HomeMy WebLinkAboutTR-5891Albert J. Krups~, President
James King, Vice-President
Attic Foster
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOV~N OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
# 0075C Date0ctober 21, 2005
is
The certificate is issued to
THIS CERTIFIESthatthe sunroom, screened porch, and deck
At Hedge St., F±shers Island
Suffolk County Tax Map # 10-7-12
Conforms to the application for a Trustees Permit heretofore filed in this office
Dated ll/18/03pursuant to which Trustees Permit # 5891 Dated 4/21/04
Was issued, and conforms to all of the requirements and conditions of the applicable
provisions of law. The project for which this certificate is being issued
for a sunroom, screened porch, and deck
W.L. Lyons Brown III owner of the
aforesaid property.
Authorized Signature
H.P. BROOM - HOUSEWRIGHT, INC.
P.O. BOX 70 - 162 FERRY RD.
HADLYME, CT 06439
(860) 526 - 9836
FAX (860) 526 - 2647
TO:
Board of Southold Town Trustees
Anthony Broom
DATE: 8/16/05 P,.E:
Board of Town Trustees
Pez~ait # 5891
To I~nom It May Concern:
The project delineated in Permit % 5891, at the Brown
Residence, Hedge St., Fishers Island, has bee completed as
per the conditions set forth in the permit.
This letter is notification of completion and in compliance
with the Terms and Conditions of the permit, most notably
paragraph 8.
Should you have any questions please feel free to call me.
On behalf of the permittee, W. L. Lyons Brown III, and for
the general contractors, H.P.Broom-Housewright., Inc.,
Board Of $outhold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO... ~"~-~>~/ ..... DATE: ...A..pr.i/u Z~..~....~g04
ISSUED TO W.L. LYONS BROWN III
P, ,',,, ant to the ~rovisions of Chapter 61~i of the Laws of
the Sta~'~ New-York, ~893: and Chapte'r 40~ of the ,L~. ws of the
State of New Yorl~ 19S2: and the Southold Town Ordinance
tiffed ."REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;"'. and in accordance with the
Resolution of The Board adopted at a meeting held on ..~P.~]...~.~:.~.-
2g.~.., and in consideration of the sum of $ .....Z°.0..~.g.Q ... paid by
W.L. Lyons Brown III .................................. , ........... : .........
of ................ Fj.~.I~-~..?.!.~..n~ ..................... N. V. and subie,:t to the
Terms end Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the following:
Wetland Permit to construct a sun.room (14~X14~), a screened
porch (l)'X14') and an oper~ deck (10'X16') onto an existing
single-family dwelling, and as depicted on the site plan
prepared by Richard H. Strouse last dated October 25, 2003.'
all in accordance with the deta~ecl specifications as presented in
· the originating application.
IN WITNESS WHEREOF, The sald Board of Trustees Ixere-
~ causes its Corporate Seal to be affixed, and these p.reseMs to
subsc~'bed by a 'majority of the sald Board .as of thru date.
- ' Trustees
TERMS IIßd CONDmONS
'DIe I'etmic.ue
W. L. Lyons Brown III
ICsi~;'>g U Hedge St. , Fishers Isl~nò N. Y.. as
.part of the coosideration for the se,.","«, of che Pemùt does ~nd and prescñbe to the fol·
looviDB:
1. That the said Ðoard of Trustees and che Town 01 Soutbold - relcoscd from any and
all damages, or claims for damages. 01 AÚØ aåsiøg. dincdy or IodiIecdy as a ~ of my oper'
-atIoa performed p"........t 10 this permit. _ !he said P-nI-wiIl, at Ids or her own a¡.tÐSC,
clefend _y and aU -" suits ·I.. ~.œd by dIkd.,arde!, and the said 1\. ..1..- ......., fuU 1iahilit.7
with reSpect thereto, 10 the ~p~ exdusioo of the I!øatd of Trustees of the Town of ~d
24.
2. That this PemIIt is wUd foe . pedod of DOS. wlùch Is O'as/.-.... to be me
r:tI....ted time required to c:omplete the wad< ind¥Cd, but shoa1d CÍfaIIiIIWICCS waaant, nqueat
for an exœosiOD rœy be made to the Board u a bier d.œ.
3. That this Pemùt should be retained indefmitely, or as 1008 IS the &aid pemdttee wishes
to ....Int.in the Itt\ICtUfC or project involved, to provide evideoce to anyone cooœmed chat aach·
orizadoo was originally obtained.
