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HomeMy WebLinkAboutMKS Realty LLC • r-- ��.�zzy� r-�, Glenn Goldsmith, Presid?-:-_ �p��5� �C�G '� Town Hall Annex A.Nicholas Krupski,Vice President �� y< 54375 Route 25 Eric SepenoskiC23 P.O. Box 1179 Liz Gillool y ��y ®' �� ,r' Southold,NY 11971 Elizabeth Peeples �1 '' Telephone(631)765-1892 ter ` Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time:0o66r.r l 2i02_5 Completed infield by: _61�Za b e+� AMP Architecture on behalf of MKS REALTY LLC to discuss a proposed dwelling, deck, stairs, and balconies. Located: 1925 North Sea Drive, Southold. SCTM# 1000- 54-4-20 Type 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 Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: 1 a.kAwMj a'b v c, V (n ' S{ t) e . LoLv\A sLq ip n1' 6ul - c 1n r a1V� s. ID d K axf4 rwo A(6vvr -e -s e iC vr'ry wide r dice t� a-- &� k mnl.-5MC- Present Were: ✓ G. Goldsmith ✓N. Krupski ✓ E. Sepenoski ✓ L. Gillooly ✓E. Peeples FILED: SUFFOLK COUNTY CLERK 08 06 2024 12 :20 PM INDEX NO. 601105/2023 NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/06/2024 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF SUFFOLK ------------------------------------------------------------------------X Index No.: 601105/2023 MKS REALTY, LLC, Assigned Justice: Petitioner, Hon. Kathy G. Bergmann, J.S.C. -ag,ainst- SO-ORDERED TOWN OF SOUTHOLD BOARD OF TRUSTEES, STIPULATION 'S y��� ; and TOWN OF SOUTHOLD TOWN BOARD, in its : SETTLEMENT == capacity as the COASTAL EROSION HAZARD BOARD OF REVIEW, OCT 7 2025 I ! Jt Respondents. ------------------------------------------- -------------------=-------X Southold Town`_ Board of Trustees WHEREAS, in the above-captioned matter, Petitioner, MKS Realty, LLC ("MKS") sued Respondents, Town of Southold Board of Trustees ("Town Trustees") and Town of Southold Town Board in its capacity as the Coastal Erosion Hazard Board of Review ("Town Board") (Town Trustees and Town Board, collectively, "Town") (MKS, Town Trustees, and Town Board, collectively, "Parties"); and WHEREAS, MKS commenced the above-captioned proceeding pursuant to, inter alia, Article 78 of the New York Civil Practice Law and Rules and Section 111- 26 of the Southold Town Code, seeking review of a decision of the Town Trustees dated December 14, 2022, that denied MKS's application for a Wetland Permit and Coastal Erosion Hazard Permit to construct a single-family residence on MKS's premises known as 1925 North Sea Drive, Southold New York ("Premises"); and WHEREAS, by Town Board Resolution 2023-410, adopted April 25, 2023, the Town Board affirmed the Town Trustees' decision dated December 14, 2022, and 1 of 7 FILED: SUFFOLK COUNTY CLERK 08 06 2024 12 : 20 PM INDEX NO. 601105/2023 NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/06/2024 MKS Realty,LLC v. Town of Southold Suffolk Co. Index No.: 601105/2023 denied MKS's request for a variance from Chapter III of the Southold Town Code, known as the Town of Southold Coastal Erosion Hazard Area ("CEHA") Law, and WHEREAS, the Parties have conferred and agreed to resolve the above- captioned proceeding pursuant to the terms set forth in this Stipulation; and WHEREAS, pursuant to Town Law §68, the Town Board authorized its Town Attorney to execute this stipulation on behalf of the Town Board (a copy of the resolution authorizing this action is annexed hereto as Exhibit"Al; and WHEREAS, pursuant to Town Law §68, the Town Trustees authorized its Town Attorney to execute this stipulation on behalf of the Town Trustees. NOW, IT IS HEREBY STIPULATED AND AGREED that: 1. MKS