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Home My WebLink AboutTR-5702 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town HaJI 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0174C Date December 7. 2006 THIS CERTIFIES that the single-family dwelling and decks At 12832 Main Rd.. East Marion. NY , Suffolk County Tax Map # 31-14-15 Couforms to the application for a Trustees Permit heretofore filed in this office Dated 3/14/05 pursuant to which Trustees Permit # 6085A Dated 3/23/05, Was issued, and conforms to all of the requirements and conditions of the applicable proyisions of law. The project for which this certificate is being issued is for a single-family dwelling and decks. The certificate is issned to WILLIAM & BARBARA CLAYTON owner of the aforesaid property. ~c7~ Authorized Signature - ~",: .;'/~"" - Mark K. Schwartz, AlA -Architect, PLLe P.O. Box 933 Cutchogue, New York 11935 Phone: (631) 734 - 4185 Fax: (631) 734 - 2110 December 06, 2006 Southold Town Building Department Main Road Southold, New York 11971 D~". 8- CL' - Re: Clayton House 12832 Route 25 East Marion, New York SCTM#1000-031-14-15 Permit # 31049 To Whom This May Concern: I inspected the house and garage roof gutters/leaders and have found them to be piped underground to the dryweIIs as required by code. Please call this office if you have any questions or require additional information Very truly yours, ~. . , !# 'II "..... if r"'i'!..rJ,<6~' ...:.:.""" '''',(1 Mark Schwartz C1aylonBldgDepldoc James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. 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 TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE.CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction -/' constructed ~ Project complete, compliance inspection./.l.h p 6 0): A e - DOUG BURNS CONSTRUCTION. INC. P.O.BOX 1135 CUTCHOCUE NY 11935 HOME 631-734-4284 CELL 631-466-1725 We are requesting clarification to Southold Town Trustees Permit No.: 6085A While applying for a building permit for the aforementione-d project, it ca..'lle to our attention we inadvertently omitted two aspect~ of the project One of which we a~sumed was understood given the nature of the project. This entailed the raising of the decks around the perimeter of the residence to conform to state and local codes. These decks are to be reconstructed within the same footprint as the existing structures. The second area of claritK:atiooinvolves our n:quest toreoovate the existing second floor. As indicated at the time of the on site inspection, the Homeowners are considering adding to the second story of the residence. They are currently retained the services of a local architect to begin the planning stages of this project. We. can assure you that aH provisions will be adhered to as you require aDd aH construction win remain within the existing "footprint". Thank you for your consideration in this matter. Should you have any further questions please contact me. ij~~~~wre 0 '\n~r I. Ifill MAR 2 8 2005 I Respectfully yours: South old lown Board of lrusteel u>>o k - 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 APPLICATION FORAN AMENDMENT TO ~M!R ~,12:j~~ DATE 1i~~ OWNERl?~.tb/4<~ .;}~PHONE 9'77-1'715 ADDRESS /Z83'C ~~ Y ~/?/ ~~ lJJ. AGENT~6/A'~ PHONE ~31-9'gy- ~Z8:1 ADDRESS PROPERTY LOCATION l2.g~2 ~~~/ ~~~ SOllflOJd lown Brard of Trustees TAX MAP NO. 3/- 1'/ - /.5 . SignedBY:~&;l'~- /. (rc, 1---.. b-.~~~.~ ~ . . DOUG BURNS CONSTRUCTION. INC. P.O.BOX 1135 CurCHOGUE NY.1l935 HOME 631-734-4284 CELL 631-466-1725 We are requesting an amendment to the Southold Town Trustees permit # 5702 in the name of William and Barbara Clayton. We wish to repair and renovate the existing residence within the existing "footprint" rather than build the previously approved new home. Proposed scope of work would include: Repair or replace as necessary the existing foundation around the residence perimeter Repair or replace the existing floor system as required Replace all existing windows and doors Replace existing siding Thank you for your consideration in this matter. Respectfully yours: GUA,;....NTfES I'JOIC.... rro HER/! ON SHALL RlJN Offl." m 1}IE P€RSON ,OR "OU THE SURVn ,:i PRCPARrn, AND ON HIS BEHALF TO THE nf'!.C r.,~PIINr. GOllf:RNII/.1iTAL AGl"NCr. LENOiN') INsnn.mON. I, lISrEO ~ON. ANO ,0 me IiSS1~CS (Y 1NE LEHDJNG INSTI TUTION. ';;v;l.R",NTfTS ARC NOT rRANSFt'R.ABLE 70 A{)f)ITJ()NAL INSTITUTIONS OR SU8SfQi.J(NT OWNERS, Mar 24 05 11:48a - 1<Ii 11 iall C1a::1t.on 212-375' -'89 .p.l MAIN ROAD N. y S. 2 lJNAtlTHOR!7fP At Tl:RA rl()N OR ADDITION TO THIS S!IR\If"1" 1$.... VIOLATION OF SECTION 7209 OF 1H! NEW rORK STAlE €DuCATlON LAW. ,. " ::l ~ ..) = .I~ ..".= IYYI :g'1S '!;"E ~ o~ "'0 '" IYYI Cl CoPlfS OF TJ.I!S SlJRli["Y M,~P NOT BEARING fHe {.wn SUR\C>"ORS EM80SSED 5EA~ Sli4LL ",,:>1 8E co'JS.cERfD TO BE A VALID TRUE C,-V',. ::Q ~ --1 o CESSPOOLS 00 IV o I~ ~ SICA , N/F MAIORANA 121 fa IOELL 00' [ N 51' 16' LlL 25' ,POLE . a" . 