4. That the ..ode inwlved will be subject to the I.."....w. and approval of me Boørd or
its ~ts, and DOD-oxupliance with the proWioDl of the orègi_tl..g app1icatioa. may be canse for
œvocation of this Pemùt by resoludoo of the said Board.
s. That there will be DO uorea_.hI~ Interference with oavigatioa IS . result of tbe work
berein aaihorized.
6. That there oball be DO interfereoœ with the right 01 the public 10 pass and repass aloag
the beach between -túgb and low water marks. .
7. That If future operatioos 01 the Town of Southold require che ømoftl UJid/or alœndoas
In the locatioo 01 me work herein aaIJ-- '---<f. or if, in the op'nlnn ol1be Board 01 Trasœes, che
wodc shall cause unreasooñd~ obstturtlOO to free ..mgadon. the said ~ r ,i..~ will be i""f.dœd,
apoa clue ootke, to _ or alter this work or project beteIn stated wIchouc tspeasc I 10 the Town
. of Souchold.
8. That the said Board will be oodf"lCd by the Penniuee ot the ~ Of the work aud1-
ori2ed.
9. That the Permittee will obtain all other permits and ~..Chat may be required sup-
pIAmeotal to this pem1Ït which may be subject to revoIce upon failure 10 obtain aame.
.
.
Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095 Route 25
P.O. Box 1179
SouthoJd, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
April 21, 2004
Mr. Glenn E. Just
J.M.O. Environmental Consulting Services
P.O. Box 447
Quogue, NY 11959-0447
RE: W.L. LYONS BROWN III
HEDGE ST., FISHERS ISLAND
SCTM#1 0-7 -12
Dear Mr. Just:
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday, April 21, 2004 regarding the above matter:
WHEREAS, Glenn E. Just on behalf of W.L. LYONS BROWN III applied to the
Southold Town Trustees for a permit under the provisions of Chapter 97 of the Southold
Town Code, the Wetland Ordinance of the Town of Southold, application dated
November 18, 2003, and,
WHEREAS, said application was referred to the Southold Town Conservation Advisory
Council for their findings and recommendations, and,
WHEREAS, a Public Hearing was held by the Town Trustees with respect to said
application on April 21, 2004, at which time all interested persons were given an
opportunity to be heard, and,
WHEREAS, the Board members have personally viewed and are familiar with the
premises in question and the surrounding area, and,
WHEREAS, the Board has considered all the testimony and documentation submitted
concerning this application, and,
2
.
.
WHEREAS, the structure complies with the standards set forth in Chapter 97 of the
Southold Town Code,
WHEREAS, the Board has determined that the project as proposed will not affect the
health, safety and general welfare of the people of the town,
NOW THEREFORE BE IT,
RESOLVED, that the Board of Trustees approve the application of W.L. LYONS
BROWN III to construct a sunroom (14'X 14'), a screened porch (13'X 14') and an open
deck (10'X 16') onto an existing single-family dwelling, and as depicted on the site plan
prepared by Richard H. Strouse last dated October 25, 2003.
Permit to construct and complete project will expire two years from the date the permit
is signed. Fees must be paid, if applicable, and permit issued within six months of the
date of this notification.
Inspections are required at a fee of $50.00 per inspection. (See attached schedule.)
Fees: None
Very truly yours,
d'~~.ý- 1/ ~ (}
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/lms
.
.
Telephone
(631)765-1892
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
CONSERVATION ADVISORY COUNCIL
TOWN OF SOUTHOLD
At the meeting of the Southold Town Conservation Advisory Council held Monday,
December 8, 2003, the following recommendation was made:
W.L. LYONS BROWN III to construct a sunroom (14'X 14'), a screened porch (13'X 14')
and an open deck (10'X 16') onto an existing single-family dwelling.
Located: Hedge St., Fishers Island. SCTM#10-7-12
The CAC did not make an inspection, therefore no recommendation was made.
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.
Alhrrt J. Krupski, President
Jarncp; King, Vice·Presidcnt
Henry Smith
Artie Foster
Ken Poliwoda
.
.
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephol'e (631) 765-1892
Fax (611) 76!d366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
_ Coastal Erosion Permit Application
""'-:Wetland Permit Application /Major
_ Waiver/ Amendment/Ch nges
_ -'Received Applicati D.3.