shall, within forty-five (45) days of the date this Stipulation is So Ordered and entered,unless such time is extended by the Office of the Town Attorney, submit to the Office of the Town Attorney a proposed revised site and building/construction plans, which shall conform to the following Requirements: a. The house may have a maximum 1,700 square foot footprint, b. The house may have 3,400 total square footage, inclusive of garage; c. The house to be centered on the lot; �==-��� d. The rear foundation may not extend farther north o than that of the neighboring property to the west, w per+ 1725 North Sea Drive, a e. The outside decking may be a maximum of 750 square feet and shall extend no farther north than i the decking of 1725 North Sea Drive; 2 2 of 7 FILED: SUFFOLK COUNTY CLERK 08 06 2024 12 : 20 PM INDEX NO. 601105/2023 NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/06/2024 MKS Realty,LLC v. Town of Southold Suffolk Co. Index No.: 601105/2023 f. No pool allowed at 1925 North Sea Drive; g. MKS's revised application will avoid and/or minimize any variances from code requirements other than issuance of Coastal Erosion Permit as set forth hereinabove, except MKS may apply to the Zoning Board for a front yard variance if needed;and h. Inclusive of all conditions imposed by previously issued wetlands permit and all , customary mitigation associated with issuance of the CEHA permit. 2. Upon confirmation by the Office of the Town Attorney that MKS's Updated Plans conform to the above-referenced Requirements, and submission of any further documents that may reasonably required in connection with the issuance of CEHA and Wetlands Permits, the Town Trustees shall grant CEHA and Wetlands permits to Petitioner, which will be subject to mitigation measures, including all customary mitigation measures typically required by the Town Trustees for new development, all mitigation measures of Wetlands Permit previously issued, and such other reasonable conditions, not inconsistent with this Stipulation, as the Town may deem reasonably appropriate. Upon issuance of a CEHA and Wetlands Permits, to the extent necessary, MKS shall apply for building permits for the construction of MKS's proposed project at MKS's Premises, which permits shall be processed by the Southold Town Building Department. 3. Nothing herein shall prevent MKS, its successors, or assigns, from seeking other variances, permits, or approvals in the future. } RD - 3 ! OCT 7 7ngq Southold Tows 3 of 7 FILED: SUFFOLK COUNTY CLERK 08 06 2024 12 : 20 PM INDEX NO. 601105/2023 NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/06/2024 MKS Realty,LLC v.Town of Southold Suffolk Co. Index No.: 601105/2023 4. Upon full execution of this Stipulation and upon the Court"so-ordering" this Stipulation, the Parties agree to execute a stipulation of discontinuance with prejudice and without costs regarding the above-captioned proceeding. 5. This Stipulation shall not in any way be construed as an admission of liability by any of the Parties to the above-captioned proceeding. 6. The Parties may apply to the Court at any time for such further order, direction, or relief as may be necessary or appropriate for the construction of this stipulation, or to effectuate or enforce compliance with its terms and conditions. 