1 STORY' ~\ ;, RES. 3.9 W, "',!tOfT ~\I 1.4' ~ p,\ ..a TM 1000-037-14-15 BIf = 1..1325 194J \OTE: ENTiR[ PARCEL IS W t!..Q']D ZONE A[ (EL9). SrA I\.'ARD O,C" BULKHEAD JS IN Fi..VOO ZONf L.E ([L 11). +100' TO CESSPOOL ~ <0 <0 .2' CESsPOOLS, 'S (3) 75'-100 ". h~ N/F HUKILL ~~~ ~ IICLL '0 100'+/- 0 - -.... .... , .~E~D Z au.... \ 10\ 3. GUARANTEED TO , , . i > .J rr-sT lIei,1, l.~ \ MCCONC_:'W l;f,"') . ',('ICN...:C 2 23.,-;},' T[~r HOLf .OVE:RHG. I I I l eJ,f,JG I,R<-'UNV CESSPOOL 15.,0 ARK BRmlN $J.NOr LC.jM l' CL RU~U LUAM ( S,lND St',! ,~' P.liF (<ROliN tiNE Te COA""St S,lND SH t;.8' HAlf/.' <0 '" SUR~Y(D 20 OCTOBER, 200' SCALE ,w=JO' ...., S 61.26' 00 W 15.00~ 7-f ~~ 10" C) C) -- 'i' ..., "" '" V) I ~-'" .-- 11-'1\ Tt..,l,,' IN [JALf b"1.~;.}lIiJ rlNE T0 r:o.'1R5F ,)ANI' 5W -- Sl,AL lo; cop. ~ ~ " PILES W/CROSSMEMBERS . 'S " "\r.~ ~Q\\" G{\ AReA= 18.84J.214SF OR O.4JJ ACRES SURVEY OF DESCRIBED PROPER TY SITUATE SURV[YeO BY EAST MARION, TOWN OF SOUTHOLD SUFFOLK COUN TY. N. Y. SURVEYeD FOR WILLIAM Cl.A YTON BARBARA CLA YTON MfLLIAM CLA YTON BARA8RA Ct..AYTON FlDEUTY NA. TIONAL TITlE INS. CO. ItE'LLS FARGO HOME MORTGAGE, INC. 1. AOD W[LL5. SANIFAR'f, T[5T HOLE nEV.'-::[HL /3 M.4~ 02 01R1061 . . 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 Permit No.: 6085A Date of Receipt of Application: March 14,2005 Applicant: William & Barbara Clayton SCTM#: 31-14-15 Project Location: 12832 Main Rd., East Marion Date of Resolution/Issuance: March 23, 2005 Date of Expiration: March 23, 2007 Reviewed by: Board of Trustees Project Description: To replace the existing foundation around the existing residence perimeter, repair or replace the existing floor system, as required, replace all existing windows and doors, replace the siding, add to the second- story of the residence, and to removelreplace the existing decks. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 97 of the Southold Town Code. The issuance of the Administrative Permit allows for the operations as indicated on the survey prepared by Stanley J. Isaksen, Jr. dated October 20, 2001 and last revised March 13, 2002. Special Conditions: A line of staked bay bales must be placed down on the seaward side of the dwelling prior to construction, a drywell installed to contain the roof run-off, and a non-turf buffer maintained landward of the bulkhead. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 97 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. JI~.$? ~'(j.. Albert J. Krupski, Jr., President Board of Trustees Mar 24 05 11:48a illiam Cla~ton 212-375 8S MAIN ROAD N. Y S. 2 ,~IJARAhTEE5 INDICA TeD HERE ON SHALL RUN .')NL' ro 7)-It, PE:RSON FOR ~ t'JE SVRVEr ,S PR[PA.RW. AND ON HIS 6CHALF TO rhE nTU; t;,'>MPA.'Jr, GQ\lf:ii'NMf.)oHAL AGlNCY. L:/'/D;jY(; !NsmUT/ON. IF LISTED HEREON. AND ;,~ rHE ,lSSlG'lEES OF mE LENDING /NsrITunON. ",'v,lRA.NtC:;S ARE NOT !RANSfTRABLE 10 AOf)onON~ INsnrunONs OR SUBSfCvENT OWNERS. l.INAf.)ThOR!7~-D ALTERATION OR ADDITION TO 1l-i!5 S!lRVE' IS A YlDL.4 r,'ON OF SEClIDN 1209 Of' THE NEW 'tORI( STAff EOuCAnoN LAIr. ~ '" ~ ::tJ ~ -I o CESSPOOLS 00 ;1; o I~ ~ C~'ES OF T>lIS SURVEY IJIAP NOT BEARING rHEl_~.iUPI€YORSEI..'80S5CO SEAL S"IAll N2T 5E c(Ws,crnED TO BE A VAliD TRUt: Cc.'f'r +100' TO C[SSPOOL 85' 80' VI g ~ \ w C) O\ICR 0.5' ~ i~ " ~ I'r) 00' [ '" g '" ~ ~ ~ "'- " ~ ~ ~ '< ~ -< R(}',I,rJ LUAM ( :,.;NV SI,' J p.\iF FiRClli'Ii liiv'F T(! (.'O~/,'St. S-INU ::11 () "'l T[~T HOLE T[,5T JI('i,r L:;' MCDONC':'W (,";[.";') . '.(."!Uoi";C, 2,';"3..,.",' . WfLL -[~ O~R 1.' 0,,'/(;. 'Rl.'1H>li.l ARK BRC~1'\' SJ.NDf U).u,/ l' U l,J 6,8' IlA7I.1,' C) C) .- "<l- I<) <c '" V) p.1 ~ =- w ~ W o SICA -- 1M -:-1:..,1,' iN (J.1Lf dR.}IJ!) rlNE T0 CQlIR<:;F SA,vn .';,w SURVEYED 20 OCTOBER, 2001 SCALE IH=JO' \1 ~. \ I" N/F HUKILL ~~~ 3: 5 61' 26' 00 w n....8 15.00/ J.B' ~EY ---7-r '; /' { ~~ 'IftXIOOCCK ./'0'i fo" 2rodLf~L ,..,0 W/RAll/l'o'C~/lo1.P.T' <)\01'1 E.FO I ~-" WfLL AREA= 18,84J.2'4SF OR O.4JJ ACR[S '""" DEIX a 100'+/- C --... ... COI>,STf.L '" 0<) ,"~E~O Z BVv' \ "' ~ :1. PiL[S W/CROSSMEM8[RS '., s~'S ~O\\'4 GI>- SUR VCY OF nw 7000-03'-'4-15 8\1 = UJ25 7943 ~.O"E: ENTiR[ PARCEL IS W ,-:.:JJD ZONE A[ (ag). S[A II-ARD OF BULKHEAD is I.V Fi..~QD ZONE l,r ([L 11). DESCR/BED PROPER TY SITUATe SURVEYED BY EAST MARION, TOWN OF SOUTHOLD SUFFOLK COUN TY, N, Y. GUARANTEED TO SURVEYED FOR WILLIAM CLA YTON BARBARA CLA YTON , I I , KfLLlAU etA YTON BARA8RA etA YTON FlOELlTY NA nONAL nnE INS. co. K[US FARGO HOME MORTGAGE, INC. ,. ADD WELLS, S.A;'.JITARY, TEST HOLE [LEV,CU-ie 1) ~J4F ('2 01Rl061 el .!!e ..,1"" '0- iSo ='E .7;:g ... . . 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 January 19, 2005 Mr. & Mrs. William Clayton 12832 Main Rd. East Marion, NY 11939 RE: 12832 MAIN RD., EAST MARION SCTM#31.14.15 Dear Mr. & Mrs. Clayton: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., January 19, 2005: RESOLVED that the Southold Town Board of Trustees grants a One-Year Extension to Permit #5702, as issued on January 22, 2003. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, J/~..y. ?K-4..~--I. <f Albert J. Krupski, Jr. President, Board of Trustees AJK:lms . . Albert J. Krupski, President James King, ViceøPresident Artie Foster Ken Poliwoda Peggy A. Dickerson Town Han 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 January 19, 2005 Mr. & Mrs. William Clayton 12832 Main Rd. East Marion, NY 11939 RE: 12832 MAIN RD., EAST MARION SCTM#31-14-15 Dear Mr. & Mrs. Clayton: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., January 19, 2005: RESOLVED that the Southold Town Board of Trustees grants a One-Year Extension to Permit #5702, as issued on January 22, 2003. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, J/~. -1 ? .K4..~ -J, () Albert J. Krupski, Jr. President, Board of Trustees AJK:lms Board Of Southold Town Trustees SOUTH OLD, NEW YORK PERMIT NO. . ISSUED TO ..' ';'ÞI.. DATE: ...J.ªIl· .22,..2003 BARBARi\ m~...WILLIAM CLA YTQ.N Autqnrilutinu Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 1952; and the Southold Town Ordinance en- titled "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 Bóard adopted at a meeting held on .J":r.'\la>:y.....22 . 200}., and in consideration of the sum of $20~~.~0 .. ... paid by En-Con~µn;tnt">...J.nç ,on behalf. of Ba"ba"'a...~ of ..... ~oµt.h;tll1ptc:>n, . N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the foUowing: Wetland Permit to relocate existing dwelling on a bulkhead pa~cel farther from the adjacent tidal waters and upgrade all ~xIStI,:,g . san1t~ry system which will oçcur beyond the Trustee's JUrISdIctIOn - Insta.jlatjpn pf ¡¡, draina.¡¡;e Soystem of ,1 11~ aU in accordance wIth the detalleCl specmcaTlons as pre~hV~IIt' the originating application. . ¡md e.'.tablis,hroep,t of,.a P:l?F:öturf buffer adiacent to Ga,rdiner's Bay. IN WITNÊSS WHERE( F, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this dat,e. ~¡ ster (Absent T _lee. I . . TERMS and CONDmONS ... ,,^ ." "" .,,,: , -- The Pem>ittee Barbara & William Clayton residiÐg at 12832 Main ROAn R,d "'~;Q~. N. y~ as part of the consideradoo for che isS<.,~ of me Permit does uødeøtmd and p.-ribe to the fol- lowing: 1. That the said Board of TrusteeS and che Town 01 Southold are re1eosed from my and aU damages, or claims fOf: damages, of suIø arising dhecdy or JncIirecdy as . result of my oper- .don performed panuaat to chis permit, and me soid p.. ÀI(e., wm. at his or her own ~ defend my and aU such suits'ini1ùted by chird patties, and tbe soid p.. ¡'IIC""""" fu1l1åbUky wich reSpect thereto. to the complete e:musioo of tbe Board 01 Trusttes 01 tbe Town 01 SoIJðv¥ 2. That chis Permit Is ~ for . period of 1.4 mas. wbkh Is Q:Df" ·ed to be the ~m.ted åme' required 10 complete the work in~hed, but ihou1d CÏt(miISIaOCCS warraat, request for an exœosion may be made to the Board at a latu dat>e. ~. That chis Permit should be ..;taiøed iødefudtdy. or as loog as the said permittee wishes to maintain the wuaure or project involved, to provide evidence to anyooe œoœmed chat auch- orizadoo was origina1ly obtained. 4. That che wotkinvolved will be subject to the iøspecIioo and appronl of the Board or ia agents, and noø-œmplianœ wich the provisiollS 01 the origi-'¡..g app1icadoa, may be cause for revocadon of chis Petmit by resoludoD of the said Bœtd. s. That there will be DO unreasonable interference wich navigation as a result of the wodo: hereiø aùthorized. 6. That there shall be DO interference wich the right of the public to pass and repass aioog the beach between high and low water marks. 7. That if future operations of che Town of Southøld require the ftØ1O\'Ù and/or aiœratioas in che location of the "",tk herein ...ch0d7e<\ or if. in the opiøIoo of the Board 01 Tzusœes, the . wad: shall cause unreuooable obsttucØO<l to free navigadoo. the said p"""¡...., will be roqairecI. upoa due notice, to remove or alter chis watk or project bereiø stated witbøac ....~ to the Town of Souchold. 8. That che said Board will be notified by the Permittee ot die ccmp1edoo. Of the wotk auch- ori:r.ed. 9. That che permittee will obtain all other permics and coosents dJat may be requùed lOp- plemental to this permit whkh may be subject to revoke upon faUnre to obtaiø same. . . 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 January 30, 2003 Mr. Rob Herrmann C/O En-Consultants, Inc. 1329 North Sea Southamp10n, NY 11968 RE: SCTM#31-14-15 Barbara & William Clayton 12832 Main Road East Marion, NY Dear Mr. Herrmann: The Board of Town Trustees took the following action during a Regular Meeting, held on January 22, 2003 regarding the above matter. WHEREAS, Eo-Consultants, Inc. on behalf of Barbara & William Clayton applied to the Southold Town Trustees for a pennit under the provisions of the Wetland Ordinance of the Town of Southold, application dated December 27,2002 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 January 22,2003 at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members haye 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, WHEREAS, the structure complies with the standard set forth in Chapter 97-18 of the Southold . 