"""'Iteceived Fee:$ ~03
. -Completed Applica ~~
_Incomplete
_SEQRA Classification:
Type I__Type II_Unlisted___.
Coordination:(date sent)
_ -CAC Referral Sent.JL!L-!7IT3
~ate oflnspection.-1;;)-/lO/O~
__Receipt ofCAC Report .
_Lead Agency Determination:
Technical Review:
--Vublic Hearing Held: 1.:J//?/ð3
Resolution:
Minor
~~~WlE
~
~
NOV 1 8 2003
Name of Applicant
W.L. Lyons Brown III
~thold Town
Board of Trustees
P.O. Box 187, Fishers Island NY 06390-0187
Address
~-----,._--
Phone Number ( )_ c/o ~~Q.::-526-:2.!3~________
Suffolk County Tax Map Number: 1000 - 010 - I-=-!L__________.____
PropertyLocation:___._Ji~clße Street, no /I, Fishers_ Island
~.../
if\,\~
(provide LILCO Pole #, distance to cross streets, and location)
AGENT:
(If applicable)
Glenn E. Just/ JMO Consulting
Address:
P.O. Box 447, Quogue, NY 11959-0447
Phone:
653-0607
. .
,. Board of Trustees Application
.
GENERAL DATA
+
Land Area (in square feet): - 21,750 s. f.
Area Zoning: R-40
Previous use of property: single family dwe1lin)"
Intended use ofproperty:__~"..me
Prior permits/approvals for site improvements:
Agency Date
------- -------------
------
X _ No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a governmental agency?
-1L No Yes
--
If yes, provide explanation: ...... ~~ IE ~ 'W IE ~
I
I;::;
U NOV 1 8 2003
Southold Towo
Board of Trustees
Project Description (use attachments if necessary):
Applicant pr-oposes to constr-uct a sunr-oom ( 14- ~ 14-)
A
por-ch or - 16-)
a screened v 14-) ~nrl :In ()ppn dprk (10 x
onto an existing single familv dwelling.
- ._--_._---~--~---
.
.
.
Board of Trustees Application
,
WETLANorrRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations:
Additions to an existing
single family dwelli~
---
-
Area of wetlands on lot: :': 2,125
-
square feet
Percent coverage oflot:___,,-L.!!___%
Closest distance between nearest existing structure and upland
edge of wetlands: 40 feet
Closest distance between nearest proposed structure and upland
edge of wetlands: 30 fect
Does the project involve excavation or filling?
No X Yes
----
+
If yes, how much material will be excavated? -20 cubic yards
How much material will be filled?
o
cubic yards
Depth of which material will be removed or deposiled:__J:lJ-ª_ feet
Proposed slope throughoullhe area of operations: I : 1
Q ~ N~ ~ 3~j~j ~ ~
Manner in which material will be removed or deposited:
paylaader
-------
Southold Town
Board of Trustees
Statement of the effect, ¡fany, on the wetlands and tidal waters of the town that may result by
reason of such proposed operations (use attachments if appropriate):
Since Dr aD a sed praiect is located landward of an
existing seawall there should be no negative impacts
upon the adjacent tidal wetlands.
-
. .
.
Board of Trustees Application
COASTAL EROSION APPLICATION DATA
Purposes of proposed activity: additions to an existing
qinr:lp family d",elling
Are wetlands present within I 00 feet of the proposed activity?
No X Yes
Does the project involve excavation or filling?
No -L_ Yes
¡fYes, how much material will be excavated? 20 (cubic yards)
How much material will be filled? 0 (cubic yards)
Manner in which material will be removed or deposited:
pavloader -.
-~---
Describe the nature and extent of the environmental impacts reasonably anticipated resulting
from implementation of the project as proposed. (Use attachments if necessary)
Sin~e proDosed pro ieci,.: is located landHard of an
existing seaHall there should be no negative
-
impact upon the adjacent tidal ¡·¡etlands.
-
,
/C (iù IE ~ W ~~
I~ IS \\!J
U L
SouthoJd Town
~ofTrLIstees
-
-
-------- --~------
------------
.
III-lEi" (1'·97)--11
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.
