROWN SILTY SAND J - "'��aN �/ � GofO-ADDITION / ALTERATION NO. 40C144; 2/5/2020 DRAWING TITLE: 1 i 6 44 i\ 4.0' - - PROJECT LOCATION CofO -IN GROUND POOL 40947 ; 12/111/201Q SITE PLAN&ZONING DATA i I I LOT COVERAGE ° SITE ELEVATION S_; VARIANCE APPROVAL PENDING NG�PP�" ��-O` � � SITE LAYOUT NOTES: p 0jll_00rPW °"' ' J89 I. THI5 15 AN ARCHITECT'S 51TE PLAN 8 IS PAGE: 1 aQ' SUBJECT TO VERIFICATION BY A LICENSED FEMA FLOOD ZONE X $ VEI6 o SURVEYOR. THE INFORMATION WETLANDS DISTRICT N/A V , ��� w REPRESENTED ON THIS 51TE PLAN 15 TO THE PALE BROWN FINE ARCHITECT'S BEST OF KNOWLEDGE. SP SAND DEC, DI5TRIGT PENDING NJ 0 =DATE-08/30, 24 1 OF 5 io5 uQ. 2. SURVEY INFORMATION WAS OBTAINED FROM A SURVEY UPDATED DUNE 25, 2025 SUFFOLK COUNTY HD APPROVAL REQUIRED GARAGE W AND PREPARED BY: PEGONIG SURVEYORS, P.G.N.Y. STATE �'.�'° �""'�,° ;^�, ,✓ LIG. #04 618 ND SURVEYOR ��; �. P.O. BOX q09 5 1250 TRAVELER STREET SOUTHOLD, NY I1a71 N ' � U COMMENTS: NO GROUNDWATER (631) 765-5020 ENCOUNTERED. PROPOSED SITE PLAT TEST HOLE DATA SCALE: 1" = 50'-0" SCALE: NTS r"`" �t GENERAL SYMBOL KEY: r==l EXI5TINB TO REMAIN r=4 NEW FOUNDATION HALL NEW HOOD FRAME =� Q \ w _l co - -- - a ::::O a0 �ZO EX15T. V DN - --- - C XO�N O EXIST. DEGK - -- -- t OO m O --- --- 4.' N C D C6 N Q �a�0 U EXISTING SOUTH ELEVATION (FRONT) I EXIST. - SCALE. I/5• - I'-0" KITCHEN U EXIST. GREAT ROOM (D m U C A L - - - - GL. - - - - _ Q EXIST EXIST, ( ( � . F-11 Q EXIST. BEDROOM BATH l� BEDROOM STUDY XIS - - i0 ATH I - - DN L I -- - - _ c ---- Ll[l EXIST. UP - -- - [Ell EXI5T. ENTRY SLOPING GRADE 5LOPING GRADE EXISTING EAST ELEVATION (RIGHT SIDE) UQ� II II II II I I EXIST. II 5UNROOM -- -- I I EXIST. NO. DECK I JI��� L F A ? - o EXI5T. JAGUZZI - --- Pv a 0 EXISTING FIRST FLOOR PLAN PROJECT: 1,568>3 S.F. HABITABLE SPACE; 1,565.3 S.F. GROSS AREA SCALE: 115•- r-0• FENSTER RESIDENCE EXISTING NORTH ELEVATION (REAR) scALE I/5• • I'-0• 955 SOUNDVIEW AVENUE MATTITUCK, NY 11952 - - A WH EXIST, DRAWING_ TITLE: EXI5T. X S AUNDR - STORAGE MEGH• T' ROOM ROOM EXIST. FLOOR PLANS >< EXIST.ELEVATIONS GI . I FURN. EXIST. $ATH ,�I,, � EX15T. EX15T. HALLWAY \�/ ND. PAGE: EXIST. � DECK Vff L-2 17 E.P. GL. EXIST. UP SAUNA 08/30/24 2 EXIST EXIST. EX15T. EXIST. �0 BATH STORAGE PLAYROOM —-- BEDROOM 1 - GL. EXIST. ND. DECK I -rm L............ �170 ',A J� maw O .Jd am f'- yam` •` �� vM�`tl r 4 r � EXISTING HEST ELEVATION (LEFT SIDE) .`=':,�z>: EXISTING BASEMENT PLAN 1226 S.F. HABITABLE SPACE; 1,310 S.F. GROSS AREA SCALE.1/5•.I'-0• SCALE: I/5•s I'-0• �~ • r+ �Y GENERAL SYMBOL KEY: r HE"HOOD rp-Am a 0 w uj _J c) Q 4-1 c� O N O = O -a —0 Lo}- 0 Oa)ZO a co(9Y� C 2XjN O O O 4-+ t 0 m Z; c CVO mLo a —0a:20 W 4_j U (3) m 4_j EXIST. "}" DN EXIST. DECK U 0) � XI --- 0 KITCHEN EXIST. GREAT ROOM REMOVE PARTIAL WALL FOR DOOR OPENING REMOVE WALL 4 DOOR5 REMOVE 4 O REPLACE W/ P C WIDER DOOR 41 "L� SLIDER REMOVE WALL G� -inI +�-f == -__ -__ 4 ALL RELOCATE�F- i -- `-- BATHROOM k —REMOVE DOOR \ FIXTURES r----- 1°l WINDOWS EXIST. XIST. —IEX15T (9 EXIST_ STUDY BEDROOM BATH =___ J'' BEDROOM 45 XIST S.F. 5P`TH I UP D REMOVE 4 - --- REPLACE � \-REMCEX�T WINDOW REMOVE 4VE ENTRY REPLACE REPLACE /-REMOVE PARTIAL WINDOW WINDOW I / WALL FOR NEW 9" DOOR OPENING z " REMOV_ PARTIAL WALL 4 WINDOWS U 1=7 L11 %NR60�M RELOCATE 11 EXISTING er - rt STEPS PROJECT: EXIST. 