2 . Town Code. WHEREAS, the Board has determined that the project as proposed will not affect the health, Safety and general welfare ofthe people of the town. NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approyed the application of BARBARA & WILLIAM CLAYTON for a Wetland & Coastal Erosion Permit to relocate existing dwelling on a bulkhead parcel farther ITom the adjacent tidal waters and upgrade all existing sanitary system which will occur beyond the Trustees jurisdiction- installation of a drainage system of drywells and establishment of a non-turf buffer adjacent to Gardiner's Bay. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency, which may also haye an application pending for the same or similar project. Fee must be paid, if applicable and permit issued within six months of the date of this notification. Ifinspections are required, at a fee of$5.00 per inspection (See attached schedule). FEES: $10.00 Very truly yours, ~ f). /4. -¡" v/k ~ Albert 1. Krupski, Jr. President, Board of Trustees AJKlcjc cc DEC Building Department . . Albert J. Krupski, Presiden t 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 COASTAL EROSION MANAGEMENT PERMIT Permit Number: 5702 Date: January 30,2003 Name of ApplicanUAgent: En-Consultants, Inc. Name of Permittee: Barbara & William Clayton Address of Permittee: 12832 Main Road East Marion, NY Description of Activity: Relocate existing dwelling on a bulkhead parcel farther rrom the adj acent tidal waters and upgrade all existing sanitary system which will occur beyond the Trustees jurisdiction- installation of a drainage system of drywells and establishment of a non- turf buffer adjacent to Gardiner's Bay. Date of Permit Issuance: January 22, 2003 This permit is yalid for a period of two years rrom the dates of issuance. SPECIAL CONDITIONS: Bluff restoration through a re-yegetation agreement is a necessary special condition of this permit. _A relocation agreement is attached hereto and is a necessary special condition to this permit. _A maintenance agreement as attached with application and is a necessary special condition of this permit. Albert J. Krupski, Jr. President, Board of Trustees AJK:cjc AlbertJ. Krupski, president. James King, Vice-President - Henry Smith Artie Foster Ken Poliwoda . Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD - IT)) IE ~ IE ~ 'W IE Iñì lJìl FE B 1 3 2003 l!dJ Southold Town Board of Trustees TO: En-Consultants. Inc. on hf':n::alf nf P',,:),,"h,=,",,"~ it ~rilliaRl CIa J tòu. Please be adyised that your application, dated Dec. 27, 2002 has been reviewed by this Board, at the regular meeting of JaRuar~ 33, 388J and the following action was taken: (~) Application Approyeq (see below) (____) Application Denied (____) Application Tabled (see below) (see below) If your application is approyed as noted aboye, a permit fee is now due. Make check or money order payable to the Southold Town Trustees. The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days orre-application fees will be necessary. COMPUTATION OF PERMIT FEES: Two Inspections @$5. 00 each TOTAL FEES DUE: $ lQ.Qg ~ tltt-4.' -I 'l A{. ~ ~o.l..' 9' SIGNED: Y" PRESIDENT, BOARD OF TRUSTEES BY' ÇJ.~oP=~ J~ ~;¡ \ 1\ \"YJ ~ 4/98 Albert J. KrupsIP, President James King, Vice-president - Henry Smith Artie Foster Ken poliwoda . . Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: En-Consultants. Inc. on hp-h;¡lf nf R~...h"'r'" it "Jilliam Cl.c.]tV'.LL Please be advised that your application, dated Dec. 27, 2002 has been reyiewed by this Board, at the regular meeting of J&RHar) 33, 2883 and the following action was taken: (~) Application ApprOyeq (see below) (-) Application Denied (see below) (-) Application Tabled (see below) If your application is approyed as noted aboye, a permit fee is now due. Make check or money order payable to the southold Town Trustees. The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: Two Inspections @$5.00 each TOTAL FEES DUE: $ 111.119 tltt...·1 ~ /&11 ,....1.: 9' SIGNED: y. PRESIDENT, BOARD OF TRUSTEES BY' ~op.