7. Additional Provisions: 8. Waiver and Release. In consideration of the promises and other commitments set forth herein, MKS, on behalf of itself, and its agents, attorneys, privies, successors in interest, and assigns, does hereby release, acquit, and forever discharge the Town of Southold, its officers, employees, and attorneys, from any and all causes of action, obligations, costs, damages, losses, claims, demands, benefits, and liabilities (including without limitation any claims for attorneys'fees or costs), of whatever character, in law or in equity, known or unknown, suspected or unsuspected, matured or unmatured, of any kind or nature whatsoever, now existing or arising in the future from any act, omission, event, occurrence, or nonoccurrence from the beginning of the world to the date of execution of this Stipulation of Settlement, including but not limited to any and all claims that were or could have been-asserted in the above-captioned proceeding. - _- D 4 � OCT 7 2025 f Southold Town Board of Trustees 4 of 7 FILED: SUFFOLK COUNTY CLERK 08 06 2024 12 : 20 PM INDEX NO. 601105/2023 NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/06/2024 MKS Realty, LLC v. Town of Southold Suffolk Co. Index No.: 601105/2023 9. Entire Agreement. The Parties acknowledge that this Stipulation and agreement represents the full, final and complete resolution of the above-captioned proceeding, so that this Stipulation and agreement supersedes all prior agreements, written or oral, if any, concerning the subject matter of the above-captioned proceeding and this Stipulation and agreement. 10. Binding Agreement. This Stipulation and agreement is and shall be binding upon, and shall inure to the benefit of, the predecessors, subsidiaries, successors, assigns, parties, agents, offices, employees, associates, legal representatives, heirs, executors, constituent partners or members and/or administrators, of each of the Parties hereto. 11. No Admission of Liability. This Stipulation and agreement shall not be construed in any way as an admission by any of the Parties of any wrongdoing or liability whatsoever. 12. Counterparts. This Stipulation and agreement may be executed in counterparts, and facsimile, pdf/scanned, and/or photocopies shall be considered originals for all purposes;any counterparts shall have the same effect as if all original signatures were placed on one document, and all of which together shall be one and the same Stipulation and agreement. Signatures may be provided as original signatures, or as facsimile or emailed PDF copies. A photocopy of this Stipulation and agreement may be used as the original. PnD E 101 E �f �r OCT 7 2025 Southall 7avdn Board of Trustees 5 of 7 FILED: SUFFOLK COUNTY CLERK 08 06 2024 12 : 20 PM INDEX NO. 601105/2023 NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/06/2024 MKS Realty, LLC v.Town of Southold Suffolk Co. Index No.: 601105/2023 13. Authority to Execute Agreement. Each of the Parties hereby represents and warrants that the individual signing this Stipulation and agreement on its behalf is duly authorized to do so by the entity on whose behalf the individual is acting. 14. Severability. In the event that any provision of this Stipulation and agreement should be held to be void, voidable, or unenforceable, that provision shall be severable to the extent it does not vitiate the core intent of the Parties under this Stipulation and agreement, and the remaining portions hereof shall remain in full effect. 15. Waiver, Modification, and Amendment. The Parties agree that this Stipulation and agreement may not be modified, altered or changed except by a written agreement signed by the Parties or their authorized representatives. 16. Successors and Assigns. This Stipulation and agreement shall accrue in favor of, and be binding upon, each of the Parties' respective successors and assigns. 