81720
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STATF.: ~'lVInOt"MeflTA'- OUAlITY "¡;VrfW
SEQR
SHORT ENVIRONMENTAL ASSESSMENT FORM
lor IIIIUSTEO ^CTIONS Only
r^nT ,·-rnO.,rr.T INrOnM^TlON (Ta hp complotod by ^rr1icent or Prol"ol Spor",,,)
.- - --.---- --- 2. roo. I! C T "M.'r
1. Arr>llcM"'iSPlltl;,On
-.-__\L.. _1,_,- JÜ' 0 n Q_B.r" \-'11 ¡ I I Pr-nno's('( ~,Irl i tintls to ;111 f' ': i s t i np,
--. ---.- ---~-- -~ ------. - ----,.. -- .-------- -- -0_-.___- -
J. rnQJEC r lOC,^ fir ''''. rh,e] Iin!'
_--.!-!~~"t~!L__ Finhers Is l;~ ~'-'! _____.____ Count Strf'fnlk
-- "Y_--- - ---~-- -------
-1. PRF.CISF. LOCATION: (S'r~ellldcfle!l! ,,,,d w:1d 1!1I"r'lpl:!lðll<l, prom nl"r1t 1:>I1r1m"'k... pIc. or pr('l"trlr "':"1"1
fle"!,f' Strept~ nn II
S.r:.T.t-!. No. ]()I"I{)-OJO-7-l2
.--- -_. -.--- -- --.--
5. I~~POSEO ACTION:
- ew 0 Ep8nslon o Modjf¡O:A~~_n/nlteratlon - ---- ------_. ------
6. DESCRIBE pnojëêT BRIEFLY:
to construct a sunroom (14- x 14-) , 16-)
Applicant proposes 13- 14-) and an open deck ( lO- x
screened porch ( x
a dwelling.
onto an existing single family
---- .--- --, ~ -.----____ _ _ n__ .---
7, AMOUfIT OF L.ltNO AFFECTED:
InJUl'llIy acte!; urr".l.""ly __.___ ACt!'!
A Vl:l;J10r'OSEñ Ar.nON COMPLY WITH F.xr!;"iitiG 10rlltlG (In oT~iF.n ExiSTii"m LANO ï.mr"iìfF.rn!ëj"ir,rï;;7--- ___ n____. ---- -----
Vpq 0 r~o If no. de~ctlb. bli../ly
Town:· Z. B. A. has approved project
.. ~ i'ñËSËmi¡¡nn lffiËÏÑViëiiïíîY6c r""iEcr,- -----.-----___ ..-- - __on ·---___n ~ _.__ -------- .-----
n('~ltI"'nt;l1r n Inctu51tlal 0 C-"'."rr""r ,,' n Aq,I'·,,"",e o "l'Irk/r(',p~t'flrf'11 ~f"""'''' o Olt.""
DporC'tlht>:
single family dwelling
I". DOES ACTION fNOlVE A PERMIT APri:iõV;:i~- ['I~ fliÑìJiÑ0:-iiõWORüi m.1hTËlŸ FROM-¡~; OTB'::" OfJVERNME.NTAl ¡GENCY rrpd""AI, SlAte or
l~_ o No If V@!I, Ii!! Itgency{o: "lid rPII'11t'IIrrr"Vltls
Southold Town trustees & NYSDEC 0 LE ~ LE ~ Wi LE ~
)
.....
DOES ANY ~T OF THE ACTION HAVE ¡¡ ëÜ"nF.tl1lY VfIJO 'EnMIT on A"AOVAl? - _.
11 U I I 0 , ~
o Vps . 0 n If y@s, U!I1 flgt'ncV MArn" "'nd rt>frnlt/lll'lptClval '-I' -" ~ - ""~....
Southold Town
- AS ^ RESULT 0trRoPOSED ACTION WILL ËXisru:ro PERMITfArPROVAL REOUIRE MODIFICATION? --B.oa.rrl (If Tttldpp.1:.
12
DY,,!! _~o
I ~EA~HAT TII. INF~ nMATtON PROVIDED ABOVE IS TRUE TO THE BEST OF My KNOWLEooe
Appllcant/Sponso, NarTI" /, GleQn / k Just as agent ll/0/(ìs
. Date
Slgnafutl. / YÁUV_,
/" /
{/
" Ihe IIcllon I" In Ihp Cnø"I,,' ArPA, IInd YOII lOre II slnle ngpncy,
complele Ihe CORsInI Asse"srnenl Form belore proceeding wllh Ihls RSSpssmenl
----
----..----
OVER
10:~2/~r"1 ~~:3J
.------- .