~ 4/98 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, Nèw York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BARBARA & Wn,LIAM CLAYTON yOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE ~ Pre-construction, hay bale line 1 st day of construction Y:. constructed x Project complete, compliance inspection. Albert J. Krupski, President James King, Vice-President . Artie Foster Ken poliwoda Peggy A. Dickerson BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall J.. 53095 Route 25 . P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE..cONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. (1~1~ INSPECTION SCHEDULE \./ Pre-construction, hay bale line 1st day of construction y. constructed -1L/ Project complete, compliance inspection. r . .. January 22, 2003 Board of Trustees, Department of Planning and Zoning, Health Department Of The Town of Southold P.O. Box 1179 53095 Main Road Southold, NY 11971 RE: PROPOSED CLAYTON PROJECT FOR DEMOLITION & REBUILDING OF HOUSE AT 12832 MAIN ROAD. EAST MARION, NY 11939 To All Interested Parties: The purpose of this letter is to express our wholehearted support for the Clayton project as recently proposed and filed. We are the neighbors of the Clay tons, adjacent to their property on the east, fronting on the water, as they do. We have seen and examined all of the details of the project, and are very much aware of the many sensitivities that must be addressed by anyone wishing to reconstruct a house on wateñront property in the Town of Southold (as we, ourselves, did several years ago): distance from water, setbacks, sanitation, overall effect, perspective of neighbors, and so on. In our view, the Clay tons have been extremely diligent and patient in exploring all the possibilities and alternatives of reconstructing their home (which very much needs extensive work) with an eye, always, to improving the impact of their home on the land near the water, being sensitive to setback and zoning requirements, substantially improving . . Telephone (631) 765-1892 Town Hall. 53095 Main Road P.O. Box 1179 Southold. New Yark 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town ConserVation Advisory Council held Wednesday, January 15, 2003, the following recommendation was made: Moved by Drew Dillingham, seconded by William Cook, Jr. it was RESOLVED to recommend to the Southold Town Board of Trustees DISAPPROVAL of the Wetland Permit application of BARBARA & WILLIAM CLAYTON to construct a new one-family dwelling landward of the location of existing dwelling, which is situated partially within CEHA and is to be demolished; place approx. 350 cy. of fill to achieve grades proposed for FEMA compliance; install drainage systems of drywells; and establish non-turf buffer within 20' of apparent high water line. Located: 12832 Main Rd., East Marion. SCTM#31-14-15 The CAC recommends Disapproval of the application because the council would like to see at least a 50' buffer from the tidal wetlands boundary. Vote of Council: Ayes: All Motion Carried 29 December, 2004 Mr. Albert J. Krupski President Board of Town Trustees Town of South old Town Hall 53095 Route 25 P.O. Box 1179 Ò~Ii:~DU~ Southold, NY 11971-0959 ri DEC 3 1 20C5 n RE: REOUEST FOR EXTENSION OF PERMIT # 57£ Dear Mr. Krupski: Southold Town Board of Trustees The purpose of this letter is to request an extension of Coastal Erosion Permit # 5702, which was granted to us January 22, 2003, copy attached. Several factors delayed the project, but it was our oversight not to realize that a permit extension would be required until two weeks ago. Heather, of the Trustees' office, advised us that the Board would consider an extension at its January, 2005 meeting if we requested an extension in writing (this letter) and paid a fee of $50.00 (attached). If you need any additional information, please call. Thank you, )(~~ I.~(~ y~ (/ 042529 w I!! 9 ~oif e::r S¡ I- - ::J - i o.¡¡¡>' DoII.rs $ o ~::E': For t ~~mi Q~ ~ irE m ð Œ III AMT. PAID U CHECK BALANCE MûNEIORDI'RD B~ A' DUE GREDlrCARD ,~ . . BARBARA AND WILLIAM CLAYTON, 12832 MAIN ROAD, EAST MARION Figure I. L/J/Jking n/Jrthwest at existing balk head and dwellingfram sh/Jreline of Gardiner's Bay. \ / i .. "--:i; "." ~. ..'~~o::;.:;- __.::.-:;:- ::<;.{~ l'.. ~ '. '. .~; :;:'::.:t:,i~~';:'~i::;,'~~ '. . .... ,<r.,."., .: 7'. "::-_ '1'"; _;' "_~. -~~i ~J:"- - . " Figure 2. LooAing wesl alollg .\hore/ine at existing bulkhead; groin; and dwelling. ,~ . . BARBARA AND WILLIAM CLAYTON, 12832 MAIN ROAD, EAST MARION .~, Figure 3. Laaking narlh al saulherly end af exisling bulkhead and al dack. Figure 4. Laaking we.'1 al nartherly end af bulkhead and relum. . . BARBARA AND WILLIAM CLAYTON, 12832 MAIN ROAD, EAST MARION T" _ ~:~ ..,,~~ .,,'. .. - . """"V':lI\ - .. ~ ~~~ g- .... ~-- ~ ~.. Figure 5. Looking sOIl/h over bulkhead /Il",ard Gardiner's Bay from sOIl/heas/erly portion of house. ..- -~- .. Figure 6. Looking southeast a/f"'n/ of existing house and /Il",ard Gardiner's Bay. . Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda . t BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only ~astal Erosion Permit Applicatio? ~etland Permit Application ~ Major Waiver/ Amendment/Changes _Received Application: J \if ;)...71 () ...