17. Stipulation to be So-Ordered. This Stipulation and agreement may be filed with the Court and submitted to be "so-ordered" without further notice. 18. Continuing Jurisdiction. The Court shall retain jurisdiction over this matter, and the Parties may, if necessary, raise issues related to enforcement of this Stipulation via motion within the above-captioned action. [INTENTIONALLY LEFT BLANK] E ( F ' .� 6 f OCT 7 2025 i Souinofo Town Board of Trustees 6 of 7 FILED: SUFFOLK COUNTY CLERK 08 06 2024 12 : 20 PM INDEX NO. 601105/2023 NYSCEF DOC. NO. 55 RECEIVED NYSCEF: 08/06/2024 MKS Realty,LLC v.Town of Southold Suffolk Co. Index No.: 601105/2023 Dated: ---' I 2024 Understood and agreed r t�'A1t L L-l1,1ti1T7, 1t,C. TOWW1 't° ORNEY OF THE ;t 'I'UWN/(7F SO --OLD By: a' BY: ' J h Ai•mentnrio, 1st :Paul De(;han•c, ��c1.. JAh _tc-Ilaf�asp I?,sc(. flttarJl(,jti fill licsponr(cli s Att(urle rfKItit-ionel. c wn An T� Hall � .nex 100 Mator Parkway,Suite 300 54375 Route 25 h�H �c�ia.ilge, New York 11788 Southold, New York 11971 P: 631.547.8400 P: 631,765.1936 F: 631.547.0501 F: 631.765.6639 E:jcarmentano@farrellfritz.com E: Pauld@southoldtownny.gov E:jstellakis@farrellfritz.eom Pursuant to Res, 2024-468, adopted May 21,2024, Dated:July 2024 50 ORDERED.- ENTER. Ho . K y G. Tier ann, J.S.C. 7 �7110 ;LL)). E CT 7 2025 FI-114653470.2 I I Southold Town Board of Trustees 7 of 7 fir .:, <�:: \ =k 12l 2':.• \ � ,ti \\ k=:\ \�,. y\ t\i \\ '1\ �[ ..,.. :.'#� �• 3„�.\.\. ..ZY.\\",�,�4Z .. I.I '��li 93 i 2 1 \ �' �\ \'\ ` tr.-r o b F ,\.\ \ \ � :: i *...: a'. k �. : \ � � \ \..,� \ \��� �• z'1(I�..a. 4s .. r�r ,, , :'� �e\\� ..� ,� \'\�, ,\�r.�,�- \,�,: \ �k T,\ ¢ 5 5 y4 '' e tW�,y�5�p?' .��'4 ar r 45.M ' y v \\� . \ #s�� !nl z esx •� \� 9 12:',::. 6 . 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S ;'v 41 - '"""•• °�:' — ��. aznyy COUNTY OF SUFFOLK© NOTICE �._K ��, 1000. ,�sEcnw nro E '�"`"—i.•••'u.,K,. _J°__ __ O N... —�— �� ,>r v R.1 Pro 1 T 8 5T e 1 W ar �nmxry rwNanre Y sourHoco .aG per y .gcncy - wn N ••"._m—__._— __.__ •_.". „_,.. _ aw<.,,/nGn,../zl..nnknrunl s�rcuccaxrvrasnwsrxnualEn G 054 (21) s.... .. ypS 0. PPfPE¢ry iM a6=W 6riE p SITE PLAN HATCH KEY: NEIGHBORING AVERAGE FRONT YARD SETBACK ZONING REGULATIONS MAIN BUILDING 0— PROPOSED HOUSE FOOTPRINT -- — —_—_ — — — — _-- SOUTHOLD TOWN CODE CHAPTER 280; ATTACHMENT 3 ['lllT� PROPOSED 2ND STORY SOUTHOLD TOWN GODS CHAPTER 280-104 (A) Li f PROPOSED COMPLIES -J -----I I— -- —!--- — ' HOUSE NUMBER APPROX FRONT YARD MIN. FRONT YARD Q ++ - (AVERAGE; N 50 45.2 45.2 YES Il 2225 41.a' PER CODE) O �t00 2125 45.6 MIN. SIDE YARD I5.0 46.2 YES O 2025 l 2Q.7' MIN. COMBINED J=---- - - O �r-Zd- ll F - -� X SIDE YARDS (1) 55.0 a2.4 YES a �p0 N 1,725 40.0' -- -- - A m U 1 ----- ----_-- -- ---=_---- -- - ----- MIN. REAR YARD 50.0'-_-- 224.3' - YES C O m(O ---- 1625 - --- - ----- -- -� - 42.1' ---- �i ----- - -__ - _ I----- - �� O Om+�q- MAX. HEIGHT 35.0 I525 7I.7' 35.0 �� YE5 Np -- \/ --— 1-SUPREME COURT OF THE STATE OF NEW YORK,COUNTY OF nQ O��O AVERAGE 45.2' OF SUFFOLK HAS INDICATED THAT THE HOUSE W -- -- --- I MUST BE CENTERED ON THE LOT AC ,ORDIN6 TO THEIR STIPULATION DATED JJLY IBTH,2024(INDEX No. -- 601105/2025) ' I"-J U ' HOUSE FOOTPRINT •— - - --- - - - --- - -- -- -- SUPREME COURT OF THE STATE OF NEW PO_ AUG 2 9 2023RK STIPULATION b U DESCRIPTION (FOOTPRINT) PROOPP05ED ALLOWED Southold Town AREA LONG ISLAND 5OUND Eoc rd of Trustees PROPOSED HOUSE FOOTPRINT (IJ 1,672.0 S.F. 1,700.0 S.F. TIE LINE ALONG APPROXIMATE HIGH WATER LANDWARD LIMIT OF TIDAL I-SUPREME COURT OF THE STATE OF NEW YORK,COUNTY