1^ID. DECK FENSTER RESIDENCE EXIST. JAGUZZI 955 SOUNDVIEW AVENUE MATTITUCK, NY 11952 DRAWING TITLE: PROPOSED DEMOLITION PLAN PAGE: PROPOSED DEMOLITION FLOOR PLAN Vff L_3 DATE:08/30/24 3 OF 5 3.,"• d OF 1, e` ;el �. GENERAL SYMBOL KEY: r=l nasme To MIAIN N54 rOUbVAnOW KALL Mi POW PRAME Lu U.1 cc cy) oo 4-J -E u') 76 --0 IL 0 C(,2zo x Fm 0 4-1 1 0 om.Z(D 0 -J 0 I Lo I 4-J 01- -�OF c\l d 4 co 0 a: NMARMT V1 EAWMLY PA. 0 SOUTH ELEVATION (FRONT) 0 •D cl) SCALE: 115' -0 1' . m EX.RAISED 4-J H=PECK + 116 Ftil''I'll............ 'u) (D n EX15VNT. no ou EXIST, PECK HEST ELEVATION (LEFT SIDE) SCALE: 115'- V-0" LJ I EXIST. KITCHEN Me EXIST. GREAT ROOM I fl LJJ H L Lo. o. A REF. I.C. I A MOO. morl>, EXIST.STUDY ll MOD. m BEDROOM MOD. BATH ON TT, L 11 PROJECT: EXIST. UP l4k NORTH ELEVATION (REAR.) FENSTER EX15T, '-4 SCALE: 116'- 1'-0" RESIDENCE ENTRY� 00) PROF. E 'p CUT. 955 SOUNDVIEW AVENUE ATH ' 5HkqR MATTITUCK, NY 11952 DRAWING TITLE: A 1 20110- PROPOSED FLOOR PLAN PROPOSED ELEVATIONS .......... El PAGE: MOD. 5ONROOM 'Aff L-4 EXIST. 1^0. DECK - l _ c� JU T+ DATE:08/30/24 4 OF n5 EX151-JACUZZI A v ;> SLOPING OP-AME SLOPING GRADE PROPOSED FIRST FLOOR PLAN EAST ELEVATION (RIGHT BIDE) 5CALM I/V-V-0 IAA S.F. EXISTING; 1,760.6 S.F. PROPOSED GENERAL SYMBOL KEY: r==l ExlsTIN6 TO REfMIN NM PO"ATION WALL - a NBA!HOOD PRM-e 12 Q to o w Lu c>3 Q c — - 0 -J 0 O�ZO a I_l 0 A �� U� � X O(V b 0 0co _rZJ Om—� Q 0226 � I I I � I EAST ELEVATION (RIGHT SIDE) Z � I � I SCALE- 1/e•- r-0• �— ..}_J — w z U .D " � I Y (D W cm —p-j z PROP. 4 UNHIEATED ! I NISHED , U STORAGE L SLOPED 54.0 i 5LOPED I GEILINC� 50.PT. CEILING •� n I I 3 Q 111 I to - Y Fill I i NORTH ELEVATION (REAR) SCALE: 1/8•- r-0• PROPOSED LOFT PLAN 540 S.F. PROP05ED SCALE. 1/9•-r-0• i I 13 PROP. Pik I z STORAGE 150 S.F. $ PROP. - - - - - - - - -- DODO o _ PROJECT: PROP. SOUTH SOUTH ELEVATION (FRONT) FENSTER GARAGE SCALE, 1/5•- r-0• RESIDENCE s.F. I h 955 SOUNDVIEW AVENUE MATTITUCK, NY 11952 - _ - - - - - / / `imO'Lo" Lmc"LarrAJWA DRAWING TITLE: / 17 PROPOSED FLOOR PLAN PROP. PROP. ,/ b� -REFU5E STORAGE / PROPOSED ELEVATIONS LM Or LID" s RM. / ' AMA PAGE: - - - - - - - - - - WTL-5 DATE:08/30/24 5 OF 5 E•EASTERLY PA. PROPOSED GARAGE PLAN -- — NEARB DI9TANG 875 S.F. PROPOSED SCALE 1/e•- r-0• I — WEST ELEVATION (LEFT SIDE) '' SCALE: 1/5"- I'—O• l APPLICANT/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 nece,ssary to avoid same. YOUR NAME: Portillo,Anthony (Last name,first name,griddle 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 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.wempfoyec of the Town of Southold? "Relationship"includes by blood,marriage;or business interest.`Busiriess intcrest"means-a business, including a partnership,in which the town officer or cmployee has even a partial ownership of(or employment by)a.corponition' in which the town officer oremployee,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 applicartt/agenthepresentative)and the town officer or employee.Either check the appropriate line A)through D)and/or describc.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 (where the applicant is a corporation); B)the legal or beneficial owner of any intcrgst'in.a.non-corporate entity(whets the applicant is not corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP .� �i '-- Submitted this � day of 20 Signature Print Name Form TS 1 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM , The Town ofSouthold' .Code of Ethics orohibits conflicts of interest on the art of town officers and em to ees.The se of this form is to rovide information which can alert the taw.of ossible eanflicts'ofinterest and allow it to take w T everaction is neeessary to avoid same_ YOUR NAME: Stritzler Trust (Last name,first name,griddle 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 Variance Building Change of Zone Trustee ✓ Approval of plat Coastal Erosion Exemption from plat or official map Mooring Other Planning (If"Other",name the activity.) Do.you personally(or through your company,spouse sibling, oFthe_Town of Southold? "Relationship"includes by officer or employee y blood,,marriage,or business into esl1QBusin ssonship withnterese'means a business, including a partnership,in which the town officer or employee has eJen a partial ownership: of(orcmployment by)a corporation in which the-town'ofticer or employee,owns more than 5%-of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name ofperson employed by the Town of Southold Title or position ofthat.person Describe the relationship between yourself(the applicant/agent/represedtative)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): fjA)the owner-of greater than 5%of the shares of the corporate stock of`the appiieaat -E (when the applicant is ad orpotation); B)the-legator 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 thiayof _ Leo Signature tt Fonn TS I Print Name of Trustees ApPlicati J AUTHORIZATION (Where the applicant is not the owner) I/We, Stritzler Trust owners of the property identified as SCTM# 1000-94-1-8 in the town of Southold , New York, hereby authorizes AMP Architecture 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. G Property Owner's Signature roperty Owner's Signature r r1c SWORN TO BEFORE ME THIS DAY OF1� NoF Y.Public EVE L:..ATL'S,CHWAMBOWN NOTARY Yt;81_IC:STATL�r NEW YbfZ-K Rcgist auc�a N,n.t31G:�6?7 it)?ii duaffied iri SufRA CGumy. Csariimissior xpire t3ec.24.2Qiwi ,Board of Trustees Applica', ;Dn AFFIDAVIT Stritzler Trust DEPOSES AND AFFIRMS THAT HE%SHE IS BEING DULY SWORN 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 WORKWILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPRO�rED 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 Ml'`PROPERTY TO INSPECT THE PREMISES IN CONJITNCTION WITH THIS APPLICATION,. IN , A FINAL Il`TSPECTION. I:.. URTHER 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. r Signature •C�jl JJ-�L2�-���"�� gn of Property Owner i afore of Property Owner SWORN TO BEFORE ME THIS t:Y DAY OF Di'Y�41� 20a� a Public EVE L.GATZ-SCHWA-MBORIV NOTARY PUBLIC,SLATE OF NEW YORK Registration No.OIGA6274028 Qualifictd in Suftntk County Commission Fxpires Dec.24,20_ ,7- flexsbm N, 77 ,W�Wmo zpi j XI iMM X, a, N N, N.x,"him N" A, zir. NN� \'T 0�- V all MM 0 A_W- N V �'­,'N­N U N_ 04,Z, P". Mom A a W— ,=Q Vow JAW Q _jK N, A ZW QW0 m""SQ . g, No An, "WA "c", W.,`X %z� x N N NN N WAS, Wk x NQ A WN N N, hy"'! P, 110PQ 14 + n N�, Z, A: N, k V Mv, Mg� N \M 4'� N'\ ilof� q 0 "N N ,bs Vvy G N, you jWy m vow R 0 sh, N� NIN y A NI. 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