¡ _Received Fee:$ Jvf()1 7 _Completed Application rv( 1 ( O-J _Incomplete SEQRA Classification: Type I_Type II_Unlisted - Coordination:(date ~t~ CAC Referral Sent: " -Date of Inspection: ?J Receipt of CAC Report: Lead Agency Determination: Technical Review: Public Hearing He~ Resolution: Minor LIEC 2. 1 Name of Applicant BARBARA & WILLIAM CLAYTON Address 808 BROADWAY, PENTHOUSE H, NEW YORK, NY 10003 Phone Number:(212 )529-3630 Suffolk County Tax Map Number: 1000 - 31-14-15 Property Location: 12832 MAIN ROAD, EAST MARION (provide LILCO Pole #, distance to cross streets, and location) AGENT: EN-CONSULTANTS, INe. (If applicable) Address: 1329 NORTH SEA ROAD, SOUTHAMPTON, NY 11968 Phone: 631-283-6360 Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fex (631) 765-1366 1\" 1-' .- ~oard of Trustees APPlica~n GENERAL DATA Land Area (in square feet): 18,843.214 Area Zoning: R-40 Previous use of property: VACANT Intended use of property: SINGLE-FAMILY RESIDENCE. Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: Project Description (use attachments if necessary): Construct new one·family dwelling landward of location of existing dwelling, which is situated partially within Coastal Erosion Hazard Area and is 10 be demolished; place approximately 350 cubic yards of fill to achieve grades proposed for FEMA compliance; install drainage system of drywells; and establish non-turf buffer within 20' of apparent high water line of Gardiner's Bay. Construction ofthe new dwelling and other associated improvemenls are located entirely landward of the Coastal Erosion Hazard Area BoundaIy and thus beyond the Trustees' jurisdiction pursuant to Chapter 37 of the Town Code; and installation ofa pervious driveway and upgraded sanitary system are located more than 100 feet landward of the apparent high water line of Gardiner's Bay and thus beyond the Trustees' jurisdiction pursuant to Chapter 97 of the Town Code. ~oard of Trustees APPlicat4lh WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: REPLACEMENT AND RELOCATION OF AN EXISTING DWELLING (AND RELOCA nON , AND UPGRADE OF A SANITARY SYSTEM LOCATED BEYOND TRUSTEE'S JURISDICTION). Area of wetlands on lot: 0 square feet Percent coverage of lot: 0 % Closest distance between nearest existing structure and upland edge of wetlands: 27 feet Closest distance between nearest proposed structure and upland edge of wetlands: 35 feet Does the project involve excavation or filling? NO x Yes If yes, how much material will be excavated? (AS NECESSARY FOR SEPTIC AND cubic yards FOUNDATION INSTALLATION) How much material will be filled? 350 cubic yards Depth of which material will be removed or deposited: +/-2 feet Proposed slope throughout the area of operations: <10% Manner in which material will be removed or deposited: MATERIAL WILL BE REMOVED, DEPOSITED, AND GRADED VIA BACKHOE. Statement ofthe effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): THE PROJECT ENTAILS THE RELOCATION OF AN EXISTING DWELLING ON A BULKHEADED PARCEL FARTHER FROM THE ADJACENT TIDAL WATERS AND THE UPGRADE OF AN EXISTING SANITARY SYSTEM, WHICH WILL OCCUR BEYOND THE TRUSTEES JURISDICTION. TIIROUGH THE EMPLOYMENT OF ADDITIONAL MITIGATION MEASURES SUCH AS INSTALLATION OF A DRAINAGE SYSTEM OF DRYWELLS AND ESTABLISHMENT OF A NON-TURF BUFFER ADJACENT TO GARDINER'S BAY, THE CUMULATIVE IMPACT OF THE PROJECT WILL BE AN IMPROVEMENT TO THE ECOLOGICAL CONDITION OF THE PARCEL. 4Ikoard of Trustees APPlicaJlþn COASTAL EROSION APPLICA nON OAT A Purposes of proposed activity. DEMOLITION AND REMOVAL OF EXISTING DWELLING AND A IT ACHED DECK LOCATED P ARTIALL Y WITHIN COASTAL EROSION HAZARD AREA. Are wetlands present within 100 feet of the proposed activity? No X Yes Does the project involve excavation or filling? NO X Y es (LANDWARD OF CEHA BOUNDARY) If Yes, how much material will be excavated? N/A (cubic yards) How much material will be filled? N/A (cubic yards) Manner in which material will be removed or deposited: N/A Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) THE IMPACT OF THE PROJECT WILL BE THE RECTIFICATION OF A PRE-EX[STING NON-CONFORMANCE THROUGH THE REMOVAL OF AN EX[STING DWELLING, A PORTION OF WHOSE STRUCTIJRAL AREA [S SITIJA TED WITHIN THE COASTAL EROSION HlAZARD AREA. Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION (To be completed by Applicant or Project sponsor) . I . '4-'6-4 (2IB7)-Texll2 I PROJECT 1.0. NUMBER 617.21 SEQR FORM 1 APPLlCANT/SPONSORBARABARA & WILLIAM CLAYTON BY EN-CONSULTANTS, INC. 3 PROJECT LOCATION: Municipality EAST MARION I 2. PROJECT NAME County SUFFOLK 4 PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc, or provide map) 12832 MAIN ROAD, EAST MARION, TOWN OF SOUTHOLD, SCTM # 1000-31-14-15 ,ð/S PROPOSEO ACT).QtI . Lð.I New U ExpanSion ~ Modification/aMeratien 6 DESCRIBE PROJECT BRIEFLY: Construct new one-family dwelling landward of location of existing dwelling, which is situated partially within Coastal Erosion Hazard Area and is to be demolished; place approximately 350 cubic yards of fill to achieve grades proposed for FEMA compliance; install drainage system of drywells; and establish non-turf buffer within 20' of apparent high water line of Gardiner's Bay. Construction of the new dwelling and other associated improvements are located entirely landward of the Coastal Erosion Hazard Area Boundary and thus beyond the Trustees' jurisdiction pursuant to Chapter 37 of the Town Code; and installation ofa pervious driveway and upgraded sanitary system are located more than 100 feet landward of the apparent high water line of Gardiner's Bay and thus beyond the Trustees' jurisdiction pursuant to Chapter 97 of the Town Code. 7. AMOUNT OF LAND AFFECTED Initially 0.43 """'. Ultimately 0.43 """"' 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? (gives D No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ~ Residential D Industrial D Commercial Describe: D Agriculture D Park ForestfOpen space D Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR lOCAL)? ~ Yes D No If yes, list agency(s) and permitJapprovals DEC, SCDH 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTlY VALID PERMIT OR APPROVAL? DYes ~ No If yes, list agency name and permitfapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? DYe. ~No I CERTIFY TIT: THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name R06li R E. HERRMANN, COASTAL MANAGEMENT SPECIALIST DATE DECEMBER 23, 2002 I /I h ~I II Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER . . NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: BARBARA & WILLIAM CLAYTON SCTM#lDDD- 31-14-15 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: Construct new one-family dwelling landward oflocation of existing dwelling, which is situated partially within Coastal Erosion Hazard Area and is to be demolished; place approximately 350 cubic yards of fill to achieve grades proposed for FEMA compliance; install drainage system of drywells; and establish non-turf buffer within 20' of apparent high water line of Gardiner's Bay. Construction of the new dwelling and other associated improvements are located entirely landward of the Coastal Erosion Hazard Area BOlmdary and thus beyond the Trustees' jurisdiction pursuant to Chapter 37 of the Town Code; and installation of a pervious driveway and upgraded sanitary system are located more than 100 feet landward of the apparent high water line of Gardiner's Bay and thus beyond the Trustees' jurisdiction pursuant 10 Chapter 97 of the Town Code. 2. That the property which is the subject of Environmental Review-is located adjacent to your property and is described as follows: 12832 MAIN ROAD, EAST MARION 3. That the project which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code is open to public comment on: JANUARY 22, 2003 You may contact the Trustees Office at 765-1892 or in writing. The above referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: BARBARA & WILLIAM CLAYTON MAILING ADDRESS: 808 BROADWAY, PENTHOUSE H NEW YORK, NY PHONE #: 908-735-8774 Enc.: Copy of sketch or plan showing proposal for your convenience. 5 . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: W. PERRY HUKILL Address: 12580 MAIN ROAD EAST MARION, NY 11939 JOHN T. SICA 1602 CLIFTON STREET BALDWIN, NY 11510 MARTINE MAIORANA 12680 MAIN ROAD EAST MARION, NY 11939 STATE OF NEW YORK COUNTY OF SUFFOLK ROBERT HERRMANN 1329 NORTH SEA ROAD SOUTHAMPTON, NY 11968 , being duly sworn, deposes and says that on the 23rd day of DECEMBER ,20 ~, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office atSOUTHAMœTON , that said Notices were mailed to each of said perso s by (certified) ~) mail. doing business atEN-CONSULTANTS,INC. Sworn to before me this 23rd da y 0 f DECEMBER ,20 02 ~.~ d ~'v Notary Pu lic j)r, -.y =v V~~A~~·A~~~~'~~ II I',I\~ 1-1. STEP.l~~· . } ~ --'" It,!:,,! r,'::,-$t3to u . .~. ..-:~ t -;. ~ ~..::~~~:~~:/::~:1 f~:). C~ I -- - _ >.). ~ _.',' CtJoi.!r.:i'¡.2. 0\ ; . !'c,7:in::~Ó;1 EX¡:.Jr.;;3 1.;;-~iJt~ __ ^ _~VV"9"-__-__;'ii~~ - .. u.s. Postal Service,,, ';: CERTIFIED MAIL,. RECEIPT ....=I (Domestic Mail Only; No Insurance Coverage Provided) LJ"") rtJ <r fT1 ::r Postage $ . .;, Postmark Here U.S. Postal Service. ü': CERTIFIED MA!L,., RECEIPT ....=I (Domestic Mail Only; No Insurance Coverage Provided) LJ"") rtJ <r fT1 ::r fT1 o o D Return AeClept Fee (Endorsement Required) o Restricted Dehvery Fee M (Endorsemenl Required) ::r rtJ Certified Fee Totar Poslage- R. 1::'...,.... ¢: rtJ OtTo o ["'- sfiiiefAiifNi. or PO Box No. ël-tY~-Ståie'-ZI¡ John T. Sica 1602 Clifton Street Baldwin, NY 11510 Postmark He", u.s. Postal Service ;. ~ CERTIFIED MAIL,.. RECEIPT r==I (Domestic Mail Only; No Insurance Coverage Provided) LJ"") ~;' .