OF SUFFOLK HAS INDICATED THAT THE HOUSE MAY MARK AS LOCATED BY US ON 11/25/20 WETLANDS AS DELINEATED BY U5 HAVE MAXIMUM OF 1,100 S.F.FOOTPRINT AGGORDIN&TO THEIR STIPULATION DATED JULY 18TH,2024 ON 11/25/20 (INDEX No.601105n02e) ------____-- ---r N40°28'S9"E 200.04' --- ---------------------- ---- -------------------------- PROJECT / ZONING DATA �. o f N _--------------------- TAX MAP # I000-054-04-20 m BEACH ZONING DISTRICT R-40 CONFORMING 50'REAR YARD SETBACK I LOT AREA 1.4 ACRES I --- -- - -- - ------- --I ( b) ED(SE OF BEACH ZONE VEEL-I I -- — - --- -(EL-1 ) 6RA55 SUPREME COURT OF THE STATE ZONE VE 601105/2023 ; 07/18/24 OF NEW YORK STIPULATION ---- - 1 - -------------- VARIANCE APPROVAL PENDING - _ --------------- FEMA FLOOD ZONE ZONE VE (EL-13) kn - -- ---- 1 WETLANDS DISTRICT PENDING 'I r DEG DISTRICT 11 PENDING F- BEACH 6RAsS 3- SUFFOLK COUNTY HD APPROVAL # OF BED. I ' I Lu D � I EXISTING CREST OF PROPOSED PROPOSED DUNE/BEACH RIDGE 711 E j CONDITIONED GROSS g M - -- I AREA AREA F. 175 S.F. BASEMENT AREA 1505. LANDWARD LIMIT OF DUNE/BEACH =--FIRST FLOOR AREA 1,4a8 S.F.-- - - S.F. SECOND I !' - - - SECOND FLOOR AREA 1,411 S.F. 1,552 S.F. --- -- -_--__ - - __ -= -- - = ------ - -- PROPOSED i 1 PROJECT: p -'_- ---- MKS REALTY AREA TOTALS 3,05LI S.F. 3,3aQ S.F. - ------ — = -- - K PECK SETBACK - - - � __ _ DECK SETBACK 1 r _ ___ r __SECOND STORY - � y r- p 1 n IER LINE ,— ZONE VE(PL-13) OVERHANG i •' - - ZONE VE(E-15) I RESIDENCE — - -- - I- - - ZONE AE-EL�2)- I -- " �- - T —- ZONE-AE(E---12) i 2 STORY FRAME HOUSE t ._fl. 462' tr ;-: IOIb' 4f�2 J � 2 STORY ;x 1 -- -- - ----------- ------- �� ---- - - -------- 1 FRAME HOUSE --- --- -- - ----------- - LOT GOVERAC�E j EXISTIt� ` I 1925 N SEA DRIVE `4s2'AV6 _ i SOUTHOLD, NY 11971 SOUTHOLD TOWN CODE 250-124 - --__- DRsiv Y OM FRONT YARD _ PER SOUTHOLD ( I EXISTING SAND, PROPOSED HOUSE r1 TOWN CODE 1 BRICK DRIVEWAY DESCRIPTION (FOOTPRINT) AREA COVERAGE LOAN BAH a FOOTPRINT 280-104(A) I - i DRAWING TITLE: — - —' -- --- -- - - ----- - ----- -- I,?75' TO KENNEY'S ROAD yBF I -- - � 5G TTERED TREES � TOTAL LOT AREA 55,1136.0 S.F. - �---__ s3a°�4�oo°wi-------------- -------- 200.00'--- IPF BUILDABLE AREA 16 665.0 S.F. EOP PAGE: -------------------------------------- LANDWARD LIMIT OF NATURAL PROTECTIVE PROPOSED DWELLING FEATURE AREA LINE AS SCALED FROM FOOTPRINT(') 1072.0 S.F. 10.0% NORTH SEA DRIVE COASTAL EROSION HAZARD AREA MAP Vff�A PROPOSED RAISED DECK i 640.0 S.F. 3.8% PROPOSED BALCONY ------------------ --------- DATE:8/29/25 OVERHANG(2) 52.0 S.F. 0.3% NACANT) �--------------------NACANT) ------ 1 GMF roWELLINB WITH PUBLIC WATER) ---- - - = - --_ - --- - --- I 11 - ------- TOTAL AREA OF ALL STRUCTURES II 2364.0 S.F. 14.2% r . --- MAXIMUM LOT COVERAGE.�ALLOWED. 20%-- I I .`„r•` ", ��.. t �,',`�, I-SUPREME COURT OF THE STATE OF NEW YORK,COUNTY OF SUFFOLK HAS INDICATED THAT THE HOUSE MAY HAVE MAXIMUM OF I TOO S.F.FOOTPRINT ACCORDING TO THEIR STIPULATION DATED JULY ISTH,2024 (INDEX No.601105/2025) 2-SUPREME COURT OF THE STATE OF NEW YORK,COUNTY OF SUFFOLK HAS INDICATED THAT THE OUTSIDE w. = DECKING MAY HAVE MAXIMUM OF-750 S.F.ACCORDIN5 TO THEIR STIPULATION DATED JULY 18TH,2024 ��� , 1. •+ (INDEX No.601105/2023) PROPOSED S 1 TE PLAN SCALE: 1" - 40'-0" �, E -: A Ali -- — --„------ 1 d - ' A is A 3 WE r ar # res; are. eak. s - '. Aw 1925 N Sea Drive Option 02 A M P Architecture Design + Build r . - r 7 4 -., T _ - - _.f._ r4L MIA72mm Mpg T'T RLA MEN T- , ;ribs bal _ m - v _ J - _ -- -_,- -_- _ AAAr low- JOW it W , ,. 