..~ 30 O~ tZI.3p
CounlV of 9""011<
'31qt1q'1~.
tJl),1L8fJ~-'¡ nl~ ~:'O .
raGE i"'4
J"n e.,.","'''C
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ÐOAIID OF TRUSTEES N>PllC^TIOH
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."""0."0" ,net .... :'1'1' I'" ",",'Dv4!ld by Ih" SO\lltot'ld r-,IN" ""lIm 01
T rl/~I'" Th" ,"'p' 'r;. III ..(I....... 10 hr,old I'" TIM" eof !:'t>t.llh'"" IIInd .,.
'l'Wn TN""" n",.,.,,,, 11'1 ..nl1 """ "om IIny II"~ "" ....""",... ..011
clfl!m. IIrl""D vr"ll - "'. ''1 vIrtue'" ....It J'4Irmlt(.), I'IJ·..n"'" 'n
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,Nt "..mi..". In Nt''''''' ~'j(\n wllh NIIvl"w of 1tI'f' 1IP{''~t;<:>n, _.
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Sworn ~.!!.-"!t ~~.~}C? _ 0., of ¥, Z~
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Southold Town
Board of Truste"
· la¡~2!2rr3 ~1:1)
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J"' 1:1.1.ull."",
MAILBO'-1:5 £r...; l:'~ .
(,,1\ c.:t JI)..
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..~ " 03 O~'I.'
BOAIID OF TRUSl EES APPLICATION
,~UTHOlllllATION
\ . , ~"" .'" 1«)11111 Ie nolI". _ne'l
I, ~~~ \~~~\_"'Idln..' ~\~~}, &~t\\'..
(prlnl _.. Of lte PltllYI emlløln lit! _)
~~\ \~">. ~ ~~_"O"."bV'UI"ðrIUJ.MO Envlmn"",n'.'
. (p.g.nQ
Con.ul"",1o "'..I) "",, Pllrmlt!., "om Che SouIIIOId lIo"ro.t of 1 own
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Southold TowlI
Board of Trustees
.
.
Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
~HIEU\H~
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
---------------------------------------------------------------
South old Town
Board of Trustees
In the Matter of the Application
of
.W!1..:_.__L~~--fto¿~[L-4!:b---------
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
I, ~'\ E. ""'Ju..3I-
, residing at \ð \
\ \ ¡;<S~
.
0~~<-~
~VeY\Lt..L
Qll~u.L { ~.......lt
being duly sw depose and say:
That on theef\day o~_ ,20~ I personally posted the property known as
0J,L- '-<-1f''\<\.'::> ~.'" ,'V,\ 'Tt\
by placing the Board of rustees official poster where It can easily be seen, and that I have
checked to be sure the poster has remained in place for eight ¡Prior to the date of the public
hearing. Date of hearing noted thereon to be held ~~ (]c. IJ.' ~~ ~ ~
on D..X; pn"
Dated:
/!
-~--' ---
(signature)
Sworn to before me this
11 dayofl!'re..lJ00'>
Q/\-~- ~)b:¡~
Notary Public
EWA 008RZYNSKA
Notary Public State uf New York
No.Oil1û6073464
Qualified In Suffolk County
CommISSion Expires April 22. 2006
.
SENDER: COAIPLETE THIS SECTION
· Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
· Print your name and address on the reverse
so that we can return the card to you.
· Attach this card to the back of the mail piece,
or on the front if space permits.
1. Article Addressed to:
\liV\ a (ÒI~t\A.Q,' \L
6J'l (LV-. "t
-h.S~I~ .l~)C<AdJI\JV
Q6~:liO
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COMPLETE THIS SECTION ON DELIVERY
A fi9~at"'\ ..~" \--Ä.--
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B. Received by ( Printed Name)
'--" \\ ~ ~-, l \ ~J l.. ':\ é_ ';.r""
D. Is delivery address different from item 1? 0 Yes
jf YES, enter delivery address below: 0 No
o Agent
o Addressee
C. Date of Delivery
3. ~iCeTYpe
'Certified Mail
Registered
o Insured Mail
o Express Mail
o Return Receipt for Merchandise
DC.OD.
4. Restricted Delivery? (Extra Fee)
DYes
2. Article Number ",.
(Transfer from service label)
PS Form 3811 . August 2001
Domestic Return Receipt
2ACPRI-03-Z-0985
u.s. Postal Service
CERTIFIED MAIL RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
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FISl£RS ISLAND, NY
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Total Postage & Fees $
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06390
0.60
2.30
1.75
4.65
.