~.",.,¡." .:~ Postage $ fT1 o o Return Reclept Fee o (Endorsement Required) o Restricted Delivery Fee M (Endorsement Required) ::r rtJ Certified Fee Total Postage & I=~~~ 4' rtJ o ntTo o ["'- šiiOOCAj;fiilõ:;u or PO Box No. citj.:-slãiã:-.zip¡4 Martine Maiorana 12680 Main Road East Marion, NY 11939 rtJ <r fT1 ::r " P_ lit fT1 o o I:] Retum RecleptFee (Endorsement ReqU1l8;d) o Restricted Delivery Fe, M (Endorsement Requlrea) ::r rtJ Certified Fee do TotaIPoS< rtJ o entTo o I"- ~i"Ãþi or PO Box citŸ:"stãtã W. Perry Hukill 12580 Main Road East Marion. NY 11939 Postm... He", Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda . . 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 BOARD OF TRUSTEES: TOWN OF SOUTHOLD ----------------------------------- In the Matter of the Application /., , _ of 1~~f__Ü:dta£(J,-é~f~ COUNTY OF SUFFOLK) STATE OF NEW YORK) I, ~krf &~"''''- AFFIDAVIT OF ~JLTANTS INC. J>g,Qi\ ~ í 329 NO nTH S~A RD , r9~' J.R~ a 0~T 'fll A ~ . c. l'· ,1FTON, Itr. 11 ~b¡j 631-2ö3-G3GO being duly sworn, depose and say: That on the 1 '-It-- day of J1tI. , 2001, I -eer¡>onal].-y posted the property known as /'Z.-;S32 No<\~ ~J E.a'1t Nw'vav. by placing the Board of Trustees official poster where it can easily be seen, and that I haye checked to be sure the poster has remained in place for eight days prior to the date O~f the public hearing. Date of hearing noted thereon to be held . If\.- fv~7()~(f/V' / ).erv:j Dated: (signa Sworn to before me this .,;¿;>^,Z-day Of:~(",-¿c-"0 2003 ~- \...._ ,).J. ----=J-t< -,..Jk Nóta y Public / "J'~............"r I - hiM H. !;T~f'P'" " ~ t:~ tlob!ry Put::.·S~I. c' . t ~ .. ~:';1'11"\,.}::;~onn:~G5¡:)n t~~. £~~.: '".", ~ ..:'_'~' ....."'.""...:111., . . c. '':':~ C·';'1,:,-,._: 05- Io ,...._.mt.,1I;!.. E"-' ." - .... ' . AI' ...':.:."¡,,.~-..,. iFlf.;.:.::, ',- - . .- ~ .¡...,".....QVr:¡_~tiØ .........>1"....---.",.. B. of Trustees APplication. .'. AUTHORIZATION (where the applicant is not the owner) I, ding at...J)£l \. PM,4\! R'. (mailing address) FA$.T' m4R/ðÑ, ,y II~dO hereby authorize~Ilh1."~ (Agent) ~-cort-'ù,""'tftj to apply for permit(s) from the A ld Board of Town Trustees on my behalf. ::-1-:,<"<->. '''- æ _cQy~ - L. C. (OWner's signature) 8 . . Board of Trustees Application County of Suffolk State of New York Iù IU.I"~ L. A-rt 0 OA~ ,_ C.UV'ToN BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF illS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN TillS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING TillS APPLICATION, I HEREBY AUTHORIZE THE 1RUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF TillS APPLICATION. - G...-o-(i,.~~. . /. ('(q ~~ Signature SWORN TO BEFORE ME TillS ;¿;). ,.;C/ DAY OF ~ fr; 1 20 D l- '- ROBERT F. KROL Nolary Pubic, StaIB 01 New Yotk No. 30-4730961 QuaUfiod In Nassau County Certificate IIIod In New York County Commission Expires March 30, :i!Oe>(ò '. . . IIPPLICIINT TRIINSIICTIONIIL DISCLOSUnE POnK 1'he Town of Southold' e Code of Ethic·e prohib1te conflicts interest on the parL of town officers and employees. The Q!!.f.pose of this form is to provide information which can alert the town of possible conflicts of interest and alloW' it to take wl1atever action is necessary to avoid same. of YOUR NIIK!!. If. Last name, [' rst name, t al, unless you are applying in the name of someone else or otl\er entity, suell as a company. If so, indicate tl1e other person's or company's name.) NIITUR!! OP IIPPLICIITION. (ChecI, aU that apply.) Tax grievance variance Change of zone IIp'pçoval of plat _____ Exe~ption from pIa, or orficial map other v (If "Other," name the activity.) WGn.Jc1.tt6 Do you personally (or through your co..pany, spoune, sibling, parent, or child) hDva II relat.ionship vith any officer or employee of the 'l'ovn of Bouthold? -Rel¡¡tionøhlp" Incluc]es by blooc], ma~~iage, or business interest. ·Dusiness interest" means a business, including a partnernhip, 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 ovnn lIIoro than 5% of the shares. Yl!S NO -X- If you answered ·YES," complete the balance of thIs form and c]atø and sign vhere indicated. Name of person employed by the Town of SOUtll0ld Ti~le or position of that person Describe the relationship between yourself (the applicant) and the town officer or employee. Either check the appropriate line A) tllrough D) and/or describe in the space provided. parent, _h) The town officer or employee or his or her spouse, sibling, or child is (check all t.hat apply) I the owner of greater titan 5~ of the shares of the corporate stock of tile applic~nt (wllel1 the applicant is a corporation)1 the legal or beneficial owner of any interest in B noneorporate'entity (wilen t.he applicant. is not a corporation) , an officer, director, partner, or employee of the appliesnt:.1 or t:.119 actual applicant. _8) _C) _D) DESCRIPTION or RELhT10NSIIIP s~ tted this !i..day of ~ Si~~-~' e(.,,~_ '"',Co",...... ,.(',,/tV".'" ·print:. name ~o . \.. ~,.Q.er~¡-... ",!.-¡¡,.vc" R.e.L r¡.þ