1925 N Sea Drive Option 02. A M PArchitecture Design + Build 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 ® EC EE WE August 27,2025 Re: MKS Realty Residence AUG 2 9 2025 1925 N Sea Drive ' Southold, NY 11971 ;. w;.. Southold Town SCTM#100-54-4-20 Board of Trustees 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: - Proposing the following: o Proposed Dwelling(1,672 sf footprint) o Proposed Railed Deck(640 sf) o Proposed Wood Stair to rear yard from Raised Wood Deck o Proposed 2"d Story Balconies 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, AMP Architecture Page 1 of 1 -1oard of Trustees Applicat AFFIDAVIT_ gl n?U n i QS Vo U('n o(,(_ __. ... _ _ _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 A 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. 4 6 Signature of Property Owner, Signature of Property Owner SWORN TO BEFORE ME THIS Ilk DAY OF "ClV S� Jenny Sakalis Notary Public,State of New York No.01SA6098042 Qualified in Nassau County. No ary Public a My Commission Expires 09/02/2027 loard of Trustees Applicat AUTHORIZATION (Where the applicant is not the owner) I/We, A4)r\1C),::� V ( )mou ; owners of the property identified as SCTM# 1000- q--2 n- in the town of U-� 1 (C� ,New York, hereby authorizes An4hc' \! I ca k2 MP Arckyier—iLxe to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town _ i Board of Trustees for this property. F Property Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS . ISM` DAY OF A-w btjST _ _, 20_oZ5' Jenny Sakalls Notary Public,State of New York No.01SA6098042 Qualified in Nassau County N tary Public My Commission Expires 09/021202;r APPLICANVAGENTIREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold'.s Code of Ethics orohibits'conflicts of interest-on-the aarf6ft6wn:officeis and employees.The purpose of. this form is to provide information which can alert thie Wwn of possible conflicts ofihteresrand allow it to take whateveraction is, necessary to avoid same, , YOUR NAME: A_1Ap11i cfs \V O QL 1r)0L) (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.) of 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 for 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 basirress, including a partnership,in which the town offiddr or employee has even a partialownership of(or employment by,)a corporation in which the town officer or employee owns more than:5%ofthe shares. 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 than 5%of the shares of the corporate stock of the a_pplicolit � (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 I cj day of A u rr 20 dS Signature ad Print Name, XQT-61\I 10 S 0 UL2-�,101 Form TS 1 r i APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM the Town of Southold's Code of Ethics prohibits earflicts of interest on the part oftown officers ande nalovees The aga ge of this form is-to provide inforinaiion which-can alertthe towrf of possible conflicts of interest and allow it to take whatever action is necessaty o avoid same. YOUR NAME: Portillo,Anthony (Last name,first name,.niiddle 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 chi ld).have a relationship with any officcror employee of the Town of S.outt%Id? "Relationship"includes by blood,rgarriage,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'56/oof 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/ag(;ndrepresentative)and the town officer or employee.Either check the appropriate line A)through D)andlor 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$%of the shaves 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}; G)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted thi day of 20 S ignature Print Name Form TS I �