SENDER: COMPLETE THIS SECTION
· Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
· Print your name and address on the reverse
so that we can return the card to you.
· Attach this card to the back of the mailpiece,
or on the front it space permits.
1. Article Addressed to:
K K.1 HN
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2. Article Number
(Transfer from service label)
PS Form 3811, August 2001
.
COMPLETE THIS SECTION ON DEL/VER'r
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I 1 ~ -(dAgenti'-
. . 0 Addressee
B.
iÌ
D.
3. Service Type
\}J Certified Mail
o Registered
o Insured Mail
o Express Mail
o Return Receipt for Merchandise
DC.D.D.
4. Restricted Delivery? (Extra Fee)
DYes
'1....,:¡4', ~...."'"' DD~
Domestic Return Receipt
2ACPRI-03-Z-o985
\I~f'>
q'j- ""-
U,S. Postal Service
CERTIFIED MAIL RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
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a- BOSTON, WI 02114
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Total Postage & Fees $
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0.60
2.30
1.75
4.65
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.
Arl'I.IC"NTI "CIi:N' m,KPlmSENT ^'J·tVE
TR,\NSACTlONAL DJSCLOSUIŒ FOI¡M
:Olû'.2>!1'J'LSJl.ll,htlld' ._Çg¡!£.SlfJ: hic~.l!rpJ>ibj ,;_,·ºQ/JÌf!!..£fj~lt!Çl!..!!!!..!~I:.J"! .nr IJI \1m "niç!ò U!~~lm11!!rc_ç~ _I ht p\l~'~uJ
!hlÚl!ml IJ'I.J!rJl.~\!IDII!Jp ~iL;~Lc:..w'~IJ:'tIlIAJ~' 5'hlß&IuonQi.~rJ'<" o"!t.all!J1Y..!1.1n.J/I C;Q..""~lc.·çlJj>J.inll.u
:::~::~~~ .\-. ~'\ ~ t'(~ ~ 11-~'« t{ ,v.
-----. ._~ ..~--- ... -- - ¿ ..
(,..~. "rune. litllll:\f1M', ,niclclle i.,iti..1, IInlt~l; you nrf 'J'I't)iIIJ ¡II tl'l? !I:\t''IO of
IOlneOIU· elite I" .,Iher rnlÎI 't, Fll~h M' COll1plrt). If 1(1, htdlC4lr. flc /,11,,',
rei SOli'!' '\r n lu~ny':t n:'Utu~)
NI\Mt'. 01' ArrLIC^TlON, (Clltck ~lIlh'lll'I'ly.)
T.x I,.çvnncc _"__ _H .____
Vltri.nee ___ __ ___.__
Çh3npeorZOM __ .,_.___
^PI'f'O,'nl .,r rl~1 _ _. _ _..__
IJumpl"" r,om r'OI or 01Tk1~11I1'" _._..___
~~~'he'" II.m.dI. '.liviIY,) .Bc;ø,rÀ.-УT Q..j 1'\ -r I(üS~ .3L__
1>0 you pc~rnllly (nr Ihrough yo II' CO"""~Y, 61'''~, ,ihlinl. partnl, or child) hn.. B rcl~Llollsh¡r wid1 Inyomca or cmrio~e
nr1~~ Tin' n ofSol.llJluld? "Ral3ti('nlhip" includt'll ~y blood, mntrilllC', or bUIÎnC:II:1 in ['tc!ll. ·'RuilinCllIlntc.e,:'I'-· I"ftefm, !I bU'i"es!,
Int:udi"@,, pnrlllenhip. In ",hlel, Ihe I.»vn Omtc, (IT employtt hal even I pnr1inl øw~er$hlr ofiø! employmenl by) I corporation
in ~hieh Ihe 10W11 omen or tlnl'loyl"t ""'ns I1INt limn ~% t>9hc shnre~.
VI:S . NO __y_._,
If yOll ar.....cr.d "YES", .""",Ide ,h. bllln", (If Ihis f¡"", BOld dal. amJ sigll wl""e inlli""I..!.
NI'11e "r penOl! en>ployed by 'he Tow" "f Southold
Tille 0' roshlon of thai pcnof\ __.
OClClibe rht r el,'lion.hip hetwten YOOlrllClf(lhe Gppl¡CAJ"lfncenlifeJ'reselll.livt) .'d rht lown omCtr 0' employee. I!ither cheek
I~' "p !rOrnnlt I ¡nc ^) Ihroulh D) ftI1d/u' (l..criÞ~ in the "I'''" prov.ld.d.
The lown uniCtl' or enl"loyer or I:i~ or htr lIpIus., ,ibI1t11. 1'3' enl. 0' mild i~ (check alllhollJl'ply):
_A) Ih. o\Vntl' ofl"a!.r II"", ~'. oft". shnrrs of the torporSlo Slotk "rln.< Ip lli..nl
("holllh. Ipplieln' i. ~ .or¡lorollon);
_ ___ B) ,h. 't8al 0' bcr.nclpl own=r or pny inl'''e$II" p non-corporalt· enllty (wh<n Ihe
1¡",lieDnt IS nolll eOl'p(....I;Oll):
___ C) 111\ ometr, diJ"C(lor, l,a,IlIe" nr elll ,loycD or II;. OI",licnnl; or
__D) I'I~ a.<lull ap¡>licant.
[JESCRII'I1UN OFIŒl¡\llONSIIII'
.. ._.. h___
_".0"__._ no.
-----
.-------
___~_h _
a__..._.__
S"'mI"'~ Q.. ... f_
Signllnr= ~ \. _
1', ¡n' Name \{'-..
~,\-~,,~~~ \
.
.
A PI'I.leANT! AGENT!RErRESEN f'ATlVE
TRANSACTIONAL DISCLOSURE FORM
Ib~_ I(~"'n of5outJlQ.!9-'.s Cock Q,ffl!!i.r<:..P! ÇlhiJ:?¡t<:s~!~lli.ÇJ~_oJ iQ!!,!Ç~_ºfI_l~f-p_arl _of.tfl\\!ll tT!C!;,.I:..s~[lf.I~ flPproy~.'_c.~ -'-- r bi='_[lurrt~~~pl
!!ti5 f(l[l11_is_It~-pro\:ß1.unfomJ:!tLQn \~:11if'kqm 1\Isrt_!~~Jt,).~"'O...Q[Qo~'!iÞl~_ÇQr_f1i_ç'-" gCm'rrC':,1 fmd_f,'lIQ,!,!:' jt tn.lflkc_}'{h:1lcH'r. a('li!J.J:Li~
fl.c;.Ç_C5-,"~XY tP.3.!9idJF!ITIÇ..
YOlln N.\ME :1"., <,+_þl£.\,,-~,~_1l.'çj...L.L ,L-tOlf\>- [3.rQw.,,"::rn=
(I æ;t n~lIn('. li,', n:1'III(', l11iX~· iflltlal, 1I11Ic<;" you ar(' :1pprYIIIg in Ilw ',;IIIlC or
sorllCOII(' cl,;;·' ')1 ,,'h"r nllr!\,. Sitch [IS a conl 1.1J1Y If"n. illdlcalr III(' toll!!'r
pC'l.;;on's or '-')1111'111:.'5 ~ !I(' )
NAME or· APPLICATION: (Chcd "l!lh" "rr,ly \
Tax gl iC\',Jnt'C
Vari'l!lc(,
Change of Z nne
Arrrov:1I (If plat _.__. .__
Excmption from plat or offici31 mal' __
Other
(Ir"Other", n"mc the acti\ ¡ty.) -l3o~ -8- Tv!-J,':\.. -Cý\.JL~~___
Do you pcr~'ln~lIy (or thwugh YOIIJ ('Olllpa!l)'. spnllc;c. sibling, parent. or child) h'!\ c a rf'lalitJIl"hip \\ith any officer or employee
orlhe f('l\\ n nfSollthold? "Rclalll1!1<;hip" incJUlie" by blood, rn:lIriagc, or busille"s inlnest "Business inlefe~t" means a business,
including a p.:Jrtnership, in which th,-' to',\'I] nOic·:r or employee h~s even a parti:!1 o\\'ncr.;;hip oreor emplo)TIlenl by) a corporation
III \\hich the town officer or emrlo~l.·e rl\\m more th3n 5% of the shares.
YES
NO
-~-
--- ----.--
(fyou answncd "YES", complete the b:rlance of this ramI and date and sign where indicated.
Name of person employed by the Town of SOllthold
Title or po<;ilion of that person ______ _________
.---- ------
.~-------------------
Describe the.' n::larionship betwcen )roufsclfOhe nrrlicantlagentlrcpresentative) :md the town officer or employee_ Either check
the arpropTiate line A) through D) and/or dec;crihr in the space provided.
The fawn omccr or employee ()f his or her spt)uc;e. ~ibling. parent, or ehild is (check all that arrly):
__A) (he owner of greater than 5% of the shares of the corporate stock of the applicnnl
(when the applicant is a corporation);
___ ß) the legal or beneficial o\\ner of any intrrest in a non-corporate entity (when the
applicant is not a corporation);
_.____ C) 8.n officer, director, pmtner, or employee 0fihe applic3nt; or
~D) the actual applicant.
DESCRIPTION OF RELATIONS"'"
----------~--- .-------.------- -~--~-~--------
----- ----. --- ---~- --- ----------~-~~---------
-----~ -----------------------.-
~:~:~:~:Cd tho is~i!*~. _T~_OO~_
Print Name __ ~G..-' ____~___
;1'
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';1'£[
"
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BENCHMARK
TOP OF Mt:Rt:STONE
ELE:VATION 20.08'
N 2396.81
W 48414
/
/
/
~
S3B'34'10"w
35.96'
LiMns OF FLOOD ZONE PER
FIRM PANEL 19 OF 1026
MAY 4, 1998, 36103C0019G
PROPOSED OPEN DECK
N78"%O"W
57.7J·
LIMITS OF
TIDAL WETLANDS
PROPOSED SUNROOM
WEST HARBOR
N/F
THOMAS F. DOHERTY, JR.
&
CAROL YN J. DOHERTY
SINGLE FAMILY RESIDENCE
MUNICIPAL WATER
ON SITE SEPTIC SYSTEM
RESERVE
LEACHING ~
POOL LOCATION
,
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JALITY CONTROL CERTIFICATION
GROUP REVIEWED DATE
,QJECT W,N....CER 10- "1 ...........}
SURVEY 1""."2:;;;:",
,NVIRONMENTAL
CIVil
STRUCTURAL
IRCHITrcrURAL
FILE F2514
N5B"06'OO"E
2,80'
1.,-""
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=
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9
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1 ) SURVEY MAP PROPERTY TO BE CONVEYED TO W.L. LYONS BROWN !It
A D SUZANNE S. BROWN; HEDGE STREET; FISHERS ISLAND, NEW YORK;
eNDLER, PALMER &. KING; NORWICH, CT.; DATE: DECEMBER 27, 1996;
SCA E: 1 """20'; SHEET 1 OF 1
=
1.) THIS SURVEY WAS PREPARED FOR THE PARTIES AND PURPOSE
INDICATED HEREON. ANY EXTENSION OF THE USE BEYOND THE
PURPOSED AGREED TO BETWEEN THE CLIENT AND THE SURVEYOR
EXCEEDS THE SCOPE OF THE ENGAGEMENT.
2.) IT IS A VIOLATION OF THE STATE EDUCATION LAW FOR ANY PERSON,
UNLESS ACTING UNDER THE DIRECTION OF A LICENSED LAND SURVEYOR,
TO ALTER AN ITEM IN ANY WAY.
3,) ONLY COPIES OF THIS SURVEY MARKED WITH THE LAND SURVEYOR'S
SIGNATURE AND AN ORIGINAL EMBOSSED OR INK SEAL ARE THE
PRODUCT OF THE LAND SURVEYOR,
4.) COORDINATE DISTANCES ARE MEASURED FROM U.S, COAST AND
GEODETIC SURVEY TRIANGULATION STATION "PROS"
5,) SITE IS IN THE TOWN OF SOUTHOLD, COUNTY OF SUFFOLK TAX MAP
1000, SECTION 010, BLOCK 7. LOT 12
6.) TOTAL AREA"" D.48± ACRES,
7.) SITE IS LOCATED IN R-40 ZONE.
8,) APPLICANT: W,L, LYONS BROWN III & SUZANNE S. BROWN
HEDGE STREET
FISHERS ISLAND, NEW YORK
9,) SITE IS SERVICED BY MUNICIPAL WATER AND ON SITE SEWAGE
DISPOSAL SYSTEM.
10.) BASE FOR LEVELS: NGVD 1929.
L.£GEND
NIF
SF
NOW OR FORMERLY
SQUARE FEET
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DATE: 10/01/2002
SCALE: 1 " - 20'
SHEET: 1 OF 1